Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Füzyonlu ve Füzyonsuz Anterior Servikal Diskektomi Sonuçlarının Retrospektif Değerlendirilmesi
Comparison of Anterior Cervical Discectomy With and Without Fusion: Retrospective Study
Musa ÇIRAKa, Ramazan ATABEYb
aBeyin ve Sinir Cerrahisi Kliniği, Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi,
bBeyin ve Sinir Cerrahisi Kliniği, İstanbul Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2019;39(3):285-98
doi: 10.5336/medsci.2019-65699
Article Language: TR
Full Text
ÖZET
 Amaç: Füzyonlu ve füzyonsuz anterior servikal diskektomi sonuçlarınının karşılaştırılmasıdır. Gereç ve Yöntemler: 1994-2001 yılları arasında, servikal disk hernisi tanısıyla anterior servikal diskektomi yapılan hastalar çalışmaya dâhil edildi. Hastalar füzyonlu (ACD) ve Füzyonsuz Anterior Servikal Diskektomi (ACDF) olarak iki gruba ayrıldı. Hastaların demografik özelikleri, ameliyat paramatreleri, ameliyat öncesi ve sonrası dönem radyolojik bulguları ve Odom kriterlerine göre bir, üç, altıncı ay ve bir yıl kontrollerinin sonuçları değerlendirildi ve karşılaştırıldı. Bulgular: Toplam 130 hasta çalışmaya dâhil edildi (63 hasta, %48,4, ACD ve 67 hasta, %51,6, ACDF). Hastaların 70'i (%53,8) erkek, 60'ı (%46,2) kadın olup, ortalama yaşları 43,5 yıl idi. Ortalama semptom süresi 1-28 ay, ortalama takip süresi ise 5-28 ay idi. Klinik olarak 98 (%75) hastada radikülopati, 11 (%8,4)'inde miyelopati ve 21 (%16)'inde miyeloradikülopati bulguları mevcuttur. Disk herniasyonunun en sık rastlandığı seviyeler C5-6 (%37,6) ve C6-7 (%25,3) seviyeleri olup 98 hastada tek mesafe (60 hasta ACD, 38 hasta ACDF), 32 hastada çift mesafe (3 hasta ACD, 29 hasta ACDF) diskektomi uygulanmıştır. ACDF uygulanan 67 hastadan 38'ine tek mesafe füzyon, iki mesafe diskektomi yapılan 29 hastadan 17'sine iki mesafe füzyon, 12 hastaya ise tek mesafe füzyon uygulanmıştır. Füzyon uygulananlarda Smith-Robinson tekniği kullanılmıştır. Kemik greft olarak iliyak otogreft kullanılmıştır. Komplikasyon oranı %10,7 olup, majör komplikasyon/mortalite görülmedi. Radikülopati olan hastaların klinik sonuçları, miyelopati ve miyeloradikülopatili hastalara göre daha iyi sonuç verdi. Miyelopati ve miyeloradikülopatili hastalarda füzyon uygulaması daha iyi sonuç verdi. Klinik takiplerde 'Mükemmel+iyi'' sonuçların da gruplar arasında, istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Füzyonlu ve füzyonsuz anterior servikal diskektomi tekniklerinin benzer klinik başarı sağladığı saptandı.

Anahtar Kelimeler: Servikal vertebra; diskektomi; radikulopati; spondiloz
ABSTRACT
 Objective: To compare the anterior vervical discectomy with and without fusion. Material and Methods: Between 1994 and 2001, subjects with cervical disc herniation that underwent anterior cervical discectomy were enrolled. Anterior vervical discectomy (ACD) and anterior cervical discectomy with fusion (ACDF). Demographic characteristics, surgical parameters, preoperative and postoperative radiological findings and clinical results of the 1st, 3rd, 6th month and 1st year controls according to Odom criteria were evaluated and compared. Results: In total 130 (53.8%, n=70 male, 46.2%, n=60 female) subjects were identified (63, 48.4%, ACD and 67, 51.6%, ACDF). Mean age was 43.5 years. Mean symptom duration was between 1 and 28 months. Clinically, 98 (75%), 11 (8.4%) and 21 (16%) subjects were presented radiculopathy, myelopathy and radiculomyelopathy respectively. Disc herniation was mostly seen at levels of C5-6 (37.6%) and C6-7 (25.3%). In 98 cases, single-level (ACD in 60, ACDF in 38 patients); In 32 patients two-levels of discectomy( ACD in 3, ACDF in 29 patients) were applied. In 38 of the 67 ACDF patients two-levels of fusion, in 12 patients single-level of fusion was applied. Smith-Robinson technique was performed for fusion. Iliac graft was preferred in all the subjects. Complication rate was 10.7%. There were no major complications or surgical mortality. Subjects with radiculopathy had beter clinical outcome than those with myelopathy and radiculomyelopathy. Subjects with myelopathy and radiculomyelopathy with fusion had beter clinical outcomes There was no significant difference between groups for clinical outcomes. Conclusion: ACDF and ACD are found effective equally in treating cervical disc pathology.

Keywords: Servical vertebrae; discectomy; radiculopathy; spondylosis
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