Clinical signs for predicting the results of surgical treatment in patients with degenerative diseases of the lumbar spine

V.О. Radchenko, A.G. Skidanov

Abstract


Background. One of the most commonly used surgical treatment for degenerative diseases of the lumbar spine is spondylodesis. Applying this method of treatment, we noticed that in different patients with similar surgical intervention, the results are often various. The purpose of the study is to determine the clinical factors that influence the results of surgical treatment. Materials and me­
thods.
We examined 129 operated patients: 15 — with the diagnosis of vertebral instability, 64 — with intervertebral disc herniation, 30  — with spondylolisthesis, and 20 patients with spinal stenosis. The onset of the disease, total duration and duration of the last exacerbation were evaluated. The severity of pain was assessed by a visual analogue scale. Assessment of the quality of life before and one year after surgical treatment was performed using Oswestry index. Methods of applied mathematical statistics were used to confirm the results. Results. In general, the statistical analysis indicates that the quality of life of patients is significantly improved after the surgery. However, in some patients, the quality of life improves but to a lesser extent, such variability of results is noteworthy. The effect of age on the value of Oswestry index after surgery can be judged by the significant positive correlation of these parameters evaluated from all observations — in elderly patients the results are worse. In case of vertebral instability and spondylolisthesis, the age of the patient especially affects the results of surgical treatment. Patients who had had the greatest Oswestry index before the operation showed the worst results of surgical treatment. In patients with worse surgical outcomes, the duration of the disease is usually greater. Before intervention, patients with spinal stenosis and spondylolisthesis suffered longer than patients with instability and intervertebral disc herniations, this makes diagnoses of spinal stenosis and spondylolisthesis less favorable for recovery. That is, in other words, if intervertebral disc herniations can lead to recovery after timely surgical treatment, then in case of spinal stenosis and spondylolisthesis, it is only about improving the quality of life. Conclusions. Clinical signs of less satisfactory recovery after surgical treatment are older age (> 48 years), longer duration of the disease (more than 6–7 years), duration of the last deterioration more than 2–2.5 months, diagnosis of spinal stenosis and spondylolisthesis. In addition, this group includes patients with the Oswestry index more than 78 % before surgery.


Keywords


spine; degenerative diseases; lumbar spine; surgical treatment; prognosis

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DOI: https://doi.org/10.22141/1608-1706.3.19.2018.136411

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