Dejeneratif Lomber Hastalıklarda Uygulanan Spinal Enstrümantasyon Sonrası Gelişen Komşu Segment Dejenerasyonu: İnsidans ve Risk Faktörleri

Öz

Posterior spinal enstrümantasyon, dejeneratif omurga patolojilerinin tedavisi için oldukça yaygın uygulanan cerrahi bir prosedürdür. Spinal enstrümantasyon sonrası komşu segment dejenerasyonu (KSD) gelişimi önemli bir problem olarak karşımıza çıkmaktadır. Bu çalışmanın amacı KSD gelişimi için risk faktörlerinin değerlendirilmesidir. Bu çalışmada posterior segmental enstrümantasyon uygulanan ve cerrahi işlemi üzerinden 4 yıldan fazla geçen 126 hasta retrospektif olarak incelenmiştir. Bu hastalar KSD ve n-KSD olarak iki gruba ayrılmıştır. İki grubun hasta karakteristikleri, preoperatif ve postoperatif radyolojik parametreleri ve cerrahi farklılıkları karşılaştırılarak KSD gelişimi için prediktif faktörler ortaya konulmaya çalışıldı. Çalışmaya dahil edilen hastaların on beşinde (%11.9) KSD geliştiği görüldü. Her iki grup arasında cinsiyet, diyabetes mellitus, sigara kullanımı ve osteoporoz açısından anlamlı farklılık yok idi (p>0.05). Lojistik regresyon analizine göre preoperatif yüksek vücut kitle indeksi, preoperatif komşu segmentteki faset dejenerasyonu varlığı, postoperatif lomber lordozda azalma ve 4 seviyeden daha fazla posterior enstürman uygulanması KSD gelişimi için bağımsız risk faktörleridir. Spinal enstrümantasyon cerrahisi öncesi yukarıda bahsedilen risk faktörlerinin bilinmesi, cerrahi açıdan daha uygun sonuçlar alınabilmesi için önlem almaya imkan tanımaktadır. Hastaların ve işlemi uygulayacak cerrahların modifiye edilebilecek risk faktörleri açısından gerekli önlemleri almaları uzun dönem komplikasyonları azaltabileceğini düşünmekteyiz.

Anahtar Kelimeler

• komşu segment dejenerasyon
• füzyon cerrahisi
• lomber omurga

Adjacent Segment Degeneration Following Spinal Fusion for Degenerative Lumbar Disease: Incidence and Risk Factors

Öz

Posterior spinal instrumentation is a fairly common surgical procedure for the treatment of degenerative spine pathologies. The development of adjacent segment degeneration (ASD) after spinal instrumentation is an important problem. The aim of this study is to evaluate the risk factors for the development of ASD. In this study, 126 patients who underwent posterior segmental instrumentation and who had undergone surgery for more than 4 years were reviewed retrospectively. These patients were divided into two groups as ASD and non-ASD. By comparing the patient characteristics, preoperative and postoperative radiological parameters and surgical differences of the two groups, predictive factors for the development of ASD were tried to be revealed. Fifteen of the patients (11.9%) included in the study had ASD. There was no significant difference between the two groups in terms of gender, diabetes mellitus, smoking and osteoporosis (p>0.05). According to logistic regression analysis, preoperative high body mass index, presence of facet degeneration in the preoperative adjacent segment, decrease in postoperative lumbar lordosis, and posterior instrumentation of more than 4 levels are independent risk factors for the development of ASD. Knowing the above-mentioned risk factors before spinal instrumentation surgery allows taking precautions to obtain more appropriate surgical results. We think that taking the necessary precautions in terms of risk factors that can be modified by the patients and the surgeons who will perform the procedure can reduce long-term complications.

Anahtar Kelimeler

• Adjacent segment degeneration
• fusion surgery
• lumbar spine

Kaynakça

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