Lomber interbody füzyon cerrahisinde kafes kullanımı ile kafes şeklinde allogreft kullanımının klinik ve radyolojik olarak karşılaştırılması
Date
2023
Authors
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Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Amaç: Bu çalışmada, lomber interbody füzyon cerrahisinde kafes kullanımı ile kafes şeklinde allogreft kullanımının klinik ve radyolojik sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntem: Çalışmada lomber interbody füzyon cerrahisi uygulanan ve füzyon amacıyla kafes ( PEEK- Polietereterketon ) kullanılan 30 hasta ile kafes şeklinde allogreft kullanılan hastaların sonuçları prospektif olarak karşılaştırıldı. Hastaların klinik değerlendirmesinde Visual Analog Skala (VAS) ve Oswestry Disabilite İndeksi (ODI) kullanıldı. Radyolojik olarak interbody füzyonu değerlendirmek amacıyla postoperatif 1. Yılda çekilen bilgisayarlı tomografilerde ‘Brantigan’ sınıflaması kullanıldı. Hastalarda radyolojik olarak preop ve takiplerde pelvik parametreler ( PI: Pelvik İnsidans, PT: Pelvik Tilt, SS: Sakral Slop ), disk yükseklik indeksi, disk yüksekliği ve rejyonel lordoz açıları değerlendirildi. Radyolojik veriler 2 radyoloji 1 ortopedi hekimi tarafından değerlendirildi ve istatistiki veriler korelasyon analizleri yapılarak kaydedildi. Bulgular: Kafes şeklinde allogreft kullanılan hastaların preop VAS skorları ortalaması 9,1 iken 1.yıl kontrollerinde 2,87 ye gerilediği görülmüştür. Yine allogreft grubunda preop ortalama 48,87 olan olan ODI skorunun 1.yıldaortalama 18,53 e gerilediği görülmüştür. PEEK kafes grubunda preop VAS skoru ortalama 8,8 den 3,97’ ye ODI skoru 42,13 ten 24,87’ye gerilemiştir. Allogreft grubunda VAS ve ODI skorlarındaki değişim daha iyi bulunmuştur (p=0,002,p=0,012). Postoperatif 1. yılda allogreft grubunda %80, PEEK kafes grubunda %70oranında radyolojik füzyon tespit edilmiştir. Brantigan sınıflamasına göre gruplar arası intervertebral füzyon değerlendirmesinde istatistiksel olarak anlamlı bir fark görülmemiştir (p=0,301). PEEK kafes kullanılan hastaların 2 (%6,6) tanesinde vertebra korpusuna migrasyon görülürken allogreft grubunda migrasyon görülmemiştir. Sonuç: Lomber interbody füzyon cerrahisinde, PEEK kafes ve ve kafes şeklinde allogreft kullanımı füzyon açısından benzer radyolojik sonuçlar sağlamaktadır. Fakat allogreft kullanımı postoperatif 1.yılda daha iyi klinik sonuçlar sağlamıştır. Bu bulgular, klinik uygulamada kafes şeklinde allogreft kullanımının benzer füzyon oranları ve daha iyi klinik sonuçlarla tercih edilebileceğini göstermektedir.
Purpose: In this study, it was aimed to compare the clinical and radiological results of the use of cages and cage-shaped allografts in lumbar interbody fusion surgery. Material and Methods: In the study, the results of 30 patients who underwent lumbar interbody fusion surgery and used cage (PEEK-Polyetheretherketone) for fusion and those who used cage-shaped allograft were compared prospectively. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used in the clinical evaluation of the patients. The 'Brantigan' classification was used in computed tomography scans taken at the 1st postoperative year in order to radiologically evaluate interbody fusion. Pelvic parameters (PI: Pelvic Incidence, PT: Pelvic Tilt, SS: Sacral Slop), disc height index, disc height and regional lordosis angles were evaluated radiologically in the patients preoperatively and during follow-up. Radiological data were evaluated by 2 radiologists and 1 orthopedic physician, and statistical data wererecorded by performing correlation analysis. Results: While the mean preoperative VAS scores of the patients who used cage-shaped allografts were 9.1, it was observed that it decreased to 2.87 in the 1st year controls. It was also observed that the preoperative mean ODI score, which was 48.87 in the allograft group, decreased to an average of 18.53 in the 1st year. In the PEEK cage group, the preoperative VAS score decreased from 8.8 to 3.97, and the ODI score decreased from 42.13 to 24.87. The change in VAS and ODI scores was better in the allograft group (p=0.002, p=0.012). At the postoperative 1st year, radiological fusion was detected at a rate of 80% in the allograft group and 70% in the PEEK cage group. There was no statistically significant difference in the evaluation of intervertebral fusion between the groups according to the Brantigan classification (p=0.301). Migration to the vertebral corpus was observed in 2 (6.6%) of the patients who used PEEK cages, but no migration was observed in the allograft group. Conclusion: In lumbar interbody fusion surgery, the use of PEEK cage and allograft in the form of a cage provides similar radiological results in terms of fusion. However, the use of allografts provided better clinical outcomes at 1 year postoperatively. These findings show that the use of cage-shaped allografts in clinical practice can be preferred with similar fusion rates and better clinical outcomes.
Purpose: In this study, it was aimed to compare the clinical and radiological results of the use of cages and cage-shaped allografts in lumbar interbody fusion surgery. Material and Methods: In the study, the results of 30 patients who underwent lumbar interbody fusion surgery and used cage (PEEK-Polyetheretherketone) for fusion and those who used cage-shaped allograft were compared prospectively. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used in the clinical evaluation of the patients. The 'Brantigan' classification was used in computed tomography scans taken at the 1st postoperative year in order to radiologically evaluate interbody fusion. Pelvic parameters (PI: Pelvic Incidence, PT: Pelvic Tilt, SS: Sacral Slop), disc height index, disc height and regional lordosis angles were evaluated radiologically in the patients preoperatively and during follow-up. Radiological data were evaluated by 2 radiologists and 1 orthopedic physician, and statistical data wererecorded by performing correlation analysis. Results: While the mean preoperative VAS scores of the patients who used cage-shaped allografts were 9.1, it was observed that it decreased to 2.87 in the 1st year controls. It was also observed that the preoperative mean ODI score, which was 48.87 in the allograft group, decreased to an average of 18.53 in the 1st year. In the PEEK cage group, the preoperative VAS score decreased from 8.8 to 3.97, and the ODI score decreased from 42.13 to 24.87. The change in VAS and ODI scores was better in the allograft group (p=0.002, p=0.012). At the postoperative 1st year, radiological fusion was detected at a rate of 80% in the allograft group and 70% in the PEEK cage group. There was no statistically significant difference in the evaluation of intervertebral fusion between the groups according to the Brantigan classification (p=0.301). Migration to the vertebral corpus was observed in 2 (6.6%) of the patients who used PEEK cages, but no migration was observed in the allograft group. Conclusion: In lumbar interbody fusion surgery, the use of PEEK cage and allograft in the form of a cage provides similar radiological results in terms of fusion. However, the use of allografts provided better clinical outcomes at 1 year postoperatively. These findings show that the use of cage-shaped allografts in clinical practice can be preferred with similar fusion rates and better clinical outcomes.
Description
Keywords
Allogreft, Füzyon, PEEK kafes, Allograft, Fusion, PEEK cage
Citation
Altun, S. (2023). Lomber interbody füzyon cerrahisinde kafes kullanımı ile kafes şeklinde allogreft kullanımının klinik ve radyolojik olarak karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.