Age-related disorders involving the deterioration of the lumbar spine, intervertebral disks with the adjacent base and upper plates of the vertebral body, and the vertebral joints affect everyone in the course of their life. The extent of these changes and the associated potential symptoms vary greatly. These symptoms are just as diverse as their triggering causes, which are significantly influenced and dependent on our lifestyle, occupational strains and constitutional factors.
The following example concerns a pensioner who is now 66 years old and has not been working for three years. For many years, he suffered from pain in the lower back accompanied occasionally with stress-dependent leg pain, which has now become increasingly problematic. Although he already stopped smoking and even lost a bit of weight, he finds it increasingly difficult to keep up his previously active lifestyle that included a lot of movement, gardening and long walks with friends. Despite several inpatient treatments at rehabilitation facilities, he is unable to carry out his normal daily activities without painkillers. His back pain and especially the significant restriction in the distance he can walk (now limited to less than 10 minutes) affects him considerably. Regular pain in both lower limbs are so strong that he needs to support his upper body or sit down for a pause before he can continue. Even making short shopping trips are no longer possible. His physical impairments contribute to a significant loss in his quality of life, which he can no longer accept.
A bleeding disorder of the legs could be excluded. There are strong degenerative changes in the lumbar spine with vertebral displacement, which can be seen in the above mentioned x-ray images. There is pronounced erosion/wear of the intervertebral disc with marked reduction in the intervertebral height, and resultant spinal canal stenosis in the middle lumbar spine (levels L3-L5) can be seen.
Surgical treatment (Fig. 7.1) involves a correction and stiffening (fusion) the spine to restore the normal spinal alignment. Screws and rods with intervertebral cages are used, so that the original height of the intervertebral disc spaces as well as the original form of the spine are restored. At the same time, narrowing of the spinal canal and all constrictions of the nerve exit channels (neural foramen) are eliminated.
The vertebral displacement (spondylolisthesis) is no longer present, there is no more nerve root compression. This enables the patient to stand up, walk on the first postoperative day and begin the aftercare rehabilitation.