Comparison of two types of surgery for lumbar spinal stenosis in elderly: decompressive laminectomy with and without fusion

Tayfun Çakır; Şeyho Cem Yücetaş

doi:10.30569/adiyamansaglik.649416

Araştırma Makalesi

Comparison of two types of surgery for lumbar spinal stenosis in elderly: decompressive laminectomy with and without fusion

Yıl 2020, Cilt: 6 Sayı: 1, 54 - 58, 23.04.2020

Tayfun Çakır Şeyho Cem Yücetaş

https://doi.org/10.30569/adiyamansaglik.649416

Öz

Aim: To compare decompressive total laminectomy with and without instrumented fusion.

Materials and Methods: 54 patients who underwent decompression formed the group 1, and 48 patients who underwent decompression plus fusion formed group 2. Patients were compared in terms of age, sex, body mass index, duration of surgery, length of hospital stay, visual analog scale (VAS) and oswestry disability index (ODI) scores and complications.

Results: No significantly differences about age, sex, body mass index (BMI), length of hospital stay were found between the groups. There was significant difference between the groups about mean operative times (p<0.05). In both of the groups VAS scores improved significantly. In both groups there was statistically significant decrease in ODI values. And second surgery requirement was significantly higher in the group 2 (p<0.01).

Conclusion: Facet protective decompression surgery performed up to two levels can be successfully terminated without fusion.

Anahtar Kelimeler

Spinal, Stenosis, Laminectomy, Fusion, Elderly

Kaynakça

1. Çelik AA, Coşkun S, Kılınç O, Yıldırım A. Bel ağrısı nedeniyle polikliniğimize başvuran hastalarda skolyoz sıklığı ve Cobb açısı değerlerinin yaş ve cinsiyet ile ilişkisi. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi. 2017;3(3):551-564.
2. Dönmez YC, Van Giersbergen MY, Başlı AA, Yıldız MD, Yıldız E. Lomber Disk Hernisi Olan Hastaların Sağlıklı Yaşam Biçimi Davranışlarının ve Öz-Bakım Gücünün Belirlenmesi. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi. 2019;5(2):1628-1641.
3. Jönsson B, Annertz M, Sjöberg C, Strömqvist B. A prospective and consecutive study of surgically treated lumbar spinal stenosis: part I: clinical features related to radiographic findings. Spine. 1997;22(24):2932-2937.
4. Truumees E. Spinal stenosis: pathophysiology, clinical and radiologic classification. Instructional Course Lectures. 2005;54:287-302.
5. Ježek J, Waldauf P, Krbec M, Douša P, Skála-Rosenbaum J. Outcomes and Complications of Surgical Treatment for LSS at 1-Year Follow-up-Prospective Study. Actachirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2019;86(4):256-263.
6. Kalbarczyk A, Lukes A, Seiler RW. Surgical treatment of lumbar spinal stenosis in the elderly. Acta Neurochirurgica. 1998;140(7):637-641.
7. Machado GC, Ferreira PH, Yoo RIJ, Harris IA, Pinheiro MB, Koes BW, Ferreira ML. Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;11:CD012421.
8. Ciol MA, Deyo RA, Howell E, Kreif, S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc. 1996;44:285–90
9. Taylor VM, Deyo RA, Cherkin DC, et al. Low back pain hospitalization: recent United States trends and regional variations. Spine. 1994;19:1207–13.
10. Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK. Revision surgery following operations for lumbar stenosis. J Bone Joint Surg Am. 2011;93:1979–86.
11. Thomas K, Faris P, McIntosh G, Manners S, Abraham E, Bailey CS, Manson NA. Decompression Alone vs Decompression plus Fusion for Claudication Secondary to Lumbar Spinal Stenosis. The Spine Journal. 2019;(10):1633-1639.
12. Forsth P, Olafsson G, Carlsson T, Frost A, Borgstr€om F, Fritzell P, Sandén, B. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374:1413–23.
13. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991;73:802–8.
14. Demiröz S, Bayram S, Coskun T, Cirakli A, Yanik HS, Atici Y, Erdem Ş. Evaluation of the distal adjacent segment after longsegment posterior instrumentation and fusion for adolescent idiopathic scoliosis. Annals of Medical Research. 2019;26(10):2134-8.
15. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management? A prospective 10‐year study. Spine. 2000;25(11):1424‐35.
16. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Hilibrand, A. SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine. 2008;358(8):794‐810.
17. Çakir T, Çakir M, Okay HÖ, Yolaş C, Tanriverdi O, Ömeroğlu M, Arslan YK. Single level discectomy with and without disc prosthesis: A comparative study of 114 patients. Medicine. 2018;97(52).
18. Ilharreborde B, Morel E, Mazda K, Dekutoski MB. Adjacent segment disease after instrumented fusion for idiopathic scoliosis: review of current trends and controversies. Clinical Spine Surgery 2009;22(7):530-539.
19. Zhong ZM, Deviren V, Tay B, Burch S, Berven SH. Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: incidence and risk factors. Clinical Neurology and Neurosurgery. 2017;156:29-34.
20. Aydin A, Çilingir D. Yeniden Ameliyat Olma (Reoperasyon) ve Hemşirelik Bakımı. Koç Üniversitesi Hemşirelikte Eğitim ve Araştırma Dergisi. 2017;14(3):218-222.
21. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine. 2004;29(17):1938-1944.
22. Kizilay Z, Topcu A, Aydin YS, Berber O, Ozturk, H. Short and Medium Term Results of Posterior Segmental Instrumentation and Posterolateral Fusion in Female Patients with Spondylolisthesis: A Clinical Trial/Spondilolistezli Kadin Hastalarda Posterior Segmental Enstrumantasyon ve Posterolateral Fuzyonun Kisa ve Orta Vadeli Sonuclari: Klinik Calisma. Meandros Medical and Dental Journal. 2018;19(4):328-336.
23. Min JH, Jang JS, joo Jung B, Lee HY, Choi WC, Shim CS, Lee SH. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. Clinical Spine Surgery. 2008;21(5):305-309.
24. Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG. Adjacent segment degeneration in the lumbar spine. The Journal of Bone and Joint Surgery. 2004;86(7):1497-1503.
25. Lee CS, Hwang CJ, Lee SW, Ahn YJ, Kim YT, Lee DH, Lee MY. Risk factors for adjacent segment disease after lumbar fusion. European Spine Journal. 2009;18(11):1637.

Yaşlılarda lomber spinal stenoz için iki tip cerrahinin karşılaştırılması: füzyonlu ve füzyonsuz dekompresif laminektomi

Yıl 2020, Cilt: 6 Sayı: 1, 54 - 58, 23.04.2020

Tayfun Çakır Şeyho Cem Yücetaş

https://doi.org/10.30569/adiyamansaglik.649416

Öz

Amaç: Lomber spinal stenoz cerrahisinde füzyonlu ve füzyonsuz dekompresif laminektomi yapılan hastaların 3 yıl sonundaki klinik bulgularını ve komplikasyon oranlarını karşılaştırmak.

Gereç ve Yöntem: Grup 1'de tek başına dekompresyon uygulanan 54 hasta, grup 2'de ise dekompresyon ve posterior transpediküler füzyon uygulanan 48 hasta vardı. Ameliyat süresi, hastanede kalış süresi, yaş, cinsiyet, vücut kitle indeksi gibi özellikler değerlendirildi. Hastaların vizüel ağrı skalası (VAS), oswestry disability index (ODI) skorlarında değişim ve komşu segment sendromu gibi komplikasyon oranları karşılaştırıldı.

Bulgular: Yaş, cinsiyet, vücut kitle indeksi (VKİ) ve hastanede kalış süresi açısından anlamlı bir farklılık yoktu ama ameliyat süresi açısından anlamlı fark vardı (p<0,05). İki grupta da VAS ve ODI açısından anlamlı şekilde iyileşme gözlendi. Grup 2'de 3 yıllık süreç içerisinde ikinci cerrahi gereksinimi daha yüksekti (p<0,01).

Sonuç: İki seviyeye kadar yapılan dekompresyon cerrahisinin füzyon gerektirmeden başarıyla yapılabileceği sonucuna vardık.

Anahtar Kelimeler

Spinal, Stenoz, Laminektomi, Füzyon, Yaşlılık

Kaynakça

1. Çelik AA, Coşkun S, Kılınç O, Yıldırım A. Bel ağrısı nedeniyle polikliniğimize başvuran hastalarda skolyoz sıklığı ve Cobb açısı değerlerinin yaş ve cinsiyet ile ilişkisi. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi. 2017;3(3):551-564.
2. Dönmez YC, Van Giersbergen MY, Başlı AA, Yıldız MD, Yıldız E. Lomber Disk Hernisi Olan Hastaların Sağlıklı Yaşam Biçimi Davranışlarının ve Öz-Bakım Gücünün Belirlenmesi. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi. 2019;5(2):1628-1641.
3. Jönsson B, Annertz M, Sjöberg C, Strömqvist B. A prospective and consecutive study of surgically treated lumbar spinal stenosis: part I: clinical features related to radiographic findings. Spine. 1997;22(24):2932-2937.
4. Truumees E. Spinal stenosis: pathophysiology, clinical and radiologic classification. Instructional Course Lectures. 2005;54:287-302.
5. Ježek J, Waldauf P, Krbec M, Douša P, Skála-Rosenbaum J. Outcomes and Complications of Surgical Treatment for LSS at 1-Year Follow-up-Prospective Study. Actachirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2019;86(4):256-263.
6. Kalbarczyk A, Lukes A, Seiler RW. Surgical treatment of lumbar spinal stenosis in the elderly. Acta Neurochirurgica. 1998;140(7):637-641.
7. Machado GC, Ferreira PH, Yoo RIJ, Harris IA, Pinheiro MB, Koes BW, Ferreira ML. Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;11:CD012421.
8. Ciol MA, Deyo RA, Howell E, Kreif, S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc. 1996;44:285–90
9. Taylor VM, Deyo RA, Cherkin DC, et al. Low back pain hospitalization: recent United States trends and regional variations. Spine. 1994;19:1207–13.
10. Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK. Revision surgery following operations for lumbar stenosis. J Bone Joint Surg Am. 2011;93:1979–86.
11. Thomas K, Faris P, McIntosh G, Manners S, Abraham E, Bailey CS, Manson NA. Decompression Alone vs Decompression plus Fusion for Claudication Secondary to Lumbar Spinal Stenosis. The Spine Journal. 2019;(10):1633-1639.
12. Forsth P, Olafsson G, Carlsson T, Frost A, Borgstr€om F, Fritzell P, Sandén, B. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374:1413–23.
13. Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991;73:802–8.
14. Demiröz S, Bayram S, Coskun T, Cirakli A, Yanik HS, Atici Y, Erdem Ş. Evaluation of the distal adjacent segment after longsegment posterior instrumentation and fusion for adolescent idiopathic scoliosis. Annals of Medical Research. 2019;26(10):2134-8.
15. Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleas F. Lumbar spinal stenosis: conservative or surgical management? A prospective 10‐year study. Spine. 2000;25(11):1424‐35.
16. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Hilibrand, A. SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine. 2008;358(8):794‐810.
17. Çakir T, Çakir M, Okay HÖ, Yolaş C, Tanriverdi O, Ömeroğlu M, Arslan YK. Single level discectomy with and without disc prosthesis: A comparative study of 114 patients. Medicine. 2018;97(52).
18. Ilharreborde B, Morel E, Mazda K, Dekutoski MB. Adjacent segment disease after instrumented fusion for idiopathic scoliosis: review of current trends and controversies. Clinical Spine Surgery 2009;22(7):530-539.
19. Zhong ZM, Deviren V, Tay B, Burch S, Berven SH. Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: incidence and risk factors. Clinical Neurology and Neurosurgery. 2017;156:29-34.
20. Aydin A, Çilingir D. Yeniden Ameliyat Olma (Reoperasyon) ve Hemşirelik Bakımı. Koç Üniversitesi Hemşirelikte Eğitim ve Araştırma Dergisi. 2017;14(3):218-222.
21. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine. 2004;29(17):1938-1944.
22. Kizilay Z, Topcu A, Aydin YS, Berber O, Ozturk, H. Short and Medium Term Results of Posterior Segmental Instrumentation and Posterolateral Fusion in Female Patients with Spondylolisthesis: A Clinical Trial/Spondilolistezli Kadin Hastalarda Posterior Segmental Enstrumantasyon ve Posterolateral Fuzyonun Kisa ve Orta Vadeli Sonuclari: Klinik Calisma. Meandros Medical and Dental Journal. 2018;19(4):328-336.
23. Min JH, Jang JS, joo Jung B, Lee HY, Choi WC, Shim CS, Lee SH. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. Clinical Spine Surgery. 2008;21(5):305-309.
24. Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG. Adjacent segment degeneration in the lumbar spine. The Journal of Bone and Joint Surgery. 2004;86(7):1497-1503.
25. Lee CS, Hwang CJ, Lee SW, Ahn YJ, Kim YT, Lee DH, Lee MY. Risk factors for adjacent segment disease after lumbar fusion. European Spine Journal. 2009;18(11):1637.

Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Sağlık Kurumları Yönetimi
Bölüm	Araştırma Makalesi
Yazarlar	Tayfun Çakır 0000-0002-9979-9291 Şeyho Cem Yücetaş Bu kişi benim 0000-0001-6421-724X
Yayımlanma Tarihi	23 Nisan 2020
Gönderilme Tarihi	21 Kasım 2019
Kabul Tarihi	22 Mart 2020
Yayımlandığı Sayı	Yıl 2020 Cilt: 6 Sayı: 1

Kaynak Göster

AMA	Çakır T, Yücetaş ŞC. Comparison of two types of surgery for lumbar spinal stenosis in elderly: decompressive laminectomy with and without fusion. ADYÜ Sağlık Bilimleri Derg. Nisan 2020;6(1):54-58. doi:10.30569/adiyamansaglik.649416

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