SURGICAL INTERVENTIONS IN UNSTABLE FORMS OF DEGENERATIVE LUMBOSACRAL SPINE

Surgical treatment of degenerative disc diseases is the fastest growing trend in spinal neurosurgery. One of the main clinical symptoms of the degenerative process in the spine is pain, and recurrent pain – the dominant cause of temporary disability with significant economic losses. These diseases affect all ages and social strata of the society, especially in the upward trend of the average life expectancy in developed countries. Despite the efforts to improve the results of surgical treatment of lumbar degenerative disc disease, changes in the volume of surgical intervention did not lead to a significant effect. Combination of decompression and stabilization interventions was suggested to transform into combo. Current approach to the patients with degenerative lumbar spine remains debating among the physicians of related specialties. The article provides an overview of surgical interventions in unstable forms of lumbar spine degenerative diseases for the prevention and treatment of degenerative instability by using fusion methods performed from the anterior, extreme lateral, posterior and transformational lumbar interbody accesses. Determination method of surgical treatment depends on proficiency of the surgeon. According to some authors, neither dorsal nor ventral approaches for the treatment of degenerative spine are universal processes. Evolution of stabilizing operations on the spine is associated with the development of modern steel structures for spinal fusion, the use of which increases the stability of the operated segment. It is found that anatomically and physiologically correct position of fixed vertebrae directly affects the outcome of the operation. Improved technologies in spine surgery led to a significant reduction of insufficient results. However, the removal of vertebral neural-conflict recovery is not always accompanied by a dynamic equilibrium in the vertebral column and contributes to the development or progression of the vertebral-motor segment instability in the long term. Currently in spinal surgery it is topical to investigate the possibility of low-traumatic restoring biomechanical stability of the spine with a full functional recovery as soon as possible. The application of various stabilizing structures, minimally invasive tubular retractors, micro toolkit and percutaneous techniques allows to fix the spine from the anterior, extreme lateral and posterior accesses with preserving supporting elements, less damage to the surrounding soft tissues and less intraoperative blood loss, which reduces the length of hospital stay, the general terms of a temporary loss disability, economic costs for treatment. keywordS: degenerative lesions, intervertebral discs, facet joints, segmental instability, spondylolisthesis, lumbar spine. ByvaltSev vadim anatolyevich Road Clinical Hospital at Irkutsk-Passenger station 10 Botkin Street, Russia 664055, Irkutsk Tel. : (89025104020), (89149520667) Office: 8(3952)638528 E-mail: byval75vadim@yandex.ru Received 03/05/2016; accepted for printing 18/09/2016 [Kaiser M et al., 2002; Drakin A, 2008; Freemont A, 2009; Van den Hauwe L, 2009]. One of the main clinical symptoms of the degenerative process in the spine is pain [Dotsenko V et al., 2004; Kim K et al., 2006], and recurrent pain – the dominant cause of temporary disability with significant economic losses [Slucky A et al., 2006; Krutko A, 2012]. These diseases affect all ages and social strata of Introduction Surgical treatment of degenerative disc diseases is the fastest growing trend in spinal neurosurgery