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SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI

Year 2018, Volume: 20 Issue: 3, 313 - 320, 30.12.2018

Mustafa Öğden Süleyman Akkaya Ulaş Yüksel Ahmet Turan Dağlı Bülent Bakar Mehmet Faik Özveren

https://doi.org/10.24938/kutfd.473716
Cited By: 1

Abstract

Amaç: Servikal omurgadaki kemik ve ligamentöz yapıların dejeneratif
değişiklikleri spinal kanal darlığına ve spinal kord basısına yol açmaktadır.
Posterior destek sağlayan kas, ligament gibi yapıların korunarak, unilateral
yaklaşım ile bilateral dekompresyon (UYBD) giderek yaygın olarak
uygulanmaktadır. Bu çalışmada, unilateral yaklaşım ile bilateral dekompresyon
cerrahi tekniği kullanılarak tedavi edilen servikal spondilotik myelopatili
(SSM) hastalarda, bu yöntemin etkinliğini değerlendirmeyi amaçladık.

Gereç ve Yöntem: SSM tanısıyla unilateral yaklaşım ile
bilateral dekompresyon tekniği ile opere edilen hastaların verileri
retrospektif olarak incelendi. Hastaların yaş, cinsiyet, operasyon öncesi ve 1
yıl sonrası ağrı şiddetini gösteren vizüel analog skala (VAS) değerleri ile
OSWESTRY Disabilite İndeksi (ODİ) değerleri kayıt edildi.

Bulgular: Çalışmamıza yaşları 41 ile 77 arasında değişen
(ortalama 60.23±9.5 yıl) toplam 13 hasta dahil edildi. Hastaların %76.9’u erkek
idi. Tedavi sonrası VAS ve ODİ değerleri karşılaştırıldığında tedavi sonrası değerlerde
istatistiksel olarak anlamlı bir iyileşme görüldü (p=0.001).







Sonuç: Çalışmamızda SSM’li hastalarda unilateral yaklaşım
ile bilateral dekompresyon cerrahisiyle başarılı sonuçlar elde edilmiştir.
SSM’li hastalarda henüz az sayıda çalışmada unilateral yaklaşım ile bilateral
dekompresyon tekniği ile tedavinin etkinliği değerlendirilmiş olduğu dikkate
alındığında, bu çalışmada elde ettiğimiz sonuçlar bundan sonraki çalışmalara
ışık tutacaktır.

Keywords

Servikal spinal stenoz servikal spondiloz servikal disk hernisi spinal dekompresyon

References

  • 1. Northover J, Wild J, Braybrooke J, Blanco J. The epidemiology of cervical spondylotic myelopathy. Skeletal Radiol. 2012;41(12):1543-6.
  • 2. Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist. 2010;16(3):176-87.
  • 3. Morishita Y, Naito M, Hymanson H, Miyazaki M, Wu G, Wang JC. The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J. 2009;18(6):877-83.
  • 4. Kumaresan S, Yoganandan N, Pintar FA, Maiman DJ, Goel VK. Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation. J Orthop Res. 2001;19(5):977-84.
  • 5. Toledano M, Bartleson JD. Cervical spondylotic myelopathy. Neurol Clin. 2013;31(1):287-305.
  • 6. Wu JC, Ko CC, Yen YS. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus. 2013;35(1):E10.
  • 7. Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG. Pathophysiology and natural history of cervical spondylotic myelopathy. Spine 2013;38(22 Suppl 1):21-36.
  • 8. Farrokhi MR, Ghaffarpasand F, Khani M, Gholami M. An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature World Neurosurgery. 2016:94:97-110.
  • 9. Cabraja M, Abbushi A, Koeppen D, Kroppenstedt S, Woiciechowsky C. Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome. Neurosurg Focus. 2010;28(3):E15.
  • 10. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery. 2003;52(5):1081-8.
  • 11. Qian L, Shao J, Liu Z, Cheng L, Zeng Z, Jia Y et al. Comparison of the safety and efficacy of anterior 'skip' corpectomy versus posterior decompression in the treatment of cervical spondylotic myelopathy. J Orthop Surg Res. 2014;9:63. Doi: 10.1186/s13018-014-0063-x.
  • 12. Yaman O, Ozdemir N, Dagli AT, Acar E, Dalbayrak S, Temiz C. A comparison of Bilateral Decompression via Unilateral Approach and classic laminectomy in Patients with lumbar spinal stenosis: A retrospective clinical study. Turk Neurosurg. 2015;25(2):239-45.
  • 13. Haba K, Ikeda M, Soma M, Yamashima T. Bilateral decompres- sion of multilevel lumbar spinal stenosis through a unilateral approach. J Clin Neurosci. 2005;12(2):169-71.
  • 14. Krut’ko AV. Results of decompressive-stabilizing procedures via unilateral approach in lumbar spinal stenosis. Zh Vopr Neirokhir Im N N Burdenko. 2012;76(2):33-40.
  • 15. Liu X, Yuan S, Tian Y. Modified unilateral laminotomy for bilateral decompression for lumbar spinal stenosis-technical note. Spine. 2013;38(12):732-7.
  • 16. Yang B, Chen R, Xie P, Liu B, Dong J, Rong L. Microendoscopic decompression via unilateral approach for lumbar spinal stenosis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011;25(10):1158-63.
  • 17. Moisi M, Fisahn C, Tkachenko L, Tubbs RS, Ginat D, Grunert P et al. Unilateral Laminotomy with Bilateral Spinal Canal Decompression for Lumbar Stenosis: A Technical Note. Cureus. 2016;8(5):e623. Doi: 10.7759/cureus.623.
  • 18. Musluman AM, Cansever T, Yilmaz A, Cavusoglu H, Yuce I, Aydin Y. Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis. J Neurosurg Spine. 2012;16(1):68-76.
  • 19. Sinha S, Jagetia A. Bilateral open-door expansive laminoplasty using unilateral posterior midline approach with preservation of posterior supporting elements for management of cervical myelopathy and radiculomyelopathy-analysis of clinical and radiological outcome and surgical technique. Acta Neurochir. 2011;153(5):975-84.
  • 20. Lin S, Zhou F, Sun Y, Chen Z, Zhang F, Pan S. The severity of operative invasion to the posterior muscular- ligament complex influences cervical sagittal balance after open-door laminoplasty. Eur Spine J. 2015;24(1):127-35.
  • 21. Roselli R, Pompucci A, Formica F, Restuccia D, Di Lazzaro V, Valerini M et al. Open door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring. J Neurosurg. 2000;92(1 Suppl):38-43.
  • 22. Kothe R, Schmeiser G, Papavero L. Open-door laminoplasty What can the unilateral approach offer? Oper Orthop Traumatol. 2018;30(1):3-12.
  • 23. Naderi S, Benzel EC, Baldwin NG. Cervical spondylotic myelopathy: surgical decision making. Neurosurg Focus. 1996;1(6):e1.
  • 24. Guérin P, Obeid I, Gille O, Bourghli A, Luc S, Pointillart V et al. Sagittal alignment after single cervical disc arthroplasty. J Spinal Disord Tech. 2012;25:10-6.
  • 25. Gum JL, Glassman SD, Douglas LR, Carreon LY. Correlation between cervical spine sagittal alignment and clinical outcome after anterior cervical discectomy and fusion. Am J Orthop. 2012;41(6):81-4.
  • 26. Asgarzadie F, Khoo LT. Minimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes. Orthop Clin North Am. 2007;38(3):387-99.
  • 27. Kim JS, Jung B, Arbatti N, Lee SH. Surgical Experience of Unilateral Laminectomy for Bilateral Decompression (ULBD) of Ossified Ligamentum Flavum in the Thoracic Spine. Minim Invas Neurosurg. 2009;52(2):74-8.

Clinical Results of Bilateral Decompression with Posterior Unilateral Approach in Patient with Cervical Myelopathy

Year 2018, Volume: 20 Issue: 3, 313 - 320, 30.12.2018

Mustafa Öğden Süleyman Akkaya Ulaş Yüksel Ahmet Turan Dağlı Bülent Bakar Mehmet Faik Özveren

https://doi.org/10.24938/kutfd.473716
Cited By: 1

Abstract

Objective: Degenerative changes in bone and ligamentous structures in
the cervical spine lead to spinal canal stenosis and spinal cord compression.
Bilateral decompression with unilateral approach is increasingly being applied
with preserving structures such as muscles and ligaments that provide posterior
support. The aim of this study was to evaluate the efficacy of this method in
patients with cervical sponylotic myelopathy (CSM) who were treated using bilateral
decompression with unilateral approach surgical technique.

Material and Method: The data of patients who had CSM and were
operated using bilateral decompression with unilateral approach technique were
retrospectively reviewed. Demographical features such as age, gender were
noted. Preoperative and postoperative (first year) pain severity were evaluated
using Visual analogue Scale (VAS) ​​and OSWESTRY Disability Index (ODI).

Results: A total of 13 patients aged between 41 and 77 years (mean 60.23±9.5
years) were included. 76.9% of the patients were male. When post-treatment VAS
and ODI values ​​were compared, there was a statistically significant
improvement in post-treatment values ​​(p=0.001).







Conclusion:
In our study, successful results were obtained with bilateral
decompression with unilateral approach in CSM patients. Considering that the
efficacy of the treatment with bilateral decompression with unilateral approach
technique has been assessed in a small number of CSM patients, the results
obtained in this study will encourage further studies.

Keywords

Cervical spinal stenosis cervical spondylosis cervical disc hernia spinal decompression

References

  • 1. Northover J, Wild J, Braybrooke J, Blanco J. The epidemiology of cervical spondylotic myelopathy. Skeletal Radiol. 2012;41(12):1543-6.
  • 2. Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist. 2010;16(3):176-87.
  • 3. Morishita Y, Naito M, Hymanson H, Miyazaki M, Wu G, Wang JC. The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J. 2009;18(6):877-83.
  • 4. Kumaresan S, Yoganandan N, Pintar FA, Maiman DJ, Goel VK. Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation. J Orthop Res. 2001;19(5):977-84.
  • 5. Toledano M, Bartleson JD. Cervical spondylotic myelopathy. Neurol Clin. 2013;31(1):287-305.
  • 6. Wu JC, Ko CC, Yen YS. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus. 2013;35(1):E10.
  • 7. Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG. Pathophysiology and natural history of cervical spondylotic myelopathy. Spine 2013;38(22 Suppl 1):21-36.
  • 8. Farrokhi MR, Ghaffarpasand F, Khani M, Gholami M. An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature World Neurosurgery. 2016:94:97-110.
  • 9. Cabraja M, Abbushi A, Koeppen D, Kroppenstedt S, Woiciechowsky C. Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome. Neurosurg Focus. 2010;28(3):E15.
  • 10. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery. 2003;52(5):1081-8.
  • 11. Qian L, Shao J, Liu Z, Cheng L, Zeng Z, Jia Y et al. Comparison of the safety and efficacy of anterior 'skip' corpectomy versus posterior decompression in the treatment of cervical spondylotic myelopathy. J Orthop Surg Res. 2014;9:63. Doi: 10.1186/s13018-014-0063-x.
  • 12. Yaman O, Ozdemir N, Dagli AT, Acar E, Dalbayrak S, Temiz C. A comparison of Bilateral Decompression via Unilateral Approach and classic laminectomy in Patients with lumbar spinal stenosis: A retrospective clinical study. Turk Neurosurg. 2015;25(2):239-45.
  • 13. Haba K, Ikeda M, Soma M, Yamashima T. Bilateral decompres- sion of multilevel lumbar spinal stenosis through a unilateral approach. J Clin Neurosci. 2005;12(2):169-71.
  • 14. Krut’ko AV. Results of decompressive-stabilizing procedures via unilateral approach in lumbar spinal stenosis. Zh Vopr Neirokhir Im N N Burdenko. 2012;76(2):33-40.
  • 15. Liu X, Yuan S, Tian Y. Modified unilateral laminotomy for bilateral decompression for lumbar spinal stenosis-technical note. Spine. 2013;38(12):732-7.
  • 16. Yang B, Chen R, Xie P, Liu B, Dong J, Rong L. Microendoscopic decompression via unilateral approach for lumbar spinal stenosis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011;25(10):1158-63.
  • 17. Moisi M, Fisahn C, Tkachenko L, Tubbs RS, Ginat D, Grunert P et al. Unilateral Laminotomy with Bilateral Spinal Canal Decompression for Lumbar Stenosis: A Technical Note. Cureus. 2016;8(5):e623. Doi: 10.7759/cureus.623.
  • 18. Musluman AM, Cansever T, Yilmaz A, Cavusoglu H, Yuce I, Aydin Y. Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis. J Neurosurg Spine. 2012;16(1):68-76.
  • 19. Sinha S, Jagetia A. Bilateral open-door expansive laminoplasty using unilateral posterior midline approach with preservation of posterior supporting elements for management of cervical myelopathy and radiculomyelopathy-analysis of clinical and radiological outcome and surgical technique. Acta Neurochir. 2011;153(5):975-84.
  • 20. Lin S, Zhou F, Sun Y, Chen Z, Zhang F, Pan S. The severity of operative invasion to the posterior muscular- ligament complex influences cervical sagittal balance after open-door laminoplasty. Eur Spine J. 2015;24(1):127-35.
  • 21. Roselli R, Pompucci A, Formica F, Restuccia D, Di Lazzaro V, Valerini M et al. Open door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring. J Neurosurg. 2000;92(1 Suppl):38-43.
  • 22. Kothe R, Schmeiser G, Papavero L. Open-door laminoplasty What can the unilateral approach offer? Oper Orthop Traumatol. 2018;30(1):3-12.
  • 23. Naderi S, Benzel EC, Baldwin NG. Cervical spondylotic myelopathy: surgical decision making. Neurosurg Focus. 1996;1(6):e1.
  • 24. Guérin P, Obeid I, Gille O, Bourghli A, Luc S, Pointillart V et al. Sagittal alignment after single cervical disc arthroplasty. J Spinal Disord Tech. 2012;25:10-6.
  • 25. Gum JL, Glassman SD, Douglas LR, Carreon LY. Correlation between cervical spine sagittal alignment and clinical outcome after anterior cervical discectomy and fusion. Am J Orthop. 2012;41(6):81-4.
  • 26. Asgarzadie F, Khoo LT. Minimally invasive operative management for lumbar spinal stenosis: overview of early and long-term outcomes. Orthop Clin North Am. 2007;38(3):387-99.
  • 27. Kim JS, Jung B, Arbatti N, Lee SH. Surgical Experience of Unilateral Laminectomy for Bilateral Decompression (ULBD) of Ossified Ligamentum Flavum in the Thoracic Spine. Minim Invas Neurosurg. 2009;52(2):74-8.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Mustafa Öğden 0000-0002-7129-0936

Süleyman Akkaya

Ulaş Yüksel This is me

Ahmet Turan Dağlı

Bülent Bakar

Mehmet Faik Özveren

Publication Date December 30, 2018
Submission Date October 23, 2018
Published in Issue Year 2018 Volume: 20 Issue: 3

Cite

APA Öğden, M., Akkaya, S., Yüksel, U., Dağlı, A. T., et al. (2018). SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 20(3), 313-320. https://doi.org/10.24938/kutfd.473716
AMA Öğden M, Akkaya S, Yüksel U, Dağlı AT, Bakar B, Özveren MF. SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI. Kırıkkale Uni Med J. December 2018;20(3):313-320. doi:10.24938/kutfd.473716
Chicago Öğden, Mustafa, Süleyman Akkaya, Ulaş Yüksel, Ahmet Turan Dağlı, Bülent Bakar, and Mehmet Faik Özveren. “SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 20, no. 3 (December 2018): 313-20. https://doi.org/10.24938/kutfd.473716.
EndNote Öğden M, Akkaya S, Yüksel U, Dağlı AT, Bakar B, Özveren MF (December 1, 2018) SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 20 3 313–320.
IEEE M. Öğden, S. Akkaya, U. Yüksel, A. T. Dağlı, B. Bakar, and M. F. Özveren, “SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI”, Kırıkkale Uni Med J, vol. 20, no. 3, pp. 313–320, 2018, doi: 10.24938/kutfd.473716.
ISNAD Öğden, Mustafa et al. “SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 20/3 (December 2018), 313-320. https://doi.org/10.24938/kutfd.473716.
JAMA Öğden M, Akkaya S, Yüksel U, Dağlı AT, Bakar B, Özveren MF. SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI. Kırıkkale Uni Med J. 2018;20:313–320.
MLA Öğden, Mustafa et al. “SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 20, no. 3, 2018, pp. 313-20, doi:10.24938/kutfd.473716.
Vancouver Öğden M, Akkaya S, Yüksel U, Dağlı AT, Bakar B, Özveren MF. SERVİKAL MİYELOPATİLİ HASTALARDA UNİLATERAL YAKLAŞIM İLE BİLATERAL DEKOMPRESYONUN KLİNİK SONUÇLARI. Kırıkkale Uni Med J. 2018;20(3):313-20.

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