Seyran KILINÇ, Zekeriya ÖZTEMUR, Utku DEMİR, Hayati ÖZTÜRK, Okay BULUT, Gündüz TEZEREN

İdiopatik skolyozda hibrid posterior enstrümentasyonun etkinliği ve güvenilirliliği

Amaç. Biz bu çalışmada skolyoz deformiteli hastalarımızda uyguladığımız cerrahi tedavilerinsonuçlarını retrospektif olarak değerlendirmeyi amaçladık. Yöntem. 2002-2010 yılları arasındakliniğimizde 21 olguya cerrahi tedavi uygulanmış olup bunlardan 13 idiopatik skolyozlu olgukriterlere uygun bulunup çalışma kapsamına alınmıştır. Bulgular. Tüm olgulara hibrid sistem (üsttorakal bölgeye çengel, lomber bölgeye poliaksiyel transpediküler vida kombinasyonu) titanyumposterior enstrümentasyon uygulanmıştır. Ek olarak tüm olgulara otolog greftler ile füzyonyapılmıştır. Ortalama takip süresi 49,7 aydır (14-92 ay). Ortalama Cobb açısı preoperatif 47o ,postoperatif 19,4o, son kontrolde 25oidi. Sonuç. Hibrid sistem posterior enstrümentasyonuyguladığımız idiopatik skolyozun cerrahi tedavisi etkin ve güvenilir bulunmuştur.

The efficacy and saf ety of hibrid posterior instrumentation in idiopathic scoliosis

Aim. In this study, we aimed to evaluate retrospectively results of surgical treatment of scoliosisdeformity in our patients. Method. In our clinic 20 cases underwent posterior instrumentation andfusion. Of them, 13 patient were included in the study. Results. All cases underwent hybridsystem instrumentation (upper hooks and lower polyaxial transpedicle screws), with titaniumimplants and fusion with autologous grafts.Mean follow-up was 49.7 months (range 14-92). Meancobb angle was 47opreoperatively, 19.4opostoperatively, 25oat last follow-up. Conclusion.Hybrid system posterior instrumentation was safe and effective method in the surgical treatment ofidiopathic scoliosis.

PDF

___

1. Herring JA. Tachdjians Pediatric Orthopaedics. 3rd Edition, New York: W. B. Saunders Company.2002; 213-99.
2. Freeman BL. Scoliosis and Kyphosis. Canale S.T. Campbell's Operative Orthopaedics, 10th Edition. Mosby, Philadelphia 2003; Volume 2; 1751-1837.
3. Mehlman CT. Idiopathic Scoliosis, Emedicine from WebMD, Http://www.emedicine.com/orthoped/topic504.htm 2004.
4. Mohan AL, Das K. History of surgery for the correction of spinal deformity. Neurosurg Focus 2003; 14(1):1-5.
5. Lowenstein JE. Idiopathic Scoliosis. MOE'S Textbook of Scoliosis and Other Spinal Deformities. 3rd Edition, Philadelphia: W.B Saunders Company 1995; 219-56.
6. Dormans JP. Pediatric Orthopaedics: Core Knowledge in Orthopaedics. 1st Edition. Elsevier Mosby, Philadelphia 2005; 265-78.
7. Bono CM, Garfin SR. Spine: Orthopaedic Surgery Essentials, Lippincott Williams &Wilkins, Philadelphia 2004; 163-74.
8. Bridwell KH. Surgical treatment of idiopathic adolescent scoliosis. Spine 1999; 24: 2607-16.
9. Kostuik JP. Current concepts review operative treatment of idiopathic scoliosis. J Bone Joint Surg 1990; 72: 1108-12.
10. Foster MR. A functional classification of spinal instrumentation. Spine J 2005; 5: 682-94.
11. Gögüş A, Akman Ş, Talu U, Şar C, Hamzaoğlu A. Adölesan idiyopatik skolyozun anterior enstrumentasyon ile tedavisi ve erken sonuçlar. Acta Orthop Traumatol Turc 2001; 35: 196-207.
12. Winter RB, Denis F, Lonstein JE, Garemella J. Techniques of surgery. MOE'S Textbook of Scoliosis and Other Spinal Deformities. 3rd Edition, Philadelphia: WB Saunders Company 1995; 133-217.
13. Kaneda K, Shuno Y, Satoh S, Abumi K. Anterior correction of thorasic scoliosis with Kaneda anterior spinal system. A preliminary report. Spine 1997; 15: 22: 1358-68.
14. Parsch D, Geartner V, Brocai DRC, Carstens C. The effect of spinal fusion on the long-term outcome of idiopthic scoliosis. J Bone Joint Surg 2003; 1133-6.
15. Lee CS, Nachemson AL. The crankshaft phenomenon after posterior Harrington fusion in skeletally immature patients with thoracic or thoracolomber idiopathic scoliosis followed to maturity. Spine 1997; 22: 58.
16. Dubousset J, Herring JA, Shufflebarger H. The crankshaft phenomenon. J Pediatr Orthop 1989; 9: 541.
17. Bjerkreim I. Steen H. Brox JI. Idiopathic scoliosis treated with Cotrel-Dubousset instrumentation: Evaluation 10 years after surgery. Spine 2007; 32: 2103-10.
18. Sucato DJ, Hadequist D, Karol LA. Operative Correction of Adolescent Idiopathic Scoliosis in Male Patients. J Bone Joint Surg 2004; 86: 2005-14.
19. Benli T, Ateş B. Akalın S 10 years follow-up surgical results of adolescent ıdiopathic scoliosis located with TSRH instrumentation. Eur. Spine J 2005; 14: 298-326.
20. Roye DP, Farcy JP, Rickert JB, Godfried D. Results of spinal instrumentation of adolescent idiopathic scoliosis by King type. Spine 1992; 17: 270-3.
21. Shapiro F, Sethna N. Blood loss in pediatric spine surgery. Eur Spine J. 2004; 1: 6-17.
22. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: A comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 2007; 32: 448-52.
23. Hamill CL, Lenke LG, Bridwell KH, Chapman MP, Blanke K, Baldus C. The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis. Is it warranted? Spine 1996; 21: 1241-9.
24. Liljenqvist U, Lepsien U, Hackenberg L, Niemeyer T, Halm H. Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Euro Spine J 2002; 11: 336-43.
25. Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 1995; 20: 1399-405.
26. Rinella A, Bridwell K, Kim Y, Rudzki J, Edwards C, Roh M, Lenke LG, Berra A. Late complications of adult idiopathic scoliosis primary fusion L4 and above: the effect of age and distal fusion level. Spine 2004; 29: 318-25.
27. Puno R, Lenke L, Richards S. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg 2007; 89: 2427-32.