İskender Samet DALTABAN, Hakan AK, Soner YAYCIOĞLU, Ali Rıza GÜVERCİN, Uğur YAZAR

Lomber Cerrahi Sonrası Gelişen Epidural Havanın Klinik Önemi

ÖzetAmaç: Lomber spinal cerrahi sonrası spinal kanalda hava görülmesi nadir olmamasına rağmen bu havanın semptomatik hale gelmesi çok nadirdir. Semptomatik epidural hava oluşumunun gerek patofizyolojisi gerekse tedavisi ile ilgili farklı yorumlar mevcuttur. Bu çalışmada amacımız kliniğimizce lomber omurga ameliyatı yapılan hastalarda semptomatik hava sıklığını ve tedavi yaklaşımlarımızı retrospektif olarak tespit etmekti.Yöntem: Ocak 2016- Aralık 2017 yılları arasında kliniğimizde lomber spinal cerrahi yapılan hastaların dosyaları ve radyolojik tetkikleri retrospektif olarak tarandı. Hastaların yaş, cinsiyet, eşlik eden kronik hastalık varlığı gibi demografik verilerinin yanında ameliyata neden olan patolojileri, yapılan cerrahi işlem ve ameliyat sonrası çekilen tomografi ve/veya manyetik rezonans görüntüleri incelenmiştir.Bulgular: Lomber spinal cerrahi yapılmış 285 hastanın 72’sinin (%25) radyolojik tetkiklerinde spinal kanalda hava tespit edildi. Bu hastaların yalnızca 3 (%0.3) tanesinde bacak ağrısı ve/veya kuvvet kaybı olduğu saptandı. Semptomu olan hastalarda üç doz tetrakosaktidinde mevcut analjezik tedaviye eklendiği konservatif tedavi ile tam klinik iyileşme tespit edilmiştir. Sonuç: Lomber omurga cerrahisi sonrası spinal kanalda hava görülmesi nadir olmamakla birlikte semptomatik epidural gaz oluşumu çok nadirdir. Bu hastalara öncelikle konservatif tedavi ile yaklaşılması uygun olacaktır. Kontrendike bir durum yoksa tedaviye tetrakosaktid eklenmesinin fayda sağladığını düşünmekteyiz.CLİNİCAL İMPORTANCE OF EPİDURAL AİR AFTER LUMBAR SPİNAL SURGERYAbstractAim: Air collection in the spinal canal after lumbar spinal surgery is not a rare event however it is very rare for this air to become symptomatic. There are different comments about pathophysiology and management of symptomatic epidural gas collection. In the present study we aimed to reveal the frequency and management of symptomatic air collection retrospectively in patients who undergo lumbar spine surgery in our clinic.Materials and method: Folders and radiological examinations of patients who underwent lumbar spinal surgery in our clinic between January 2016 and December 2017 were retrospectively reviewed. Age, gender, presence of comorbid chronic diseases, pathologies leading to operation, performed surgical procedures, and postoperative tomography and / or magnetic resonance images were investigated.Results: Radiological examinations of 72 (25%) of the 288 patients who underwent lumbar spinal surgery showed air in spinal canal. We detected leg pain and/or loss of strength only in 3 (0.3%) of these patients. In these symptomatic patients, complete clinical improvement was observed only by conservative treatment, in which three doses of tetracosactide was added to their routine analgesic treatment.Conclusion: Air in the spinal canal after lumbar spine surgery is not uncommon but symptomatic epidural gas formation is a very rare event. Conservative treatment should be the first line treatment in these patients. If there is no contraindication, it may be beneficial to add tetracosactide to routine treatment.

Anahtar Kelimeler:

LOMBER CERRAHİ, EPİDURAL HAVA, TERAKOSAKTİD

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