Ömer KARATOPRAK, Mehmet AYDOĞAN, Çağatay ÖZTÜRK, CÜNEYT MİRZANLI, Mehmet TEZER, Azmi HAMZAOĞLU

Lomber dejeneratif disk hastalığının total disk protezi ile tedavisi

Amaç: Ağrılı dejeneratif lomber disk hastalığı nedeniyle ProDisc II total disk protezi (TDP) uygulanan olguların klinik ve radyografik sonuçları değerlendirildi. Çalışma planı: Dejeneratif disk hastalığı (DDH) tanısıyla lumbar TDP uygulanan 34 hasta (25 kadın, 9 erkek; ort. yaş 44; dağılım 37-54) çalışmaya alındı. Toplam 62 TDP prosedürü olmak üzere, 12 olguya tek, 17 olguya iki, dört olguya üç, bir olguya ise dört seviyeli lomber TDP uygulandı. Olgular ameliyat öncesinde ve ameliyat sonrası 3, 6, 12, 24. aylarda klinik ve radyografik olarak değerlendirildi. Klinik değerlendirmede görsel analog skala (GAS) ve Oswestry Engellilik İndeksi (OEİ) kullanıldı. Radyografik değerlendirmede, lomber lordoz açısı, tutulan diskin yüksekliği ile fleksiyon-ekstansiyon açıları ölçüldü. Ortalama takip süresi 29.3 ay (dağılım 24-39 ay) idi. Sonuçlar: Olguların bel ve bacak ağrıları en geç üçüncü ayda tama yakın düzeldi. Klinik değerlendirmede, ameliyat öncesi 59.6 olan OEİ skoru ameliyat sonrası 24. ayda 19.8’e, GAS skoru ise 7.8’den 1.0’e geriledi. Lomber lordoz ameliyat öncesinde 52.6°, ameliyat sonrasında 57.1° olarak ölçüldü. Disk yüksekliği implantasyon yapılan seviyelerde 4.6 mm’den 12.1 mm’ye yükseldi. Fleksiyon-ekstansiyon açısı L5-S1 seviyesinde 2.8 dereceden 8.4 dereceye; L4-5 seviyesinde ise 2.6 dereceden 9.8 dereceye yükseldi. Total disk protezi uygulanan tüm disklerde fleksiyon-ekstansiyon açısında düzelme ortalama 7.2° bulundu. Çıkarımlar: Lomber disk protezi, dejeneratif disk hastalığının cerrahi tedavisinde hastaların fonksiyonları ve yaşam kalitelerinin sürdürülmesi açısından önemli avantajlara sahiptir.

Anahtar Kelimeler:

Bel ağrısı, Diskektomi, İntervertebral disk, Artroplasti, replasman, Lumbar omurga, Protezler ve implantlar

Total disc prosthesis for painful degenerative lumbar disc disease

Objectives: We evaluated clinical and radiographic results of patients treated by the ProDisc II total disc prosthesis (TDP) for painful degenerative lumbar disc disease. Methods: The study included 34 patients (25 females, 9 males; mean age 44 years; range 37 to 54 years) who underwent a total of 62 lumbar TDP procedures for degenerative lumbar disc disease. Lumbar disc replacement involved one level in 12 cases, two levels in 17 cases, three levels in four cases, and four levels in one case. Clinical and radiographic assessments were made preoperatively and at 3, 6, 12, and 24 months postoperatively. Clinical evaluations were made with a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Radiographic parameters included lumbar lordotic angle, the height and flexion-extension range of the affected discs. The mean follow-up period was 29.3 months (range 24 to 39 months). Results: Low back pain and lower extremity pain showed near-complete improvement up to the third postoperative month. At the end of the 24th month, preoperative ODI and VAS scores of 59.6 and 7.8 decreased to 19.8 and 1.0, respectively. Preoperative and postoperative lumbar lordotic angles were 52.6° and 57.1°, respectively. The mean disc height of implanted discs increased from 4.6 mm to 12.1 mm postoperatively. The mean flexion-extension angle increased from 2.8° to 8.4° at L5-S1, and from 2.6° to 9.8° at L4-5. The overall improvement in the mean flexionextension angle was 7.2°. Conclusion: Lumbar disc prosthesis offers significant advantages in terms of functional improvement and increased quality of life in the surgical treatment of degenerative disc disease.

Keywords:

Low Back Pain, Diskectomy, Intervertebral Disk, Arthroplasty, Replacement, Lumbar Vertebrae, Prostheses and Implants,

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