Lumbar Posterior Transpedicular Screw Fixation and Fusion Applications; What We Do Peroperatively with 117 Spinal Instability Cases

Yıl 2022, Cilt: 32 Sayı: 1, 72 - 76, 28.02.2022

Güray Bulut , Murat Hamit Aytar , Mustafa Güdük

https://doi.org/10.54005/geneltip.1030254

Öz

Objective: In this study, we aimed to share our surgical principles and surgical outcomes in cases of fixation and fusion with lumbar posterior transpedicular screw-rod systems in our clinic.
Methods: 117 patients who underwent posterolateral fusion surgery with lumbar posterior transpedicular screw-rod system between 2014 and 2017 were evaluated retrospectively. Dynamic lumbar radiographs, computed tomography and magnetic resonance imaging were performed in all cases before the operation. All patients were operated with microsurgical principles and internal fixation and posterolateral fusion were performed with posterior interpedicular screw-rod systems. Stabilization systems were evaluated with lumbar X-ray and/or computed tomography on the first postoperative day. In the 1st and 3rd months, lumbar X-rays were repeated.
Results: All these patients, in whom lumbar spinal instability was detected clinically and radiologically, had low back and/or leg pain and different levels of neurological deficits. Of the cases, 23 were male and 94 were female. The mean age was 53.4 years. According to the Meyerding classification, there were grade I and II spondylolisthesis in 69, and 8 cases respectively, spinal stenosis in 28 cases, burst fracture in 1 case, compression fracture in 3 cases, disc herniation in 11 cases. The mean follow-up period was 28.6 months.
Conclusions: Meticulous case selection, careful preoperative planning and adherence to spinal microsurgery principles will increase the success rate in lumbar posterior internal fixation and posterolateral fusion surgeries.

Anahtar Kelimeler

lumbar spine, Instrumentation, posterolateral fusion, microsurgery

Destekleyen Kurum

None

Proje Numarası

-

Lomber Posterior Transpediküler Vida ile Fiksasyon ve Füzyon Uygulamaları; 117 Spinal İnstabilite Olgusunda Peroperatif Olarak Neler Yapıyoruz?

Öz

Amaç: Bu çalışmada kliniğimizde lomber posterior transpediküler vida-rod sistemleri ile fiksasyon ve füzyon vakalarında cerrahi prensiplerimizi ve cerrahi sonuçlarımızı paylaşmayı amaçladık.
Gereç ve Yöntem: 2014-2017 yılları arasında lomber posterior transpediküler vida-rod sistemi ile posterolateral füzyon cerrahisi uygulanan 117 hasta retrospektif olarak değerlendirildi. Operasyon öncesi tüm olgulara dinamik lomber radyografiler, bilgisayarlı tomografi ve manyetik rezonans görüntüleme yapıldı. Tüm hastalar mikrocerrahi prensipler ile opera edildiler ve posterior interpediküler vida-rod sistemleri ile internal fiksasyon ve posterolateral füzyon uygulandı. Postoperatif birinci gün lomber grafi ve/veya bilgisayarlı tomografi ile stabilizasyon sistemleri değerlendirildi. Postoperatif 1. ve 3. aylarda lomber grafiler tekrarlandı.
Bulgular: Lomber spinal instabilitenin klinik ve radyolojik olarak tespit edildiği tüm bu hastalarda bel ve/veya bacak ağrısı ve farklı düzeylerde nörolojik defisitler vardı. Vakaların 23'ü erkek, 94'ü kadındı. Ortalama yaş 53.4 idi. Meyerding sınıflamasına göre sırasıyla 69 ve 8 olguda grade I ve II spondilolistezis, 28 olguda spinal stenoz, 1 olguda patlama kırığı, 3 olguda kompresyon kırığı, 11 olguda disk hernisi mevcuttu. Ortalama takip süresi 28.6 ay idi.
Sonuç: Lomber posterior internal fiksasyon ve posterolateral füzyon ameliyatlarında titiz vaka seçimi, ameliyat öncesi dikkatli planlama ve spinal mikrocerrahi prensiplerine bağlılık başarı oranını artıracaktır.

Anahtar Kelimeler

lomber omurga, enstrumantasyon, posterolateral füzyon, mikrocerrahi

Proje Numarası

-

Kaynakça

• [1] Japanase Orthopaedic Association. Assesement of surgical treatment for low back pain. Journal of the Japanese Orthopaedic Association, 1984; 58: 1183-1187.
• [2] Vaccaro AR, Garfin SR. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective study comparing decompression and decompression with intertransverse processes arthrodesis. A critical analysis spine, 1997; 22: 368-369.
• [3] Zileli M, Özer F: Spinal cord and spinal surgery, Volume 1, third edition, İzmir: İnter Tıp, 2014:701-712.
• [4] Dickman AC, Fessler GR, Macmillan M. Transpedicular screw-rod fixation of the lumbar spine: Operative technique and outcome in 104 cases. J Neurosurg 1992; 77: 860-870.
• [5] Issack PS, Cunningham ME, Pumberger M, Hughes AP, Cammisa FP Jr. Degenerative lumbar spinal stenosis: Evaluation and management. Review article. J Am AcadOrthop Surg 20: 527-535, 2012.
• [6] Miao J, Wang S, Park WM, Xia Q, Fang X, Torriani MP, et al. Segmental spinal canal volume in patients with degenerative spondylolisthesis. Spine J 13: 706–712, 2013.
• [7] Wang G, Karki SB, Xu S, Hu Z, Chen J, Zhou Z, et al. Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis. J Back MusculoskeletRehabil 28: 277–285, 2015.
• [8] Hadra BE. Wiring the spinous processes in Pott's disease. Trans Am Orthop Assoc 4. 1891; 206-210.
• [9] Albee FH. Transplantation of a portion of the tibia into the spine for Pott's disease. JAMA 1911; 57: 885-886.
• [10] Hibbs RA. An operation for progressive spinal deformities. NY Med J 1911; 93: 1013-1016.
• [11] Abumi K, Panjabi MM, Duranceau J. Biomechanical evaluation of spinal fixation devices Part III. Stability provided by six spinal fixation devices and interbody bone graft. Spine 1989; 14: 1249-1255.
• [12] Rosa La G, Conti A, Cacciola F, Cardali S, La Torri D, Gambadauro NM et al. Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg(Spine 2) 2003; 99: 143-150.
• [13] Krag MH, Fredrickson BE, Yuan HA. Biornechanics of the transpedicle spinal fusion. The Lumbar Spine Philadelphia 1990; 916- 940.
• [14] Krag MH. Biomechanics of thorocolumbar spinal fixation A Rewiew. Spine 16(Supply 3) 1991; 84-99.
• [15] Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: A prospective, randomized, controlled study. Clinical article. J Neurosurg Spine 10: 476-485, 2009.
• [16] Lehman TR, Spratt KF. Long-term follow -up of lower lumbar fusion patients. Spine 1987; 12: 97-104.
• [17] Rahm MD, Hall BB. Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study.J Spinal Disord 1996; 9: 392-400.
• [18] Herno A, Airaksinen O, Saari T, Luukkonen M. Lumbar spinal stenosis: A matched-pair study of operated and non-operated patients. Br J Neurosurg 10: 461-465, 1996.
• [19] Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, et all. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 32: 1-8, 2007.
• [20] Yücetaş C, Üçler N, Özdemir N. Lumbar Stenosis and Listhesis: Time of Stabilization. TürkNöroşirDerg 28(2):238-243, 2018.
• [21] Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and with-out spinal instrumentation. Spine 1997, 22(24):2807-2812.
• [22] Ashman RB, Galpin RD, Corin JD, Johnston CE. Biomechanical analysis of pedicle screw instrumentation systems in a corpectomy model. Spine 1989; 14: 1398-1405.
• [23] Gurr KR, McAfee PC. Cotrel-Dobousset instrumentation in adults. A preliminary report. Spine 1988; 13: 510-520.
• [24] Yogonondan N, Larson SJ, Pintar F, Maiman DJ, Reinartz J, Sances A Jr. Biomechanics of lumbar pedicle screw plate fixation in trauma. Neurosurg 1990; 27: 873- 881.
• [25] Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg (Am) 2000; 82: 1458-1476.
• [26]Güven O, Esemenli T, Yalçın S. Transpedicular fixation in the treatment of various spinal disorders. Acta ChirBelg 1993; 93: 188-192.
• [27] Halvorson TL, Kelley LA, Thomas KA, Whitecloud TS 3rd, Cook SD. Effects of bone mineral density on pedicle screw fixation. Spine 1994; 19: 2415-2420.
• [28] Postacchini F, Cinotti G. Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg Br 1992; 74-B(6):862-869.
• [29] West JL III, Ogilvie JW, Bradford DS. Complications of the variable screw plate pedicle screw fixation. Spine 1991; 16: 576-579.
• [30] Whitecloud TS III, Butler JC, Cohen JL, Candelora PD. Complications with the variable spinal plating system. Spine 1989; 14: 472-476.
• [31] Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 1992; 17(1): 1-8.
• [32] Truumees E, Fischgrund J, Herkowitz H. Management of spinal stenosis adjacent to a previously treated segment. Semin Spine Surg 1999; 11: 282-291.