A retrospective analysis of repeated surgical interventions for the lumbar intervertebral discs herniation in older patients
- 1State Institution "Institute of Traumatology and Orthopedics of NAMS of Ukraine", Kyiv
- 2Municipal institution "Rivne Regional Clinical Hospital"
Summary. 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.
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