Yurdal GEZERCAN, Kerem Mazhar ÖZSOY, Nuri Eralp ÇETİNALP, Kıvanç OLGUNER, Kadir OKTAY, Tahsin ERMAN

Servikal Spondilotik Myeloradikülopati"nin Cerrahi Tedavisinde Anterior Yaklaşımın Seçilme Nedenleri

Servikal spondilosis; servikal intervertebral diskte başlayıp, daha sonra çevre kemik ve yumuşak dokularda devam eden, ilerleyici, süreğen ve sinsi bir dejeneratif hastalıktır. Bu dejeneratif değişikliklere bağlı omurilik ve sinir kökü tutulumu olur ise servikal spondilotik myeloradikülopati (SSMR) olarak isimlendirilir ve 50 yaş üzerinde myelopatinin en sık sebebidir. İlerleyici ve fonksiyonel nörolojik defisite sahip olan olgular ile uzun süreli tanı almış ve konservatif tedaviye yanıt vermeyen yakınmaları bulunan olguların cerrahi olarak tedavi edilmeleri gerekir. Cerrahi tedavinin amacı omurilik ve sinir kökleri üzerindeki basıyı ortadan kaldırmak, servikal omurganın dizilimini korumak veya bozulmuş ise bunu yeniden oluşturmak, hastanın nörolojik bulgularını ve yakınmalarını ortadan kaldırarak yaşam kalitesini artırmak ve bunları yaparken de mümkün olduğu kadar komplikasyona neden olmamaktır. Bu hedefler servikal omurgaya anterior veya posterior cerrahi yaklaşım yolları ile sağlanabilir. Cerrahi yaklaşımın şekline ancak hastanın klinik ve radyolojik olarak çok ayrıntılı değerlendirilmesi ile karar verilebilir. Cerrahi yaklaşımın en büyük amacı olan yeterli nöral dekompresyon ve servikal dizilimin korunması/sağlanması en iyi anterior yaklaşımlar ile sağlanabilir. Bu çalışmamızda SSMR"nin cerrahi tedavisinde anterior yaklaşımın tercih edilme sebepleri özetlenecektir.

Criteria for preferring anterior approach in surgical treatment of cervical spondylotic myeloradiculopathy

Cervical spondylosis is a progressive, chronic and insidious degenerative disease, which origins from the cervical intervertebral disc and then diffuses to surrounding bony and soft tissues. If the spine and nerve roots are involved due to degenerative changes, this is called as cervical spondylotic myeloradiculopathy (CSMR) and it is the most frequent cause of myelopathy over age of 50. Cases with progressive character and functional neurological deficits and cases with a prolonged course refractory to conservative therapy shall be treated surgically. The aim of the surgical treatment is to relieve the pressure on the spinal cord and nerve roots, to preserve the proper anatomical alignment of the cervical vertebrae or to reestablish correct anatomical positioning if it is distorted and lastly to increase the life quality by relieving patients neurological signs and complaints. While achieving these goals, complications shall be avoided as much as possible. These goals can be accomplished by anterior or posterior surgical approaches to the cervical vertebrae. The style of the surgical approach can only be decided by a detailed evaluation of the patient"s clinical and radiological features. The utmost aim of the surgical procedure, which is to achieve sufficient neurological decompression and to preserve/establish proper cervical vertebral alignment, can be provided best by anterior approaches. In our current study, the criteria to prefer anterior approach in surgical treatment of CSMR will be reviewed.

Keywords:

Cervical, spondylosis, surgical treatment, anterior approach, posterio approach,

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Yazışma Adresi / Address for Correspondence: Dr.Kerem Mazhar Özsoy Çukurova ÜniversitesiTıp Fakültesi Beyin ve Sinir Cerrahisi Anabilim Dalı ADANA E-mail: mazhartac95@hotmail.com G eliş tarihi/Received on : 02.05.2014
Kabul tarihi/Accepted on: 30.05.2014