Publication: Servikal Dar Kanal tanısı ile farklı yöntemlerle opere edilen hastaların uzun dönem klinik ve radyolojik sonuçlarının değerlendirilmesi
Abstract
Bu çalışmada Servikal Dar Kanal (SDK) nedeniyle değişik yöntemlerle ameliyat edilen hastaların uzun dönem klinik ve radyolojik sonuşlarını araştırıldı. Marmara Üniversitesi Nöroşirurji kliniğinde 2005-2010 yılları arasında SDK tanısıyla ameliyat edilen 104’ü erkek (% 52,3), 94’ü kadın (% 47,3) olmak üzere toplam 198 hasta popülasyonu seçildi. Yapılan ameliyat yöntemine göre hastalar 5 gruba ayrıldı. A grubuna (iki ve üzeri seviye) anterior dikektomi + anteriordan plaklama ile füzyon (n=32), B grubuna Anterior korpektomi + anteriordan plaklama ile füzyon (n=11), C grubuna postrerior yaklaşımla laminektomi ile dekompresiyon (n=24), D grubuna postrerior yaklaşımla laminektomi ile dekompresiyon + lateral mass vidaları ile füzyon (n=85), E grubuna kombine anterior plaklama ile posteriordan dekompresiyon (n=46) yapılan hastalar alındı. Hastaların klinik değerlendirmesi beş parametreli Japon Ortopedi Birliğin Miyelopati Değerlendirme Skalası (JOB) kullanıldı. Ameliyat olmadan önceki JOB skoru ile son kontrole geldiklerindeki JOB skorları karşılaştırıldı. Radyolojik olarak, direkt grafi ve Manyetik rezonans görüntüleme (MRG) tetkikler incelendi. Olguların ameliyat öncesi ve sonrası servikal sagital vertebra dizilim açısı (C2-C7) Cobb yöntemiyle ölçüldü. Ameliyat öncesi ve sonrası sagital MRG’lerde servikal vertebral kanal çapı ölçüldü ve JOB skorları ile karşılaştırıldı. Korpektomi yapılan (B) grupta, MRG’de servikal kanal çapı farkı ile servikal fonksiyon değişikliği arasında (%76) pozitif korelasyon ve Laminektomi yapılan (C) grupta, SKÇF ile alt ekstrimite fonksiyonu değişikliği arasında (%89) pozitif korelasyon saptandı (Spearman's rho testi ile). Servikal dar kanal hastalığı dinamik, ilerleyici bir hastalıktır. Genellikle orta ileri yaşta görülür. Olguların ameliyat sonrası memnuniyeti, uygulanan cerrahi yönteme bağlı olarak %80-85 arasında değişmektedir. Bu nedenle servikal dar kanal hastalığında, hangi cerrahi yöntemin uygulanacağına hastanın genel medikal durumu, yaşam şekli, eğitim durumu gibi hasta bağımlı faktörlerle birlikte cerrahın eğitimi, uygun teknik ve coğrafik şartlara bağlı olarak karar verilmelidir. Anahtar Sözcükler: korpektomi, laminektomi, servikal multiseviye diskektomi, sevikal spondiloz.
In this work long term clinical and radiological follows up of patients operated with different method for cervical spinal canal stenoses were discussed. Patient were strictly selected from cases operate for cervical stenoses in Neurosurgery Clinic of Marmara University between 2005-2010 years. We enrolled total of 198 patients who underwent surgery, 104 (%52,3) were men, 94 (%47,3) were women. Patients were grouped in to five groups according to operation approaches. Group A, multilevel anterior diskectomy + anterior plate fusion (n=32). Group B, anterior corpectomy + anterior plate fusion (n=11). Group C, decompresive laminectomy without fusion (n=24). Group D, decompessive laminectomy with lateral mass screwing and fusion (n=85). Group E, combined anterior posterior decompresive approaches and fusion (n=46). Clinical evaluations were done in five parameters by Japanese Orthopedic Association (JOA) scoring system. Preoperative and last visit JOA scores were analyzed. Plan X-ray and MRI done for radiological evaluation. Cervical vertebral alignment angle (C2-C7) measured by Cobb method. In preoperative and last visit’s sagital cervical MRI investigation diameters of cervical vertebral canal were measured and analyzed with JOA scores. In corpectomy + anterior plate fusion group (B), there was positive correlation (76%) between MRI cervical vertebral diameter and JOA cervical function. In laminectomy without fusion group (C), there was strong correlation (89%) between MRI cervical vertebral diameter and JOA lower extremity function (Spearman's rho test). Cervical spinal canal stenosis is dynamic, progressive diseases. Generally, it is diagnosed in middle advanced age population. Postoperative patient satisfaction is about 80-85% and differs among operative approaches. For this reason, in treatment of cervical spinal canal stenosisi proper surgical approach decision mast include, not only, patient’s general medical status, education, occupation and living condition but also, surgeons training state, proper technical and geographical conditions. Key words: cervical spondylosis, corpectomy, laminectomy, multilevel cervical diskectomy.
In this work long term clinical and radiological follows up of patients operated with different method for cervical spinal canal stenoses were discussed. Patient were strictly selected from cases operate for cervical stenoses in Neurosurgery Clinic of Marmara University between 2005-2010 years. We enrolled total of 198 patients who underwent surgery, 104 (%52,3) were men, 94 (%47,3) were women. Patients were grouped in to five groups according to operation approaches. Group A, multilevel anterior diskectomy + anterior plate fusion (n=32). Group B, anterior corpectomy + anterior plate fusion (n=11). Group C, decompresive laminectomy without fusion (n=24). Group D, decompessive laminectomy with lateral mass screwing and fusion (n=85). Group E, combined anterior posterior decompresive approaches and fusion (n=46). Clinical evaluations were done in five parameters by Japanese Orthopedic Association (JOA) scoring system. Preoperative and last visit JOA scores were analyzed. Plan X-ray and MRI done for radiological evaluation. Cervical vertebral alignment angle (C2-C7) measured by Cobb method. In preoperative and last visit’s sagital cervical MRI investigation diameters of cervical vertebral canal were measured and analyzed with JOA scores. In corpectomy + anterior plate fusion group (B), there was positive correlation (76%) between MRI cervical vertebral diameter and JOA cervical function. In laminectomy without fusion group (C), there was strong correlation (89%) between MRI cervical vertebral diameter and JOA lower extremity function (Spearman's rho test). Cervical spinal canal stenosis is dynamic, progressive diseases. Generally, it is diagnosed in middle advanced age population. Postoperative patient satisfaction is about 80-85% and differs among operative approaches. For this reason, in treatment of cervical spinal canal stenosisi proper surgical approach decision mast include, not only, patient’s general medical status, education, occupation and living condition but also, surgeons training state, proper technical and geographical conditions. Key words: cervical spondylosis, corpectomy, laminectomy, multilevel cervical diskectomy.