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

Year 2020, Volume: 13 Issue: 2, 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.

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