Lomber Cerrahi Sonrası Gelişen Epidural Havanın Klinik Önemi

Yıl 2018, , 404 - 409, 29.06.2018

İskender Samet Daltaban , Hakan Ak , Soner Yaycıoğlu Ali Rıza Güvercin , Uğur Yazar

https://doi.org/10.31832/smj.397065

Öz

Özet

Amaç: Lomber
spinal cerrahi sonrası spinal kanalda hava görülmesi nadir olmamasına rağmen bu
havanın semptomatik hale gelmesi çok nadirdir. Semptomatik epidural hava
oluşumunun gerek patofizyolojisi gerekse tedavisi ile ilgili farklı yorumlar
mevcuttur. Bu çalışmada amacımız kliniğimizce lomber omurga ameliyatı yapılan
hastalarda semptomatik hava sıklığını ve tedavi yaklaşımlarımızı retrospektif
olarak tespit etmekti.

Yöntem: Ocak 2016-
Aralık 2017 yılları arasında kliniğimizde lomber spinal cerrahi yapılan
hastaların dosyaları ve radyolojik tetkikleri retrospektif olarak tarandı.
Hastaların yaş, cinsiyet, eşlik eden kronik hastalık varlığı gibi demografik
verilerinin yanında ameliyata neden olan patolojileri, yapılan cerrahi işlem ve
ameliyat sonrası çekilen tomografi ve/veya manyetik rezonans görüntüleri
incelenmiştir.

Bulgular: Lomber
spinal cerrahi yapılmış 285 hastanın 72’sinin (%25) radyolojik tetkiklerinde
spinal kanalda hava tespit edildi. Bu hastaların yalnızca 3 (%0.3) tanesinde
bacak ağrısı ve/veya kuvvet kaybı olduğu saptandı. Semptomu olan hastalarda üç
doz tetrakosaktidinde mevcut analjezik tedaviye eklendiği konservatif tedavi
ile tam klinik iyileşme tespit edilmiştir.

Sonuç: Lomber
omurga cerrahisi sonrası spinal kanalda hava görülmesi nadir olmamakla birlikte
semptomatik epidural gaz oluşumu çok nadirdir. Bu hastalara öncelikle
konservatif tedavi ile yaklaşılması uygun olacaktır. Kontrendike bir durum
yoksa tedaviye tetrakosaktid eklenmesinin fayda sağladığını düşünmekteyiz.

CLİNİCAL
İMPORTANCE OF EPİDURAL AİR AFTER LUMBAR SPİNAL SURGERY

Abstract

Aim: Air
collection in the spinal canal after lumbar spinal surgery is not a rare event
however it is very rare for this air to become symptomatic. There are different
comments about pathophysiology and management of symptomatic epidural gas
collection. In the present study we aimed to reveal the frequency and management
of symptomatic air collection retrospectively in patients who undergo lumbar
spine surgery in our clinic.

Materials and
method: Folders and radiological examinations of patients who underwent lumbar
spinal surgery in our clinic between January 2016 and December 2017 were
retrospectively reviewed. Age, gender, presence of comorbid chronic diseases,
pathologies leading to operation, performed surgical procedures, and
postoperative tomography and / or magnetic resonance images were investigated.

Results: Radiological
examinations of 72 (25%) of the 288 patients who underwent lumbar spinal
surgery showed air in spinal canal. We detected leg pain and/or loss of
strength only in 3 (0.3%) of these patients. In these symptomatic patients,
complete clinical improvement was observed only by conservative treatment, in
which three doses of tetracosactide was added to their routine analgesic
treatment.

Conclusion: Air in
the spinal canal after lumbar spine surgery is not uncommon but symptomatic
epidural gas formation is a very rare event. Conservative treatment should be
the first line treatment in these patients. If there is no contraindication, it
may be beneficial to add tetracosactide to routine treatment.

Anahtar Kelimeler

LOMBER CERRAHİ, EPİDURAL HAVA, TERAKOSAKTİD

Kaynakça

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