Publication: Dejeneratif spondilolisteziste cerrahi tedavi
Abstract
Omurgada segmenter patolojik hareketliliğin önemli nedenlerinden biri lumbosakral spondilolistezistir. Bu yazıda, dejeneratif spondilolistezis nedeniyle ameliyat edilen 21 olgu sunulmaktadır. Yapılan incelemeler sonunda 18 olguda evre I, 3 olguda da evre II spondilolistezis belirlenmiştir. Olguların % 61.9'unda spondilolistezisin L4-5 seviyesinde olduğu, % 14.3 olguda L3-4'te, % 9.5 olguda L5-Sl'de ve % 14.3 olguda ise çift segmentte olduğu belirlenmiştir. Olguların % 85.7'sinde dekompresyon yapılmıştır. Ayrıca tüm olgularda transpediküler tespit ile sabitleştirme ve posterolateral füzyon yapılmıştır. Ortalama izlem süresi 14.4 aydır. Radyolojik incelemeler ortalama kayma yüzdesinin ameliyat sonrası dönemde istatistiksel olarak anlamlı bir düzeyde azaldığını ortaya koymaktadır. Ameliyat sonrası dönemde olguların % 52.3'ünün mükemmel, % 42.8'inin iyi, % 4.7'sinin ise orta durumda olduğu belirlenmiştir. Ortalama 14.4 aylık takibi izleyerek % 90.4 oranında füzyon saptanmıştır. Transpediküler tespit ve posterolateral füzyonun dejeneratif lumbosakral spondilolistezisin cerrahi tedavisinde etkin ve güvenilir bir yöntem olduğu, omurgada yüksek oranda füzyon sağladığı sonucuna varılmıştır.
One of the most important causes of spinal segmental instability is lumbosacral spondylolisthesis. Twenty one consecutive patients with degenerative spondylolisthesis who had surgical treatment are presented. Radiologic examination demonstrated grade I spondylolisthesis in 85.75 %, and grade II spondylolisthesis in 14.7 % of the patients. Spondylolisthesis was detected at L4-5 segment in 61.9 %, at L3-4 in 14.3 %, at L5-S1 in 9.5%, and in multiple segments in 14.3 % of the patients. A decompressive laminectomy was performed in 85.7 % of patients, and transpedicular fixation and posterolateral fusion was performed in all. A comparison of pre- and postoperative radiological investigations revealed a significant decrease in percent-slip (p<0.05). Postoperative clinical assessment showed an excellent clinical outcome in 52.3 %, a good outcome in 42.8 %, and a fair outcome in 4.7 % of the patients. A 90.4 % fusion rate was achieved after a 14.4 months of mean follow-up period. On the basis of our clinical and radiological results it cart be concluded that internal fixation and posterolateral fusion are effective and safe methods in the treatment of degenerative lumbosacral spondylolisthesis, providing high spinal fusion rate.
One of the most important causes of spinal segmental instability is lumbosacral spondylolisthesis. Twenty one consecutive patients with degenerative spondylolisthesis who had surgical treatment are presented. Radiologic examination demonstrated grade I spondylolisthesis in 85.75 %, and grade II spondylolisthesis in 14.7 % of the patients. Spondylolisthesis was detected at L4-5 segment in 61.9 %, at L3-4 in 14.3 %, at L5-S1 in 9.5%, and in multiple segments in 14.3 % of the patients. A decompressive laminectomy was performed in 85.7 % of patients, and transpedicular fixation and posterolateral fusion was performed in all. A comparison of pre- and postoperative radiological investigations revealed a significant decrease in percent-slip (p<0.05). Postoperative clinical assessment showed an excellent clinical outcome in 52.3 %, a good outcome in 42.8 %, and a fair outcome in 4.7 % of the patients. A 90.4 % fusion rate was achieved after a 14.4 months of mean follow-up period. On the basis of our clinical and radiological results it cart be concluded that internal fixation and posterolateral fusion are effective and safe methods in the treatment of degenerative lumbosacral spondylolisthesis, providing high spinal fusion rate.