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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1. Zileli M, Özer F. Omurilik ve omurga cerrahisi. Meta Basım Matbaacılık Hizmetleri.İzmir 2002; 739-46.
2. 2. Brigham CD, Tsahakis PJ. Anterior cervical foraminotomy and fusion. Surgical technique and results. Spine 1995;20(7):766-70.
3. 3. Dasgupta R. Re-reading the salaryman in Japan: Crafting masculinities. Routledge 2012.
4. 4. Kuran O. Columma Vertebralis, İn; Sistematic Anatomy (Kuran O, ed), 3. Baskı, Filiz Kitabevi, 1993;74.
5. 5. Dvorak J, Sandler A. Historical Perspective Hubert von Luschka: Pioneer of Clinical Anatomy. Spine 1994;19(21):2478-82.
6. 6. Payne EE, Spillane JD. The cervical spine an anatomico-pathological study of 70 specimens (using a special technique) with particular reference to the problem of cervical spondylosis. Brain 1957;80(4):571-96.
7. 7. Özbek Z, Özkara E, Yağmur İ, Arslantaş A. Servikal Komşu Segment Hastalığı. Osmangazi Tıp Dergisi 2018;40(2):101-6.
8. 8. Grasso G, Landi A. Long Term Radiological And Clinical Evaluation Of Simple Cervical Discectomy Versus Anterior Fusion With Peek Cage. 2018;9(2):87-92

9. 9. Bradford DS, Zdeblick TA. The spine.Lippincott Williams & Wilkins, 2004.
10. 10. Fernyhough JC, White J,LaRocca H. Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 1991;16(10):561-4.
11. 11. Birch J. Efficiency of the Ishihara test for identifying red‐green colour deficiency. Ophthalmic and Physiological Optics 1997;17(5):403-8.
12. 12. Ware J, John E. SF-36 health survey. Lawrence Erlbaum Associates Publishers, 1999;1227-46.
13. 13. Cleland JA, Fritz JM, Whitman JM, Palmer JA. The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy. Spine 2006;31(5):598-602.
14. 14. Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nursing research 1992.
15. 15. Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery 2007;60:1-28.
16. 16. Hyong IH, Kim HS, Lee SY. The effect of immediate pain and cervical ROM of cervical pain patients on stretching and manipulation. The Journal of Korean Physical Therapy 2009;21(4):1-7.
17. 17. Kaner T, Özer AF. İatrojenik Spinal Deformiteler. Türk Nöroşirürji Dergisi 2013;23(2):74-82.
18. 18. Chang SW, Kakarla UK, Maughan PH, DeSanto J, Fox D, Theodore N, et al. Four-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Neurosurgery 2010;66(4):639-47.
19. 19. Isomi T, Panjabi MM, Wang JL, Vaccaro AR, Garfin SR, Patel T. Stabilizing potential of anterior cervical plates in multilevel corpectomies. Spine 1999;24(21):2219.
20. 20. DiAngelo DJ, Foley KT, Vossel KA. Rampersaud YR, Jansen TH. Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine 2000; 25(7):783-95.
21. 21. Galler RM, Dogan S, Fifield MS, Bozkus H, Chamberlain RH, Sonntag VK,et al. Biomechanical comparison of instrumented and uninstrumented multilevel cervical discectomy versus corpectomy. Spine 2007;32(11):1220-6.
22. 22. Samartzis D, Shen FH, Goldberg EJ, An HS. Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation? Spine 2005;30(15):1756-61.
23. 23. Ryu SI, Lim JT, Kim SM, Paterno J, Kim DH. Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion. European Spine Journal 2006;15(9):1339-45.
24. 24. Roberts S, Urban JP, Evans H, Eisenstein SM. Transport properties of the human cartilage endplate in relation to its composition and calcification. Spine 1996; 21(4):415-20.
25. 25. Boger DC. Traction device to improve CT imaging of lower cervical spine. American journal of neuroradiology.1986;7(4):719-21.
26. 26. Baleriaux D, Noterman J, Ticket L. Recognition of cervical soft disk herniation by contrast-enhanced CT. American Journal of Neuroradiology 1983;4(3):607-8.
27. 27. Jahnke R, Hart B. Cervical stenosis, spondylosis, and herniated disc disease. Radiologic Clinics of North America 1991;29(4):777-91.
28. 28. Daniels DL, Grogan JP, Johansen JG, Meyer GA, Williams AL, Haughton VM. Cervical radiculopathy: computed tomography and myelography compared. Radiology 1984;151(1):109-13.
29. 29. Fukushima T, Ikata T, Taoka Y, Takata S. Magnetic resonance imaging study on spinal cord plasticity in patients with cervical compression myelopathy. Spine 1991;16(10):534-8.
30. 30. Mann KS,Khosla VK, Gulati DR. Cervical spondylotic myelopathy treated by single-stage multilevel anterior decompression: A prospective study. Journal of neurosurgery, 1984;60(1):81-7.