Posterior Yaklaşımla Uygulanan Lomber Disk Protezlerinde Füzyon Oranları

Yıl 2022, Cilt: 6 Sayı: 2, 150 - 153, 30.08.2022

İhsan Canbek , Hakan Ak , İskender Samet Daltaban , Soner Yaycıoğlu

https://doi.org/10.46332/aemj.1017364

Öz

Amaç: Cerrahi gerektiren dejeneratif disk hastalığında sadece diskektomi yapılması yeterli olduğu gibi ilgili seviyede hareketin devamlılığını koruma, nüks ve komşu seviye hastalığı gelişimini engelleme amaçları ile lomber disk protezleri kullanılabilmektedir. Bu çalışmada posterior yaklaşımla uygulanan lomber disk protezlerindeki füzyon oranları değerlendirilmiştir.

Araçlar ve Yöntem: Yozgat Bozok Üniversitesi Tıp Fakültesi Hastanesinde 1 Haziran 2016 ve 31 Ekim 2020 yılları arasında tek seviye lomber disk protezi uygulanan hastalar retrospektif olarak tarandı. Füzyon gelişiminin varlığı bilgisayarlı tomografi tetkiklerine dayanılarak konuldu. İstatiksel analizde SPSS 25 kullanıldı ki-kare ve lineer regresyon testleri yapıldı.

Bulgular: Çalışmaya toplamda 94 hasta dahil oldu. Bunların 48’i (%51) erkek 46 tanesi (%48.9) ise kadın cinsiyette idi. Lomber (L)3-4 (n=9), L4-5 (n=60) ve L5-Sakral(S)1 (n=25) seviyelerine protez uygulamasının yapıldığı belirlendi.12 (%12.7) hastada daha önce diskektomi öyküsü mevcuttu.10 (%10.6) hastada füzyon geliştiği belirlendi. Füzyon gelişim zamanının ortalama 13±6.6 ay (minimum 2-maksimum 25 ay) olduğu tespit edildi. Füzyon gelişimi ile yaş, cinsiyet, takip süresi ve eski operasyon öyküsü arasında istatiksel olarak anlamlı farklılık tespit edilmedi (sırasıyla p=0.15, p=0.20, p=0.24 ve p=0.35).

Sonuç: Posterior yaklaşımla uygulanan lomber disk protezlerinde 2 ay gibi çok kısa bir sürede ve azımsanamayacak oranda füzyon gelişebilmektedir. Füzyon gelişim oranının cinsiyet, yaş, takip süresi ve geçirilmiş diskektomi öyküsü ile ilişkisi yoktur. 

Anahtar Kelimeler

posterior, lomber disk protezi, füzyon

Fusion Rates in Lumbar Disc Prosthesis Applied by posterior approach

Öz

Purpose: In lumbar herniation which requires surgery, only simple discectomy may be sufficient; however, lumbar disc prostheses are used to protect the continuity of movement at the relevant level and to prevent recurrence and development of adjacent level disease. In this study, the fusion rates of lumbar disc prostheses applied by posterior approach were evaluated.

Materials and Methods: Patients who underwent single-level lumbar disc prosthesis in Yozgat Bozok University School of Medicine Hospital between June 1, 2016 and October 31, 2020 were retrospectively scanned. The presence of fusion development was determined based on the computerized tomography examinations. SPSS 25 was used for statistical analysis, chi-square and linear regression tests were performed.

Results: A total of 94 patients were included in the study. 48 of them (51%) were male and 46 of them (48.9%) were female. It was determined that prosthesis was applied to Lumbar (L)3-4 (n=9), L4-5 (n=60) and L5-Sacral(S)1 (n=25) levels. 12 patients (12.7%) had a previous history of discectomy. It was determined that fusion developed in 10 (10.6%) patients. The mean fusion development time was 13±6.6 months (minimum 2-maximum 25 months). There was no statistically significant difference between fusion development and age, gender, follow-up period and previous operation history (p=0.15, p=0.20, p=0.24 and p=0.35, respectively). 

Conclusion: In lumbar disc prostheses applied posteriorly, fusion can develop at a considerable rate, even for a very short time such as 2 months. The rate of fusion development was not related to gender, age, follow-up period, and history of previous discectomy.

Anahtar Kelimeler

posterior, lumbar disc prosthesis, fusion

Kaynakça

• 1. Fardon D, Williams A, Dohring E, Murtagh F, Rothman S, Sze G. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology. Spine (Phila Pa 1976). 2014;39(24):E1448–E1465.
• 2. Lee JC, Choi SW. Adjacent Segment Pathology after Lumbar Spinal Fusion. Asian Spine J. 2015;9(5):807-817.
• 3. Kaner T, Sasani M, Oktenoglu T, Ozer AF. Dynamic stabilization of the spine: a new classification system. Turk Neurosurg. 2010;20(2):205-215.
• 4. Kulkarnı A.G, Diwan A.D. Prosthetic Lumbar disc replacement for degenerative disc disease, Neurology India. 2005;53(4):499-505.
• 5. Fernström U. Arthroplasty with intercorporal endoprosthesis in herniated disc and in painful disc. Acta Chir Scand Suppl. 1966;357:154-159.
• 6. Szpalski M, Gunzburg R, Mayer M. Spine arthroplasty: a historical review. Eur Spine J. 2002;11(2):65-84.
• 7. Othman YA, Verma R, Qureshi SA. Artificial disc replacement in spine surgery. Ann Transl Med. 2019;7(5):170.
• 8. Tropiano P, Huang RC, Girardi FP, et al. Lumbar disc replacement: preliminary results with ProDisc II after a minimum follow-up period of 1 year. J Spinal Disord Tech. 2003;16(4):362-368.
• 9. Bono CM, Kadaba M, Vaccaro AR. Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine. J Spinal Disord Tech. 2009;22(5):376-383.
• 10. Holt RT, Majd ME, Isaza JE, et al. Complications of Lumbar Artificial Disc Replacement Compared to Fusion: Results From the Prospective, Randomized, Multicenter US Food and Drug Administration Investigational Device Exemption Study of the Charité Artificial Disc. SAS J. 2007;1(1):20-27.
• 11. Sasso RC, Foulk DM, Hahn M. Prospective, randomized trial of metal-on-metal artificial lumbar disc replacement: initial results for treatment of discogenic pain. Spine (Phila Pa 1976). 2008;33(2):123-131.
• 12. Strömqvist F, Jönsson B, Strömqvist B; Swedish Society of Spinal Surgeons. Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome. Eur Spine J. 2010;19(3):439-442.
• 13. Lazennec JY. Lumbar and cervical viscoelastic disc replacement: Concepts and current experience. World J Orthop. 2020;11(8):345-356.
• 14. Formica C, Zanirato A, Divano S. Total disc replacement for lumbar degenerative disc disease: single centre 20 years experience. Eur. Spine J. 2020;29(7):1518-1526.