A retrospective analysis of repeated surgical interventions for the lumbar intervertebral discs herniation in older patients | Український Медичний Часопис

The purpose of the work — to determine the causes of negative results of surgical treatment of herniated intervertebral discs in elderly and old age compared with young patients, which will allow to choose the correct surgical tactics in the future and prevent the occurrence of complications. Material and methods. A retrospective analysis of the surgical treatment of hernias of the intervertebral discs of the lumbar spine in 190 patients was carried out. All patients had a history of the dates when the first operation for herniation of the intervertebral disk was performed — from 3 months to 7 years in various medical institutions of Ukraine. The results. A common cause of repeated surgical interventions in older patients is instability at the operated and adjacent levels, which leads surgeons to more widespread use of stabilizing surgical interventions and more detailed preoperative planning at the choice of stabilization level. In the older age category stenosis processes prevail, therefore, they need to apply a wider decompression. To prevent the development of epidural fibrosis it is necessary to use atraumatic surgical techniques with minimal intraoperative blood loss. Patients of the older age group, in addition to discotomy, often need correction of degenerative deformities. When critical osteoporosis is detected, in order to prevent the failure of the metalwork, it is necessary to use special implants with cement augmentation to enhance the contact of the implant — bone. Conclusions. Among the main reasons for repeated surgical interventions in elderly patients is instability at the operated and adjacent levels, as well as recurrence of hernia at the same level.

DOI 10.32471/umj.1680-3051.131.142024

Published: 13.05.2019

References:

Benson R.T., Tavares S.P., Robertson S.C. et al. (2010) Conservatively treated massive prolapsed discs: a 7-year follow-up. Ann. R. Coll. Surg. Engl., 92(2): 147–153.
Chapman J.R., Hanson B.P., Dettori J. et al. (Eds.) (2007) Spine outcomes measures and instruments. Stuttgart, Germany, New York, Thieme Medical Publishers, 289 p.
Chiu C.C., Chuang T.Y., Chang K.H. et al. (2015) The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin. Rehabil., 29(2): 184–195.
Datta R., Upadhyay K.K. (2011) A randomized clinical trial of three different steroid agents for treatment of low backache through the caudal route. Med. J. Armed Forces India, 67(1): 25–33.
Kim E.S., Oladunjoye A.O., Li J.A., Kim K.D. (2014) Spontaneous regression of herniated lumbar discs. J. Clin. Neurosci., 21(6): 909–913.
Manchikanti L., Knezevic N., Boswell M. (2016) Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Phys., 19(3): 365–410.
Modic M., Obuchowski N.A., Ross J.S. (2015) Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology, 237: 597–604.
Murakibhavi V.G., Khemka A.G. (2011) Caudal epidural steroid injection: a randomized controlled trial. Evid. Based Spine Care J., 2(4): 19–26.
Sharma A., Vorobeychik Y., Wasserman R., Jameson J. (2016) The effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroidInjections: a systematic review with comprehensive analysis of the published data. Pain Med., 20: 45–56.
Yamato T., Maher C., Saragiotto, B. et al. (2017) The Roland-Morris Disability Questionnaire: one or more dimensions? Eur. Spine J., 26(2): 301–308.