20.500.12556/DKUM-83641 Primerjava uspešnosti minimalno invazivne unilateralne in bilateralne transfoaminalne fuzije segmentov z magnetnoresonančno preiskavo COMPARISON OF THE SUCCESS OF MINIMALLY INVASIVE UNILATERAL AND BILATERAL TRANSFORAMINAL LUMBAR INTERBODY FUSION PROCEDURE WITH MAGNETIC RESONANCE EXAMINATION Uvod: Degeneracija sosednjega segmenta je postala velika skrb kirurgov kot pozni zaplet pri bolnikih po transforaminalni zatrditveni operaciji ledvene hrbtenice (TLIF) z morebitno potrebo po revizijski operaciji. Segmenti nad operirano zatrjeno hrbtenico imajo večjo gibljivost in so še posebej nagnjeni k degeneraciji diska. Namen naše študije je raziskati degenerativne spremembe diskov dva nivoja nad zatrditvijo segmentov ledvene hrbtenice tako pri obojestranski (BIL TLIF) kot tudi pri enostranski zatrditveni operaciji (UNI TLIF). Poleg tega je naš namen z magnetnoresonančno preiskavo (MR) oceniti spremembe površine nevroforamnov (PN) obojestransko nad operiranim segmentom hrbtenice po UNI TLIF. Metode: V retrospektivno študijo ocene diskov je bilo vključenih 117 bolnikov. MR po standardnem protokolu je bila opravljena pri nekaterih do pol leta pred operacijo in pri vseh bolnikih 2,5 leta po operaciji. Za oceno stopnje degeneracije diska je bil uporabljen modificiran 8-stopenjski Pfirrmannov klasifikacijski sistem ter rezultati Mann-Whitneyjevega in Wilcoxonovega statističnega testa. Pri desetih bolnikih po UNI TLIF so bile opravljene MR preiskave 4 mesece do 5 let po posegu. MR preiskave teh bolnikov so bile opravljene v standardnem nevtralnem položaju (NP) in dodatno tudi v aksialni rotaciji (AR). Iz največjih premerov nevroforamnov je bila izračunana njihova površina (PN) ter korelirana glede na stran rotacije in med operiranim nivojem ter nivojem nad njim. Podatki so bili primerjani z analizo variance in t-testom deskriptivne statistike ter mešanim modelom ANOVA. Rezultati: Stopnja degeneracije medvretenčnih diskov nad zatrjenim segmentom hrbtenice je pomembno višja pri BIL TLIF (16,74 %) kot pri UNI TLIF (9,28 %). V študiji PN je bilo največje povečanje PN nad zatrjenim segmentom v skupini ipsilateralnih kot tudi kontralateralnih rotacij. Največje povečanje PN je na kontralateralni strani od UNI TLIF (za 73 % več v AR kot v NP). Primerjava PN med obema položajema kaže, da je PN večja pri AR ne glede na nivo in stran. Zaključek: Bolniki po UNI TLIF imajo nižjo stopnjo zgodnjih degenerativnih sprememb diskov v primerjavi z bolniki po BIL TLIF. Glede na to je pri starejših po bilateralni TLIF v primerjavi z UNI TLIF potrebna dodatna previdnost pri izbiri ustrezne kirurške tehnike, ko se odločamo za vrsto zatrditve. Nevroforamni nad nivojem zatrditve po UNI TLIF se pri AR odpirajo bolj kot v višini zatrjenih segmentov. MR z AR lahko nudi dodatne informacije o stopnji dinamičnih sprememb foramnov in mobilnosti zgornjega sosednjega segmenta v primerjavi z nativno MR preiskavo. Background: Adjacent segment degeneration has become a major concern of surgeons as a late complication in patients after transforaminal lumbar spine stabilization surgery (TLIF) with the potential need for revision surgery. Segments above the operated stabilized spine have greater mobility and are particularly prone to disc degeneration. The purpose of our study is to investigate the degenerative changes of the discs two levels above the fixation of lumbar spine segments in both bilateral (BIL TLIF) and unilateral fixation surgery (UNI TLIF). In addition, to assess changes in the surface of the neural foramina (PN) bilaterally above the operated segment of the spine after UNI TLIF, both with magnetic resonance imaging (MR). Methods: A retrospective study of disc evaluation included 117 patients. MR was performed in some patients half a year before surgery and in all patients 2.5 years after surgery. The modified 8-level Pfirrmann classification system and the results of the Mann-Whitney and Wilcoxon statistical tests were used to evaluate the degree of disc degeneration. Ten patients after UNI TLIF underwent MR examinations four months to five years after the procedure. MR examinations of these patients were performed in a standard neutral position (NP) and in additionally in axial rotation (AR). Their area (PN) was calculated from the largest diameters of the neural foramina and correlated according to the side of rotation and between the operated level and the level above it. Data were compared using analysis of variance and descriptive statistics t-test and mixed model ANOVA. Results: The degree of degeneration of the intervertebral discs above the compressed spinal segment is significantly higher in BIL TLIF (16.74%) than in UNI TLIF (9.28%). In the PN study, the most significant increase in PN over the suppressed segment was in the ipsilateral as well as contralateral rotation group. The most significant increase in PN is on the contralateral side from UNI TLIF (by 73% more in AR than in NP). A comparison of PN between the two positions shows that PN is greater in AR regardless of level and side. Conclusion: Patients after UNI TLIF have a lower rate of early degenerative disc changes compared to patients after BIL TLIF. In view of this, in the elderly, additional caution is required in choosing the appropriate surgical technique when deciding on the type of fixation. After UNI TLIF, neural foramina above the level of fusion open more in AR than at the level of fusion. MR with AR can offer additional information about the degree of dynamic changes of the neural foramen and the mobility of the upper adjacent segment compared to the native MR examination. degeneracija medvretenčne ploščice fuzijska kirurgija slikanje z magnetno resonanco aksialna rotacija biomehanika hrbtenice intervertebral disc degeneration fusion surgery magnetic resonance imaging axial rotation spinal biomechanics true true false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2023-01-18 19:40:34 2023-09-13 14:03:42 2023-10-24 07:17:42 0000-00-00 00:00:00 2023 0 Maribor 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 169562883 DOK_Kljaic_Dujic_Milka_2023.pdf DOK_Kljaic_Dujic_Milka_2023.pdf 1 9B96EEA6D6EC4B2A3C1E40B95EE01568 788ed127bdb91d86202b248e651d9f7908e603a210a11001856fd557050b8c9b 793ab48a-5193-11ee-9995-00155d000105 https://dk.um.si/Dokument.php?lang=slv&id=172086 Medicinska fakulteta 0 0 0