Opere Edilen Lomber Disk Hernili Hastalarda Sagital Denge Parametreleri ile Herniasyon Seviyesi Arasındaki İlişki

Öz

Amaç: Lomber disk hernisi nedeni ile opere olan hastalarda disk hernisinin görüldüğü seviye ile pelvik ve lomber vertebra insidansları arasındaki ilişkinin değerlendirilmesi amaçlandı Materyal ve Metot: Retrospektif olarak planlanan çalışmaya dosya kayıtları incelenen hastalar dâhil edildi. Tek seviye lomber disk hernisi tespit edilen ve tek taraflı mikrodiskektomi yöntemi ile opere olan 59 hastanın demografik verileri ve klinik bulguları kayıt edildi. Değişkenlerin analizinde SPSS 25.0 (IBM Corparation, Armonk, New York, United States) programı kullanıldı Bulgular: Yirmi sekizi erkek 31’i kadın olan hastaların yaş ortalaması 43,31±4,27 (38-54) yıl olarak bulundu. Yerleşim yerlerine bakıldığında 28 (%47,5) hastanın sağ, 31 (%52,5) hastanın ise sol yerleşimli disk hernilerinin olduğu saptandı. Seviyeye göre bakıldığında L5-S1seviyesinde disk hernisi olan hastaların pelvik indeks ve L4 indeks ortalamaları L4-5 ve L3-4 seviyelerinde disk hernisi olan hastaların ortalamalarına göre anlamlı derecede düşük bulunurken (p=0,002, p=0,001), L4-5 seviyesinde disk hernisi olan hastaların L5 insidans ortalamaları anlamlı derecede yüksek bulundu (p=0,001). Sonuç: Bu çalışmada, L5-S1 seviyesinde disk hernisi olan hastalarda pelvik indeks, L4 ve L5 indeksler anlamlı derecede düşük bulunmuştur. Gelecekte, uzun süreli takipli ve prospektif, çok merkezli çalışmaların yapılmasının gerekli olduğunu düşünmekteyiz.

Anahtar Kelimeler

• Indeks
• pelvik indeks
• insidans
• L5 ve L 4 insidans
• lomber disk hernisi.

Correlation Between Sagittal Balance Parameters and Herniation Levels in Patients Operated For Lumbar Disc Herniation

Öz

Aim: The aim of this study is to assess the correlation between the level of disc herniation and pelvic and lumbar vertebral incidences in patients operated for lumbar disc herniation. Material and Method: This retrospective study included those patients whose file records were analyzed. The demographic data and clinical findings of 59 patients diagnosed with single level lumbar disc herniation and underwent unilateral microdiscectomy were recorded. In the analysis of the variables, SPSS 25.0 (IBM Corparation, Armonk, New York, United States) was used. Results: The patients involved 28 men and 31 women whose median age was found as 43,31±4,27 (38-54) years. With regard to location, it was determined that in 28 (47,5%) patients, the herniated discs were located on the right and in 31 patients (52,5%), they were located on the left. In terms of levels, in patients with herniated discs at level L5-S1, the median pelvic index and L4 index were found to be significantly lower than those of patients with herniated discs at levels L4-5 and L3-4 (p=0,002, p=0,001), whereas in patients with herniated discs at level L4-5, the median L5 incidence was found to be significantly high (p=0,001). Conclusion: In this study, the pelvic index and L4 and L5 indexes were found to be significantly low in patients with herniated discs at level L5-S1. It is considered that future prospective and multi-centered studies with long-term follow-up are necessary.

Anahtar Kelimeler

• Index
• Pelvic index
• incidence
• L5 and L4 incidence
• lumbar disc herniations.

Kaynakça

1. 1. Lafage R, Ferrero E, Henry JK, Challier V, Diebo V, Liaboud B, et al. Validation of a new computer-assisted tool to measure spino-pelvic parameters. Spine J. 2015;15(12):2493–2502.
2. 2. Duval-Beaupère G, Schmidt C, Cosson P. A Bary centremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992, 20: 451–462.
3. 3. Roussouly P, Gollogly S, Berthonnaud E, Labelle H, Weidenbaum M. Sagittal alignment of the spine and pelvis in the presence of L5-S1 isthmic lysis and low-grade spondylolisthesis. Spine 31(21):2484-2490, 2006
4. 4. Ozer AF, Kaner T. Omurgada Sagital Balans. Türk Nöroşirürji Dergisi 2013;23:13-18
5. 5. Fei H, Li WS, Sun ZR, Ma QW, Chen ZQ. Analysis of Spino-pelvic Sagittal Alignment in Young Chinese Patients with Lumbar Disc Herniation.Orthopaedic Surgery 2017;9:271–276
6. 6. 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: 569–575.
7. 7. 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: 1459–1467.
8. 8. Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J, 2010, 19: 435–438.

9. 9. Fei H, Li WS, Sun ZR, Ma QW, Chen ZQ. Analysis of Spino-pelvic Sagittal Alignment in Young Chinese Patients with Lumbar Disc Herniation. 2017, 9(3):271-276.
10. 10. Rajnics P, Templier A, Skalli W, Lavaste F, Illes T. The importance of spinopelvic parameters in patients with lumbar disclesions. Int Orthop, 2002, 26: 104–108.
11. 11. Aono K, Kobayashi T, Jimbo S, Atsuta Y, Matsuno T. Radiographic analysis of newly developed degenerative spondylolisthesis in a mean twelve-year prospectives tudy. Spine 2010;35(8):887–91.
12. 12. Barrey C, Jund J, Perrin G, Roussouly P. Spinopelvic alignment of patients with degenerative spondylolisthesis. Neurosurgery 2007;61:981–986.
13. 13. Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B, et al. Sagittal alignment in lumbosacral fusion relations between radiological parameters and pain. Eur Spine J 2000;9(1):47–55.
14. 14. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 2005; 30(3):346–353.
15. 15. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 2005;87(2):260–267.
16. 16. Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Morphology and equilibrium of pelvis and spine. Eur Spine J 2002;11(1):80–87.
17. 17. Schwab F, Lafage V, Shaffrey C, Farcy JP. Pre-operative pelvic parameters must be considered to achieve adequate sagittal balance after lumbar osteotomy. IMAST 2009. Vienna, Austria.
18. 18. Schwab F, Lafage V, Boyce R, Skallı W, Farcy JP. Gravity line analysis in adult volunteers: Age-related correlation with spinal parameters, pelvic parameters and foot position. Spine 2006;31(25):959-967.