Özcan Aslanbaş, Kadir Oktay, Kerem Mazhar Özsoy, Nuri Eralp Çetinalp, Metin Tuna

Torakolumbosakral omurgada pedikül vidası malpozisyon oranlarının değerlendirilmesi: 100 hastanın postoperatif bilgisayarlı tomografi sonuçları

Amaç: Çalışmamızda elektif ve acil şartlarda çeşitli tanılarla opere olarak transpediküler vida uygulanan hastaların, vida pozisyonlarının retrospektif olarak incelenerek vida malpozisyonlarının değerlendirilmesi amaçlandı.Gereç ve Yöntem: Ocak 2012 ile Eylül 2016 tarihleri arasında çeşitli spinal patolojilerle transpediküler vida uygulanan 100 hasta retrospektif olarak incelendi. Operasyon sonrası 72 saat içinde anteroposterior ve lateral direk grafi ve ince kesit spinal bilgisayarlı tomografi görüntülemeleri yapıldı. Hastaların yaş, cinsiyet, operasyon seviyeleri, yerleştirilen vida sayıları, preoperatif ve postoperatif nörolojik durumları, komplikasyonlar, vida malpozisyon sayıları ve revizyon ameliyatlarını içeren verileri toplandı.Bulgular: 100 olguya toplam 692 transpediküler vida uygulandı. Yerleştirilen 692 transpediküler vidanın 610'u (%88.15) normal olarak değerlendirildi. 82 vida (%11.85) malpozisyon olarak değerlendirildi ve 5'i revize edildi. Gertzbein sınıflamasına göre; 20 vida derece 1, 44 vida derece 2 ve 18 vida derece 3 olarak değerlendirildi. 4 hastada anterior perforasyon, 39 hastada medial perforasyon, 38 hastada lateral perforasyon, 1 hastada inferior perforasyon vardı. Vida malpozisyonlarının torakal seviyelerde daha çok görüldüğü saptandı.Sonuç: Ameliyat sonrası alınan ince kesitli bilgisayarlı tomografi taramaları vida malpozisyonlarının belirlenmesinde altın standart olarak kabul edilmektedir. Malpozisyonların pediküllerin anatomik yapısına bağlı olarak en sık torakal bölgede medial pedikül duvarı perforasyonları şeklinde olduğunu tespit ettik.

Anahtar Kelimeler:

Transpediküler vida, malpozisyon, spinal enstrumantasyon

Assessment of pedicle screw malposition rates in thoracolumbosacral spine: results of postoperative computed tomography in 100 patients

Purpose: The purpose of this retrospective study was to evaluate the screw malpositions of patients who underwent transpedicular screw application in various elective and emergency conditions.Material and Methods: 100 patients who underwent transpedicular screw application with various spinal pathologies between January 2012 and September 2016 were included in this retrospective study. Anteroposterior and lateral X-rays and thin section spinal computed tomography scans were performed within 72 hours after the operation. The data including age, gender, operation levels, number of screws placed, preoperative and postoperative neurological conditions, complications, number of screw malpositions and revision surgeries of the patients were gathered.Results: A total of 692 transpedicular screws were applied to 100 cases. 610 (88.15%) of the 692 transpedicular screws placed were evaluated as normal. 82 screws (11.85%) were evaluated as malpositions and 5 of them were revised. According to Gertzbein classification; 20 screws were grade 1, 44 screws were grade 2 and 18 screws were grade 3. 4 patients had anterior perforation, 39 patients had medial perforation, 38 patients had lateral perforation and 1 patient had inferior perforation. There was a dominancy of thoracal levels in screw malpositions.Conclusion: Thin section CT scans taken postoperatively was found to be the gold standard for detecting screw malpositions. We identified that malpositions were most frequently seen as medial pedicle wall perforations in the thoracal region due to anatomical structure of the pedicles.

Keywords:

Transpedicular screw, malposition, spinal instrumentation,

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