Nikola AZAR, CÜNEYT MİRZANLI, Erol Rüştü BOZKURT, Bünyamin BERBER

Dekortikasyonun spinal füzyondaki etkisi: Kobaylarda in-vivo çalışma

Amaç: Spinal füzyon, spinal cerrahinin en sık uygulanan bir işlemi olmasina rağmen özellikleri halen tam olarak bilinmemektedir. Dekortikasyonun bu işlemdeki rolü ise tartışmalıdır. Bu çalışmada dekortikasyonun spinal füzyondaki etkisi araştırıldı. Çalışma planı: Otuz erkek kobay (guinea pig, Cavia porcellus) kullanılarak in vivo deneysel hayvan modeli oluşturuldu. Tüm hayvanlarda L2-L6 arası omurga, sağ taraftan subperiosteal diseksiyon ile ortaya çıkarıldı. Omurganın sol tarafı kontrol grubu olarak kullanıldı. Hayvanlar uygulanan işlemlere göre üç gruba ayrıldı: Dekortikasyon+otogreft (grup 1), dekortikasyon+enstrümantasyon+otogreft (grup 2) ve dekortikasyonyapılmadan enstrümantasyon+otogreft (grup 3). Cerrahiden sonra altıncı haftada hayvanlar öldürülerek oluşan füzyon kütlesi makroskobik olarak, elle stres testi ile, radyolojik olarak ve mikroskobik olarak değerlendirildi. Sonuçlar: Segmentlere göre değerlendirmede grup l'de %80, grup 2'de %95, grup 3'te %92.5 füzyon elde edildi. Bu değerler istatistiksel olarak Kruskal-Wallis nonparametric ANOVA testinde anlamlı bulundu.

Anahtar Kelimeler:

Kobaylar, Kemik matriksi, Omurilik füzyonu, İnternal fiksatörler, Hastalık modelleri, hayvan, Biyouyumlu materyaller, Kemik nakli, Lumbar omurga

The effect of decortication on spinal fusion: An in vivo study in guinea pigs

Objectives: Although spinal fusion is one of the most commonly used procedures in spinal surgery its properties are not fully known. The role of decortication is still not clear. In this animal model, we investigated the effect of decortication on spinal fusion. Methods: The study included 30 male guinea pigs (Cavia porcellus). Spine exposure was obtained through the right subperiosteal dissection between L2 and L6 in all animals, whereas the left sides were used as controls. The animals were assigned to three groups including decortication and autografting (group 1), decortication, instrumentation, and autografting (group 2), and instrumentation and autografting without decortication (group 3). All animals were sacrificed in the sixth postoperative week. The fusion mass was assessed by means of macroscopic evaluation, manual stress test, radiologic examination, and microscopic evaluation. Results: Based on segmentary evaluations, fusion was obtained in 80%, 95%, and 92.5% in groups 1, 2, and 3, respectively. The results were found statistically significant (Kruskal-Wallis nonparametric ANOVA test, p<0.001). Conclusion: The results show that decortication should be an essential step for spinal fusion if spinal instrumentation is not considered. However, in case of a stable instrumentation, decortication seems to exert no positive effect on the formation of spinal fusion.

Keywords:

Guinea Pigs, Bone Matrix, Spinal Fusion, Internal Fixators, Disease Models, Animal, Biocompatible Materials, Bone Transplantation, Lumbar Vertebrae,

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