NEUROGENIC SPINAL DEFORMITIES IN ADULTS: MODERN PROBLEMS AND APPROACHES TO TREATMENT

Abstract

Objective.To present the features of clinical manifestations, diagnostic aspects and approaches to the treatment of neurogenic deformi- ties of the spine in adults based on the literature data.Material and Methods.The literature review was performed using PubMed, Medline, Web of Science, Scopus, CrossRef, AOSpine, Clini- cal Key, eLibrary databases and references of key articles published in the period from 06.02.2017 till 04.11.2017.Results.General trends in the treatment of adult patients with neurogenic deformities of the spine have been determined. Assessment of the risk from performing an intervention, taking into account possible complications and potential outcome, determines the approach to surgery in these patients. It is necessary to develop protocols of management with the definition of the main clinical symptoms, the ratio- nale for the use of non-invasive, minimally invasive or other options for care. Surgical treatment of patients with spinal deformities asso- ciated with neurodegenerative diseases (Parkinson’s disease) is accompanied by a high rate of complications and repeated interventions. Tactical algorithms for these patients should include the consistency of non-surgical and mini-invasive techniques and considering clinical manifestations of myopathy, mielo-, radiculopathy, which, in comparison with diagnostic tests, can determine the indications and volume of decompressive interventions, and the extent and levels of spinal fixation.Conclusion.The complexity of pathogenetic mechanisms and ambiguous results of non-surgical and surgical treatment determine the need for multidisciplinary approach and the development of protocols for the management of adult patients with neurogenic deformities of the spine.