Anterior servikal diskektomi ve füzyon yapılan hastaların klinik ve radyolojik bulgularının pre/postoperatif dönemlerde retrospektif olarak değerlendirilmesi

Öz

Amaç: Servikal disk hernilerinde altın standart tedavi yöntemi olarak kabul edilen anterior servikal diskektomi ve içi demineralize kemik matriks ile dolu polyether-ether-ketone (PEEK) kafes ile füzyon uygulanan hastaların cerrahi sonuçları değerlendirilerek, günümüzde popüler olan disk artroplastisi gibi cerrahi tekniklerle literatür taraması eşliğinde karşılaştırılmıştır.
Gereç ve yöntem: Ağustos 2011 ile Nisan 2015 tarihleri arasında opere edilen 347 hastanın, retrospektif olarak yapılan nörolojik muayenelerinin, klinik bulgularının, ağrı ve yaşam kalitesi skalaları ve 142 hastanın pre/postoperatif radyolojik bulguları değerlendirilmiştir.
Bulgular: Hastaların ortalama yaşı 46,7±9,4 (min 23-maks 75), 165’i (%47,6) erkek, 182’si (%52,4) kadın olarak tespit edilmiştir. Tek seviye diskektomi ve füzyon yapılan 229 hasta (%66); iki seviye diskektomi ve füzyon yapılan 112 hasta (%32,3); 3 seviye diskektomi ve füzyon yapılan 6 hasta (%1,7) olarak tespit edilmiştir. Hastaların ortalama takip süreleri 16±11,7 aydır (min3 ay-maks 46 ay). Toplam 14 (%4) hastada postoperatif komplikasyon tespit edilmiş olup bunlardan sadece ikisinde (kozalji ve motor güç kaybı olan hastalar) şikayetler tam olarak düzelme göstermemiştir.
Sonuç: Çalışmamız, servikal disk hastalığının tedavisinde eski ve yeni birçok yöntemle karşılaştırıldığında, ASDF yönteminin günümüzde altın standart tedavi olduğunu desteklemektedir. Gerek klinik skalalar gerekse radyolojik kriterler göz önüne alındığında yüksek hasta memnuniyeti, etkinlik ve güvenlik sağladığı görülmektedir

Anahtar Kelimeler

• Servikal diskektomi
• PEEK kafes
• Servikal aks

Retrospective evaluation of clinical and radiological findings of patients who underwent anterior cervical discectomy and fusion in pre/postoperative periods

Öz

Purpose: The surgical results of patients who underwent anterior cervical discectomy, which is accepted as the gold standard treatment method in cervical disc hernia, and fusion with polyether-ether-ketone (PEEK) cage filled with demineralized bone matrix, were evaluated and compared with today's popular surgical techniques such as disc arthroplasty, accompanied by a literature review.
Materials and methods: Retrospective neurological examinations, clinical findings, pain, and quality of life scales of 347 patients operated between August 2011 and April 2015, and pre/postoperative radiological findings of 142 patients were evaluated.
Results: The mean age of the patients was 46.7±9.4 (min 23-max 75), 165 (47.6%) male, 182 (52.4%) female. Two hundred twenty-nine patients (66%) underwent single-level discectomy and fusion; 112 patients (32.3%) underwent two-level discectomy and fusion; six patients (1.7%) underwent three levels of discectomy and fusion. The mean follow-up period of the patients was 16±11.7 months (min 3 months-max 46 months). Postoperative complications were detected in a total of 14 (4%) patients, and only two of them (patients with causalgia and loss of motor power) did not show complete improvement.
Conclusion: Our study supports that the anterior cervical discectomy and fusion method is currently the gold-standard treatment compared with many old and new methods in treating cervical disc disease. Considering both clinical scales and radiological criteria, ASDF provides high patient satisfaction, efficacy, and safety.

Anahtar Kelimeler

• Cervical discectomy
• PEEK cage
• cervical axis

Kaynakça

1. 1. Wong, J. J., Côté, P., Quesnele, J. J., Stern, P. J., & Mior, S. A. (2014). The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. The Spine Journal, 14(8), 1781-1789.
2. 2. Kondo, K., Molgaard, C. A., Kurland, L. T., & Onofrio, B. M. (1981). Protruded intervertebral cervical disk: incidence and affected cervical level in Rochester, Minnesota, 1950 through 1974. Minnesota medicine, 64(12), 751-753.
3. 3. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A. A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine (Phila Pa 1976) 2002;27(16):1694–701.
4. 4. Hirsch, C. (1961). Cervical disk rupture: diagnosis and therapy. Acta orthopaedica Scandinavica, 30(1-4), 172-186.
5. 5. Caspar W, Barbier DD, Klara PM: Anterior cervical fusion and Caspar Plate stabilization for cervical trauma. Neurosurgery 25: 491,1989.
6. 6. Hilibrand AS, Carlston GD, Palumbo MA, Jones PK, Bohlman HH: Radiculopathy and myelopathy at segments adjacent to the site of a previus anterior cervical arthrodesis. J. Bone Joint Surg Am 81:519-528, 1999
7. 7. Mummaneni P, Burkus J, Haid R, Traynelis V, Zdeblick T (2007) Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6:198–200
8. 8. Watters WC, Levintal R: Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up. Spine Oct 15;19 (20): 2343-7, 1994.

9. 9. Vernon H, Mior S: The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther.;14(7):409-415, 1991.
10. 10. Ware J, KK Snow, Kosinski M, Gandek B: SF-36 Health Survey: Manual and Interpretation Guide. Boston, Mass., The Health Institute, New England Medical Center,1993.
11. 11. Harrison DE, Harrison DD, Cailliet R, et al: Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis? Spine 25:2072-2078,2000.
12. 12. Kelsey, J. L., Githens, P. B., Walter, S. D., Southwick, W. O., Weil, U., Holford, T. R., ... & White 3rd, A. A. (1984). An epidemiological study of acute prolapsed cervical intervertebral disc. The Journal of bone and joint surgery. American volume, 66(6), 907-914.
13. 13. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. European Spine Journal. 2007;16(5):669-678. doi:10.1007/s00586-006-0254-1.
14. 14. Gore DR, Sepic SB, Gardner GM, Murray MP (1987) Neck pain: a long-term follow-up of 205 patients. Spine 12(1):1–5
15. 15. Abd-Alrahman N, Dokmak AS, Abou-Madawi A: Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 141:1089-1092, 1999.
16. 16. Xie, Jing-cheng, and R. John Hurlbert. "Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study." Neurosurgery 61.1 (2007): 107-117.
17. 17. Savolainen S, Rinne J, Hernesniemi J: A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 43(1):51- 55,1998.
18. 18. van den Bent, M. J., Oosting, J., Wouda, E. J., van Acker, R. E., Ansink, B. J., & Braakman, R. (1996). Anterior cervical discectomy with or without fusion with acrylate: a randomized trial. Spine, 21(7), 834-839.
19. 19. Wirth FP, Dowd GC, Sanders HF, Wirth C: A prospective analysis of three operative techniques. Surg Neurol; 53:340-348, 2000.
20. 20. Smith GW, Robinson RA: The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbady fusion. J Bone Joint Surg 40 A: 607, 1958.
21. 21. Samartzis, D., Shen, F. H., Lyon, C., Phillips, M., Goldberg, E. J., & An, H. S. (2004). Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion? The Spine Journal, 4(6), 636-643.
22. 22. Goffin J, Loon JV, Calenbergh FV, et al. Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord 1995;8: 500–8
23. 23. Teramoto T, Ohmori K, Takatsu T, et al. Long-term results of the anterior cervical spondylosis. Neurosurgery 1994; 35:64–8.
24. 24. Baba, H., Furusawa, N., Imura, S., Kawahara, N., Tsuchiya, H., & Tomita, K. (1993). Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine, 18(15), 2167-2173.
25. 25. Ishihara, H., Kanamori, M., Kawaguchi, Y., Nakamura, H., & Kimura, T. (2004). Adjacent segment disease after anterior cervical interbody fusion. The Spine Journal, 4(6), 624-628.
26. 26. Verma, K., Gandhi, S. D., Maltenfort, M., Albert, T. J., Hilibrand, A. S., Vaccaro, A. R., & Radcliff, K. E. (2013). Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies. Spine, 38(26), 2253-2257.
27. 27. Boselie, T. F., Willems, P. C., van Mameren, H., de Bie, R., Benzel, E. C., van Santbrink, H. (2012). Arthroplasty versus fusion in single‐level cervical degenerative disc disease. The Cochrane Library.