[Possibilities and advantages of minimally invasive dorsal decompressive-stabilizing interventions in the treatment of degenerative spondylolisthesis of the elderly patients.]

The purpose of the study was a comparative analysis of the clinical and radiographic efficacy of minimally invasive rigid stabilization techniques and the traditional open interbody fusion with transpedicular fixation in the treatment of degenerative spondylolisthesis in elderly patients. The study included 65 elderly patients (over 60 years old) divided into 2 groups: the 1st group (MIS-TLIF, n=31), who underwent minimally invasive transforaminal interbody fusion, unilateral open contralateral transcutaneous transpedicular stabilization; the 2nd group (O-TLIF, n=34), operated using rigid stabilization from the median approach. For the comparative analysis, gender characteristics (gender, age), constitutional features (height, weight, body mass index), ASA physical status, intraoperative parameters of interventions and specificity of postoperative management of patients, clinical data, radiographic outcomes, complications were used. Dynamic evaluation was performed at the time from 24 to 48 months after the operation (median 32 months). As a result, it has been established that the use of minimally invasive dorsal decompressive-stabilizing interventions allows achieving better clinical outcomes and fewer perioperative complications than open transforaminal interbody spondylodesis and transpedicular stabilization with similar radiographic results of fusion formation and reduction of abnormal vertebral displacement. Low traumatic surgery in the main study group makes it possible to use a technique for treating degenerative spondylolisthesis in elderly patients.

[Analysis of the effectiveness of Dexmedetomidine in the treatment of degenerative diseases of the lumbar spine with minimally invasive puncture techniques in elderly patients.]

The aim of the study was a comparative analysis of the effectiveness of the use of Dexmedetomidine and Propofol in the treatment of degenerative diseases of the lumbar spine with minimally invasive puncture techniques in elderly patients. The study included 83 elderly patients (over 60 years old) who underwent laser denervation of facet joints (n=44) and posterolateral transforaminal endoscopic discectomy (n=39): in the first group, Dexmedetomidine (n=32), in the second group - Propofol (n=51). For the comparative analysis, gender characteristics (gender, age), constitutional features (height, weight, body mass index), the degree of physical status by ASA, the intensity of the pain syndrome before surgery, the duration of the operation, the degree of patient satisfaction with the Macnab surgery, the complications. In the dynamics analyzed: the level of sedation on the scales RASS and Ramsay; intraoperative parameters of cardiovascular and respiratory systems (systolic blood pressure, heart rate, hemoglobin oxygen saturation (SpO2), level of pain syndrome according to VAS in the field of operative intervention. As a result, it has been established that the use of Dexmedetomidine in minimally invasive puncture techniques in elderly patients allows ensure safety and efficacy in the perioperative period, a sufficient degree of sedation and analgesia without depression of the cardio-respiratory system.