Dejeneratif lumbar kombine spinal stenozda radikal dekompresyon, enstrümentasyon füzyonla kısa-orta dönem sonuçlarımız
Küçük Resim Yok
Tarih
2006
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, dejeneratif lumbar kombine spinal stenozda radikal dekompresyon, enstrümentasyon-füzyon yapılan hastaların kısa-orta dönem sonuçlarının değerlendirilmesi amaçlandı. Genel Bilgiler: Dejeneratif spinal stenoz, spinal kord veya köklerinin geçtikleri kanallarda çeşitli nedenlere bağlı daralması durumudur. Bu nedenler konjenital veya travma ile ilişkili kazanılmış sorunlar olabilir. Stenoz orta yaşm sonlarına kadar genellikle semptomatik hale gelmez. Dejeneratif lumbar spinal stenozun büyük kısmı konservativ olarak tedavi edilebilmesine rağmen, şiddetli stenozu olan veya segmental instabilitesi bulunan hastalar bu tedaviden çok fayda görmezler. Literatürde, minimal invaziv veya daha sofistike birçok cerrahi metod tanımlanmıştır. Yine literatürde gerek cerrahi tedavi, gerekse konservativ tedavinin sonuçlarında oldukça büyük farklar gözükmektedir. Spinal stenoz cerrahisinden sonraki ana problem; yetersiz veya yanlış seviye dekompresy onları, iyatrojenik instabilite ve dejeneratif yeni gelişime bağlı rekürrens oluşumudur. Materyal ve Metod: Ekim 2001 ile Mart 2004 tarihleri arasında Selçuk Üniversitesi Meram Tıp Fakültesi Ortopedi ve Travmatoloji Kliniği'nde radikal dekompresyon, enstrümentasyon-füzyon yapılan 52 hasta değerlendirildi. Ameliyat edilen hastaların çoğu cerrahi öncesi en az 6 ay boyunca konservativ tedavi görmüşler ve şikayetleri geçmemiş hastalardı. Hastaların tüm demografik verileri, etyolojileri ve semptomları kaydedildi. Daralmanın ve instabilitenin olduğu seviyeler düz grafiler ve ileri görüntüleme yöntemleri ile değerlendirildi. Ağrının derecesi Visual Analog Scala (VAS), ağrının günlük yaşama olan etkisi ise Oswestry Disability Index (ODI) ile tanımlandı. Ayrıca ağrısız yürüme mesafesi (AYM) hesaplandı. Hastalarımız, ek hastalığın, yaşın, dekompresyon-füzyon seviye sayılarının, semptom süresinin ve sakrumun fîizyona dahil edilip edilmemesinin sonuçlar üzerine etkisi araştırıldı. Bulgular: Ortalama yaş 62,1 (33-80)di. Ortalama takip süresi ise 26 (18-40) ay idi. Ameliyat öncesi ortalama VAS, ODI ve AYM'leri sırasıyla 9.0, 39.9, 88 metre şeklindeydi. Bunlar ameliyat sonrası sırasıyla 3.0, 6.8 ve 898 metre şeklinde gelişti. Bunlar istatistiki olarak değerlendirildiğinde anlamlı bir düzelmeyi gösteriyordu (PO.05). Ek hastalığın, hastanın yaşının, dekompresyon-füzyon seviye sayısının, semptom süresinin ve sakrumun füzyonunun sonuçlar üzerinde istatistiksel bir anlamı görülmedi (P>0.05). Takiplerimizde iyi ve çok iyi hasta savımız 39 (%75)dL Sonuç: Çalışmamız, şiddetli dejenere lumbar spinal stenozu olan hastalarda radikal dekompresyon, enstrümentasyon-füzyonun oldukça etkili bir tedavi metodu olduğunu göstermektedir. Bu teknikle tüm patoloji tek bir operasyonla çözülmekte, ameliyat sonrası instabilite ve dejeneratif yeni büyüme engellenmektedir.
Prospective and consecutive study on spinal stenosis surgery. Objective: To evaluate the efficacy of radical decompression and fusion with stabilization for severe combined canal stenosis of the lumbar spine. Summary of Background Data: Degenerative spinal stenosis is narrowing the spinal canal or neural foramina secondary to modifications that occur over time. These modificatins can be related to congenital, aquired disease including traumatic. Stenosis usually does not become symptomatic until patients reach late middle age. The majority of patients with canal stenosis of lumbar spine can be treated conservatively. However, the conservative modalities does not benefit in patients with severe stenosis or segmental instability. There have several surgical methods including minimally invasive or more sophisticated described in literature. There is no uniform results in either surgery or conservative treatment. The main problems after spinal stenosis surgery are reccurence of the symptoms due to inadequate or wrong level/levels decompession, iatgenic instability and degenerative regrowth. This study was especially focused on mid-term clinical results of multi-level laminectomies with facetectomy plus stabilization for the treatment of severe canal stenosis. Material and Methods: Radical decompressive surgery with stabilization was performed in fifty-two patients with multi-level severe canal stenosis between 2001 and 2004 at our instiution. Fifty of one hundred and twenty four patients were good candidate for surgery because of they no response for conservative treatment for least six months and meanwhile their symptoms were progressed. All patients' demographic datas, etiologies and symptoms were recorded. The number of stenotic segments and instability were evaluated with plain radiograph and advance radiology. The degree pain was assessed with Visual Analog Scale(VAS). Also Oswestry Disability Index (ODI) was used for patient daily activities with pain. Additionally, the walking capacity distance(WCD) was assessed preoperatively. We also investigated to the patients' co morbidities, fusion extention to the sacrum, duration of symptoms, patient age and decompression-fusion levels affects on clinical results. Results.* The average age was 62.1(33-80). The average follow-up was 26 months (18-40). The average preoperative WCD, VAS and ODI was 88 m., 9.0 and 39.9 respectively. And they improved to 898 m., 3.0 and 6.8 respectively at last follow- up visit. Statistically significance was found between preoperative and postoperative WCD, VAS and ODI values (p<0.05). No statistical difference between preoperative and postoperative patients' co-morbidities, fusion extention to the sacrum, duration of symptoms, patient age and decompression-fusion levels. Excellent result was obtained in 39(75%). Conclusion: This study demostrated that radical decompression with facetectomy plus stabilization is highly effective method for the treatment of severe spinal stenosis that adresses on all neuro-mechanic pathologies. The technique also prevents postoperative instability and degenerative regrowth by inhibition of abnormal segmental movement.
Prospective and consecutive study on spinal stenosis surgery. Objective: To evaluate the efficacy of radical decompression and fusion with stabilization for severe combined canal stenosis of the lumbar spine. Summary of Background Data: Degenerative spinal stenosis is narrowing the spinal canal or neural foramina secondary to modifications that occur over time. These modificatins can be related to congenital, aquired disease including traumatic. Stenosis usually does not become symptomatic until patients reach late middle age. The majority of patients with canal stenosis of lumbar spine can be treated conservatively. However, the conservative modalities does not benefit in patients with severe stenosis or segmental instability. There have several surgical methods including minimally invasive or more sophisticated described in literature. There is no uniform results in either surgery or conservative treatment. The main problems after spinal stenosis surgery are reccurence of the symptoms due to inadequate or wrong level/levels decompession, iatgenic instability and degenerative regrowth. This study was especially focused on mid-term clinical results of multi-level laminectomies with facetectomy plus stabilization for the treatment of severe canal stenosis. Material and Methods: Radical decompressive surgery with stabilization was performed in fifty-two patients with multi-level severe canal stenosis between 2001 and 2004 at our instiution. Fifty of one hundred and twenty four patients were good candidate for surgery because of they no response for conservative treatment for least six months and meanwhile their symptoms were progressed. All patients' demographic datas, etiologies and symptoms were recorded. The number of stenotic segments and instability were evaluated with plain radiograph and advance radiology. The degree pain was assessed with Visual Analog Scale(VAS). Also Oswestry Disability Index (ODI) was used for patient daily activities with pain. Additionally, the walking capacity distance(WCD) was assessed preoperatively. We also investigated to the patients' co morbidities, fusion extention to the sacrum, duration of symptoms, patient age and decompression-fusion levels affects on clinical results. Results.* The average age was 62.1(33-80). The average follow-up was 26 months (18-40). The average preoperative WCD, VAS and ODI was 88 m., 9.0 and 39.9 respectively. And they improved to 898 m., 3.0 and 6.8 respectively at last follow- up visit. Statistically significance was found between preoperative and postoperative WCD, VAS and ODI values (p<0.05). No statistical difference between preoperative and postoperative patients' co-morbidities, fusion extention to the sacrum, duration of symptoms, patient age and decompression-fusion levels. Excellent result was obtained in 39(75%). Conclusion: This study demostrated that radical decompression with facetectomy plus stabilization is highly effective method for the treatment of severe spinal stenosis that adresses on all neuro-mechanic pathologies. The technique also prevents postoperative instability and degenerative regrowth by inhibition of abnormal segmental movement.
Açıklama
Anahtar Kelimeler
Dejeneratif, Degenerative, lumbar, lumbar, radikal dekompresyon, radical decompression
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Tuna, S. (2006). Dejeneratif lumbar kombine spinal stenozda radikal dekompresyon, enstrümentasyon füzyonla kısa-orta dönem sonuçlarımız. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
