Organ nakli sonrası spinal enstrumantasyon sonuçları: Retrospektif kohort çalışma

Yıl 2020, Cilt: 4 Sayı: 5, 327 - 330, 01.05.2020

Murat Mert , Cenk Ermutlu

https://doi.org/10.28982/josam.730276

Öz

Amaç: Organ nakli cerrahisi, anestezi ve postoperatif bakım daki gelişmeler transplant hastalarında ek cerrahi girişimlerin de yapılabilmesinin önünü açmıştır. Bu çalışmanın amacı farklı organ nakilli hastalarda omurga cerrahisinin sonuçlarını incelemektir.
Yöntemler: Farklı etiyolojilerle omurga cerrahisi uygulanan 10 transplant hastası çalışmaya dahil edildi. Yedi hasta (%70) böbrek nakli, 2 hasta (%20) karaciğer ve 1 hasta (%10) akciğer nakli olmuştu. Hastaların 6’sı (%60) spinal stenoz, 3’ü (%30) vertebra kırığı ve 1’i (%10) vertebra metastazı sebebi ile omurga cerrahisi geçirmişti. Hastaların ameliyat öncesi ve sonrası radyolojik, klinik ve fonksiyonel durumları ve ağrı skorlamaları incelendi. Ameliyat süreleri, kan transfüzyon ihtiyacı ve hastanede kalış zamanları not edildi.
Bulgular: Hastaların yaş aralığı 38-62 yıl ve yaş ortalaması 57,1 (8,9) idi. Hastaların altısı erkek, dördü kadındı. Transplant cerrahisinden omurga ameliyatına kadar geçen süre ortalama 15,6 (2,1) ay bulundu. Hastalara ameliyat esnasında ortalama 5,6 (0,8) ünite eritrosit süspansiyonu verildi. Hastanede kalış süresi ortalama 8,5 (5,6) gündü. İki hastada ameliyat sonrası minör komplikasyon gelişti. Hastaların ameliyat öncesi 6,4 (0,8) olan VAS ağrı skorlarının 3,1’e (1,6) düştüğü gözlendi (P<0.001).
Sonuç: Posterior spinal enstrumantasyon, transplant hastalarında da yaşam kalitesini arttırmada etkili bir yöntemdir. Tecrübeli bir ekip ve multidispliner yaklaşım şarttır. 

Anahtar Kelimeler

Organ nakli, Hepatosellüler karsinom, Omurga cerrahisi, Omurga metastazı, Enstrumantasyon

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Evaluation of spinal instrumentation following organ transplantation: A retrospective cohort study

Öz

Aim: Improvements in transplantation medicine and surgery, anesthesiology, and postoperative care paved the way for successful procedures for transplant patients. The aim of the present study is to describe the results of surgical correction for spinal deformities in patients who underwent several types of organ transplantation.
Methods: The study group consisted of ten patients with a history of organ transplantation who require spinal surgery with different etiologies. Seven (70%), two (20%) and one (10%) patient had lung, liver, and lung transplantations, respectively. The etiology for spinal surgery was spinal stenosis in six (60%), vertebra fracture in three (30%), and vertebral metastasis in one (10%) patient. Pre- intra- and postoperative radiological, clinical, and functional outcomes were noted.
Results: The mean age of the patients was 57.1 (8.9) years, ranging between 38-62 years. Six of the patients were male, and four were female. Surgery time following the transplant surgery was 15.6 (2.1) months. The blood requirement in the operating room was 5.6 (0.8) units of erythrocyte suspension. Hospital length of stay was 8.5 (5.6) days following the spinal instrumentation surgery. Two patients had mild complications in the postoperative period. The preoperative VAS score significantly decreased from 6.4 (0.8) to 3.1 (1.6) after the surgery (P<0.001).
Conclusions: Posterior spinal instrumentation on transplanted patients can be an effective treatment which improves the life quality of the patients. A multidisciplinary approach with an experienced team is highly required.

Anahtar Kelimeler

Organ transplantation, Hepatocellular carcinoma, Spinal surgery, Spine metastasis, Instrumentation

Proje Numarası

Yok

Kaynakça

• 1. Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. Ann Transl Med. 2018 Oct;6(20):409.
• 2. Ertuğrul G, Yanaral T. Living donor liver transplantation in hepatocellular carcinoma: A single-center experiences. J Surg Med. 2019;3(4):320-3.
• 3. Lipton A, Uzzo R, Amato RJ, Ellis GK, Hakimian B, Roodman GD, et al. The science and practice of bone health in oncology: managing bone loss and metastasis in patients with solid tumors. J Natl Compr Canc Netw. 2009 Oct;7(Suppl 7):S1-29; quiz S30. doi: 10.6004/jnccn.2009.0080.
• 4. Shaikh KA, Helbig GM, Shapiro SA, Shah MV, Khairi SA, Horn EM. Spinal surgery following organ transplantation. J Neurosurg Spine. 2011 Jun;14(6):779-84. doi: 10.3171/2011.2.SPINE10481.
• 5. Nickel BT, Ledford CK, Watters TS, Wellman SS, Bolognesi MP. Arthroplasty in organ transplant patients. Arthroplast Today. 2015 Jun 19;1(2):41-4. doi: 10.1016/j.artd.2015.04.002.
• 6. Duplantier NL, Rivere AE, Cohen AJ, Chimento GF. Hip and Knee Arthroplasty Outcomes After Abdominal Organ Transplantation. J Surg Orthop Adv. 2018;27(2):119-24.
• 7. Nowicki P, Chaudhary H. Total hip replacement in renal transplant patients. J Bone Joint Surg Br. 2007 Dec;89(12):1561-6.
• 8. Massoudi N, Safari F, Mottaghi K. Spinal Anesthesia for Renal Transplantation in Lung Resected Patient: A Case Report. Tanaffos. 2018 Mar;17(3):207-10.
• 9. Herborn J, Parulkar S. Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery. Anesthesiol Clin. 2017 Sep;35(3):539-53. doi: 10.1016/j.anclin.2017.04.009.
• 10. Solomon BD. VACTERL/VATER Association. Orphanet J Rare Dis. 2011 Aug 16;6:56. doi: 10.1186/1750-1172-6-56.
• 11. Turnpenny PD, Alman B, Cornier AS, Giampietro PF, Offiah A, Tassy O, et al. Abnormal vertebral segmentation and the notch signaling pathway in man. Dev Dyn. 2007 Jun;236(6):1456-74.
• 12. Tan BWL, Zaw AS, Rajendran PC, Ruiz JN, Kumar N, Anil G. Preoperative embolization in spinal tumour surgery: Enhancing its effectiveness. J Clin Neurosci. 2017 Sep;43:108-14.
• 13. Clausen C, Dahl B, Frevert SC, Hansen LV, Nielsen MB, Lönn L. Preoperative embolization in surgical treatment of spinal metastases: single-blind, randomized controlled clinical trial of efficacy in decreasing intraoperative blood loss. J Vasc Interv Radiol. 2015 Mar;26(3):402-12.
• 14. Kim JM, Losina E, Bono CM, Schoenfeld AJ, Collins JE, Katz JN, et al. Clinical outcome of metastatic spinal cord compression treated with surgical excision ± radiation versus radiation therapy alone: a systematic review of literature. Spine (Phila Pa 1976). 2012 Jan 1; 37(1):78–84.
• 15. Yoshihara H, Yoneoka D, Paulino C, Agarwal S, Reyna JR, Hasegawa K. National Trends and In-Hospital Outcomes of Patients With Solid Organ Transplant Undergoing Spinal Fusion. Spine (Phila Pa 1976). 2017 Nov 1;42(21):E1231-E1237. doi: 10.1097/BRS.0000000000002226.
• 16. Klika AK, Myers T, Szubski CR, Schiltz NK, Navale S, Barsoum WK. Early postoperative outcomes of primary total knee arthroplasty after solid organ transplantation in the United States, 1998–2011. J Arthroplasty. 2015;30:1716–23.