Object: pathogenesis and surgical treatment of hernia of lumbar intervertebral discs (IVD) in patients of the elderly and aged. Aim: to the improve of the surgical treatment results in elderly patients with lumbar IVD hernias on the basis of the study of age characteristics of pathogenesis, diagnostic improvement and the development of differentiated methods of surgical treatment depending on the structural and functional features of the spinal motor segments. Methods: clinical, radiological, computed and magnetic resonance tomography, mathematical and experimental modeling, morphological, biochemical, DEXA, statistical. For the first time, based on determining the age-related features of pathogenesis, structural and functional changes in the spinal motor segments the concept of operative treatment of elderly patients with the herniated lumbar IVD was created. Based on the results of clinical, radiological, tomographic, morphological and experimental researches differentiated techniques for operative treatment of IVD herniation in elderly patients were developed. Endoscopic foraminotomy techniques were developed in the case of combination of hernias and protrusions of lumbar IVD with foraminal stenosis and non-invasive decompression and stabilization techniques with a set of tools for minimally invasive decortication of facet joints in the case of combination of disc hernias with the lumbar instability. For the first time, the effectiveness of radiofrequency ablation was experimentally proved to prevent the recurrence of the IVD herniation as well as the formation of new hernias in the adjacent IVD. The effectiveness of radiofrequency bipolar coagulation of epidural vessels for the prevention of epidural fibrosis and scar stenosis was explained. Based on the analysis the bone mineral density of lumbar vertebra before and after percutaneous vertebroplasty and math modelling of equivalent loads of the anterior and posterior support complexes under conditions of different configuration of the lumbar spine, a method of intraoperative augmentation of vertebral bodies was developed providing a stable fixation at osteoporosis. For the first time, frequency and causes of unsatisfactory outcomes of primary operative treatment of the herniated lumbar IVD were demonstrated, the criteria were set for the instability of the spinal motor segments in patients with miofixation of the spine. The theoretical knowledge was expanded regarding the features of IVD herniation pathogenesis under conditions of the involutive dehydration of the nucleus pulposus, sclerosis of the vertebral end plates and osteoporosis of the vertebrae; the kind of loads in in various kind of the sagittal contour of the lumbar spine. The proposed algorithmic system of operative treatment of the herniated lumbar IVD in elderly patients provides the improved diagnostics, the clarification of the extent of operative intervention, and increases the treatment efficiency. Indications for the application of minimally-invasive techniques to the operative treatment of IVD herniation combined with foraminal stenosis or the spinal instability were presented enables to reduce the degree of operation risk, the time of operation and the staying in hospital providing early physical and social rehabilitation. The improved techniques for reducing the intradiscal pressure with the application of radiofrequency ablation enables to reduce the frequency of IVD herniation recurrence. The application of radiofrequency ablation of the degenerative IVD cavity (grade V according to Pfirrmann) or the protruded adjacent disc enables to prevent the formation of the IVD hernias and to reduce the risk of developing the adjacent syndrome. The improved techniques for radiofrequency ablation to stop bleeding from damaged epidural vessels enable to reduce the frequency of the epidural fibrosis and scar stenosis formation. The developed intraoperative techniques for diagnosing the instability of lumbar segments in patients with severe pain and musculoskeletal syndrome using the proposed tests (distraction and the determination of the amount of disc lost during discectomy) allow assessing the spinal segments stability, to determine the extent of operative intervention and to prevent the development of postoperative iatrogenic instability. The developed techniques for postoperative wounds follow-up depending on the type of the "controlled liquorrhea" enable to prevent the formation of liquorous fistulas and create conditions for the postoperative wounds healing. The results of the study were introduced into clinical practice in Sytenko Institute of Spine and Joint Pathology, ITO NAMN, Research Institute of Traumatology and Orthopedics Donetsk National Medical University, ME "Rivne Regional Clinical Hospital", KKLGZOZ "Regional Clinical Hospital", LLC "Clinic "Neuromed" (Kyiv), Regional Clinical Hospital (Ivano-Frankivsk), Ternopil University Hospital. Тraumatology and Orthopaedics.
