Servikal Diskektomi Yapılan Hastaların Takiplerinde Servikal Kafes Malpozisyonu Gelişme Riskini Etkileyen Faktörlerin Araştırılması

Yıl 2024, , 1 - 7, 25.03.2024

Mustafa Cemil Kılınç , Baran Can Alpergin , Ömer Mert Özpişkin , Bekir Tunç , Ümit Eroglu

https://doi.org/10.55517/mrr.1328287

Öz

Amaç: Dejeneratif servikal omurga hastalıklarının tedavisinde servikal diskektomi ve bir kafes yerleştirilerek füzyon sağlanması günümüzde en sık uygulanan yöntemlerden biridir. Bu cerrahi sonrası takiplerde görülebilen komplikasyonlardan biri servikal kafes çökmesidir. Bu çalışmada cerrahi sonrası erken dönemde çekilmiş olan servikal grafide görülebilecek olan son plak parlaklık kaybının, takiplerde servikal kafes çökmesi gelişmesi ile ilişkisi araştırılmıştır. Yöntem: 2013-2023 yılları arasında tek seviye servikal disk hernisi cerrahisi uygulanmış olan 100 hasta çalışmaya dahil edilmiştir. Hastalar cerrahi sonrası 60. gün kontrolünde çekilmiş olan servikal grafisinde kafes çökmesi olanlar ve olmayanlar olarak 2 gruba ayrılmıştır. Çalışmada yer alan tüm hastaların ameliyattan sonra ilk 24 saat içerisinde çekilmiş olan servikal grafi görüntülerinde kafese komşu omurlarda son plak parlaklık kaybı olup olmadığı incelenmiş ve elde edilen sonuçlar bu gruplar arasında kıyaslanmıştır. Bulgular: 89 hastada (%89) servikal kafes çökmesi saptanmazken, 11 hastada (%11) servikal kafes çökmesi geliştiği saptanmıştır. Kafes çökmesi gelişen 11 hastanın 8'inde (%72,7), kafes çökmesi meydana gelmeyen 89 hastanın ise10'unda (%11,2) son plak parlaklık kaybı tespit edilmiştir. Bu sonuçlar göstermektedir ki erken dönem grafide saptanan son plak parlaklık kaybı ile ileri takiplerde gelişen servikal kafes çökmesi arasında anlamlı bir ilişki vardır ve son plak parlaklık kaybı tespit edilenlerde servikal kafes çökmesi görülme oranı daha fazladır (p<0,001). Sonuç: Cerrahiden hemen sonrası çekilmiş erken dönem servikal grafide son plak kortikal parlaklık kaybı saptanması, takiplerde kafes çökmesi ile karşılaşılma sıklığını arttırmaktadır. Bu nedenle bu hastaların daha kısa takip aralığı ile dikkatle takip edilmesi düşünülebilir.

Anahtar Kelimeler

Servikal disk hernisi, servikal diskektomi, servikal kafes çökmesi

Factors Affecting the Risk of Developing Cervical Cage Malposition in Patients with Cervical Discectomy

Öz

Aim: Cervical discectomy followed by cage placement for fusion is nowadays a commonly used method for the treatment of degenerative cervical spine diseases. One of the complications that can be observed during postoperative follow-up is cervical cage subsidence. At this point, it is investigated in this study the relationship between the loss of endplate brightness observed on early postoperative cervical radiographs and the development of cervical cage subsidence during follow-up. Methods: 100 patients who underwent single-level cervical disc herniation surgery between 2013 and 2023 were selected. The patients were divided into two groups based on the presence or absence of cage subsidence in cervical radiographs taken at the 60-day postoperative follow-up. In all patients included in the study, the presence of endplate brightness loss in the cervical radiographs taken within the day 1 of post-surgery period in the vertebrae adjacent to the cage was evaluated and compared between groups. Results: Cage subsidence was detected in 11 patients (11%), while it was not observed in 89 patients (89%). Among the 11 patients with cage subsidence, endplate brightness loss was identified in 8 patients (72.7%), whereas it was found in 10 patients (11.2%) among the 89 patients without cage subsidence. These results indicate a significant relationship between the loss of endplate brightness observed on early radiographs and the occurrence of cervical cage subsidence during later follow-up (p<0.001). Conclusion: The identification of endplate cortical brightness loss on early postoperative cervical radiographs increases the likelihood of encountering cage subsidence during follow-up. Therefore, these patients may require shorter follow-up intervals.

Anahtar Kelimeler

Cervical disc herniation, cervical discectomy, cervical cage subsidence

Kaynakça

• Badhiwala JH, Ahuja CS, Akbar MA, Witiw CD, Nassiri F, Furlan JC, et al. Degenerative cervical myelopathy - update and future directions. Nat Rev Neurol. 2020;16(2):108-24.
• Majd ME, Vadhva M, Holt RT. Anterior cervical reconstruction using titanium cages with anterior plating. Spine (Phila Pa 1976). 1999;24(15):1604-10.
• Ahmed AF, Al Dosari MAA, Al Kuwari A, Khan NM. The outcomes of stand alone polyetheretherketone cages in anterior cervical discectomy and fusion. Int Orthop. 2021;45(1):173-80.
• Lv ZT, Xu Y, Cao B, Dai J, Zhang SY, Huang JM, et al. Titanium-coated PEEK Versus Uncoated PEEK Cages in Lumbar Interbody Fusion: A Systematic Review and Meta-analysis of Randomized Controlled Trial. Clin Spine Surg. 2023;36(5):198-209.
• Pinder EM, Sharp DJ. Cage subsidence after anterior cervical discectomy and fusion using a cage alone or combined with anterior plate fixation. J Orthop Surg (Hong Kong). 2016;24(1):97-100.
• Yang JJ, Yu CH, Chang BS, Yeom JS, Lee JH, Lee CK. Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage. Clin Orthop Surg. 2011;3(1):16-23.
• Ji C, Yu S, Yan N, Wang J, Hou F, Hou T, et al. Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion. BMC Musculoskelet Disord. 2020;21(1):32.
• Hasegawa K, Abe M, Washio T, Hara T. An experimental study on the interface strength between titanium mesh cage and vertebra in reference to vertebral bone mineral density. Spine (Phila Pa 1976). 2001;26(8):957-63.
• Truumees E, Demetropoulos CK, Yang KH, Herkowitz HN. Effects of disc height and distractive forces on graft compression in an anterior cervical corpectomy model. Spine (Phila Pa 1976). 2008;33(13):1438-41.
• Kulkarni AG, Hee HT, Wong HK. Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence. Spine J. 2007;7(2):205-9.
• Kast E, Derakhshani S, Bothmann M, Oberle J. Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev. 2009;32(2):207-14.
• Kao TH, Wu CH, Chou YC, Chen HT, Chen WH, Tsou HK. Risk factors for subsidence in anterior cervical fusion with stand-alone polyetheretherketone (PEEK) cages: a review of 82 cases and 182 levels. Arch Orthop Trauma Surg. 2014;134(10):1343-51.
• Barsa P, Suchomel P. Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J. 2007;16(9):1395-400.
• Porto Filho MR, Pastorello MT, Defino HL. Experimental study of the participation of the vertebral endplate in the integration of bone grafts. Eur Spine J. 2005;14(10):965-70.
• Yan D, Wang Z, Deng S, Li J, Soo C. Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients. Arch Orthop Trauma Surg. 2011;131(10):1369-74.
• Bartels RH, Donk RD, Feuth T. Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery. 2006;58(3):502-8.
• Chen Y, Wang X, Lu X, Yang L, Yang H, Yuan W, et al. Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J. 2013;22(7):1539-46.
• Hakalo J, Wronski J, Ciupik L. Subsidence and its effect on the anterior plate stabilization in the course of cervical spondylodesis. Part I: definition and review of literature. Neurol Neurochir Pol. 2003;37(4):903-15.
• Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976). 2009;34(26):2886-92.
• Joo YH, Lee JW, Kwon KY, Rhee JJ, Lee HK. Comparison of fusion with cage alone and plate instrumentation in two-level cervical degenerative disease. J Korean Neurosurg Soc. 2010;48(4):342-6.
• Song KJ, Taghavi CE, Hsu MS, Lee KB, Kim GH, Song JH. Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders. Eur Spine J. 2010;19(10):1677-83.