BURAK KAYMAZ, HALİL GÖKHAN DEMİRKIRAN, MEHMET AYVAZ, İbrahim AKEL, Emre ACAROĞLU, Ahmet ALANAY

Treatment of thoracolumbar burst fractures using combined pedicle screw-laminar hook fixation

Amaç: Bu çalışmanın amacı torakolomber patlama kırıklarının cerrahi tedavisinde kullanılan pedikül vi- dası-laminar kanca (PS-LH; pedicle screw-laminar hook) tespitinin orta dönem sonuçlarını incelemekti. Çalışma planı: Çalışmada 1996 ile 2006 yılları arasında torakolomber patlama kırığı nedeniyle PS- LH ile tedavi edilen 19 hasta (12 erkek, 7 kadın; ortalama yaş: 34.4, dağılım: 19-57) değerlendirildi. Bu hastalardan en az 2 yıllık takibi olan 17’si (11 erkek, 6 kadın) çalışmaya alındı. Lokal kifoz açısı (LKA) ve anterior vertebra yüksekliği (AVH; anterior vertebral height) ölçümleri yapılarak radyolojik değerlendirme yapıldı. Hastaların ortalama 81 (dağılım: 38-122) ay takip edilirken, bunlardan 15’inin takibi 5 yıldan fazla bir zamanda tamamlandı. Bulgular: Cerrahi öncesi vertebra yükseklik kaybı ve LKA’lar, sırasıyla, %41.2 (dağılım: %29-%64) ve 16.8°(dağılım: 5°-36°) iken, bu değerlerin cerrahi sonrası %16.3 (dağılım: %0-%44) ve -1.2°’ye (dağı- lım: -17°-10°) düzeldiği görüldü. İkinci yıl takibinde, vertebra yüksekliği ve LKA’daki ortalama düzel- tim kaybı, sırasıyla, %1.8±7.9 ve 4.3±7.1 derece iken, 2. ve 5. yıllar arasındaki ortalama kayıp ise, sıra- sıyla, %-1.8±4.5 ve 0.5±1.5 idi. Lokal kifoz açısındaki düzeltim kaybı anlamlı iken (p=0.023), vertebra yükseklik kaybı anlamlı değildi (p=0.360). Beş hastada 5 dereceden daha fazla düzeltim kaybı gözlen- di. İkinci ve 5. yıl değerleri karşılaştırıldığında ise, vertebra yükseklik kaybı ve LKA düzeltim kaybında anlamlı bir farklılık saptanmadı (sırasıyla, p=0.147 ve p=0.205). Cerrahi öncesi değerlerle kıyaslan- dığında ise hem 2. hem de 5. yıl değerlerinin belirgin olarak daha iyi olduğu görüldü (p

Torakolomber patlama kırıklarının pedikül vidası ve laminar kanca kombine tespiti ile tedavisi

Objective: The aim of this study was to evaluate the mid-term outcome of pedicle screw-laminar hook (PS-LH) fixation in the surgical treatment of thoracolumbar burst fractures.Methods: Nineteen patients (12 male, 7 female; mean age: 34.4 years, range: 19 to 57 years) with thoracolumbar burst fractures treated using PS-LH between 1996 and 2006 were evaluated. The 17 patients (11 male, 6 female) who had a minimum of 2 years follow-up were included in the study. Radiographic outcome was evaluated by measuring the local kyphosis angle (LKA) and anterior vertebral height (AVH). Mean follow-up was 81 (range: 38 to 122) months and 15 patients completed more than 5 years of follow-up.Results: Preoperative vertebral height loss and LKA of 41.2% (range: 29% to 64%) and 16.8° (range: 5° to 36°), respectively, were corrected to 16.3% (range: 0% to 44%) and -1.2° (range: -17° to 10°), respectively, after the operation. Mean losses of correction for vertebral height and local kyphosis were 1.8±7.9% and 4.3±7.1 degrees, respectively, at the 2-year follow-up and -1.8±4.5% and 0.5±1.5 degrees, respectively, between 2 years and 5 years. Loss of correction was significant for the LKA (p=0.023) but not for vertebral height (p=0.360). Five patients had losses of correction of more than 5 degrees. Changes between 2 and 5 years were not significant for vertebral height loss and local kyphosis (p=0.147 and p=0.205, respectively) and remained improved when compared with the preoperative values (p<0.001). Average SF-36 scores of the 15 patients evaluated at the final follow-up were comparable with the general Turkish population.Conclusion: The PS-LH construct provided a significant correction of the local kyphotic deformity. Augmentation of the upper and lower pedicle screw by the sublaminar hook did not completely prevent correction loss but was found to stabilize at the 5th year of follow-up without any clinical problems.

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