神经外科脊柱植入物治疗老年腰椎管狭窄症

Z. Siedlecki, E. Główczewska-Siedlecka, M. Szafrańska, M. Śniegocki
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摘要

介绍。退行性腰椎管狭窄的发生率随着年龄的增长而增加。年轻人容易出现单纯的椎间盘突出伴椎间盘根受压,而老年人则会出现退行性狭窄:小关节肥大、骨赘和黄韧带肥大。典型的老年人是由腰椎间孔狭窄引起的神经源性跛行。其症状在脊柱屈曲时减轻。该研究包括对医疗数据的回顾性评估:对患者年龄的分析、手术过程的描述和脊柱植入物的清单。材料和方法。该分析包括Nicolaus Copernicus University (Bydgoszcz, Poland)医学院神经外科于2020年接受腰椎管狭窄手术治疗的患者。围手术期风险随着患者年龄的增长而增加,因此老年患者的手术通常应减少侵入性,短暂性,甚至在局部麻醉下。因此,神经外科医生倾向于在老年人植入脊柱植入物以支持手术效果并优化手术时间。棘间间隔器是神经源性跛行的植入物。棘突间间隔器引起椎间孔牵开,因此理论上可以间接机制诱导神经根减压,侵入性小,组织损伤小。我们注意到超过70岁的患者更频繁地使用棘间间隔器。这一观察结果需要进一步的研究和分析;然而,这与现有文献和临床实践的实际情况是一致的。这对神经外科护理具有潜在的重要意义-在腰椎手术后的老年患者中,植入物-棘间间隔物明显更常见,应在围手术期护理建议中考虑。(JNNN 2021; 10 (3): 91 - 95)
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Neurosurgical Spine Implants in Geriatric Patients Treated Surgically for Lumbar Stenosis
Introduction. The incidence of degenerative lumbar spine stenosis increases with age. While young people tend tohave simple disc herniations with root compression, older people develop degenerative stenosis: facet joint hypertrophy,osteophytes, and ligamentum flavum hypertrophy. A typical for senility is neurogenic claudication caused by lumbarforaminal stenosis. Its symptoms decrease in spine flexion.Aim. The study consisted of a retrospective evaluation of medical data: analysis of the patient’s age, description ofthe surgical procedure and a list of spine implants.Material and Methods. The analysis included patients treated surgically for lumbar stenosis in 2020 in NeurosurgicalDepartment of Collegium Medicum in Nicolaus Copernicus University (Bydgoszcz, Poland).Results. The perioperative risk increases with the age of patients, therefore procedures in elderly patients shouldusually be less invasive, ephemeral, and even under local anesthesia. Therefore, neurosurgeons tend to insert spinalimplants in senility to support the surgical effect and optimize the time of the procedure. Interspinous spacers areimplants for neurogenic claudication. Interspinous spacers causes foraminal distraction and thus can theoreticallyinduce nerve roots decompression in indirect mechanism, less invasive, with less tissue damage. We notice significantlymore frequent use of interspinous spacers in patients over seventy.Conclusions. This observation requires further research and analysis; however, it is consistent with the availableliterature and the actual state of clinical practice. This has potentially important implications for neurosurgicalnursing — in geriatric patients after lumbar spine surgery, implants are significantly more common — interspinousspacers, which should be considered in nursing perioperative recommendations. (JNNN 2021;10(3):91–95)
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