Torakolomber bileşke disk herniasyonlarının cerrahi tedavisinde posterolateral transkambin yaklaşım
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Istanbul Univ, Fac Medicine, Publ Off
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Torakolomber bileşke disk herniasyonlarının (TLBDH) tedavisi için optimal cerrahi yaklaşım biçimi halen tartışmalıdır. TLBDH’nın güncel cerrahi tedavisinde anterolateral retroperitoneal, anterior transtorasik, posterolateral, lateral ve transforaminal endoskopik yaklaşımlar uygulanmaktadır. Posterolateral transkambin yaklaşımda, pars interartikülaris ve faset ekleminden minimal kemik alınarak, instabiliteye yol açmadan diskektomi ile dekompresyon sağlanmaktadır. Transkambin yaklaşımın, ileri düzeyde nöral doku retraksiyonu olmaksızın diskektomi yapılabilmesi, iyileşme süresinin kısa olması ve postoperatif komplikasyonların daha az görülmesi gibi avantajları vardır. Yöntemler: Kliniğimizde 2016-2018 tarihleri arasında posterolateral transkambin yaklaşım ile ameliyat edilen 3’ü T12-L1 ve 5’i L1-2 TLBDH’lı 8 hasta retrospektif olarak sunuldu. Çalışmamıza far lateral, foraminal ve paramedian uzanım gösteren, klinik olarak kauda ekuina sendromu, konus medüllaris sendromu ve radikülopatiye neden olmuş, ekstrüde veya sekestre disk hernili hastalar dahil edildi. Hastalarda cilt insizyonu ve fasyanın açılışı orta hattan yapıldı. Paravertebral adeleler subperiostal sıyrılarak pars lateralinde çıkan kök açığa konulup sekestre veya ekstrüde disk fragmanlarının alınması hedeflendi. Bulgular: Hastaların 3’ü erkek, 5’i kadın ve ortalama yaşı 45,1 (32- 66) olarak saptandı. Ortalama operasyon süresi 57,8 dakikaydı. Preoperatif VAS değerleri 8,75±0,51, postoperatif VAS değerleri 1,25±0,65 saptandı. MacNab klasifikasyonuna göre postoperatif 6 ay sonraki sonuçları; %62,5‘i mükemmel, %25’i iyi, %12,5’i vasat olarak bulundu. Hastalarda nörolojik hasar, beyin omurilik sıvısı (BOS) fistülü, pnömotoraks ve operasyon lojunda hematom gelişmedi.
Objective: The optimal surgical approach for treatment of thoracolumbar junction disc herniations (TLJDH) remains controversial. Anterolateral retroperitoneal, anterior transthoracic, posterolateral, lateral and transforaminal endoscopic approaches are used in current surgical treatment of TLJDH. In a posterolateral transcambin approach, a small piece of bone is removed from the pars interarticularis and facet joints, and decompression is achieved by discectomy without causing instability. The transcambin approach has advantages such as discectomy without advanced neural tissue retraction, short recovery time and less postoperative complications. Methods: The eight patients with 3 T12-L1 and 5 L1-2 TLJDH who were operated on using the posterolateral transcambin approach between 2016-2018 in our clinic were presented retrospectively. The study included patients with extruded or sequestrated disc herniation that had far lateral, foraminal, and paramedian extension, and caused cauda equina syndrome, conus medullaris syndrome, and radiculopathy. A skin incision and fascia opening were done from midline. The exiting root was revealed at laterally of pars interarticularis by subperiosteally stripping of paravertebral muscles and the removal of disc fragments were targeted. Results: Three male and five female patients with a mean age of 45.1 (32-66). Mean operation time was 57.8 minutes. Preoperative VAS values were 8.75 +/- 0.51 and postoperative VAS values were 1.25 +/- 0.65. According to the MacNab classification, 62.5% excellent, 25% good and 12.5% were fair. There was no neurological injury, cerebrospinal fluid (CSF) fistula, pneumothorax, or operation field hematoma. Conclusion: The transcambin approach was found to be useful in terms of a relatively short operation time, low morbidity probability, and less postoperative pain in patients with TLJDH.
Objective: The optimal surgical approach for treatment of thoracolumbar junction disc herniations (TLJDH) remains controversial. Anterolateral retroperitoneal, anterior transthoracic, posterolateral, lateral and transforaminal endoscopic approaches are used in current surgical treatment of TLJDH. In a posterolateral transcambin approach, a small piece of bone is removed from the pars interarticularis and facet joints, and decompression is achieved by discectomy without causing instability. The transcambin approach has advantages such as discectomy without advanced neural tissue retraction, short recovery time and less postoperative complications. Methods: The eight patients with 3 T12-L1 and 5 L1-2 TLJDH who were operated on using the posterolateral transcambin approach between 2016-2018 in our clinic were presented retrospectively. The study included patients with extruded or sequestrated disc herniation that had far lateral, foraminal, and paramedian extension, and caused cauda equina syndrome, conus medullaris syndrome, and radiculopathy. A skin incision and fascia opening were done from midline. The exiting root was revealed at laterally of pars interarticularis by subperiosteally stripping of paravertebral muscles and the removal of disc fragments were targeted. Results: Three male and five female patients with a mean age of 45.1 (32-66). Mean operation time was 57.8 minutes. Preoperative VAS values were 8.75 +/- 0.51 and postoperative VAS values were 1.25 +/- 0.65. According to the MacNab classification, 62.5% excellent, 25% good and 12.5% were fair. There was no neurological injury, cerebrospinal fluid (CSF) fistula, pneumothorax, or operation field hematoma. Conclusion: The transcambin approach was found to be useful in terms of a relatively short operation time, low morbidity probability, and less postoperative pain in patients with TLJDH.
Açıklama
Anahtar Kelimeler
Posterolateral Transcambin, Exiting Root, Thoracolumbar
Kaynak
Journal of Istanbul Faculty of Medicine-Istanbul Tip Fakultesi Dergisi
WoS Q Değeri
N/A
Scopus Q Değeri
Cilt
83
Sayı
3
Künye
Can, H., & Diren, F. (2020). Posterolateral transcambın approach for surgıcal treatment of thoracolomber dısc hernıatıons.
