ALL LEVELS PEDICLE SCREW FOR DECOMPRESSION AND CORRECTION IN DEGENERATIVE LUMBAR SPINE SCOLIOSIS: SHORT-TERM RESULTS

Giriş: 40 yaş üstü popülasyonda görülen, yavaş seyirli bir skolyoz tipidir. Dejeneratif veya de novo lomber skolyoz, adelösan idiopatik skolyoz olmaksızın iskelet maturasyonu tamamlandıktan sonra 10 derecenin üstünde Cobb açısı bulunan anormal omurga eğriliği olarak tanımlanır. Hareketle artan bel ağrısı tipik klinik bulgusu olup buna radikülopati, yürüme bozukluğu, intermittan kladikasyo gibi çeşitli nörolojik semptomlar da eşlik edebilir. İdeal yöntem, koronal planda deformiteye katılan tüm segmentlere füzyon uygulamaktır.Materyal-Metot: Çalışmamızda 2012-2014 yılları arasında dejeneratif lomber skolyoz tanısı ile opere edilen 20 hasta retrospektif olarak değerlendirildi. Hastaların 15'i kadın, 5'i erkek, yaş ortalaması 57 idi. Hastaların ortalama takip süresi 16.3 ay olup klinik olarak pre ve postoperatif VAS ve ODI skalaları ile değerlendirildi. Hastaların radyolojik kontrolü preoperatif ve postoperatif olarak ayakta skolyoz grafilerinde ölçülen Cobb açıları ve L1-S1 lomber lordoz açısı ile yapıldı.Sonuçlar: Hastaların ölçülen preoperatif ortalama Cobb açısı 22.6 derece idi. Postoperatif ortalama Cobb açısı 4.8 (010) derece olarak ölçüldü. Hastaların preoperatif L1-S1 lomber lordoz açısı ortalama 30.8 derece olup belirgin lordoz kaybı olduğu saptandı. Postoperatif L1-S1 lomber lordoz açısı ortalama 40.3 derece olarak ölçüldü. Preoperatif ortalama VAS 7.8 iken postoperatif 2.4 'e geriledi. Preoperatif ortalama ODI % 54 iken postoperatif % 18 'e geriledi.Çıkarım: Doğru seçilmiş hastalarda skolyoz korreksiyonu ile başarılı sonuçlara ulaşabiliriz. Lomber dejeneratif skoyoz cerrahisinde enstrümantasyon, dekompresyon ve koreksiyon uygun seçilmiş vakalarda tatmin edici bir cerrahi tedavi seçeneğidir.

DEJENERATİF LOMBER OMURGA SKOLYOZUNDA KORREKSİYON VE DEKOMPRESYONUNDA TÜM SEVİYELERE PEDİKÜLER VİDA KULLANIMI

Introduction: Degenerative lumbar scoliosis is a slow progressed scoliosis most commonly seen in over 40 year adults. Degenerative or de novo lumbar scoliosis is defined as over 10 degrees of Cobb angle bent spine in adults with completed spine development sans having adolescent idiopathic scoliosis. Increased pain with movement is a common symptom along with walking irregularities and intermittent claudication like neurologic symptoms. Ideally spine should be fused in all segments contributing to the deformity.Method: Our Study includes 20 patients operated between years 2012-2014 with lumbar degenerative scoliosis diagnosis. The patients are retrospectively studied. 15 women, 5 men with an age average of 57 . The average follow-up is 16.3 months . Pre and postoperative VAS and ODI scores are used for assessment. Radiologic control of the patients was done using calculated Cobb's angle from standing scoliosis images and L1-S1 lumbar lordosis angles.Results: The calculated preoperative average Cobb's angles of the patients were 22.6 with postoperative average has fallen to 4.8 . The preoperative average L1-S1 lumbar lordosis angle of the patients was 30.8 and significant lordosis loss was noted. Postoperative average L1-S1 lordosis angle were calculated to be 40.3 . Preoperative average VAS was 7.8 with the postoperative average 2.4(04). Preoperative average ODI was 54 % (46-74 %) with the postoperative resulting average of 18% (12-30 %).Conclusion: With the patients that are picked right, the correction of the scoliosis operation renders good results. We can say that with the correctly chosen patients the lumbar degenerative scoliosis correction operation with decompression and instrumentation is a correct treatment option.

Kaynakça

1. Aebi M. The adult scoliosis. Eur Spine J 2005; 14: 925-948.

2. Berven SH, Deviren V, Mitchell B, Wahba G, Hu SS, Bradford DS. Operative management of degenerative scoliosis: an evidence-based approach to surgical strategies based on clinical and radiographic outcomes. Neurosurg Clin North Am 2007; 18: 261-272.

3. Birknes JK, White AP, Albert TJ, Shaffrey CI, Harrop JS. Adult degenerative scoliosis: a review. Neurosurgery 2008; 63: 94-103.

4. Bradford DS, Tay BK, Hu SS. Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine 1999; 24: 2617-2629.

5. Bridwell KH. Adult spinal deformity revision surgery. In: Heary RF, Albert TJ, eds. Spinal deformity: the essentials. 1st ed., Thieme, New York, 2007; pp: 240-248.

6. Carreon LY, Puno RM, Dimar JR, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg 2003; 85-A: 2089-2092.

7. Cho KJ, Suk SI, Park SR, Kim JH, Choi WK, Lee SR. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine 2007; 32: 2232-2237.

8. Daubs MD, Lenke L, Cheh G, Stobbs G, Bridwell KH. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine 2007; 32: 2238 - 2244.

9. Dhruv BP, Khaled MK, Brett MC. Posterior Only Versus Combined Anterior and Posterior Approaches to Lumbar Scoliosis in Adults. Spine 2007; 32 (14): 1551- 1554.

10. Frazier DD, Lipson SJ, Fossel AH, Katz JN. Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine 1997; 22: 2025- 2029.

11. Glassman SD, Berven S, Bridwell K, Horton W, Dimar J R. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 2005; 30: 682-688.

12. Grubb SA, Lipscomb HJ, Conrad RW. Degenerative adult onset scoliosis. Spine 1988; 13: 241-245.

13. Hasegawa K, Homma T. One-stage three-dimensional correction and fusion: a multilevel posterior lumbar interbody fusion procedure for degenerative lumbar kyphoscoliosis. Technical note. J Neurosurg 2003; 99: 125-131.

14.Kleinstueck FS, Fekete TF, Mannion AF, Grob D, Porchet F, Mutter U, Jeszenszky D. To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer? Eur Spine J 2012; 21: 268-275.

15.Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, Takeda N. A prospective study of de novo scoliosis in a community based cohort. Spine 2006; 31: 178-182.

16.Kostuik JP, Hall BB. Spinal fusions to the sacrum in adults with scoliosis. Spine 1983; 8: 489 - 500.

17. Lang J, Tang X, Xu Y, Zhou T, Shi J, Cui Y, Xiang Q, Cai Z, Zhao Q, Yang X, Zhao C. Surgical treatment of degenerative lumbar scoliosis with multi-segment lumbar spinal stenosis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28(8): 960-964.

18. Lippman CR, Spence CA, Youssef S, Cahill DW. Correction of adult scoliosis via a posterior-only approach. Neurosurg Focus 2003; 14: 1-6.

19. Raffo CS, Lauerman WC. Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 2006; 31: 99-103.

20. Roy-Camille R. Osteosynthese du rachis dorsal, lombaire et lombrosacre par plaque metalliques visees dans peducules vertebraux et les apophyses articulaires. Presse Med 1970; 78: 1447-1448.

21. Ruf M, Harms J. Pedicle screws in 1- and 2- yearold children: technique, complications, and effect on further growth. Spine 2002; 27: E460-466.

22. Schwab F, Dubey A, Pagala M, Gamez L, Farcy JP. Adult scoliosis: a health assessment analysis by SF-36. Spine 2003; 28: 602-606.

23. Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M. Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 2002; 27: 387-392.

24. Schwab F, Dubey A, Gamez L, Gamez L, Farcy JP, Pagala M. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 2005; 30: 1082-1085.

25. Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus 2010; 28: E1. PubMed PMID:20192655.

26. Simmons ED, Kowalski JM , Simmons EH . The results of surgical treatment for adult scoliosis. Spine 1993; 18: 718-724.

27. Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res 2001; 384: 45-53.

28. Smith JS, Shaffrey CI, Kuntz CT, Mummaneni PV. Classification systems for adolescent and adult scoliosis. Neurosurgery 2008; 63: 16-24.

29. Swank S, Lonstein JE, Moe JH, Winter RB, Bradford DS. Surgical treatment of adult scoliosis: a review of two hundred and two cases. J Bone Joint Surg 1981; 63-A: 268 - 287.

30. Tribus CB. Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg 2003; 11: 174-183.

31. Tsutsui S, Kagotani R, Yamada H, Hashizume H, Minamide A, Nakagawa Y, Iwasaki H, Yoshida M. Can decompression surgery relieve low back pain in patients with lumbar spinal stenosis combined with degenerative lumbar scoliosis? Eur Spine J 2013; 22(9): 2010-2014.

32.Vanderpool DW, James JI, Wynne-Davies R. Scoliosis in the elderly. J Bone Joint Surg 1969; 51-A: 446- 455.

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