Araştırma Makalesi
BibTex RIS Kaynak Göster

Possible prognostic markers of subaxial cervical spine dislocations

Yıl 2019, Cilt: 44 Sayı: Ek 1, 202 - 210, 29.12.2019
https://doi.org/10.17826/cumj.512089

Öz

Purpose: The aim of this study was to determine the prognostic factors, the demographic and clinical findings of the patients with cervical dislocation were evaluated.

Materials and Methods: Age, gender, dislocation reason, Japanese Orthopedic Association Scale (JOAS) score, dislocation level of the spine, facet locking, degree of spondylolisthesis, surgical intervention modalities, neurological levels at discharged from hospital (Modified Rankin Scale, mRS) were retrospectively analyzed in patients operated for cervical dislocation.

Results: In this study, 13 patients were included. Dislocation was mostly seen at C5-6 and C6-7 segments secondary to facet fracture. Anterior spinal approach was commonly performed to the patients, and 75% of the patients had lower mRS scores. Correlation analysis results demonstrated that probability of developing spinal shock, need for ventilator support, duration of ICU stay and mRS scores could be increased in patients with lower JOAS scores. The number of stabilized vertebrae, need for ventilator support and duration of ICU and hospital stay could be increased if spondylolisthesis degree was higher. In patients who developed spinal shock, it was assumed that the length of stay in ICU and hospital could be increased and the mRS scores could be increased.

Conclusion: This study demonstrated that surgical intervention type had no effect on patients’ prognosis, however, lower JOAS score, occurence of spinal shock, need for ventilator support, long duration at ICU could affect the patients’ prognosis, poorly.


Kaynakça

  • 1. Özay R, Hanalioğlu Ş, Güneş SÖ, Yaman B, Türkoğlu ME, Ergün BR. Alt servikal omurganın travmatik kırık ve dislokasyonları: tek merkez bulguları. Cukurova Med J. 2017;43(1):122-30.
  • 2. Gao W, Wang B, Hao D, Zhu Z, Guo H, Li H, Kong L. Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5- to 15-Year Follow-Up. World Neurosurg. 2018;115:137-45.
  • 3. Passias PG, Poorman GW, Segreto FA, Jalai CM, Horn SR, Bortz CA, Vasquez-Montes D, Diebo BG, Vira S, Bono OJ, De La Garza-Ramos R, Moon JY, Wang C, Hirsch BP, Zhou PL, Gerling M, Koller H, Lafage V. Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. World Neurosurg. 2018;110:427-37.
  • 4. Quarrington RD, Jones CF, Tcherveniakov P, Clark JM, Sandler SJI, Lee YC, Torabiardakani S, Costi JJ, Freeman BJC. Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury. Spine J. 2018;18(3):387-98.
  • 5. Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, Zimmermann H, Lecky F. Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study. J Trauma Acute Care Surg. 2012;72(4):975-81.
  • 6. Vitzthum HE, Dalitz K. Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J. 2007;16(12):2096-103.
  • 7. Sumer M, Benbir G, Can U, Kutluk K, Uzuner N. Scales: Guidelines Of Turkish Society Of Cerebrovascular Diseases – 2015. Turkish Journal of Cerebrovascular Diseases. 2015;21(3):185-8.
  • 8. Aarabi B, Walters BC, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Theodore N, Hadley MN. Subaxial cervical spine injury classification systems. Neurosurgery. 2013;72(Suppl)2:170-86.
  • 9. Marcon RM, Cristante AF, Teixeira WJ, Narasaki DK, Oliveira RP, de Barros Filho TE. Fractures of the cervical spine. Clinics (Sao Paulo). 2013;68(11):1455-61.
  • 10. Kocis J, Wendsche P, Visna P, Muzík V, Pasa L. Injuries to the lower cervical spineActa Chir Orthop Traumatol Cech. 2004;71(6):366-72.
  • 11. Yadollahi M, Paydar S, Ghaem H, Ghorbani M, Mousavi SM, Taheri Akerdi A, Jalili E, Niakan MH, Khalili HA, Haghnegahdar A, Bolandparvaz S. Epidemiology of Cervical Spine Fractures. Trauma Mon. 2016; 21(3):e33608.
  • 12. Wang H, Xiang Q, Li C, Zhou Y. Epidemiology of traumatic cervical spinal fractures and risk factors for traumatic cervical spinal cord injury in China. J Spinal Disord Tech. 2013;26(8):306-13.
  • 13. Wilson JR, Vaccaro A, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R, Okonkwo DO, Fehlings MG. The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. Spine (Phila Pa 1976). 2013;38(2):97-103.
  • 14. Delamarter RB, Sherman J, Carr JB. Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression. J Bone Joint Surg Am. 1995;77(7):1042-9.
  • 15. Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7: e32037.
  • 16. Öğden M, Akkaya S, Yüksel U, Dağlı AT, Bakar B, Özveren MF. Servikal myelopatili hastalarda unilateral yaklaşım ile bilateral dekompresyonun klinik sonuçları. KÜ Tıp Fak Derg. 2018;20(3):313-20.
  • 17. Wagner FC Jr, Chehrazi B. Early decompression and neurological outcome in acute cervical spinal cord injuries. J Neurosurg. 1982;56(5):699-705.
  • 18. Maynard FM, Reynolds GG, Fountain S, Wilmot C, Hamilton R. Neurological prognosis after traumatic quadriplegia. Three-year experience of California Regional Spinal Cord Injury Care System. J Neurosurg. 1979;50(5):611-6.
  • 19. Vaccaro AR, Daugherty RJ, Sheehan TP, Dante SJ, Cotler JM, Balderston RA, Herbison GJ, Northrup BE. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine (Phila Pa 1976). 1997;22:2609-13.
  • 20. Sapkas GS, Papadakis SA. Neurological outcome following early versus delayed lower cervical spine surgery. J Orthop Surg (Hong Kong). 2007;15(2):183-6.

Alt servikal omurga dislokasyonlarında olası prognostik belirteçler

Yıl 2019, Cilt: 44 Sayı: Ek 1, 202 - 210, 29.12.2019
https://doi.org/10.17826/cumj.512089

Öz

Amaç: Bu çalışmanın amacı prognozlarını etkileyen faktörleri belirlemeye yönelik olarak servikal dislokasyon tespit edilen hastaların tedavi sonuçlarını  incelemektir..

Gereç ve Yöntem: Bu çalışmada servikal dislokasyon nedeniyle opere edilen hastaların yaş, cinsiyet, dislokasyon sebebi, “Japanese Orthopedic Association (JOAS)” ölçeği puanı, dislokasyon gelişen omurga seviyesi, faset kilitlenmesi, spondilolistesiz derecesi, cerrahi tedavi bilgileri, yoğun bakım ünitesine (YBU) ve hastane tedavi bilgileri ve hastaneden ayrılış nörolojik düzeylerine ait bilgiler (Modifiye Rankin Skalası, mRS) geriye dönük incelendi.

Bulgular: Çalışmaya alınan 13 hastada dislokasyonun çoğunlukla faset kırığına ikincil C5-6 ve C6-7 segmentlerinde oluştuğu görüldü. Çoğu hastada (9 tane) anterior yaklaşımla omurga stabilizasyonu yapıldığı, hastaların %50 kadarında çok seviyeli stabilizasyon uygulandığı saptandı. Korelasyon analizi sonunda JOAS puanları düşük olduğunda spinal şok gelişme olasılığının, ventilatör desteği ihtiyacının, YBU kalma süresinin ve mRS puanlarının artabileceği öngörüldü. Spondilolistezis derecesi arttığında stabilizasyon uygulanan omurga sayısının, ventilatör desteği ihtiyacının, YBU ve hastanede kalma süresinin artabileceği düşünüldü. Spinal şok gelişen hastalarda ventilatör desteği ihtiyacının artabileceği, YBU ve hastanede kalma sürelerinin uzayabileceği ve mRS puanlarının artabileceği varsayıldı.  

Sonuç: Çalışma sonunda yapılan cerrahi girişimin türünün prognoza etkisinin olmadığı; buna karşılık düşük JOAS puanlarının, spinal şok gelişmesinin, ventilatör desteği verilmesinin, uzun süre yoğun bakım ünitesinde kalmanın hastaların prognozunu kötü etkileyebileceği öngörüldü.


Kaynakça

  • 1. Özay R, Hanalioğlu Ş, Güneş SÖ, Yaman B, Türkoğlu ME, Ergün BR. Alt servikal omurganın travmatik kırık ve dislokasyonları: tek merkez bulguları. Cukurova Med J. 2017;43(1):122-30.
  • 2. Gao W, Wang B, Hao D, Zhu Z, Guo H, Li H, Kong L. Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5- to 15-Year Follow-Up. World Neurosurg. 2018;115:137-45.
  • 3. Passias PG, Poorman GW, Segreto FA, Jalai CM, Horn SR, Bortz CA, Vasquez-Montes D, Diebo BG, Vira S, Bono OJ, De La Garza-Ramos R, Moon JY, Wang C, Hirsch BP, Zhou PL, Gerling M, Koller H, Lafage V. Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. World Neurosurg. 2018;110:427-37.
  • 4. Quarrington RD, Jones CF, Tcherveniakov P, Clark JM, Sandler SJI, Lee YC, Torabiardakani S, Costi JJ, Freeman BJC. Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury. Spine J. 2018;18(3):387-98.
  • 5. Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, Zimmermann H, Lecky F. Epidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study. J Trauma Acute Care Surg. 2012;72(4):975-81.
  • 6. Vitzthum HE, Dalitz K. Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J. 2007;16(12):2096-103.
  • 7. Sumer M, Benbir G, Can U, Kutluk K, Uzuner N. Scales: Guidelines Of Turkish Society Of Cerebrovascular Diseases – 2015. Turkish Journal of Cerebrovascular Diseases. 2015;21(3):185-8.
  • 8. Aarabi B, Walters BC, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Theodore N, Hadley MN. Subaxial cervical spine injury classification systems. Neurosurgery. 2013;72(Suppl)2:170-86.
  • 9. Marcon RM, Cristante AF, Teixeira WJ, Narasaki DK, Oliveira RP, de Barros Filho TE. Fractures of the cervical spine. Clinics (Sao Paulo). 2013;68(11):1455-61.
  • 10. Kocis J, Wendsche P, Visna P, Muzík V, Pasa L. Injuries to the lower cervical spineActa Chir Orthop Traumatol Cech. 2004;71(6):366-72.
  • 11. Yadollahi M, Paydar S, Ghaem H, Ghorbani M, Mousavi SM, Taheri Akerdi A, Jalili E, Niakan MH, Khalili HA, Haghnegahdar A, Bolandparvaz S. Epidemiology of Cervical Spine Fractures. Trauma Mon. 2016; 21(3):e33608.
  • 12. Wang H, Xiang Q, Li C, Zhou Y. Epidemiology of traumatic cervical spinal fractures and risk factors for traumatic cervical spinal cord injury in China. J Spinal Disord Tech. 2013;26(8):306-13.
  • 13. Wilson JR, Vaccaro A, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R, Okonkwo DO, Fehlings MG. The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. Spine (Phila Pa 1976). 2013;38(2):97-103.
  • 14. Delamarter RB, Sherman J, Carr JB. Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression. J Bone Joint Surg Am. 1995;77(7):1042-9.
  • 15. Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7: e32037.
  • 16. Öğden M, Akkaya S, Yüksel U, Dağlı AT, Bakar B, Özveren MF. Servikal myelopatili hastalarda unilateral yaklaşım ile bilateral dekompresyonun klinik sonuçları. KÜ Tıp Fak Derg. 2018;20(3):313-20.
  • 17. Wagner FC Jr, Chehrazi B. Early decompression and neurological outcome in acute cervical spinal cord injuries. J Neurosurg. 1982;56(5):699-705.
  • 18. Maynard FM, Reynolds GG, Fountain S, Wilmot C, Hamilton R. Neurological prognosis after traumatic quadriplegia. Three-year experience of California Regional Spinal Cord Injury Care System. J Neurosurg. 1979;50(5):611-6.
  • 19. Vaccaro AR, Daugherty RJ, Sheehan TP, Dante SJ, Cotler JM, Balderston RA, Herbison GJ, Northrup BE. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine (Phila Pa 1976). 1997;22:2609-13.
  • 20. Sapkas GS, Papadakis SA. Neurological outcome following early versus delayed lower cervical spine surgery. J Orthop Surg (Hong Kong). 2007;15(2):183-6.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma
Yazarlar

Mustafa Öğden 0000-0002-7129-0936

Alemiddin Özdemir 0000-0002-5431-7287

Ulaş Yüksel 0000-0002-6398-4110

Bülent Bakar 0000-0002-6236-7647

Mehmet Faik Özveren 0000-0001-7768-1519

Yayımlanma Tarihi 29 Aralık 2019
Kabul Tarihi 2 Mayıs 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 44 Sayı: Ek 1

Kaynak Göster

MLA Öğden, Mustafa vd. “Alt Servikal Omurga dislokasyonlarında Olası Prognostik belirteçler”. Cukurova Medical Journal, c. 44, 2019, ss. 202-10, doi:10.17826/cumj.512089.