Lomber Disk Cerrahisinde İnsizyon Büyüklüğünün Ameliyat Sonrası Paraspinal Adale İyileşmesine Etkisi

Yıl 2020, Cilt: 4 Sayı: 2, 71 - 77, 31.08.2020

Emrah Keskin , Bektaş Açıkgöz , Murat Kalaycı , Şanser Gül , Hasan Aydın Evren Aydoğmuş , Kenan Şimşek

Öz

Amaç: Bu çalışmada subperiostal mikrodiskektomi tekniğinde daha küçük insizyon ve daha küçük
ekartör kullanımının paraspinal adele iyileşmesi ve yaşam kalitesi üzerindeki etkisi araştırılmıştır.

Gereç ve Yöntemler: Bu çalışma, Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Nöroşirürji
Anabilim Dalı’nda lomber disk hernisi tanısı ile ameliyat edilen 100 hasta üzerinde retroprospektif
olarak yapılmıştır. Çalışmada iki ayrı grup oluşturulmuş ve her iki grubun postoperatif lomber
Manyetik rezonans (MR) görüntüleri karşılaştırılarak sonuca varılmıştır.

Bulgular: Cerrahide kullanılan ekartörün ve insizyonun büyüklüğünün paraspinal adele atrofisi
üzerinde istatistiksel olarak anlamlı şekilde etkisinin olduğu gözlenmiştir (p < 0.001). Sistemik
hastalığı olan hastalarda ekartör ve insizyonun büyüklüğünün paraspinal kas atrofisi üzerinde
istatistiksel olarak anlamlı şekilde etkisinin olmadığı gözlemiştir (p = 0.052).

Sonuç: Bu çalışmada mikrodiskektominin küçük retraktör ve küçük insizyon kullanılarak
yapılmasının paraspinal kas atrofisi gelişmesinin en aza indirilebilmiş olması, kas dokusu üzerinde
koruyucu etkileri olduğunu işaret etmektedir.

Anahtar Kelimeler

multifidus, atrofi, lomber disk hastalığı

The Effect of Incision Size in Lumbar Disc Surgery on Post-operative Paraspinal Muscle Healing

Öz

Objective: In this study, the effect of the use of smaller incision and smaller retractor in subperiosteal microdiscectomy technique on muscle healing and quality of life is investigated.

Materials and Methods: This retrospective study is conducted on 100 patients who underwent surgery with the diagnosis of lumbar disc herniation in Bülent Ecevit University School of Medicine, Department of Neurosurgery. In this study, two group was formed and result was obtained by comparing the postoperative lumbar MR images of the two groups.

Results: The size of the retractor used in the surgery and the size of the incision used in the surgery were significant in statistical result of muscle atrophy effect.

Conclusions: In this clinical study, minimizing the formation of muscle atrophy suggests that performing microdiscectomy with small retractor and small incision has muscle tissue protective properties.

Anahtar Kelimeler

multifidus, atrophy, lumbar disc disease

Kaynakça

• 1. Zileli M. Lomber disk hernisinde cerrahi teknik. Omurilik ve omurga cerrahisi cilt1. 2nci baskı, İzmir:Meta Basım Matbaacılık Hizmetleri; 2002. s.679-87.
• 2. Thongtrangan I, et al. Minimally invasive spinal surgery: a historical perspective. Neurosurg Focus 2004;16:1-10.
• 3. Çobanoğlu S. Minimal invaziv nöroşirürji. Nöroşirürji beyin - omurilik – sinir cerrahisi dersleri. Edirne:Nobel Tıp Kitabevleri; 2002. p.455-62.
• 4. Caspar W : A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 4 : 152, 1977
• 5. Katayama Y, et al. Comparison of surgical outcomes between macrodiscectomy and micro discectomy for lumbar disc herniation : a prospective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech 19 : 344-347, 2006
• 6. Sihvonen T, et al. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976) 18 : 575-581, 1993
• 7. Xinyu Liu, et al. Impact of surgical approaches on the lumbar multifidus muscle: an experimental study using sheep as models J Neurosurg Spine 12:570–576, 2010
• 8. Kang CH, et al. MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain. Clin Radiol 62: 479–486, 2007
• 9.Laasonen EM. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Neuroradiology 26:9-13
• 10. Mayer TG, et al. Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. Spine 14:33-36
• 11.E. Kotilainen, A. et al. Cross-Sectional Areas of Lumbar Muscles After Surgical Treatment of Lumbar Disc Herniation A Study with Magnetic Resonance Imaging After Microdiscectomy or Percutaneous Nucleotomy
• 12. Ryang YM, et al. Standart open microdiscectomy versus minimal access trocar microdiscectomy: results of a prospective raddomized study. Neurosurgery 2008; 62(1):174-81; discussion 181-2.
• 13. Koebbe CJ, et al. Lumbar microdiscectomy: a historical perspective and current technical considerations. Neurosurg Focus 13 : E3, 2002
• 14. Kawaguchi Y, et al. Back muscle injury after posterior lumbar spine surgery. Topographicevaluation of intramuscular pressure and blood flow in the porcineback muscle during surgery. Spine (Phila Pa 1976) 21 : 2683 2688,1996
• 15. Taylor RS: Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome: results of a systematic review and meta-analysis. J Pain Symptom
• 16. Falck B, et al. Prognostic value of EMG in patients with lumbar disc herniation - a five year follow-up. Electromyogr Clin Neurophysiol 33:19-26
• 17. Macnab I, et al. the incidence of denervation of the sacrospinales muscles following spinal surgery. Spine 2:294-298
• 18. Mack E. Electromyographic observations on the postoperative disc patients. J Neurosurg 8:469-472
• 19. Crossman K, et al. Chronic low back pain-associated paraspinal muscle dysfunction is not the result of a constitutionally determined “adverse” fiber-type composition. Spine 29:628–634, 2004
• 20. Weber BR, et al. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine 22:1765–1772, 1997
• 21. Kawaguchi Y, et al. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine 21:941–944, 1996
• 22. Cosmin Four, et al. Correlation Between Multifidus Fatty Atrophy and Lumbar Disc Degeneration in Low Back Pain, BMC Musculoskelet Disord. 2019 Sep 5;20(1):414.doi: 10.1186/s12891-019-2786-7.
• 23. Lehto M, et al. Connective tissuechanges of the multifidus muscle in patients with lumbar disc herniation. An immunohistologic study of collagen types I and III and fibronectin. Spine 14:302-309
• 24. Rantanen J, et al. The lumbar multifidus musclefive years after surgery for a lumbar intervertebral disc herniation.Spine 18:568-574
• 25. Pope MH, et al. Therelationship between anthropometric, postural, muscular, andmobility characteristics of males ages 18 55. Spine 10:644-648
• 26. Parkkola R, et al. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine 18: 830-836
• 27.Foley KT, et al. Microendoscopic discectomy. In: Schmidek HH (Ed.). Operative neurosugical technigues: indications, methods; and results vol.II. 4th ed. Philadelphia: W.B. Saunders Co; 2000. p.2246-56.
• 28. Arts MP, et al. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial. BMC Musculoskelet Disord 2006; 7(42):2-7.
• 29. Muramatsu K, et al. Postoperative magnetic resonance imaging of lumbar disc herniaion: comparison of microendoscopic discectomy and Love’s method. Spine 2001; 26(14): 1599-605 30. Nakagawa H, et al. Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci 2003; 10(2):231-5.
• 31.Schick U, et al. Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 2002; 11(1):20-6.