PERSONALIZED ALGORITHMS FOR TREATING DEGENERATIVE SPINAL CANAL STENOSIS: FROM CONSERVATIVE THERAPY TO SURGICAL DECOMPRESSION
Keywords:
degenerative spinal canal stenosis; personalized treatment; conservative therapy; surgical decompression; pelvic organ dysfunction; risk factors; myelopathy; urodynamic disordersAbstract
Degenerative spinal canal stenosis (DSCS) is a leading cause of chronic myelopathy and disability, requiring optimization of therapeutic strategies. Objective: To develop personalized treatment algorithms for DSCS based on analysis of patient structure, risk factors, and pelvic organ dysfunction (POD).
Materials and Methods. Retrospective analysis of data from 62 DSCS patients (25% of cohort n=250). Comprehensive examination included neurological status (ASIA), urodynamic studies (uroflowmetry, urodynamics, USP scale), and neuroimaging (1.5T MRI, CT myelography). Statistics: IBM SPSS 26.0 (descriptive statistics, Spearman correlation, χ², Mann-Whitney, OR calculation with 95% CI; p<0.05).
Results. Predominant findings: thoracic level lesions (Th7–Th12 – 60%), mixed-type POD (58%), and stenosis >50% (82%). Risk factors for severe disability (mRS 4-5): age >50 years (OR=3.2; 95%
CI 1.8–5.7), stenosis >70% (OR=4.1; 95% CI 2.3–7.3), urinary retention (OR=5.6; 95% CI 3.1–10.2),
and thoracic localization (OR=2.8; 95% CI 1.5–5.1). Conservative therapy was effective (68%) for stenosis <50% and mild POD. Surgical decompression was indicated for stenosis >50%, symptom progression, and conservative treatment failure >3-6 months.
Conclusion. A personalized approach considering stenosis severity, lesion level, POD type, and risk factors optimizes DSCS patient management, reducing disability risk and improving quality of life.
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