Possible prognostic markers of subaxial cervical spine dislocations

Yıl 2019, Cilt: 44 Sayı: Ek 1, 202 - 210, 29.12.2019

Mustafa Öğden , Alemiddin Özdemir , Ulaş Yüksel , Bülent Bakar , Mehmet Faik Özveren

https://doi.org/10.17826/cumj.512089

Öz

Purpose: The aim of this study was to determine the prognostic factors, the demographic and clinical findings of the patients with cervical dislocation were evaluated.

Materials and Methods: Age, gender, dislocation reason, Japanese Orthopedic Association Scale (JOAS) score, dislocation level of the spine, facet locking, degree of spondylolisthesis, surgical intervention modalities, neurological levels at discharged from hospital (Modified Rankin Scale, mRS) were retrospectively analyzed in patients operated for cervical dislocation.

Results: In this study, 13 patients were included. Dislocation was mostly seen at C5-6 and C6-7 segments secondary to facet fracture. Anterior spinal approach was commonly performed to the patients, and 75% of the patients had lower mRS scores. Correlation analysis results demonstrated that probability of developing spinal shock, need for ventilator support, duration of ICU stay and mRS scores could be increased in patients with lower JOAS scores. The number of stabilized vertebrae, need for ventilator support and duration of ICU and hospital stay could be increased if spondylolisthesis degree was higher. In patients who developed spinal shock, it was assumed that the length of stay in ICU and hospital could be increased and the mRS scores could be increased.

Conclusion: This study demonstrated that surgical intervention type had no effect on patients’ prognosis, however, lower JOAS score, occurence of spinal shock, need for ventilator support, long duration at ICU could affect the patients’ prognosis, poorly.

Anahtar Kelimeler

Cervical dislocation, surgical treatment, prognosis

Alt servikal omurga dislokasyonlarında olası prognostik belirteçler

Öz

Amaç: Bu çalışmanın amacı prognozlarını etkileyen faktörleri belirlemeye yönelik olarak servikal dislokasyon tespit edilen hastaların tedavi sonuçlarını  incelemektir..

Gereç ve Yöntem: Bu çalışmada servikal dislokasyon nedeniyle opere edilen hastaların yaş, cinsiyet, dislokasyon sebebi, “Japanese Orthopedic Association (JOAS)” ölçeği puanı, dislokasyon gelişen omurga seviyesi, faset kilitlenmesi, spondilolistesiz derecesi, cerrahi tedavi bilgileri, yoğun bakım ünitesine (YBU) ve hastane tedavi bilgileri ve hastaneden ayrılış nörolojik düzeylerine ait bilgiler (Modifiye Rankin Skalası, mRS) geriye dönük incelendi.

Bulgular: Çalışmaya alınan 13 hastada dislokasyonun çoğunlukla faset kırığına ikincil C5-6 ve C6-7 segmentlerinde oluştuğu görüldü. Çoğu hastada (9 tane) anterior yaklaşımla omurga stabilizasyonu yapıldığı, hastaların %50 kadarında çok seviyeli stabilizasyon uygulandığı saptandı. Korelasyon analizi sonunda JOAS puanları düşük olduğunda spinal şok gelişme olasılığının, ventilatör desteği ihtiyacının, YBU kalma süresinin ve mRS puanlarının artabileceği öngörüldü. Spondilolistezis derecesi arttığında stabilizasyon uygulanan omurga sayısının, ventilatör desteği ihtiyacının, YBU ve hastanede kalma süresinin artabileceği düşünüldü. Spinal şok gelişen hastalarda ventilatör desteği ihtiyacının artabileceği, YBU ve hastanede kalma sürelerinin uzayabileceği ve mRS puanlarının artabileceği varsayıldı.  

Sonuç: Çalışma sonunda yapılan cerrahi girişimin türünün prognoza etkisinin olmadığı; buna karşılık düşük JOAS puanlarının, spinal şok gelişmesinin, ventilatör desteği verilmesinin, uzun süre yoğun bakım ünitesinde kalmanın hastaların prognozunu kötü etkileyebileceği öngörüldü.

Anahtar Kelimeler

Servikal dislokasyon, cerrahi tedavi, prognoz

Kaynakça

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