Specific Features of Degenerative Lumbar Spine Disease in Elderly and Senile Patients

Objective. To study clinical and morphological features of degenerative lumbar spine disease in elderly and senile patients for substantiation of optimal surgical treatment. Material and Methods. Prospective study included 128 consecutive patients operated for lumbar spine degeneration during 2003–2005. Patients were divided into two age groups: 88 patients of 60–83 years of age (mean 65.7 years) and 40 patients of 19–40 years of age (mean 31.8 years). Complex diagnosis consisted of anamnestic, general clinical, neurological, X-ray, MRI, and CT examinations. Results. Patients with clinical manifestations of segmental instability and neurogenic intermittent claudication syndrome prevailed in the older group. Clinical symptoms in elderly patients were associated primarily with degenerative stenosis of the spinal canal. Radiological and CT signs of segmental instability (or hypermobility) were more frequent in older age group than in young patients. Degenerative spondylolisthesis and degenerative scoliosis of the lumbar spine were found only in elderly patients (20.4 % and 21.5 % of cases, respectively). Segmental hypermobility in elderly patients was presented predominantly as a linear translation of vertebrae. Sagittal translation of vertebrae over 3 mm was registered in 54.5 % of older age group patients and only in 22.5 % of young ones (р < 0,01). Flexion-extension hyperangulation of damaged spine segments was found in 61.3 % of older patients and in 65.0 % of young ones. Conclusion. It may be assumed that surgical treatment of degenerative lumbar spine disease in elderly and senile patients should involve not only extensive decompression of neurovascular formations but also stabilization of damaged spine segments despite a higher risk and implementation difficulties of the surgery.