Lomber dar kanalda iki taraflı mikrodekompresyon için tek taraflı yaklaşım: klinik ve radyolojik değişikliklerin detaylı araştırılması

Year 2020, , 393 - 402, 14.05.2020

İsmail İştemen , Ali Arslan , Semih Kivanc Olguner , Ali Ökten , Kemal Afşer , Vedat Açık , Emre Bilgin

https://doi.org/10.31362/patd.699441

Abstract

Amaç:
 Önceki makaleler sıklıkla dekompresyonu göstermek için sadece radyolojik veya klinik iyileşmeyi değerlendirmiştir. Ancak literatürde hem yaşam kalitesini hem de fonksiyonel ve radyolojik iyileşmeyi değerlendiren ayrıntılı bir çalışma yoktur. Bu çalışmada dejeneratif lomber spinal stenozda bilateral dekompresyon için mikrocerrahi ile tek taraflı laminotominin etkinliğini araştırmayı amaçladık.
Materyal ve Metodlar:
80 hastayı ve 116 segmenti retrospektif olarak değerlendirdik. Klinik, fonksiyonel ve radyolojik iyileşmeyi değerlendirdik. Klinik değerlendirme için Vizüel Analog Skala (VAS), Oswestry Disability İndeksi (ODI), Tıbbi Sonuçlar Çalışması 36 Madde Kısa Form Sağlık Araştırması (SF36) kullanıldı. Radyolojik değerlendirme için ön ve arka disk yüksekliği, lateral resses yüksekliği, spinal kanalın ön-arka çapı, spinal kanal kesitsel alanı, preoperatif ve postoperatif radyografik görüntülerde segmental lordotik açıları değerlendirdik. Fonksiyonel değerlendirme için yürüme performansı da 15 Dakika Kendi Hızınızda Yürüyüş Testi ile değerlendirildi.
Bulgular:
Hastaların ortalama yaşı 58.6 ± 11.3 idi. Kırk ikisi kadındı (% 52.5) ​​ve otuz sekizi erkekti (% 47.5). VAS, ODI ve SF36 ile ölçülen klinik sonuçlar önemli ölçüde iyileşti. Yürüme performansı, dural kese kesit alanı ve diğer radyografik ölçümler de önemli ölçüde iyileşti. Spinal instabilite nedeniyle 8 hasta, dura onarım nedeniyle 4 hasta tekrar ameliyat edildi. Sadece iki yara enfeksiyonu gelişti.
Sonuç:
Dejeneratif spinal stenozda bilateral dekompresyon için mikrocerrahi ile tek taraflı laminotomi, minimum doku hasarı ve daha az komplikasyon ile yeterli dekompresyon ve tatmin edici klinik sonuçlar sağlar.

Keywords

Lomber dar kanal, Minimal invaziv cerrahi, Tek taraftan bilateral dekompresyon

Unilateral approach for bilateral microdecompression in lumbar stenosis: the detailed assessment of clinical, functional and radiological changes

Abstract

Purpose:
Previous articles have frequently evaluated only radiological or clinical improvement for showing decompression. But there is not a detailed study in the literature assessing both quality of life and functional and radiological improvement. In this study we aimed to investigate the effectiveness of microsurgical unilateral laminotomy for bilateral decompression for degenerative lomber spinal stenosis.
Materials and Methods:
We assessed 80 patients and 116 segments retrospectively. We evaluated clinical, functional and radiological improvement. For clinical evaluation Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Medical Outcomes Study 36-Item Short- Form Health Survey (SF36) were used. For radiological evalution, we assessed the changes of anterior and posterior disc height, lateral resses heigt, anteior-posterior diameter of spinal canal, spinal canal cross sectional area, segmental lordotic angle on preoperative and postoperative radiographic images. For functional evalution, walking performance was also evaluated by 15 Minutes Self Paced Walking Test.
Results:
The mean age of the patients was 58.6±11.3 years. Forty-two of them were females (52.5%), and thirty-eight were males (47.5%). Clinical outcomes, measured by VAS, ODI and SF36 were improved significantly. Walking performance, dural sac cross sectional area and other radiographic measurments were also improved significantly. 8 patients were reoperated due to the spinal instability, 4 patients due to the dura repair. Only two wound infection developed.
Conclusion:
Microsurgical unilateral laminotomy for bilateral decompression for degenerative spinal stenosis achieves adequate decompression and satisfactory clinical outcomes with minimal tissue damage and less complications.

References

• Referans1. Mobbs RJ, Li J, Sivabalan P, Raley D, Rao PJ. Outcomes after decompressive laminectomy for lumbar spinal stenosis: Comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: Clinical article. J Neurosurg Spine 2014;21:179-186. https://doi.org/10.3171/2014.4.SPINE13420
• Referans2. Özdoğan S, Yaltırık CK, Yılmaz SG, Koçak A, Isbir T. Association of rs2228570 polymorphism of vitamin D receptor gene with lumbar degenerative disc disease. Turk Neurosurg 2019;29(2):159-163. https://doi.org/10.5137/1019-5149. JTN.22275-17.2
• Referans3. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar stenosis. Attempted meta- analysis of the literature. Spine 1992;17:1–8. https://doi.org/10.1097/00007632-199201000-00001
• Referans4. Chang Y, Singer DE, Wu YA, Keller RB, Atlas SJ. The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc 2005;53:785–792. https://doi.org/10.1111/j.1532-5415.2005.53254.x
• Referans5. Özdoğan S, Yaltırık CK, Atalay B, Tiryaki M, Düzkalır AH, Süslü H. Unilateral approach for bilateral spinal microdecompression in lumbar spinal stenosis: Short term results. The Journal of Turkish Spinal Surgery 2015;26(3): 205-209.
• Referans6. Yaman O, Ozdemir N, Dagli AT, Acar E, Dalbayrak S, Temiz C. A comparison of bilateral decompression via unilateral approach and classic laminectomy in patients with lumbar spinal stenosis: a retrospective clinical study. Turk Neurosurg 2015;25:239-245. https://doi.org/10.5137/1019-5149.JTN.8710-13.1
• Referans7. Usman M, Ali M, Khanzada K, et al. Unilateral approach for bilateral decompression of lumbar spinal stenosis: a minimal invasive surgery. J Coll Physicians Surg Pak 2013;23(12):852-856. https://doi.org/12.2013/JCPSP.852856.
• Referans8. Toyoda H, Nakamura H, Konishi S, Dohzono S, Kato M, Matsuda H. Clinical outcome of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis : minimum five-year follow-up. Spine 2011;36:410-415. https://doi.org/10.1097/BRS.0b013e3181d25829
• Referans9. Cavuşoğlu H, Kaya RA, Türkmenoglu ON, Tuncer C, Colak I, Aydin Y. Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study. Eur Spine J 2007;16:2133-2142. https://doi.org/10.1007/s00586-007-0471-2
• Referans10. Airaksinen O, Herno A, Kaukanen E, Saari T, Sihvonen T, Suomalainen O. Density of lumbar muscles 4 years after decompressive spinal surgery. Eur Spine J 1996;5(3):193–197. https://doi.org/10.1007/bf00395513
• Referans11. See DH, Kraft GH. Electromyography in paraspinal muscles following surgery for root compression. Arch Phys Med Rehabil 1975;56(2):80–83.
• Referans12. Haba K, Ikeda M, Soma M, Yamashima T. Bilateral decompression of multilevel lumbar spinal stenosis through a unilateral approach. J Clinical Neurosci 2005;12(2):169–171. https://doi.org/10.1016/j.jocn.2004.05.016
• Referans13. Papavero L, Thiel M, Fritzsche E, Kunze C, Westphal M, Kothe R. Lumbar spinal stenosis: Prognostic factors for bilateral microsurgical decompression using a unilateral approach. Neurosurgery 2009;65(6):182-187. https://doi.org/10.1227/01.NEU.0000341906.65696.08.
• Referans14. Oertel MF, Ryang YM, Korinth MC, Gilsbach JM, Rohde V. Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression. Neurosurgery 2006;59:1264-1269. https://doi.org/10.1227/01.NEU.0000245616.32226.58
• Referans15. Yang SM, Park HK, Chang JC, Kim RS, Park SQ, Cho SJ. Minimum 3-Year Outcomes in patients with lumbar spinal stenosis after bilateral microdecompression by unilateral or bilateral laminotomy. J Korean Neurosurg Soc 2013;54(3):194-200. https://doi.org/10.3340/jkns.2013.54.3.194.
• Referans16. Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH. Sev¬en- to 10-year outcome of decompressive surgery for degenerative lum¬bar spinal stenosis. Spine 1996;21:92-98. https://doi.org/10.1097/00007632-199601010-00022.
• Referans17. Chung SW, Kang MS, Shin YH, Baek OK, Lee SH. Postoperative expansion of dural sac cross-sectional area after unilateral laminotomy for bilateral decompression: Correlation with clinical symptoms. Korean J Spine 2014;11(4):227-231. https://doi.org/10.14245/kjs.2014.11.4.227
• Referans18. Alimi M, Hofstetter CP, Torres-Campa JM, et al. Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain. Eur Spine J 2017;26(2):389-396. https://doi.org/10.1007/s00586-016-4594-1
• Referans19. Palmer S, Turner R, Palmer R. Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system. J Neurosurg 2002;97(2):213–217. https://doi.org/10.3171/spi.2002.97.2.0213
• Referans20. Park WB, Hong JT, Lee SW, Sung JH, Yang SH, Kim IS. Clinical and radiological comparison between ipsilateral and contralateral side canal decompression using an unilateral laminotomy approach. Korean J Spine 2016;13(2): 41-46. https://doi.org/10.14245/kjs.2016.13.2.41
• Referans21. Ryu SJ, Kim IS. Interspinous implant with unilateral laminotomy for bilateral decompression of degenerative lumbar spinal stenosis in elderly patients. J Korean Neurosurg Soc 2010;47(5):338-44. https://doi.org/10.3340/jkns.2010.47.5.338
• Referans22. Tomkins-Lane CC, Conway J, Hepler C, Haig AJ. Changes in objectively measured physical activity (performance) after epidural steroid injection for lumbar spinal stenosis. Arch Phys Med Rehabil 2012;93(11):2008-2014. https://doi.org/10.1016/j.apmr.2012.05.014
• Referans23. Demiral Y, Ergor G, Unal B. Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population. BMC Public Health 2006;6:247. https://doi.org/10.1186/1471-2458-6-247
• Referans24. Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 2002;51(5):146–154.
• Referans25. Thome C, Zevgaridis D, Leheta O. Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 2005;3(2):129–141. https://doi.org/10.3171/spi.2005.3.2.0129