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ANTERİOR SERVİKAL DİSKEKTOMİ VE FÜZYON UYGULANAN HASTALARDA KEMİK MİNERAL YOĞUNLUĞUNUN FÜZYON VE FİKSASYON ÜZERİNE ETKİSİ

Amaç Bu çalışmanın amacı, anterior servikal diskektomi ve füzyon uyguladığımız hastaların radyolojik ve klinik sonuçlarını karşılaştırmak ve füzyon oluşumu ile kemik mineral yoğunluğu arasındaki ilişkiyi saptamaktır. Gereç ve Yöntem Çalışmaya, Celal Bayar Üniversitesi Tıp Fakültesi Hastanesi Ortopedi ve Travmatoloji kliniğinde servikal dejeneratif disk hastalığı ve servikal spondiloz tanıları ile başvuran toplam 23 hasta dahil edildi. Olgular en az 3 ay süreyle tıbbi tedaviye yanıt vermeyen anterior diskektomi ve füzyon uygulanan hastalardan oluştu. Hastaların operasyon öncesi ve sonrası servikal bilateral grafileri alınarak, 1-3-6. ve 12. ay sonunda kemik mineral yoğunluğu, VAS skor değerleri, Boyun Engellilik İndeksi, Ishihara indeksi ve SF-36 değerlendirme sonuçları belirlenerek karşılaştırıldı. Bulgular Çalışmada kaynama oranı %95,6 bulundu 3. ayda sigara içmeyen grupta kaynama oranı %45, 6.ayda %65, 12. ayda %100’e ulaşıldı. Sigara içen grupta 3.ayda kaynama oranı %35, 6. ayda %55, 12. ayda ise % 85 bulundu. Ishihara indeksi değerlerindeki değişim ile hastaların yaşam standardı ve fonksiyonel sonuçlar arasında istatistiksel olarak anlamlı ilişki gözlendi. Hastalarda fonksiyonel sonuçlar ile servikal indeks kıyaslanarak, servikal indeksin anlamlı bir şekilde düzeltilmesi ile fonksiyonel sonuçlarda anlamlı bir iyileşme izlendi. Sonuç Günümüzde orta hat yerleşimli servikal disk hernilerinde en uygun girişim anterior yaklaşımdır. Füzyonlu ya da füzyonsuz yapılabilecek bu girişim hastanın stabilite sorununa göre karar verilecek bir durumdur. Otogreft, allogreft, kafes ya da plak-vida uygulama sonuçları, uzun dönem takiplerde sonuçların karşılaştırmasını gerekli kılmaktadır. Radyolojik incelemelerde servikal omurganın sagital plandaki eğiminde düzleşme veya kifotik deformite varsa posterior girişim ile yer yer füzyon olmuş spondilotik omurgada sagital deformiteyi düzeltmenin güç olması, mevcut olan kifotik deformiteyi artırması nedeniyle posterior servikal dekompresyon uygulanamaz hale gelmektedir.

Anahtar Kelimeler:

Anterior Servikal Diskektomi, Füzyon, Kemik Mineral Yoğunluğu, Ishihara indeksi

IN PATIENTS UNDERGOING ANTERIOR CERVICAL DISCECTOMY AND FUSION EFFECT OF BONE MINERAL DENSITY ON FUSION AND FIXATION

Objective The aim of this study is to compare the radiological and clinical results of patients who underwent anterior cervical discectomy and fusion, and to determine the relationship between fusion formation and bone mineral density. Materials and Methods A total of 23 patients, who were admitted to the study with a diagnosis of cervical degenerative disc disease and cervical spondylosis at a Faculty of Medicine Orthopedics and Traumatology clinic, were included in the study. The cases consisted of patients who underwent anterior discectomy and fusion, and did not respond to medical treatment for at least 3 months. Cervical bilateral radiographs of patients were taken before and after the operation and bone mineral density, VAS score values, Neck Disability Index, Ishihara index and SF-36 evaluation results were compared at the end of the 1st, 3rd, 6th and 12th months. Results In the study, the joining rate was found to be 95.6%. In the non-smoking group at the end of the 3rd month, the joining success was reached to 45%, 65% at the 6th month, and 100% at the 12th month. In the smoker group, the joining success at the 3rd month was 35%, 55% at the 6th month and 85% at the 12th month. A statistically significant relationship was observed between the changes in the Ishihara index values and the standard of living of patients and functional results. The functional results were compared with the cervical index, and a significant improvement was observed in the functional results with a significant correction of the cervical index. Conclusion Nowadays, the most suitable intervention is considered to be the anterior approach in midline cervical disc hernias. This intervention, which can be performed with or without fusion, is a situation to be decided according to the patient's stability problem. It can be concluded that autograft, allograft, cage or plate-screw application results require comparison of results in long-term follow-up. Moreover, in radiological examinations, if there is a flattening or kyphotic deformity in the inclination of the cervical spine in the sagittal plane, it is difficult to correct the sagittal deformity in the spondylotic spine, which has been fused in places with posterior intervention, and it increases the existing kyphotic deformity, making posterior cervical decompression impossible.

Keywords:

Anterior cervical discectomy, fusion, bone mineral density, Ishihara index,

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