Bosphorus Med J. 2022; 9(4): 216-221 | DOI: 10.14744/bmj.2022.51423

Lomber Dar Kanallý Yaþlý Hastalarda Cerrahi Dekompresyonun Klinik ve Radyolojik Sonuçlarý

Þevki Gök¹, Merih Ýþ², Alp Karaaslan¹, Recep Baþaran¹, Neþe Keser², Mehmet Zafer Berkman^3
1Saðlýk Bilimleri Üniversitesi Sancaktepe Eðitim ve Araþtýrma Hastanesi Nöroþirürji Anabilim Dalý, Ýstanbul, Türkiye
²Saðlýk Bilimleri Üniversitesi Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi Nöroþirürji Anabilim Dalý, Ýstanbul, Türkiye
³Ýstanbul Acýbadem Üniversitesi Týp Fakültesi Nöroþirürji Anabilim Dalý, Ýstanbul, Türkiye

GÝRÝÞ ve AMAÇ: Lomber spinal stenoz (LSS), bel aðrýsý veya bel aðrýsý olmadan ortaya çýkabilen, bel omurgasýndaki nöral ve vasküler elemanlar için mevcut alanýn azalmasýyla iliþkili klinik bir kalça veya alt ekstremite aðrýsý sendromudur. Bu çalýþmanýn amacý, dejeneratif LSS hastalarýnda lomber dekompresyonun klinik ve radyolojik sonuçlarýný analiz etmektir.
YÖNTEM ve GEREÇLER: Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi Nöroþirürji Kliniðinde dejeneratif LSS'li hastalar geriye dönük olarak incelendi. Radyolojik deðerlendirmeler manyetik rezonans görüntülemeyle Extreme PACS sistemi (2010) ile ölçüldü. Klinik sonuçlar VAS ve JOA skorlarý ile deðerlendirildi. Sonuçlar için Odom kriterleri kullanýldý.
BULGULAR: Altmýþ beþ yaþ üstü dejeneratif LSS'li 35 hastaya posterior dekompresyon ameliyatý uygulandý. Katýlýmcýlarýn %40'ý (n=14) erkek, %60'ý (n=21) kadýndý. Ortalama yaþ 63,34±8,08 yýldý. Alan ölçümleri, modifiye edilmiþ alan ölçümleri, sað ve sol lateral girintinin AP çap ölçümleri, sað ve sol lateral transvers AP çap ölçümleri, sað ve sol nöral foramen AP çap ölçümleri ameliyat sonrasýnda belirgin artma gösterdi. VAS ve JOA skorlarýnýn ameliyattan sonra azaldýðý tespit edildi. Odom kriterlerine göre; 14 hastadan mükemmel, 12 hastadan iyi, 9 hastadan orta sonuç alýndý.
TARTIÞMA ve SONUÇ: Cerrahi sonrasý VAS ve JOA skorlarýndaki iyileþme yönünde azalmalar belirgindir. Cerrahi sýrasýnda foraminotomi ve lateral girintinin geniþlemesi, 65 yaþýn üzerindeki dejeneratif LSS hastalarýnýn yaþam kalitesini artýrmýþ ve postoperatif radyolojik belirteçleri iyileþtirmiþtir.

Anahtar Kelimeler: Dejeneratif lomber dar kanal, ameliyat, sonuç, radyoloji, klinik.

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The Clinical and Radiological Outcomes of Surgical Decompression in Older Patients with Lumbar Spinal Stenosis

Þevki Gök¹, Merih Ýþ², Alp Karaaslan¹, Recep Baþaran¹, Neþe Keser², Mehmet Zafer Berkman^3
1Department of Neurosurgery, University of Health Sciences Sancaktepe Training and Research Hospital, Istanbul, Türkiye
²Department of Neurosurgery, University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
³Department of Neurosurgery, Istanbul Acibadem University, Faculty of Medicine, Istanbul, Türkiye

INTRODUCTION: Lumbar spinal stenosis (LSS) is “a clinical syndrome of the buttock or lower extremity pain, which may occur with or without back pain, associated with diminished space available for the neural and vascular elements in the lumbar spine.” This study aims to analyze the clinical and radiological outcomes of lumbar decompression in patients with degenerative LSS.
METHODS: The patients with degenerative LSS in the Department of Neurosurgery of Haydarpasa Numune Training and Research Hospital were included retrospectively. The radiological evaluations were measured with the extreme PACS system (2010) by magnetic resonance imaging. The clinical outcomes were evaluated with visual analog score (VAS) and Japanese orthopedic association (JOA) scores. Odom’s criteria were used for outcomes.
RESULTS: Thirty-five patients over 65 years old with degenerative LSS were underwent posterior decompression surgery. Of the participants, 40% (n=14) were male and 60% (n=21) were female. The mean age is 63.34±8.08. The area measurements, modified area measurements, AP diameter measurements of the right and left lateral recess, right and left lateral transverse AP diameter measurements, and AP diameter measurements of the right and left neural foramen were improved after surgery. VAS and JOA scores were good after surgery. Fourteen patients had an excellent result, 12 patients had a good result, and nine patients had a fair result according to Odom’s criteria.
DISCUSSION AND CONCLUSION: Improvements in the VAS and JOA scores are prominent after surgery. Foraminotomy and expansion of the lateral recess during surgery increased the quality of life and improved post-operative radiologic parameters in over 65 years of age with degenerative LSS.

Keywords: Clinics, degenerative lumbar spinal stenosis, outcome, radiology, surgery.

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