Evren SANDAL, Burak KINALI, Ali KARADAG, Sedat ÇAĞLI

Baziler İnvajinasyonun Cerrahi Tedavisi: Farklı Cerrahi Yaklaşımların Klinik ve Radyografik Sonuçların Karşılaştırılması

Amaç: Baziler invajinasyonun cerrahi tedavisine yönelik çeşitli yaklaşımların ana hatları literatürdeki birçok çalişmada araştırılmış ancak hiçbiri objektif klinik ve radyolojik kriterler kullanarak farklı tedavi seçeneklerini karşılaştırmamıştır. Çalışmamızda farklı cerrahi girişimle opera edilen baziller invaginasyonu olan hastaların objektif klinik ve radyolojik parametreler kullanılarak karşılaştırılması amaçlandı. Yöntemler: 2000-2014 yılları arasında baziler invajinasyon nedeniyle opere edilen hastalar retrospektif olarak incelendi. Sekonder baziler invajinasyon kriterlerini karşılayan romatoid artritin neden olduğu atlantoaksiyal subluksasyonu olan iki olgu da çalışmaya dahil edildi. Çalışmaya beş farklı cerrahi yaklaşımla tedavi edilen baziler invajinasyonlu toplam 30 hasta dahil edildi. Cerrahi sonuçlar objektif klinik (Ranawat skoru) ve radyolojik parametreler (Chamberlain mesafesi, atlantodental interval ve kraniovertebral açı) kullanılarak değerlendirildi ve karşılaştırıldı. Bulgular: Çalışmamızda posterior stabilizasyonlu anterior dekompresyon, posterior stabilizasyonlu posterior dekompresyon ve Goel prosedürü (posterior dekompresyon, posterior redüksiyon, kafes distraksiyonu ve posterior stabilizasyon) uygulanan hastalarda Ranawat skorunda istatistiksel olarak anlamlı bir iyileşme olduğu saptandı. Bunlardan Goel prosedürü fonksiyonel ve radyografik surveyde en iyi sonuçları gösterdi. Posterior stabilizasyonu uygulanmayan hiçbir grupta (tek başına posterior dekompresyon veya yalnızca endoskopik transnazal odontoidektomi), Ranawat skorunda veya radyografik sonuçlarda anlamlı bir iyileşme olmadı. Anterior dekompresyon ve posterior stabilizasyonun birlikte uygulandığı cerrahi prosedürlerde de başarı oranı yüksek idi. Sonuç: Baziler invajinasyonun cerrahi tedavisinde posterior dekompresyon, posterior redüksiyon, kafes distraksiyonu ve posterior stabilizasyonun birlikte yapıldığı cerrahi uygulamalar en iyi klinik ve radyolojik sonucu verdi. Posterior stabilizasyonsuz cerrahi tedavi edilen hastalarda, kranioservikal instabilite ve kifoz gelişimi tekrar darlık oluşumu riskleri vardır. Bu nedenle posterior stabilizasyonsuz basiler invaginasyon ameliyatı kararı alınırken titizlikle düşünülmeli bu durumlar göz önünde bulundurulmalıdır.

Anahtar Kelimeler:

Basiller invajinasyon, cerrahi tedavi, kranioservikal bileşke, Goel prosedürü, omurga cerrahisi

Surgical Management of Basilar Invagination: Comparison of Clinical and Radiographic Outcomes Utilizing Differing Surgical Approaches

Aim: Previous studies have outlined various surgical approaches to treatment of basilar invagination, but none have compared multiple different treatment options using objective clinical and radiological criteria. Material and Methods: We retrospectively reviewed the records of 30 patients with basilar invagination treated by five different surgical approaches. The surgical outcomes were evaluated and compared using objective clinical (Ranawat score) and radiological parameters (Chamberlain distance, atlantodental interval, and craniovertebral angle). Results: Our results show a statistically significant improvement in the Ranawat score for patients undergoing 1) anterior decompression with posterior stabilization, 2) posterior decompression with posterior stabilization, and 3) the Goel procedure (posterior decompression, posterior reduction, cage distraction, and posterior stabilization). Of these, the Goel procedure produced the most significant improvement in functional and radiographic outcomes. Neither group without posterior stabilization (posterior decompression alone or endoscopic transnasal odontoidectomy alone) had a significant improvement in Ranawat score or radiographic outcomes. Conclusion: For surgical management of basilar invagination, a combination of posterior decompression, posterior reduction, cage distraction, and posterior stabilization yielded the best clinical and radiological outcome. There is a risk of craniocervical instability and kyphosis and recurrence of stenosis in patients treated surgically without posterior stabilization. Therefore, when deciding on bacillary invagination surgery without posterior stabilization, it should be carefully considered.

Keywords:

Basilar invagination, surgical treatment, craniocervical junction, Goel procedure, spine surgery,

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