Füzyon kitlesinin altında kalan L5-S1 diskinde uzun dönemde görülen değişiklikler ve sagittal dengenin dejenerasyona etkisi
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Tarih
2010
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, kliniğimizde Ocak 1994 - Temmuz 2005 tarihleri arasında füzyon cerrahisi uygulanan 23 olgunun, en erken 5 yıl sonraki direk radyografileri ve manyetik rezonans görüntüleme tetkikleri incelenerek füzyon kitlesinin altında kalan L5-S1 diskinde dejenerasyon gelişimi değerlendirildi. Çalısmamızdaki 23 olgunun direk radyografileri değerlendirildiğinde hiçbirinde uç plak sklerozu, vakum fenomeni ve yeni gelişen bir listezis görülmedi. Olguların 7`sinde hafif düzeyde osteofit gelişimi görüldü. Ön ve arka disk yüksekliği bakımından operasyon öncesi ve operasyon sonrası ölçümler arasında istatistiksel yönden düşme yönünde anlamlı bir fark görüldü (p=0,001) (p=0,000). Lordoz açılarının ölçümünde operasyon öncesi ve operasyon sonrası istatistiksel yönden anlamlı bir fark yoktu (p=0,716). Direk radyografilerine göre 23 olgunun 6`sında dejenerasyon görülmezken, 9 olguda grade I , 8 olguda grade II dejenerasyon geliştiği görüldü. Olguların manyetik rezonans görüntüleme tetkiklerine göre anterior ve posterior disk yüksekliği bakımından operasyon öncesi ve sonrası ölçümleri arasında istatistiksel olarak düşme yönünde anlamlı fark görüldü (p=0,007) (p=0,007). Olguların hiçbirinde L5-S1 seviyesinde Schmorl nodülü ve listezis görülmedi. Modic tiplendirmesine göre sadece 3 olguda dejenerasyon görüldü ve bu sonuç istatistiksel olarak anlamlı bulunmadı (p=0,102). Disk dejenerasyonu ve faset eklem dejenerasyonu değerlendirildiğinde ise istatistiksel yönden anlamlı bir fark vardı (p=0,000) (p=0,000). Sonuç olarak; bizim 23 olguluk çalışmamızda manyetik rezonans görüntüleme tetkiklerinin değerlendirmesine göre füzyon kitlesinin altında kalan L5-S1 komşu segment dejenerasyonu, olguların 15' inde (% 65,3) saptanmıştır. Bu olgulardan L3-L5 füzyon yapılan 7 olgunun 3 `ünde (%42,8) , L4-L5 füzyon yapılan 16 olgunun 12` sinde (%75) dejenerasyon gelişmiştir. Anahtar kelimeler: Füzyon, disk dejenerasyonu, faset eklem dejenerasyon, komşu segment problemi.
Abstract
Degeneration in L5-S1 disc in 23 patients who underwent fusion surgery between January 1994 and July 2005 were evaluated in minimum 5 years of follow up, using plain radiographs and magnetic resonance imaging scans. In this study, no end plate sclerosis, vacuum phenomenon, newly developed lysthesis were seen in plain radiographs of any patients. Ostheophyte formations were seen in 7 patients. A statistically significant decrease was found in anterior and posterior disc height between preoperative and postoperative measurements (p=0.001) (p=0.000). No statistically significant difference was found in lordosis angle between preoperative and postoperative measurements (p=0.716). Grade I degeneration were found in 9 patients and grade II degeneration were found in 8 patients, no degeneration was determined in 6 of total 23 patients. A statistically significant decrease was found in anterior and posterior disc height using magnetic resonance imaging scans between preoperative and postoperative measurements (p=0.007) (p=0.007). No schmorl nodule and lysthesis were seen in any patient. Degenerations according to Modic classification were found in 3 patients, this event was not thought to be statistically significant (p=0.102). Statistically significant differences were found in disc degeneration and facet joint degeneration (p=0.000) (p=0.000). As a conclusion; L5-S1 level degenerations adjacent to fusion mass were found in 15 (%65,3) patients using magnetic resonance imaging scans in our study including 23 cases. Degenerations were determined in 3 (%42,8) of 7 patients who underwent L3-L5 fusion and in 12 (%75) of 16 patients who underwent L4-L5 fusion. Key words: Fusion, disc degeneration, facet joint degeneration, adjacent level problem.
Abstract
Degeneration in L5-S1 disc in 23 patients who underwent fusion surgery between January 1994 and July 2005 were evaluated in minimum 5 years of follow up, using plain radiographs and magnetic resonance imaging scans. In this study, no end plate sclerosis, vacuum phenomenon, newly developed lysthesis were seen in plain radiographs of any patients. Ostheophyte formations were seen in 7 patients. A statistically significant decrease was found in anterior and posterior disc height between preoperative and postoperative measurements (p=0.001) (p=0.000). No statistically significant difference was found in lordosis angle between preoperative and postoperative measurements (p=0.716). Grade I degeneration were found in 9 patients and grade II degeneration were found in 8 patients, no degeneration was determined in 6 of total 23 patients. A statistically significant decrease was found in anterior and posterior disc height using magnetic resonance imaging scans between preoperative and postoperative measurements (p=0.007) (p=0.007). No schmorl nodule and lysthesis were seen in any patient. Degenerations according to Modic classification were found in 3 patients, this event was not thought to be statistically significant (p=0.102). Statistically significant differences were found in disc degeneration and facet joint degeneration (p=0.000) (p=0.000). As a conclusion; L5-S1 level degenerations adjacent to fusion mass were found in 15 (%65,3) patients using magnetic resonance imaging scans in our study including 23 cases. Degenerations were determined in 3 (%42,8) of 7 patients who underwent L3-L5 fusion and in 12 (%75) of 16 patients who underwent L4-L5 fusion. Key words: Fusion, disc degeneration, facet joint degeneration, adjacent level problem.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Ortopedi ve Travmatoloji, Orthopedics and Traumatology, Füzyon, Disk Dejenerasyonu, Faset Eklem Dejenerasyon, Komşu Segment Problemi, Fusion, Disc Degeneration, Facet Joint Degeneration, Adjacent Level Problem
