Lomber Dejeneratif Skolyozlardaki Koronal Dengesizlikte Çift Rod Kullanımının Düzeltme Üzerindeki Etkisi

Giriş: Lomber dejeneratif skolyozda uygulanan cerrahilerde hedef; koronal ve sagittal dengenin sağlanmasıdır. Uygun hizalanma ile oluşan denge hastanın postoperatif yaşam kalitesi ve memnuniyeti ile yakından ilişkilidir. Sagittal ve koronal denge için her iki düzlemde cerrahi manevralara ihtiyaç duyulur. Bu çalışmadaki amacımız, koronal dengesizlikte tek ya da çift rod kullanımının koronal uyumsuzluğun düzeltilmesi üzerindeki etkisini değerlendirmektir. Yöntem: Çalışmaya Ocak 2019-Aralık 2021 tarihleri arasında kurumumuza başvuran lomber dejeneratif skolyoz tanısı almış toplam 22 hasta (14 kadın ve 8 erkek, ortalama yaş 64,3±10,3 yıl) dahil edildi. Hastalar iki gruba ayrıldı, birinci grup tekli rod (n:11), ikinci grup çiftli rod (n:11) uygulanan hastalar olarak belirlendi. Hastaların cerrahi öncesi ve sonrası 12. ayda skolyoz grafisi üzerinden pelvik insidans (PI), sakral slope (SS), pelvik tilt (PT), lomber lordoz (LL), sagittal vertikal aks (SVA), cobb açısı, santral sakral vertikal line (CSVL), T1 plumbline dahil olmak üzere her hastanın spinopelvik parametre ölçümleri yapıldı. Ayrica Vizuel Analog Skala (Visual Analog Scale-VAS) ve Oswestry skalası (Oswestry Disability Index-ODI)’na bakıldı. İstatistiksel çalışma için Wilcoxon Signed Ranks testi kullanıldı. İstatistiksel anlamlılık düzeyi p <0,05 olarak belirlendi. Bulgular: Tek ve çift rod kullanılan hasta gruplarındaki postoperatif cobb açısı, koronal balans, VAS ve ODI değerleri ile preoperatif değerler arasındaki farklılıklar istatistiksel olarak (p<0,05) anlamlıydı. Her bir grup içindeki spinopelvik parametrelerden PI, PT, SS ve SVA değerlerindeki değişiklikler istatistiksel olarak (p>0,05) anlamlı değildi. Her iki grup arasındaki parametrelerde istatistiksel anlamlı bir değişim saptanmadı (p>0,05). Sonuç: Koronal uyumsuzluğun düzeltilmesi için en önemli kriterlerden biri enstrümantasyon için uygun seviyelerin seçilmesi ve yeterli düzeltme yapılmasıdır. Yaptığımız çalışmada klinik iyileşmenin rod sayısı ile ilişkili olmadığı, koronal dengesizliğin ne kadar başarılı şekilde düzeltildiği ile bağlantılı olduğu gözlenmiştir. Bunun yanında uzun süreli takiplerde rodlara binecek yükün implant yetmezliğine neden olabileceği unutulmamalıdır. Bu soruna çözüm olarak çiftli rod kullanılması akılda tutulmalıdır.

Anahtar Kelimeler:

Skolyoz, koronal balans, lomber dejenerasyon, sagittal balans

The Effect of Double Rod Use on Correction of Coronal Imbalance in Lumbar Degenerative Scoliosis

Aim: Maintaining coronal and sagittal balance is the main goal in surgeries for lumbar degenerative scoliosis. The balance created by proper alignment is closely related to the patient's postoperative quality of life and satisfaction. Surgical maneuvers in both planes are needed for sagittal and coronal balance. In this study, it was aimed to compare the effect of using single or double rods in the correction of coronal mismatch. Method: A total of 22 patients (14 female and 8 male, mean age 64.3±10.3 years) diagnosed with lumbar degenerative scoliosis, who applied to our institution between January 2019 and December 2021, were included in the study. The patients were divided into two groups, the first group was determined as single rod (n:11) and the second group as double rod (n:11) patients. Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), cobb angle, central sacral vertical line (CSVL), spinopelvic parameter measurements were made for each patient, including the T1 plumbline. In addition, the Visual Analog Scale (Visu-al Analog Scale-VAS) and the Oswestry scale (Oswestry Disability Index-ODI) were examined. Wilcoxon Signed Ranks test was used for statistical study. The statistical significance level was determined as p<0.05. Results: The differences between the postoperative cobb angle, coronal balance, VAS and ODI values and preoperative values in the patient groups using single and double rods were statically significant (p<0.05). Changes in PI, PT, SS and SVA values of spinopelvic parameters within each group were not statistically significant (p>0.05). There was no statistically significant change in the parameters between the two groups (p>0.05). Conclusion: One of the most important criteria for correcting coronal mismatch is the selection of appropriate levels for instrumentation and adequate correction. In our study, it was observed that clinical improvement was not related to the number of rods, but to how successfully the coronal imbalance was corrected. In addition, it should be kept in mind that the load on the rods may cause implant failure in long-term follow-ups. The use of double rods should be kept in mind as a solution to this problem.

Keywords:

Scoliosis, coronal balance, lumbar degeneration, sagittal balance,

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