Rafet ÖZAY, Şahin HANALİOĞLU, Serra Özbal GÜNEŞ, Betül YAMAN, Mehmet Erhan TÜRKOĞLU, Behzat Rüçhan ERGÜN

Alt servikal omurganın travmatik kırık ve dislokasyonları: tek merkez bulguları

Amaç: Alt servikal omurganın (C3-7) yaralanmaları; aksiyal iskeletin en sık görülen ve potansiyel olarak en katastrofik yaralanmaları arasında sayılmaktadır. Gençlerde daha çok motorlu taşıt kazalarıyla, yaşlılarda ise düşmelerle ortaya çıkmaktadır. Bu çalışmanın amacı kliniğimizde alt servikal omurga yaralanmaları nedeniyle cerrahi olarak tedavi edilen olgularla ilgili deneyimlerimizi paylaşmaktır.Gereç ve Yöntem: 2014-2016 tarihleri arasında alt servikal omurganın travmatik kırık ve dislokasyonları nedeniyle kliniğimizde opere edilen 27 olguya ait demografik, klinik ve radyolojik veriler ile cerrahi teknikler ve tedavi sonuçları incelenmiştir. Hastalar Spinal Travma Çalışma Grubu tarafından tanımlanan “Subaxial Injury Classification and Severity Scale” (SLICS) ile sınıflandırılmıştır. Bulgular: Hastaların yaş ortalaması 44.8±17.4 yıldı (21 erkek, 6 kadın). Travmalar; hastaların 2/3’ünde motorlu taşıt kazası, üçte birinde ise düşme sonucu oluşmuştu. %70.4 hastada pre-operatif nörolojik defisit mevcuttu (%40.7'sinde kuadriparezi/kuadripleji). Hastaların tamamında, SLIC skorları 4 veya üzerinde bulundu (ortalama 6.9±2.0). 12 hastaya hem anterior hem posterior, 11 hastaya yalnızca anterior, 4 hastaya ise yalnızca posterior stabilizasyon yapıldı. Post-op dönemde hastaların %18.5'inde pnömoni gelişirken, 3 hasta (%11) komplikasyonlar nedeniyle kaybedildi.Sonuç: Servikal omurga yaralanmaları, önemli mortalite ve morbidite nedenleri arasındadır. İnstabilitenin önlenmesi ve omurilik üzerindeki baskının kaldırılmasına yönelik olarak erken dönemde uygulanan dekompresyon ve stabilizasyonun sonuçları yüz güldürücüdür. Ayrıntılı pre-operatif klinik ve radyolojik değerlendirme, ameliyat kararının verilmesinde ve doğru yaklaşımın seçilmesinde yol göstericidir.

Anahtar Kelimeler:

Alt servikal omurga, travma, kırık, dislokasyon

Traumatic fractures and dislocations of subaxial cervical spine: one center results

Purpose: Traumatic injuries of the subaxial spine (C3-7) are among the most common and potentially most catastrophic injuries of axial skeleton. They occur with motor vehicle accidents in young and with falls in older population. In this study, we aimed to share our experiences with subaxial spinal injury patients surgically treated at our institution.Materials and Methods: We analyzed demographic, clinical and radiological data, surgical technique and results of 27 cases operated for traumatic fracture and dislocations of subaxial cervical spine. Subaxial Injury Classification and Severity Scale (SLICS) was used to assess severity of trauma and to guide surgical decision.Results: Mean age of the patients was 44.8±17.4 years (21 male, 6 female). Injury was due to motor vehicle accidents in nearly two-thirds, and falls in one-third of the patients. Neurologic deficits were present in 70.4% of the patients (quadriparesis/quadriplegia in 40.7%). All patients had SLIC scores of 4 or above (mean 6.9±2.0). Both anterior and posterior (12 patients), only anterior (11 patients) and only posterior (4 patients) stabilizations were performed for the instability of servical spine. During postoperative course, 18.5% of the patients had pneumonia and hospital infections and three patients (11%) died due to complications. Conclusion: Cervical spine injuries are among the important mortality and morbidity causes. Early surgical intervention for spinal cord compression and instability yields satisfactory results. Detailed preoperative clinical and radiological evaluations are required to select cases for surgical management.

Keywords:

Subaxial cervical spine, trauma, fracture, dislocation,

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