Nükleoplasti Endikasyonlarının ve Başarısız Nükleoplasti Uygulamalarının İki Olgu Işığında Gözden Geçirilmesi
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Dosyalar
Tarih
2010
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Nükleoplasti nükleus pulposusun koblasyonu esasına göre çalışan ve son günlerde özellikle minimal invazif bir tedavi yöntemi olması ile popularite kazanan bir cerrahi girişimdir. Her cerrahi girişim gibi uygun endikasyonla ve deneyimli kişilerce uygulanması gereken bir yöntem olan nükleoplasti uzun dönem sonuçları bilinmemekle birlikte ümit vaat edici bir yöntem olarak görülmektedir. Bu raporda nükleoplasti ve endikasyonları hakkında genel bilgiler verilmekte ve özellikle uygun endikasyonla yapılmadığında ortaya çıkabilecek komplikasyonlar; başarısız nükleoplasti sonrasında iyileşmeyen hastaların cerrahi tedavisinde yaşanabilecek sorunlar ilgili literatür eşliğinde irdelenmektedir. Olgu Sunumu: Dış merkezde uygulanan nükleoplasti sonrasında ağrı şikayetleri ve nörolojik tabloları düzelmeyen iki hasta kliniğimizde tekrar opere edilerek ilk olguya mikrodiskektomi ikinci olguya ise total laminektomi uygulanmıştır. Sonuç: İlk olguda sinir köküne bası yapan ekstrude disk fragmanı tespit edilmiş ve cerrahi alanda oluşan yapışıklık ve anatomik yapının bozulmuş olmasından dolayı mikrodiskektomi esnasında teknik zorluklar yaşanmıştır. İkinci olguda ise spinal kanal çapının ileri derecede daralmış olması ve yine dural sak ve sinir köklerini çepeçevre saran yoğun fibroz yapışıklıklar ve yoğun venöz konjesyon nedeniyle uygulanan laminektomide teknik zorluklar yaşanmıştır. Her iki hasta da kliniğimizde uygulanan ameliyatlardan sonra sorunsuz bir şekilde, şifa ile taburcu edilmişlerdir.
Objective: Nucleoplasty is a new minimally invasive surgical intervention which gains popularity especially last years. It is working on the basis of coblation of the nucleus pulposus. It's a fact that all surgical procedures should be applied as appropriate indications and by experienced surgens. Nucleoplasty is a relatively new technique and it's long-term results are unknown. Early results are seen as promising. In this report, indications of the nucleoplasty are given in an overview and complications and experienced problems in the surgical treatment of two not healed patient after failed nucleoplasty is discussed in the light of relevant literature. Case Report: Two patients were operated in a foreign hospital and nucloplasty was performed to both of them. The patient's pain complaints and neurological deficits were not fixed after nucleoplasty. They were reoperated in our clinic and microdiscectomy to the first and lumbar laminectomy to the second patient was performed. Conclusion: A nerve root compression due to extruded disc fragment was found in the first case. Technical difficulties were experienced during microdiscectomy related with fibrous adhesions and damage of anatomical landmarks. In the second case, the spinal canal was markedly narrowed. Technical difficulties were experienced during laminectomy due to severe fibrous adhesions and venous congestion over the dural sac and nerve roots circumferentially. Both patient's complaints were resolved and they have been discharged from our hospital without any problem.
Objective: Nucleoplasty is a new minimally invasive surgical intervention which gains popularity especially last years. It is working on the basis of coblation of the nucleus pulposus. It's a fact that all surgical procedures should be applied as appropriate indications and by experienced surgens. Nucleoplasty is a relatively new technique and it's long-term results are unknown. Early results are seen as promising. In this report, indications of the nucleoplasty are given in an overview and complications and experienced problems in the surgical treatment of two not healed patient after failed nucleoplasty is discussed in the light of relevant literature. Case Report: Two patients were operated in a foreign hospital and nucloplasty was performed to both of them. The patient's pain complaints and neurological deficits were not fixed after nucleoplasty. They were reoperated in our clinic and microdiscectomy to the first and lumbar laminectomy to the second patient was performed. Conclusion: A nerve root compression due to extruded disc fragment was found in the first case. Technical difficulties were experienced during microdiscectomy related with fibrous adhesions and damage of anatomical landmarks. In the second case, the spinal canal was markedly narrowed. Technical difficulties were experienced during laminectomy due to severe fibrous adhesions and venous congestion over the dural sac and nerve roots circumferentially. Both patient's complaints were resolved and they have been discharged from our hospital without any problem.
Açıklama
Anahtar Kelimeler
Genel ve Dahili Tıp, Nükleoplasti, endikasyon, cerrahi, Nucleoplasty, indication, surgery
Kaynak
Genel Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
20
Sayı
3
Künye
Güney, Ö., Kocaoğulları, Y., Erdi, F., Kaya, B., (2010). Nükleoplasti Endikasyonlarının ve Başarısız Nükleoplasti Uygulamalarının İki Olgu Işığında Gözden Geçirilmesi. Genel Tıp Dergisi, 20(3), 113-116.
