Piontkovskiy V. K.

METHODS AND METHODOLOGIES

Scentific article

Due to the demographic processes that occur in modern society treatment of spinal pathology in middle-aged and older patients is becoming increasingly relevant with each decade transforming from a medical problem into a social and ethical problem. The essence of this problem is not only in the adequate assessment of the severity of the situation and running a differential diagnostics with natural involuntary changes but also in the choice of optimal treatment technique for a particular patient. In addition, it is necessary to consider the fact that the surgical risk in patients of this age group is much higher than in young patients which is why there is no consensus among experts regarding the treatment of this category of patients. It is common knowledge that in the development of the degenerative cascade of the lumbar spine in older patients stenosis processes with the phenomena of degenerative segmental instability prevail. There is a large number of surgical interventions for the treatment of herniated discs which can be divided into the following groups: decompression (discectomy, microdiscectomy, laminectomy, hemilaminectomy, interlaminectomy and facetectomy), rigid stabilizing, dynamic stabilizing and decompression stabilizing interventions. A big role in providing assistance to this category of patients has recently been played by such percutaneous procedures as epidural adhesiolysis, epidural steroid injections, percutaneous nucleotomy, Stryker disc decompression, laser discectomy, etc. However, there is no consensus regarding the indications for these procedures in middle-aged and older patients, and long-term results do not always satisfy patients. The author proposes new techniques for the decortication of facet joints and a vertebral body augmentation by the bone cement for stabilizing surgical interventions in middle-aged and elderly patients. The application of new techniques will enable to create the appropriate conditions for the posterior spondylodesis for minimally invasive spinal stabilization. The proposed techniques of vertebral body augmentation by the bone cement will enable to perform the stabilization of the spine in the conditions of critical osteoporosis and to reduce the cases of the bone cement migration to the spinal canal.

minimally invasive decortication of facet joints, vertebral body augmentation

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«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 232-237 pages, index UDK 617.089844:616711-018.3-002-06

10.29254/2077-4214-2019-1-1-148-232-237