Сочетание дегенеративного стеноза позвоночного канала с деформацией позвоночника на поясничном уровне. Обзор литературы

Цель исследования – провести анализ данных литературы, посвященной вопросам деформации позвоночника у больных с дегенеративным стенозом позвоночного канала на поясничном уровне.

Материалы и методы. Изучены 90 научных источников, опубликованных в 1980–2017 гг.

Результаты. Описаны параметры, используемые для оценки деформации позвоночника, рассмотрена их роль в прогнозировании течения дегенеративной болезни позвоночника. Приведены результаты современных исследований влияния деформации позвоночника на исход хирургического лечения больных с дегенеративным стенозом позвоночного канала на поясничном уровне. Определены факторы риска прогрессирования сколиоза: клиновидная форма межпозвонкового диска во фронтальной плоскости, низкое прохождение межгребневой линии, латеральный спондилолистез, маленький размер тела позвонка L , ротация позвонков, угол Кобба более 20°, нарушение сагиттального баланса.

Заключение. При отсутствии факторов риска прогрессирования сколиоза и наличии только корешковой симптоматики (без выраженной боли в поясничной области) у пациентов с дегенеративным стенозом позвоночного канала на поясничном уровне и деформацией позвоночника рекомендовано выполнение декомпрессивных вмешательств с сохранением дугоотростчатых суставов. При отсутствии факторов риска прогрессирования сколиоза, наличии корешковой симптоматики и боли в поясничной области целесообразно сочетать декомпрессию с короткой фиксацией. При наличии факторов риска декомпрессию необходимо дополнить длинной фиксацией, превышающей длину дуги сколиоза.

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