Lomber Spinal Stenoz Cerrahisinde Dekompresyona Stabilizasyon Eklenmeli Mi?

Year 2024, Volume: 11 Issue: 3, 156 - 164, 18.12.2024

Aydoğan Tekin , Hasan Kamil Sucu , Hamit Güneş Feran , Ertan Sevin

https://doi.org/10.47572/muskutd.1450121

Abstract

Lomber spinal stenozun cerrahi tedavisinde sadece dekompresyon yapmak veya dekompresyona stabilizasyon eklemek seçenekleri hep bir tartışma konusu olmuştur. Biz de lomber spinal stenoz cerrahisinde dekompresyona stabilizasyon eklenmesinin klinik sonuçlara etkisini araştırmayı amaçladık. Altı yıl boyunca total laminektomi ile lomber stenoz ameliyatı geçiren hastalar klinik sonuçlar açısından değerlendirildi. Hasta memnuniyeti birincil başarı kriteri olarak kabul edildi. Tekrar ameliyat edilen hastalar cerrahi sonuçlardan memnun olduklarını belirtseler bile başarısız olarak değerlendirildiler. Çalışmaya toplam 73 hasta dahil edildi. Bir veya iki segment stabilizasyonu olan hastaların, hiç stabilize olmayanlara (p=0,019) göre daha tatmin edici sonuçlara sahip olduğu görüldü. Ancak üç veya daha fazla segment stabilizasyon grubu ile sadece laminektomi (p=1.0000) ve bir veya iki segment stabilizasyon (p=0.0667) grupları arasında başarı açısından fark yoktu. Ayrıca ameliyat sırasında dura yaralanması olmamasının (p=0.02148) başarıyı arttırdığı belirlendi. Bir veya iki seviyeli stabilizasyon ile lomber dekompresyonun, tek başına dekompresyon grubuna göre daha tatmin edici sonuçlara sahip olduğu bulundu. Ancak stabilize segment sayısı arttıkça bu farkın kaybolduğu göz önünde bulundurularak stabilizasyon endikasyonu dikkatle değerlendirilmeli ve stabilize segmentin gereksiz yere uzatılmaması için azami çaba gösterilmelidir. Stabilizasyonun etkilerinin daha fazla araştırılması için daha geniş hasta serileriyle yapılacak prospektif çalışmalar faydalı olacaktır.

Keywords

Dekompresyon, Laminektomi, Lomber Vertebra, Spinal Stenoz, Stabilizasyon

Should Stabilization be Added to Decompression in Lumbar Spinal Stenosis Surgery?

Abstract

In the lumbar spinal stenosis surgery, the options of performing only decompression or adding stabilization to decompression have always been a matter of debate. We aimed to investigate the effect of adding stabilization to decompression on clinical outcomes in lumbar spinal stenosis surgery. Patients who underwent lumbar stenosis surgery with total laminectomy over six years were evaluated for clinical outcomes. Patient satisfaction was accepted as the primary success criterion. Patients who underwent reoperation were considered unsuccessful even if they stated that they were satisfied with the surgical results. A total of 73 patients were included in the study. Notably, patients who underwent stabilization of one or two spinal segments had more satisfying results than those without stabilization (p=0.0195). However, no significant differences in satisfaction were observed between patients with three or more stabilized segments and either the laminectomy-only group (p=1.0000) or the one-to-two segment stabilization group (p=0.0667). It was also determined that no dural injury during surgery (p=0.02148) increased success. Lumbar decompression with one- or two-level stabilization was found to have better satisfying results than the decompression-only group. However, considering that success decreases as the number of stabilized segments increases, the indication for stabilization should be carefully evaluated and maximum effort should be made to prevent unnecessary extension of the stabilized segment. Prospective studies with more extensive patient series will help investigate the effects of stabilization further.

Keywords

Decompression, Laminectomy, Lumbar Vertebrae, Spinal Stenosis, Stabilization

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