Atlantoaksiyel eklem instabilitesinde sublaminar sarmal ipekle yapılan redüksiyon ve artrodez

Öz

Amaç: Bu yazıda atlantoaksiyel eklem instabilitesinde sublaminar telleme yerine kalın sarmal ipek kullanılarak yapılan C1-C2 artrodez tekniğinin klinik ve radyolojik sonuçlarının değerlendirilmesi amaçlandı.

Çalışma planı: Atlantoaksiyel instabilitesi bulunan ve redüksiyonları yapıldıktan sonra sublaminar sarmal ipekle C1-C2 füzyonu gerçekleştirilen 16 hasta (10 kadın, 6 erkek; ortalama yaş: 43.4, ortalama takip süresi: 34 ay) retrospektif olarak incelendi. Açık redüksiyondan sonra tel yerine sarmal ipekle iki taraflı laminaları bağlanan ve sonrasında otogreftle artrodezi yapılan bu olguların, redüksiyon oranları, vidaların pozisyonları ve füzyon değerleri bilgisayarlı tomografiyle değerlendirildi.

Bulgular: Cerrahi öncesi ortalama atlantodental açıklık (ADA) değeri 8 (dağılım: 6-11) mm, cerrahi sonrasında ise ortalama 2.1 (dağılım: 0.5-2.5) mm olarak ölçüldü. Dural veya spinal kord yaralanmasına bağlı bir komplikasyon gözlenmedi. Tüm olgularda redüksiyonun tam olduğu görüldü. Sadece bir olguda füzyon oluşmadı (%6.25). Olguların cerrahi sonrası fleksiyonda ortalama 10 mm olan ADA değeri, ekstansiyonda 1 mm olarak ölçüldü. Tomografik ince kesitlerde C1-C2 arasında bir olgu hariç greft ayrışmasına ait bulguya rastlanmadı. İki adet vidada (%4) malpozisyon belirlendi.

Çıkarımlar: Sublaminar sarmal ipek tekniği güvenli anatomik redüksiyon sağlaması, ucuz ve basit bir yöntem olması, ekstra implant gerektirmemesi, gevşememesi, nörolojik hasar yaratmaması ve radyolojik kirlilik oluşturmaması nedeniyle sublaminar tellemeye alternatif bir cerrahi uygulamadır.

Anahtar Kelimeler

• Atlantoaksiyel stabilizasyon; servikal omurga; interlaminar füzyon.

Reduction and arthrodesis with sublaminar spiral silk in atlantoaxial joint instability

Abstract

Objective: The aim of this study was to evaluate the clinical and radiologic results of the use of thick spiral silk knotting instead of sublaminar wiring for C1-C2 arthrodesis in patients with atlantoaxial instability.

Methods: We retrospectively evaluated 16 patients (10 females, 6 males; mean age: 43.4 years; mean follow-up: 34 months) with atlantoaxial instability who underwent C1-C2 fusion by reduction and sublaminar spiral silk knotting. All patients underwent open reduction, bounding both laminae with thick spiral silk instead of wiring and arthrodesis with autografting. Reduction rates, screw position and fusion rates were evaluated using computed tomography.

Results: Preoperative mean atlantodental interval (ADI) was 8 (range: 6 to 11) mm and postoperative ADI was 2.1 (range: 0.5 to 2.5) mm. There was no dural or spinal cord injury. Complete reduction was observed in all cases. Fusion was unsuccessful in 1 case (6.25%). Postoperative mean flexion ADI was 10 mm and mean extension ADI was 1 mm. Graft separation between C1-C2 was observed in slice tomographic examination in one patient. Malposition was observed in 2 screws (4%).

Conclusion: The sublaminar silk knotting technique appears to provide safe anatomical reduction. As this method is cheap and simple and does not require extra implantation, loosen, create neurologic compromise or cause radiologic crowding, it can be considered an alternative surgical technique to sublaminar wiring.

Keywords

• Atlantoaxial stabilization
• cervical spine
• interlaminar fusion

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