Pre-operative planning in surgical treatment of patients with lumbar spinal stenosis of degenerative etiology
Authors: Afaunov A. A. , Basankin I. V. , Kuzmenko A. V. , Shapovalov V. K. , Mukhanov M. L. 
Published: March 2020

Aim. Develop a pre-operative planning algorithm to treat patients with lumbar spinal stenosis of degenerative etiology.

Material and methods. The results of surgical treatment of 522 patients at the age of 23-78 years with degenerative lumbar stenosis were analyzed. Patients with osteoporosis, with a sagittal spinal profile disorder or deviations in the frontal plane of more than 20 degrees, with spondylolistesis of more than 1 Meyerding degree, with accompanying pathology aggravating the Charlson Commorbidity Index of more than 8 points, were not included in this group. All patients underwent decompressive-stabilizing operations using TPF for 1 to 8 vertebral-motor segments (PDS). Decompression and interbody stabilization were performed by the method PLIF, TLIF, or by the method of reconstruction of the lumbar vertebral-motor segment (patent #2527150), or the ventral fusion was performed.

Results. Immediate and distant results over a period of 24-36 months were studied by regression in major clinical manifestations. The VAS, McCulloch and Young scales, the Oswestry questionnaire, and the modified Macnab scale were applied. The quality of decompression, correction in operated PDS and intertose splicing were evaluated. The effect of the initial state of patients on the obtained results and the number of complications were studied as well. For this purpose, the correlation analysis was carried out between clinical parameters characterizing initial condition of patients (length of lumbar spinal stenosis, degree of functional maladaptation, duration of anamnesis and severity of premorbid background) and achieved results of treatment, as well as number of complications. A correlation analysis was also performed between the technique of performed operations and surgical tactics on the one hand and the achieved results and the number of complications on the other.

Discussion. Differences in results and number of complications depending on the applied technical and tactical treatment options and statistical treatment with determination of the correlation coefficient of Spirman and Fisher's criterion determined clinical and spondylometric signs in the pre-operative state of patients, that influenced the probability of complications when using the specified technical and tactical treatment options. It has been found that the state of the premorbid background reliably affects the probability of the most dangerous intraoperative and early complications. The length of decompressive stabilizing operations affects the probability of evidence for audits in the distant period. When performing TLIF, the spondylolistesis presence increases the likelihood of intraoperative liquvorea. The method of lumbar vertebral-motor segment reconstruction in lumbar lordosis deficiency improves the possibility of correction in operated PDS in comparison with TLIF technique.

Conclusion. Taking into account the revealed statistically confirmed effect of a number of clinical and spondylometric signs of the pre-operative condition in patients on the probability of complications using various technical and tactical versions of treatment, an algorithm of pre-operative planning of surgical intervention in patients with lumbar stenosis of degenerative etiology is presented.