Erkam KOMURCU, Burak KAYMAZ, Gurhan ADAM, Umut GOLGE, Ferdi GOKSEL, Raif OZDEN

Lomber omurgada intralaminar vida kullanımının güvenilirliği ve uygulanabilirliği: Bilgisayarlı tomografi bazlı morfometrik çalışma

Özet:Amaç: Spinal cerrahide intralaminar vida (ILV) son zamanlarda daha popüler olmaya başlamıştır. Bu çalışmanın amacı lomber omurganın morfometrik parametrelerini belirlemek ve doğru intralaminar vida koymak için bir kılavuz oluşturmaktır.Çalışma Planı: Çalışmada 235 hastanın (127 erkek, 108 kadın) lomber omurga bilgisayarlı tomografi görüntüleri incelendi. Hastaların ortalama yaşı 44.2 (19-78) idi. Lomber omurga laminası açısından L1 den L5 e kadar her seviye için transvers iç çap, transvers dış çap (lamina genişliği), lamina boyu, subdural mesafe (güvenli bölge) ve spinolaminar açı ölçümleri yapıldı.Bulgular: L1 den L5 e kadar ortalama transvers dış çap 7.2 ile 7.8 mm arasında değişirken transvers iç çap 2.5 ile 3.0 mm arasında değişiyordu. En geniş lamina L3 olarak saptanırken, L1 ve L5 en dar laminalar olarak saptandı. Lamina boyu 21.0 ile 34.0 mm arasında değişirken ortalama değer 26.6 mm idi. Spinolaminar açı 111° ile 135° arasında değişirken ortalama değer 124.7° olarak bulundu. L1 en kısa lamina boyuna sahipken, L4 en düşük spinolaminar açıya sahipti. Subdural mesafe (güvenli bölge) 1.3 mm ile 3.6 mm arasında değişirken ortalama değer 2.4 mm idi ve subdural mesafenin en dar olduğu seviye L5 seviyesiydi.Çıkarımlar: Intralaminar vidalar uygun genişlik (3.5- 4.5 mm arası) ve uygun boylarda (20-25 mm) lomber omurgada güvenilir bir şekilde kullanılabilir. Ancak fiksasyon gücünün değerlendirmesi için biomekanik çalışmalara ihtiyaç vardır.Anahtar kelimeler: Intralaminar vida, kurtarıcı prosedür, lomber omurga, bilgisayarlı tomografi, morfoloji, lamina

Anahtar Kelimeler:

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Safety and feasibility of lumbar spine for intralaminar screw fixation: Computed tomography based morphometric study

Objective:The use of intralaminar screw in spinal surgery has become more and more popular recently. The aim of the study is to define the morphological parameters of the lumbar laminas so that to define a guidance for intralaminar screw placementMethods: The study involved the evaluation of lumbar computed tomography images of the patients. Two hundred thirty-five patients (127 male and 108 female) were included in the study. The mean patient age was 44.2 years (19-78 years). The measured parameters of the lamina were the transverse inner diameter, transverse outer diameter (lamina width), lamina length, subdural space (safe zone) and spino-laminar angle for each lumbar level (L1-L5).Results: The mean transverse outer diameter (L1 to L5) ranged between 7.2 and 7.8 mm and mean transverse inner diameter ranged between 2.5 and 3.0 mm. The lamina of L3 had the largest width and the lamina of L1 and L5 the smallest. The mean lamina length was 26.6 mm ranged between 21.0 and 34.0 mm and the mean spino-laminar angle was 124.7° ranged between 111° and 135°. The L1 level has the shortest mean lamina length and L4 the lowest spino-laminar angle. Mean subdural space (safe zone) was 2.4 mm ranged between 1.3 and 3.6 mm and it was narrowest at the L5 level.Conclusions: Intralaminar screws with the appropriate size (3,5 to 4,5 mm) and lengths (20 and 25 mm) can be used safely in lumbar spine.. However, biomechanical studies should be performed to measure strength of the fixation.Keywords: Intralaminar screw, salvage procedure, lumbar vertebrae, computed tomography, morphology, lamina

Keywords:

Computed tomography; intralaminar screw; lamina; lumbar vertebrae; morphology; salvage procedure,

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