Levent ÇELEBİ, Hasan Hilmi MURATLI, Özgür DOĞAN, Mehmet Fırat YAĞMURLU, Cem Nuri AKTEKİN, ALİ BİÇİMOĞLU

Torakolomber vertebra burst kırıklarında konservatif tedavinin etkinliği

Amaç: Torakolomber vertebra burst kırıklarında konservatif tedavinin etkinliği değerlendirildi. Çalışma planı: Çalışmaya, tek seviyeli torakolomber vertebra kırığı nedeniyle konservatif tedavi uygulanan 26 hasta (19 erkek, 7 kadın; ört. yaş 36; dağılım 18-67) alındı. Olgularda nörolojik defisit veya posterior kolon tutulumu yoktu; kanal içi deplasman oranı %50 veya altında idi. Fonksiyonel sonuçlar Deniş'in ağrı ve iş skalaları kullanılarak değerlendirildi. Takip süresi, Cobb açısındaki artış, rezidüel kifoz ve rezidüel kanal darlığı ile fonksiyonel sonuçlar arasındaki ve incelenen radyolojik parametrelerin birbirleri ile ilişkileri değerlendirildi. Sonuçlar: Fonksiyonel sonuçlar %65.3 oranında mükemmel veya iyi, %7.7 oranında kötü bulundu. Üç hasta ağrı nedeniyle ameliyat edildi. Son kontrollerde, ortalama Cobb açısında anlamlı artış (p

Anahtar Kelimeler:

Omurga kırıkları, Spinal stenoz, Kemiğin yeniden şekillenmesi, Tomografi, x-ışınlı bilgisayarlı, Torasik omurga, Lumbosakral bölge, Lumbar omurga

The efficacy of non-operative treatment of burst fractures of the thoracolumbar vertebrae

Objectives: We evaluated the efficacy of non-operative treatment of thoracolumbar burst fractures. Methods: The study included 26 patients (19 males, 7 females; mean age 36 years; range 18 to 67 years) who under went conservative treatment for single-level thoracolumbar fractures without posterior column involvement. None of the patients had neurologic deficits and canal encroachment was 50% or less in all fractures. Functional results were evaluated with the use of Denis' pain and work scales. Relationships were sought between functional results and follow-up time, progression in kyphosis angle, residual kyphosis, and residual canal stenosis, and between radiologie parameters. Results: Functional results were excellent or good in 65.3%, and poor in 7.7%. Three patients required surgery because of pain. Final follow-up evaluations showed a significant pro-gression in the mean Cobb angle (p<0.001) and a significant remodelization in the mean canal encroachment (p<0.001). No significant correlations were found between progression in kyphosis, residual kyphosis, residual canal stenosis, and functional results (p>0.05). The mean initial Cobb angle was correlated with the mean initial canal encroachment (p<0.05). There was also a correlation between the initial canal encroachment and final remodelization (p<0.001). Conclusion: Although non-operative management of thoracolumbar fractures has considerable efficacy, it may yield poor results in a small percentage of patients, some of whom require surgery because of pain. Thus, further prospective, randomized, and comparative studies with longer follow-up periods are required to define prognostic factors that may predict poor results following non-operative treatment.

Keywords:

Spinal Fractures, Spinal Stenosis, Bone Remodeling, Tomography, X-Ray Computed, Thoracic Vertebrae, Lumbosacral Region, Lumbar Vertebrae,

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