TREATMENT OUTCOMES IN ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE DEFORMATIONS AND INSTABILITY OF THE SPINAL COLUMN
Authors: Mikhaylov D. A. , Ptashnikov D. A. , Masevnin S. V. , Smekalenkov O. A. , Zaborovski N. S. , Lapaeva O. A. , Mooraby Z. 
Published: July 2017

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with such disease. The authors present the results of 14-year experience in treatment of this pathology. Various approaches to the surgical treatment depending on the stage of the disease and the degree of deformation, including decompression, instrumental posterior spinal fusion, anterior spinal fusion, and osteotomy were examined. Above treatment options are based on the analysis of clinical aspects, mechanical stability of deformation, the degree of imbalance in the body and causes of pain or neurological deficit.The risk of postoperative complications is extremely high and seems to be outweighed by the possible successful outcomes of surgical treatment. The results presented in the treatment of degenerative scoliosis mainly provide positive outcomes and can assist in the selection of treatment for this group of patients.The purpose of the study is to evaluate the treatment outcomes of elderly and senile patients with degenerative deformations and instability of the spinal column using various surgical techniques.Material and methods. During the present retrospective study the authors analyzed 437 patients (337 (77%) women and 100 (23%) men) aged 60 years and older who underwent surgical treatment at Russian Research institute of traumatology and orthopaedics named after R.R.Vreden between 2000 and 2016. The study group included patients with diseases and consequences of injuries in the spine, leading to its deformation and following spinal stenosis with development of neurological deficit in some cases.The patients were subdivided into four groups depending on surgical procedure. Patients in group I underwent decompression of neural structures at affected levels on both sides without implants for fixation. This group was used as the comparison group. Patients in group II underwent fixation the affected spinal motion segments locally with transpedicular system without correction of deformity and with decompression of neural structures at the level of spine stenosis. Patients of group III underwent surgery for fixation of affected PDS up to lower thoracic spine using short transpedicular system along with decompression of the neural structures and correction of spine deformity. Patients in group IV underwent surgery for fixation of affected PDS up to upper thoracic spine using transpedicular system, bone cement, decompression of neural structures and correction of spine deformity.The average postoperative follow up was 5 years (from 3 months to 15 years), 266 patients were followed for more than three years.Results. The best results were obtained in group IV: good results – 57,2% (60 patients), satisfactory 40% (42 patients), poor 2,8% (3 patients).The worst results were obtained in group I: after 5 years follow up satisfactory results were observed in 13,4% (15 patients), poor in 86,6% (97 patients) and no good results were reported.Conclusion. Thus, the performed study and observed outcomes indicate the rationale for performing a full deformity correction by transpedicular fixation and bone cement, applying all the required methods and techniques of osteotomy. This approach allows to maximally quickly achieve the desired treatment outcomes in mid-and long-term follow up period and to avoid complications and revisions.