Pedikül Vidası Tekniği İle Ameliyat Edilen Hastada Aynı Segmentte Rekürren Lomber Disk Herniasyonu Gelişmesi
Özet
Lomber disk herniasyonu, çalışma çağındaki bireylerde ciddi sorunlara yol açan yaygın bir omurga hastalığıdır. Cerrahi tedavi, konservatif yöntemlere yanıt vermeyen vakalarda sıklıkla tercih edilir, ancak cerrahi sonrası komplikasyonlar arasında rekürren disk herniasyonu önemli bir yer tutar. Rekürren disk herniasyonu oranları %5-15 arasında değişir ve pedikül vidası tekniği gibi stabilizasyon yöntemleri, bu komplikasyonları önlemek için kullanılır. Pedikül vidası tekniği, omurgadaki anormal hareketleri azaltarak diskin yeniden fıtıklaşmasını önler ve biyomekanik dengeyi sağlar. Ancak nadiren aynı segmentte rekürrens görülebilir.
Bu olgu sunumunda, pedikül vidası ile stabilize edilmiş bir hastada yeniden gelişen rekürren disk herniasyonu tartışılmıştır. Cerrahi tedavi ve interbody füzyon gibi ek yöntemlerle omurganın yapısal bütünlüğü sağlanmış ve başarılı sonuçlar elde edilmiştir. Pedikül vidalarının omurganın stabilitesini artırdığı, ancak bazı durumlarda minimal hareketliliğin kaldığı ve bunun uzun vadeli sonuçlar üzerinde tartışmalar yarattığı vurgulanmıştır.
Lumbar disc herniation is a common spinal condition affecting working-age individuals and leading to significant discomfort and disability. Surgical treatment, such as microdiscectomy and endoscopic discectomy, is often required when conservative therapies fail, but recurrent disc herniation remains a common postoperative complication, with recurrence rates between 5-15%. Pedicle screw fixation is a stabilization technique used to prevent reherniation by reducing abnormal motion in the spine. While effective, recurrence at the same segment may still occur in rare cases.
This case study presents a patient who developed recurrent lumbar disc herniation despite prior pedicle screw stabilization surgery. The patient underwent revision surgery, including discectomy and interbody fusion, resulting in improved outcomes. The discussion highlights the benefits of pedicle screws in stabilizing the spine and preventing reherniation, but also addresses the biomechanical challenges and risks, such as residual motion and cage migration, which can complicate recovery. The study underscores the importance of evaluating each surgical approach's long-term efficacy in reducing complications.
Referanslar
Yao M, Xu BP, Li ZJ, et al. A comparison between the low back pain scales for patients with lumbar disc herniation: validity, reliability, and responsiveness. Health Qual Life Outcomes. 2020;18(1):175. doi:10.1186/s12955-020-01403-2
Chen X, Chamoli U, Vargas Castillo J, Ramakrishna VAS, Diwan AD. Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: a systematic review and meta-analysis. Eur Spine J. 2020;29(7):1752-1770. doi:10.1007/s00586-020-06389-5
Leven D, Passias PG, Errico TJ, et al. Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation: A Subanalysis of Eight-Year SPORT Data. J Bone Joint Surg Am. 2015;97(16):1316-1325. doi:10.2106/JBJS.N.01287
Swartz KR, Trost GR. Recurrent lumbar disc herniation. Neurosurg Focus. 2003;15(3) doi:10.3171/foc.2003.15.3.10
Shepard N, Cho W. Recurrent Lumbar Disc Herniation: A Review. Global Spine J. 2019;9(2):202-209. doi:10.1177/2192568217745063
Mamuti M, Fan S, Liu J, et al. Mini-open Anterior Lumbar Interbody Fusion for Recurrent Lumbar Disc Herniation Following Posterior Instrumentation. Spine (Phila Pa 1976). 2016;41(18) doi:10.1097/BRS.0000000000001569
Bulut G, Aytar MH, Güdük M. Lumbar Posterior Transpedicular Screw Fixation and Fusion Applications; What We Do Peroperatively with 117 Spinal Instability Cases. Genel Tıp Derg. 2022;32(1):72-6.
Burkhard MD, Cornaz F, Spirig JM, et al. Residual motion of cortical versus pedicle screw constructs after decompression, interbody fusion and cross-link augmentation. Eur Spine J. 2023;32(4):1401-1410. doi:10.1007/s00586-023-07596-6
Pei B, Xu Y, Zhao Y, et al. Biomechanical comparative analysis of conventional pedicle screws and cortical bone trajectory fixation in the lumbar spine: An in vitro and finite element study. Front Bioeng Biotechnol. 2023;11:1060059. doi:10.3389/fbioe.2023.1060059
Matsukawa K, Yato Y. Lumbar pedicle screw fixation with cortical bone trajectory: A review from anatomical and biomechanical standpoints. Spine Surg Relat Res. 2017;1(4):164-173. Published 2017 Nov 27. doi:10.22603/ssrr.1.2017-0006
Ha KY, Kim YH, Park HY, et al. Lumbar Disc Herniation Within Solid Fused Segments After Removal of Pedicle Screws: A Case Report. JBJS Case Connect. 2019;9(4) doi:10.2106/JBJS.CC.19.00071
Luo L, Zhao C, Li P, et al. Posterior Dynamic Stabilization with Limited Rediscectomy for Recurrent Lumbar Disc Herniation. Pain Res Manag. 2021;2021:1288246. doi:10.1155/2021/1288246
Xu M, Yang J, Lieberman I, et al. Stress distribution in vertebral bone and pedicle screw and screw-bone load transfers among various fixation methods for lumbar spine surgical alignment: A finite element study. Med Eng Phys. 2019;63:26-32. doi:10.1016/j.medengphy.2018.10.003
Tanaka M, Wei Z, Kanamaru A, et al. Revision for cage migration after transforaminal/posterior lumbar interbody fusion: how to perform revision surgery?. BMC Surg. 2022;22(1):172. doi:10.1186/s12893-022-01620-0
Referanslar
Yao M, Xu BP, Li ZJ, et al. A comparison between the low back pain scales for patients with lumbar disc herniation: validity, reliability, and responsiveness. Health Qual Life Outcomes. 2020;18(1):175. doi:10.1186/s12955-020-01403-2
Chen X, Chamoli U, Vargas Castillo J, Ramakrishna VAS, Diwan AD. Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: a systematic review and meta-analysis. Eur Spine J. 2020;29(7):1752-1770. doi:10.1007/s00586-020-06389-5
Leven D, Passias PG, Errico TJ, et al. Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation: A Subanalysis of Eight-Year SPORT Data. J Bone Joint Surg Am. 2015;97(16):1316-1325. doi:10.2106/JBJS.N.01287
Swartz KR, Trost GR. Recurrent lumbar disc herniation. Neurosurg Focus. 2003;15(3) doi:10.3171/foc.2003.15.3.10
Shepard N, Cho W. Recurrent Lumbar Disc Herniation: A Review. Global Spine J. 2019;9(2):202-209. doi:10.1177/2192568217745063
Mamuti M, Fan S, Liu J, et al. Mini-open Anterior Lumbar Interbody Fusion for Recurrent Lumbar Disc Herniation Following Posterior Instrumentation. Spine (Phila Pa 1976). 2016;41(18) doi:10.1097/BRS.0000000000001569
Bulut G, Aytar MH, Güdük M. Lumbar Posterior Transpedicular Screw Fixation and Fusion Applications; What We Do Peroperatively with 117 Spinal Instability Cases. Genel Tıp Derg. 2022;32(1):72-6.
Burkhard MD, Cornaz F, Spirig JM, et al. Residual motion of cortical versus pedicle screw constructs after decompression, interbody fusion and cross-link augmentation. Eur Spine J. 2023;32(4):1401-1410. doi:10.1007/s00586-023-07596-6
Pei B, Xu Y, Zhao Y, et al. Biomechanical comparative analysis of conventional pedicle screws and cortical bone trajectory fixation in the lumbar spine: An in vitro and finite element study. Front Bioeng Biotechnol. 2023;11:1060059. doi:10.3389/fbioe.2023.1060059
Matsukawa K, Yato Y. Lumbar pedicle screw fixation with cortical bone trajectory: A review from anatomical and biomechanical standpoints. Spine Surg Relat Res. 2017;1(4):164-173. Published 2017 Nov 27. doi:10.22603/ssrr.1.2017-0006
Ha KY, Kim YH, Park HY, et al. Lumbar Disc Herniation Within Solid Fused Segments After Removal of Pedicle Screws: A Case Report. JBJS Case Connect. 2019;9(4) doi:10.2106/JBJS.CC.19.00071
Luo L, Zhao C, Li P, et al. Posterior Dynamic Stabilization with Limited Rediscectomy for Recurrent Lumbar Disc Herniation. Pain Res Manag. 2021;2021:1288246. doi:10.1155/2021/1288246
Xu M, Yang J, Lieberman I, et al. Stress distribution in vertebral bone and pedicle screw and screw-bone load transfers among various fixation methods for lumbar spine surgical alignment: A finite element study. Med Eng Phys. 2019;63:26-32. doi:10.1016/j.medengphy.2018.10.003
Tanaka M, Wei Z, Kanamaru A, et al. Revision for cage migration after transforaminal/posterior lumbar interbody fusion: how to perform revision surgery?. BMC Surg. 2022;22(1):172. doi:10.1186/s12893-022-01620-0
