Lomber Mikrodiskektomi Olgularının Tuffier Çizgi Seviyelerine Göre Dağılımı

Yıl 2023, Cilt: 33 Sayı: 2, 194 - 198, 30.04.2023

Ali Akar Ümit Ali Malçok

https://doi.org/10.54005/geneltip.1229507

Öz

Amaç: Lomber disk hernisinin (LDH) cerrahi tedavisinde en sık kullanılan yöntem, lomber mikrodiskektomidir (LMD). Bu çalışma ile, lomber spinal girişimlerde L4-5 mesafesini tespit edilmesinde yaygın olarak kullanılan Tuffier’s çizgisi (TL) ile LMD seviyeleri arasındaki ilişkiyi göstermeyi amaçladık.
Gereç ve yöntem: Bu çalışmada, LMD yapılan veya bel ağrısı şikayeti olan toplam 204 hasta retrospektif olarak incelendi. TL seviyesinin omurga düzeyindeki izdüşümüne göre; L4 korpus, L4 alt endplate, L4-5 disk aralığı, L5 üst endplate, L5 korpus olmak üzere 5 kategoriye ayrıldı. Olgular yaş, cinsiyet, disk seviyesi ve TL seviyesindeki değişimlere göre analiz edildi.
Bulgular: Olguların % 92.1’i L4-5 veya L5-S1 seviyesinden opere edilmişti. TL seviyesi, kadınlarda sıklıkla L5 üst endplate seviyesinde iken erkeklerde L4-5 disk aralığı ve üstünde idi ve TL seviyeleri ile cinsiyet arasında her iki grupta da anlamlı bir ilişki mevcuttu (p<0.05).
Sonuç: Çalışmamızda, TL seviyeleri, L5-S1 seviyesinden opere edilen hastalarda kaudalde olmasına karşın, L4-5 seviyesinde opere edilenlerde kraniale doğru yer değiştirdiğini tespit ettik. Bununla birlikte, LDH gelişiminin alt lomber bölgeden başladığı ve yaşın ilerlemesi ile birlikle üst seviyelerde arttığı görüldü.

Anahtar Kelimeler

Tuffier çizgisi, Lomber disk hernisi, Lomber mikrodiskektomi

Distribution of Lumbar Microdiscectomy Cases by Tuffier’s Line Levels

Öz

Objective: The most used method in the surgical treatment of lumbar disc herniation (LDH) is lumbar microdiscectomy (LMD). In this study, we aimed to show the relationship between Tuffier's line (TL), which is widely used in determining the L4-5 distance in lumbar spinal interventions, and LMD levels.
Materials and Methods: In this study, a total of 204 patients who had LMD or had low back pain were reviewed retrospectively. According to the projection of TL at the spine level; it was divided into 5 categories as L4 corpus, L4 lower endplate, L4-5 disc space, L5 upper endplate, L5 corpus. The cases were analyzed according to age, gender, disc level and changes in TL.
Results: 92.1% of the cases were operated at the L4-5 or L5-S1 level. TL was mostly at L5 upper endplate level in women, L4-5 disc space and above in men, and there was a significant relationship between TLs and gender in both groups (p<0.05).
Conclusion: In our study, we found that although TLs were caudally in patients operated at L5-S1 level, they displaced cranially in patients operated at L4-5 level. However, it was observed that LDH development in the lower lumbar region and increased at the upper levels with ageing.

Anahtar Kelimeler

Tuffier, Lumbar disc herniation, Lumbar microdiscectomy, Tuffier çizgisi, Lomber disk hernisi, Lomber mikrodiskektomi

Kaynakça

• Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018; 27(11): 2791-2803
• Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(6): 968-74
• Lagerbäck T, Fritzell P, Hägg O, Nordvall D, Lønne G, Solberg TK, et al. Effectiveness of surgery for sciatica with disc herniation is not substantially affected by differences in surgical incidences among three countries: results from the Danish, Swedish and Norwegian spine registries. Eur Spine J. 2019; 28(11): 2562-2571
• Gregory D.Schroeder, MDChristine A.GuyreBS, Alexander R.VaccaroMD, PhD. The epidemiology and pathophysiology of lumbar disc herniations. Seminars in Spine Surgery . 2016; 28: 2-7
• Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011; 20 Suppl 5: 609-18
• Tuffier T. The treatment of chronıc empyema. Ann Surg. 1920; 72(3): 266 87
• Chowdhury A, Sharma H. A review of 571 radiographs on Tuffier's inter-cristal line and its' application in lumbar spinal surgery. J Spine Surg. 2018; 4(2): 383-387
• Cooperstein R, Truong F. Systematic review and meta-analyses of the difference between the spinal level of the palpated and imaged iliac crests. J Can Chiropr Assoc. 2017; 61(2): 106-120
• Snider KT, Kribs JW, Snider EJ, Degenhardt BF, Bukowski A, Johnson JC. Reliability of Tuffier's line as an anatomic landmark. Spine (Phila Pa 1976). 2008; 33(6): 161-5
• Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J. 2010; 19(3): 435-8
• Xia W, Liu C, Duan S, Xu S, Wang K, Zhu Z, al al. The influence of spinal-pelvic parameters on the prevalence of endplate Modic changes in degenerative thoracolumbar/lumbar kyphosis patients. PLoS One. 2018; 13(5): 0197470
• Yang X, Kong Q, Song Y, Liu L, Zeng J, Xing R. The characteristics of spinopelvic sagittal alignment in patients with lumbar disc degenerative diseases. Eur Spine J. 2014; 23(3): 569-75
• Horsanalı BÖ, Tekgül ZT, Özkalkanlı MY, Adıbelli ZH, Esen Ö, Duran FY. Radiological Evaluation of the Line Between the Crista Iliaca (Tuffier's line) in Elderly Patients. Turk J Anaesthesiol Reanim. 2015; 43(3): 149-53
• Kim JT, Bahk JH, Sung J. Influence of age and sex on the position of the conus medullaris and Tuffier's line in adults. Anesthesiology. 2003; 99(6): 1359-63
• Awad JN, Moskovich R. Lumbar disc herniations: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006; 443: 183-97
• Dammers R, Koehler PJ. Lumbar disc herniation: level increases with age. Surg Neurol. 2002; 58(3-4): 209-12; discussion 212-3
• Ma D, Liang Y, Wang D, Liu Z, Zhang W, Ma T, et al. Trend of the incidence of lumbar disc herniation: decreasing with aging in the elderly. Clin Interv Aging. 2013; 8: 1047-50
• Parisien RC, Ball PA. William Jason Mixter (1880-1958). Ushering in the "dynasty of the disc". Spine (Phila Pa 1976). 1998; 23(21): 2363-6
• Cummins J, Lurie JD, Tosteson TD, Hanscom B, Abdu WA, Birkmeyer NJ, et al. Descriptive epidemiology and prior healthcare utilization of patients in the Spine Patient Outcomes Research Trial's (SPORT) three observational cohorts: disc herniation, spinal stenosis, and degenerative spondylolisthesis. Spine (Phila Pa 1976). 2006; 31(7): 806-14
• Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007; 356(22): 2245-56
• Schmid SL, Wechsler C, Farshad M, Antoniadis A, Ulrich NH, Min K, et al. Surgery for lumbar disc herniation: Analysis of 500 consecutive patients treated in an interdisciplinary spine centre. J Clin Neurosci. 2016; 27: 40-3
• Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998; 7(2): 99-103
• Chakraverty R, Pynsent P, Isaacs K. Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? J Anat. 2007; 210(2): 232-6
• Wei X, Gengwu L, Chao C, Yifan L, Shang S, Ruixi H, et al. Correlations between the sagittal plane parameters of the spine and pelvis and lumbar disc degeneration. J Orthop Surg Res. 2018; 13(1): 137
• Barrey C, Jund J, Noseda O, Roussouly P. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J. 2007; 16(9): 1459-67