Opere Lomber Dar Kanal Hastalarında Lomber Vertebral Kanal Morfolojik Varyasyonu
Yükleniyor...
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç:
Lomber dar kanal ( LDK), spinal kanalın , nöral foramenin ve ya nöral elemanların
sıkışmasına bağlı olarak nörojenik ağrı veya kladikasyoya s ebep olan klinik sendrom
olarak ifade edilmektedir. Bu klinik durumun cerrahi tedavisinde ise nöral elem an ların
sıkışıklığının ortadan kaldırılması için dekompresyon, gerekli durumlarda da
enstr u m a ntasyon ve füzyon uygula nır. Bu çalışmamızda opere edilen lomber dar kanal
hastaları yaş, cinsiyet, opere edilen lomber bölgenin morfolojik yapısı, ek sistemik
hastalığı , açısından mevcut literatür ışığında değerlendirilecektir.
Gereç ve Yöntem:
Çalışma kapsamında Ocak 2019 Ocak 2023 yılları arasında
kliniğimizde lomber stenoz tanısıyla değerlendirilen ve opere edilen hastalar retrospektif
incelen e cektir. Ameliyattan önce tüm hastalar cerrahi yaklaşımlar hakkında deteylı
bilgilendiril di ve cerrahi onam formu alın dı . Hastalar nöro lojik muayene , radyolojik
değerlendirme sonuçları, sistemik hastalıklar göz önüne alınarak cerrahi uygulan dı .
Hastalar lomber stenozun anatomik yeri, lomber vertebranın morfolojik yapıs ının dar kanal
oluşumuna etkisi , lomber dar kanal sayısı , lomber dar k analın olduğu seviyede kanal
ölçüleri, lomber dar kanalı olan hastaların kadın erkek oranı , ameliyat öncesi laseq
varlığı, ameliyat öncesi de fi sit varlığı, ameliyatta enstruman kull a nılıp kullanılmadığı
açısından değerlendilecektir.
Bulgular:
Çalışmaya dahil ettiğimiz 26 87 yaş aralığındaki hast a ların ortalam a yaşı 63
olarak bulundu. 212 hastanın 141 tanesi (%66,5) kadın cinsiyete sahip hastalardan
oluşmaktadır. Hastaların %68,9’ unda özgeçmişlerinde ek hastalık olduğu tespit edilmiştir.
Ek hastalıklarda n HT (Hipertansiyon) 103 kişiyle en çok görülen hastalık olurken, 55 DM
(Diyabetes Mellitus), 20 astım, 19 KA H Koroner Arter Hastalığı ), 16 guatr, 10 HL
(Hiperlipidemi), 6 SVO (Serebrovasküler Olay), 37 hastada diğer ek hastalıkların olduğu
görülmüştür. H astalar darlık görülen kanal seviyelerine bakıldığı nda; L1 2 kanal darlığı 3
hasta , L2 3 kanal darlığı 19 hasta, L3 4 kanal darlığı 68 hasta, L4 5 kanal darlığı 145
hasta, L5 S1 kanal darlığı 8 hasta olduğu tespit edilmiştir. Hastaların 40 tanesinde birde n
fazla seviyede kanal darlığı olduğu bunların 26 tanesinde L3 4, L4 5 kanal darlığı
birlikteliği bulunduğu gözlemlenmiştir. 40 hastanın 38’ inde 2 seviyede darlık varken 2
tanesinde 3 seviyede darlık bulunmuştur. Hastaların 114 tanesinde (%53,8) defisit o lduğu
tespit edilmiştir. Muayene edilen hastaların 47 tanesinde (%22,2) laseq mevcuttur. 184
hastada (%86,8) ameliyat sırasında enstrumantasyon uygulanmıştır. Hastalar vertebral
kanal morfolojilerine göre değerlendirildiklerinde; 149’ u (%70,3) triangüler,
kanal morfolojilerine göre değerlendirildiklerinde; 149’ u (%70,3) triangüler, 54’ ü (%25,5) 54’ ü (%25,5) elips, 9’ u (%4,2) oval olarak belirlenmiştir.elips, 9’ u (%4,2) oval olarak belirlenmiştir.
Sonuç:
Sonuç: Çalışmamızda kanal darlığı Çalışmamızda kanal darlığı tanısı ile tanısı ile opere ettiğimiz hastaların çoğunluğunun opere ettiğimiz hastaların çoğunluğunun triangüler morfolojitriangüler morfolojiye sahipye sahip olduğu ve en çok L4olduğu ve en çok L4--5 5 mesafesinmesafesinde görüldüğünü tespit ettik. de görüldüğünü tespit ettik. Bu nedenle triangüleBu nedenle triangüler morfolojiye sahip hastaların r morfolojiye sahip hastaların bilgisayarlı tomografi (BT)bilgisayarlı tomografi (BT), , manyetik manyetik rezonans görüntüleme (MRG) rezonans görüntüleme (MRG) görüntüleri ve muayeneleri detaylı bir şekilde görüntüleri ve muayeneleri detaylı bir şekilde değerlendirilmeli ve bu hastaların cerrahi adayı olmalarının diğer morfolojiye sahip değerlendirilmeli ve bu hastaların cerrahi adayı olmalarının diğer morfolojiye sahip hastalardan daha fazla olabihastalardan daha fazla olabileceği göz önünde bulundurulmalıdır. leceği göz önünde bulundurulmalıdır.
Aim: Lumbar stenosis can be expressed as a clinical syndrome that causes neurogenic pain or claudication due to compression of the spinal canal, neural foramen or neural elements. The treatment of this clinical treatment is necessary to eliminate the congestion of the normal elements, the necessary hardware, instrumentation and fusion are applied. In this study, information about the operated lumbar stenosis, age, gender, morphological structure of the operated lumbar region, additional systemic disease, and current literature features will be evaluated from a perspective. Material and Methods: Within the scope of the study, patien ts who were evaluated and operated on with the diagnosis of lumbar stenosis in our clinic between January 2019 and January 2023 will be examined retrospectively. Before the surgery, all patients were informed in detail about the surgical approaches and a s urgical consent form was obtained. Surgery was performed on the patients, taking into account neurological examination, radiological evaluation results and systemic diseases. Patients were asked about the anatomical location of lumbar stenosis, the effect of the morphological structure of the lumbar vertebra on the formation of stenosis, the number of lumbar stenosis, the dimensions of the lumbar stenosis at the level of the lumbar stenosis, the male female ratio of patients with lumbar stenosis, the presen ce of preoperative laseq, the presence of preoperative deficit, the instrument used in surgery. It will be evaluated in terms of whether it is used or not. Results: The average age of the patients between the ages of 26 and 87 included in the study was 63. 141 of 212 patients (66.5%) were female patients. It was determined that 68.9% of the patients had additional diseases in their medical history. Among the additional diseases, HT (Hypertension) was the most common disease in 103 patients, 55 DM (Diabetes Mellitus), 20 asthma, 19 CA D C oronary A rtery D isease ), 16 goiter, 10 HL (Hyperlipidemia), 6 CV C (Cerebrovascular Case ), 37 other patients. It has been observed that there are additional diseases. When patients look at the canal levels with stenosis; L1 2 canal stenosis was found in 3 patients, L2 3 canal stenosis in 19 patients, L3 4 canal stenosis in 68 patients, L4 5 canal stenosis in 145 patients, and L5 S1 canal stenosis in 8 patients. It was observed that 40 of the patients had canal stenosis at more than one level, and 26 of them had L3 4 and L4 5 canal stenosis together. While 38 of 40 patients had stenosis at 2 levels, 2 of them had stenosis at 3 levels. It was determined that 114 of the patients (53.8%) had a deficit. 47 (22.2%) of the examined pat ients had laseq. Instrumentation was applied during surgery in 184 patients (86.8%). When patients are Instrumentation was applied during surgery in 184 patients (86.8%). When patients are evaluated according to their vertebral canal morphology; 149 (70.3%) were determined as evaluated according to their vertebral canal morphology; 149 (70.3%) were determined as triangular, 54 (25.5%) as ellipse, and 9 (4.2%) as oval.triangular, 54 (25.5%) as ellipse, and 9 (4.2%) as oval. Conclusi Conclusion:on: In our study, we found that the majority of the patients we operated on with In our study, we found that the majority of the patients we operated on with the diagnosis of canal stenosis had triangular morphology and were most common at the the diagnosis of canal stenosis had triangular morphology and were most common at the L4L4--5 distance. For this reason, 5 distance. For this reason, CTCT (Computed Tomography)(Computed Tomography), , MRIMRI (Magnetic Resonance (Magnetic Resonance ImagingImaging)) images and examinations of patients with triangular morphology should be images and examinations of patients with triangular morphology should be evaluated in detail and it should be taken into consideration that these patients may be evaluated in detail and it should be taken into consideration that these patients may be more likely to be surgical candidates than patients with other morphologies.more likely to be surgical candidates than patients with other morphologies.
Aim: Lumbar stenosis can be expressed as a clinical syndrome that causes neurogenic pain or claudication due to compression of the spinal canal, neural foramen or neural elements. The treatment of this clinical treatment is necessary to eliminate the congestion of the normal elements, the necessary hardware, instrumentation and fusion are applied. In this study, information about the operated lumbar stenosis, age, gender, morphological structure of the operated lumbar region, additional systemic disease, and current literature features will be evaluated from a perspective. Material and Methods: Within the scope of the study, patien ts who were evaluated and operated on with the diagnosis of lumbar stenosis in our clinic between January 2019 and January 2023 will be examined retrospectively. Before the surgery, all patients were informed in detail about the surgical approaches and a s urgical consent form was obtained. Surgery was performed on the patients, taking into account neurological examination, radiological evaluation results and systemic diseases. Patients were asked about the anatomical location of lumbar stenosis, the effect of the morphological structure of the lumbar vertebra on the formation of stenosis, the number of lumbar stenosis, the dimensions of the lumbar stenosis at the level of the lumbar stenosis, the male female ratio of patients with lumbar stenosis, the presen ce of preoperative laseq, the presence of preoperative deficit, the instrument used in surgery. It will be evaluated in terms of whether it is used or not. Results: The average age of the patients between the ages of 26 and 87 included in the study was 63. 141 of 212 patients (66.5%) were female patients. It was determined that 68.9% of the patients had additional diseases in their medical history. Among the additional diseases, HT (Hypertension) was the most common disease in 103 patients, 55 DM (Diabetes Mellitus), 20 asthma, 19 CA D C oronary A rtery D isease ), 16 goiter, 10 HL (Hyperlipidemia), 6 CV C (Cerebrovascular Case ), 37 other patients. It has been observed that there are additional diseases. When patients look at the canal levels with stenosis; L1 2 canal stenosis was found in 3 patients, L2 3 canal stenosis in 19 patients, L3 4 canal stenosis in 68 patients, L4 5 canal stenosis in 145 patients, and L5 S1 canal stenosis in 8 patients. It was observed that 40 of the patients had canal stenosis at more than one level, and 26 of them had L3 4 and L4 5 canal stenosis together. While 38 of 40 patients had stenosis at 2 levels, 2 of them had stenosis at 3 levels. It was determined that 114 of the patients (53.8%) had a deficit. 47 (22.2%) of the examined pat ients had laseq. Instrumentation was applied during surgery in 184 patients (86.8%). When patients are Instrumentation was applied during surgery in 184 patients (86.8%). When patients are evaluated according to their vertebral canal morphology; 149 (70.3%) were determined as evaluated according to their vertebral canal morphology; 149 (70.3%) were determined as triangular, 54 (25.5%) as ellipse, and 9 (4.2%) as oval.triangular, 54 (25.5%) as ellipse, and 9 (4.2%) as oval. Conclusi Conclusion:on: In our study, we found that the majority of the patients we operated on with In our study, we found that the majority of the patients we operated on with the diagnosis of canal stenosis had triangular morphology and were most common at the the diagnosis of canal stenosis had triangular morphology and were most common at the L4L4--5 distance. For this reason, 5 distance. For this reason, CTCT (Computed Tomography)(Computed Tomography), , MRIMRI (Magnetic Resonance (Magnetic Resonance ImagingImaging)) images and examinations of patients with triangular morphology should be images and examinations of patients with triangular morphology should be evaluated in detail and it should be taken into consideration that these patients may be evaluated in detail and it should be taken into consideration that these patients may be more likely to be surgical candidates than patients with other morphologies.more likely to be surgical candidates than patients with other morphologies.
Açıklama
Anahtar Kelimeler
Lomber dar kanal, Lumbar spinal stenosis, morfoloji, morphology, varyasyon, variation
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yıldırım, M. T. (2024). Opere Lomber Dar Kanal Hastalarında Lomber Vertebral Kanal Morfolojik Varyasyonu. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Beyin Cerrahisi Anabilim Dalı, Konya.
