IN PATIENTS UNDERGOING ANTERIOR CERVICAL DISCECTOMY AND FUSION EFFECT OF BONE MINERAL DENSITY ON FUSION AND FIXATION

Year 2021, , 221 - 227, 15.06.2021

Zafer Şen , Serkan Erkan

https://doi.org/10.17343/sdutfd.789263

Abstract

Objective
The aim of this study is to compare the radiological
and clinical results of patients who underwent anterior
cervical discectomy and fusion, and to determine the
relationship between fusion formation and bone mineral
density.
Materials and Methods
A total of 23 patients, who were admitted to the study
with a diagnosis of cervical degenerative disc disease
and cervical spondylosis at a Faculty of Medicine
Orthopedics and Traumatology clinic, were included
in the study. The cases consisted of patients who underwent
anterior discectomy and fusion, and did not
respond to medical treatment for at least 3 months.
Cervical bilateral radiographs of patients were taken
before and after the operation and bone mineral density,
VAS score values, Neck Disability Index, Ishihara
index and SF-36 evaluation results were compared at
the end of the 1st, 3rd, 6th and 12th months.
Results
In the study, the joining rate was found to be 95.6%.
In the non-smoking group at the end of the 3rd month,
the joining success was reached to 45%, 65% at
the 6th month, and 100% at the 12th month. In the
smoker group, the joining success at the 3rd month
was 35%, 55% at the 6th month and 85% at the 12th
month. A statistically significant relationship was observed
between the changes in the Ishihara index
values and the standard of living of patients and functional
results. The functional results were compared
with the cervical index, and a significant improvement
was observed in the functional results with a significant
correction of the cervical index.
Conclusion
Nowadays, the most suitable intervention is considered
to be the anterior approach in midline cervical
disc hernias. This intervention, which can be performed
with or without fusion, is a situation to be decided
according to the patient's stability problem. It can be
concluded that autograft, allograft, cage or plate-screw
application results require comparison of results
in long-term follow-up. Moreover, in radiological examinations,
if there is a flattening or kyphotic deformity
in the inclination of the cervical spine in the sagittal
plane, it is difficult to correct the sagittal deformity in
the spondylotic spine, which has been fused in places
with posterior intervention, and it increases the
existing kyphotic deformity, making posterior cervical
decompression impossible.

Keywords

Anterior cervical discectomy, fusion, bone mineral density, Ishihara index

ANTERİOR SERVİKAL DİSKEKTOMİ VE FÜZYON UYGULANAN HASTALARDA KEMİK MİNERAL YOĞUNLUĞUNUN FÜZYON VE FİKSASYON ÜZERİNE ETKİSİ

Abstract

Amaç
Bu çalışmanın amacı, anterior servikal diskektomi ve
füzyon uyguladığımız hastaların radyolojik ve klinik
sonuçlarını karşılaştırmak ve füzyon oluşumu ile kemik
mineral yoğunluğu arasındaki ilişkiyi saptamaktır.
Gereç ve Yöntem
Çalışmaya, Celal Bayar Üniversitesi Tıp Fakültesi
Hastanesi Ortopedi ve Travmatoloji kliniğinde servikal
dejeneratif disk hastalığı ve servikal spondiloz tanıları
ile başvuran toplam 23 hasta dahil edildi. Olgular en
az 3 ay süreyle tıbbi tedaviye yanıt vermeyen anterior
diskektomi ve füzyon uygulanan hastalardan oluştu.
Hastaların operasyon öncesi ve sonrası servikal bilateral
grafileri alınarak, 1-3-6. ve 12. ay sonunda kemik
mineral yoğunluğu, VAS skor değerleri, Boyun Engellilik
İndeksi, Ishihara indeksi ve SF-36 değerlendirme
sonuçları belirlenerek karşılaştırıldı.
Bulgular
Çalışmada kaynama oranı %95,6 bulundu 3. ayda
sigara içmeyen grupta kaynama oranı %45, 6.ayda
%65, 12. ayda %100’e ulaşıldı. Sigara içen grupta
3.ayda kaynama oranı %35, 6. ayda %55, 12. ayda
ise % 85 bulundu. Ishihara indeksi değerlerindeki
değişim ile hastaların yaşam standardı ve fonksiyonel
sonuçlar arasında istatistiksel olarak anlamlı ilişki
gözlendi. Hastalarda fonksiyonel sonuçlar ile servikal
indeks kıyaslanarak, servikal indeksin anlamlı bir şekilde
düzeltilmesi ile fonksiyonel sonuçlarda anlamlı
bir iyileşme izlendi.
Sonuç
Günümüzde orta hat yerleşimli servikal disk hernilerinde
en uygun girişim anterior yaklaşımdır. Füzyonlu
ya da füzyonsuz yapılabilecek bu girişim hastanın
stabilite sorununa göre karar verilecek bir durumdur.
Otogreft, allogreft, kafes ya da plak-vida uygulama
sonuçları, uzun dönem takiplerde sonuçların karşılaştırmasını
gerekli kılmaktadır. Radyolojik incelemelerde
servikal omurganın sagital plandaki eğiminde düzleşme
veya kifotik deformite varsa posterior girişim
ile yer yer füzyon olmuş spondilotik omurgada sagital
deformiteyi düzeltmenin güç olması, mevcut olan kifotik
deformiteyi artırması nedeniyle posterior servikal
dekompresyon uygulanamaz hale gelmektedir.

Keywords

Anterior Servikal Diskektomi, Füzyon, Kemik Mineral Yoğunluğu, Ishihara indeksi

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