Durmuş Oğuz KARAKOYUN, Ali YILMAZ, Hasan Serdar IŞIK, Oğuzhan UZLU

Subaksial Servikal Omurga Yaralanmalarında Cerrahi Yaklaşımımız ve Tedavi Sonuçlarımızın Retrospektif Değerlendirilmesi

GİRİŞ ve AMAÇ: Çalışmanın amacı Subaksiyel servikal travma (SST) nedeniyle tek bir omurga cerrahı tarafından ameliyat edilen olgulara uygulanan tedavi yönetimini Subaxiyel ServikalTravma Klasifikasyonu (SLIC) ve AOSpine klasifikasyon kriterlerine göre değerlendirmek ve olguların klinik ve radyolojik sonuçlarını geriye dönük olarak incelemektir YÖNTEM ve GEREÇLER: 2019-2020 yılları arasında kliniğimizde SST nedeniyle opere edilen 9 hastanın klinik ve radyolojik sonuçları değerlendirildi. BULGULAR: Olguların yaş dağılımı 18 ile 74 arasındaydı (ortalama = 46,2). Olguların takip süresi 5-27 (ortalama = 17.3) ay idi. Travma düzeyleri incelendiğinde 7 (%77.8) olguda C5-C6 düzeyinde, 2 olguda (%22.2) C6-C7 düzeyinde lezyonlar olduğu görüldü. Olguların SLIC puanları 5-9 (ortalama =6.4) aralığındaydı. Olguların ameliyat öncesiAmerikan Omurga Derneği Sınıflama (ASIA)skorları incelendiğinde 2 olguda A, 4 olguda C, 3 olguda D olduğu görüldü. TARTIŞMAve SONUÇ: SSTyüksek morbidite ve mortalite riski olan patolojilerdir.Anterior, posterior veya kombine yaklaşımlarla dekompresyon yapılarak spinal stabilite ve nörolojik iyileşme sağlanabilir. SST’de faset eklemler kırık açısından dikkatle değerlendirilmeli ve stabilizasyonun yetersiz olduğunu düşündüren radyolojik bulguların varlığında 360° füzyon yapılmalıdır.

Retrospectıve Evaluatıon of Our Surgıcal Approach and Treatment Results in Subaxıal Cervıcal Spıne Injury

INTRODUCTION: Objective: The aim of the study is to evaluate the treatment management applied to the cases operated by a single spinal surgeon for Subaxial cervical trauma (SCT) according to the Subaxial cervical spine injury classification (SLIC) and AOSpine criteria, and to analyze the clinical and radiological results of the cases retrospectively. METHODS: The clinical and radiological results of 9 patients who were operated for SCT in our clinic between 2019-2020 were evaluated. RESULTS: The age distribution of the cases was between 18 and 74 (mean = 46.2). The follow-up period of the cases was 5-27 (mean = 17.3) months. When the trauma levels were examined, it was seen that there were lesions at the C5-C6 level in 7 (77.8 %) cases and at the C6-C7 level in 2 (22.2 %) cases. The SLIC scores of the cases were in the range of 5-9 (mean =6.4). When the preoperative American Spinal Injury Association (ASIA) scores of the cases were examined, it was seen that it was A in 2 cases, C in 4 cases, and D in 3 cases. DISCUSSION AND CONCLUSION: SCT are pathologies with high morbidity and mortality risk. By performing decompression with anterior, posterior or combined approaches, spinal stability and neurological recovery can be achieved. Facet joints should be carefully evaluated in terms of fractures in SCT and 360° fusion should be performed in the presence of radiological findings suggesting that the stabilization is insufficient.

PDF

___

1. Canseco JA, Schroeder GD, Paziuk TM, Karamian BA, Kandziora F, Vialle EN, et al. The Subaxial Cervical AO Spine Injury Score. Global Spine Journal. December 2020. https://doi.org/10.1177/2192568220974339
2. Feuchtbaum E, Buchowski J, Zebala L. Subaxial cervical spine trauma. Curr Rev Musculoskelet Med. 2016;9(4):496- 504. https://doi.org/10.1007/s12178-016-9377-0
3. Shen Y, Shen HL, FengML, ZhangWB. Immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of lower cervical spine. J Spinal Disord Tech. 2015;28(1):1-8. https://doi.org/10.1097/BSD.0000000000000065
4. Aebi M. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J. 2010;19 (1):33-S39. https://doi.org/10.1007/s00586-009-1120-8
5. Cao BH, Wu ZM, Liang JW. Risk Factors for Poor Prognosis of Cervical Spinal Cord Injury with Subaxial Cervical Spine Fracture-DislocationAfter Surgical Treatment:ACONSORT Study. Med Sci Monit. 2019;25:1970-1975. https://doi.org/10.12659/MSM.915700
6.6. Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa1976). 1982;7(1):1-27. https://doi.org/10.1097/00007632-198201000-00001
7.Harris JH Jr, Edeiken-Monroe B, Kopaniky DR. A practical classification of acute cervical spine injuries. Orthop Clin North Am. 1986;17(1):15-30. https://doi.org/10.1016/S0030-5898(20)30415-6
8. Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman Jr RA et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). 2007;32(21):2365-2374. https://doi.org/10.1097/BRS.0b013e3181557b92
9. Samuel S, Lin JL, Smith MM, Hartin NL, Vasili C, Ruff SJ, et al. Subaxial injury classification scoring system treatment recommendations: external agreement study based on retrospective review of 185 patients. Spine (Phila Pa 1976). 2015;40(3):137-142. https://doi.org/10.1097/BRS.0000000000000666
10.Joaquim AF, Lawrence B, Daubs M, Brodke D, Patel AA. Evaluation of the subaxial injury classification system. J Craniovertebr Junction Spine. 2011;2(2):67-72. https://doi.org/10.4103/0974-8237.100057
11. Feuchtbaum E, Buchowski J, Zebala L. Subaxial cervical spine trauma. Curr Rev Musculoskelet Med. 2016;9(4):496-504. https://doi.org/10.1007/s12178-016-9377-0
12. Lee WJ, Yoon SH, Kim YJ, Kim JY, Park HC, Park CO. Interobserver and Intraobserver Reliability of Sub-Axial InjuryClassification and Severity Scale between Radiologist, Resident and Spine Surgeon. J Korean Neurosurg Soc. https://doi.org/10.1016/j.surneu.2007.05.006 2012;52(3):200-203. https://doi.org/10.3340/jkns.2012.52.3.200
13. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J. 2016;25(7):2173-2184. https://doi.org/10.1007/s00586-015-3831-3
14. Urrutia J, Zamora T, Yurac R, Campos M, Palma J, Mobarec S, et al. An Independent Inter- and Intraobserver Agreement Evaluation of the AOSpine Subaxial Cervical Spine Injury Classification System. Spine (Phila Pa 1976). 2017;42(5):298-303. https://doi.org/10.1097/BRS.0000000000001302
15. Rizzolo SJ, Piazza MR, Cotler JM, Balderston RA, Schaefer D,FlandersA.Intervertebraldiscinjurycomplicatingcervical spine trauma. Spine (Phila Pa 1976). 1991;16(6):187-189. https://doi.org/10.1097/00007632-199106001-00002
16. Orlando ER, Caroli E, Ferrante L. Management of the cervical esophagus and hypofarinx perforations complicating anterior cervical spine surgery. Spine (Phila Pa 1976). 2003;28(15):290-295. https://doi.org/10.1097/01.BRS.0000087093.89889.0A
17. Patel NP, Wolcott WP, Johnson JP, et al. Esophageal injury associated with anterior cervical spine surgery. Surg Neurol. 2008;69(1):20-24. https://doi.org/10.1016/j.surneu.2007.05.006
18. Abumi K, Kaneda K. Pedicle screw fixation for nontraumatic lesions of the cervical spine [published correction appears in Nurse Pract 1997 Oct;22(10):143]. Spine (Phila Pa 1976). 1997;22(16):1853-1863. https://doi.org/10.1097/00007632-199708150-00010
19. HadleyMN,Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, et al. Pharmacological therapy after acute cervical spinal cord injury. Neurosurgery. 2002;50(3):63-72. https://doi.org/10.1097/00006123-200209000-00063
20. Hurlbert RJ, Hadley MN, Walters BC, Aarabi B, Dhall SS, Gelb DE et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013;72 (2):93-105. https://doi.org/10.1227/NEU.0b013e31827765c6
21. Fehlings MG,Wilson JR, Harrop JS, Kwon BK,Tetreault LA, Arnold PM, et al. Efficacy and Safety of Methylprednisolone Sodium Succinate in Acute Spinal Cord Injury: ASystematic Review. Global Spine J. 2017;7(3):116-137. https://doi.org/10.1177/2192568217706366