Aans 2011 Yunus Aydin
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Transcript of Aans 2011 Yunus Aydin
PRESERVATION OF SEGMENTAL MOTION PRESERVATION OF SEGMENTAL MOTION WITH ANTERIOR CONTRALATERAL WITH ANTERIOR CONTRALATERAL CERVICAL MICRODISKECTOMY AND CERVICAL MICRODISKECTOMY AND
INTERBODY FAT GRAFT: INTERBODY FAT GRAFT: PROSPECTIVE PROSPECTIVE STUDYSTUDY
CLINIC OF NEUROSURGERY, CLINIC OF NEUROSURGERY,
ŞİŞLİ ETFAL TEACHING & ŞİŞLİ ETFAL TEACHING &
RESEARCH HOSPITALRESEARCH HOSPITAL
İSTANBUL, TURKEYİSTANBUL, TURKEY
Yunus AYDIN, MD
Halit ÇAVUŞOĞLU, MD
Cengiz TUNCER, MD
Osman TÜRKMENOĞLU, MD
Ahmet Murat MÜSLÜMAN, MD
MATERIAL & METHOD
• with cervical paramedian disc herniation
• who underwent one or two-level anterior contralateral
simple microdiskectomy (without fusion)
• Interbody fat graft raplacement were performed on 91 of
330 patients
• between 1992 and 2009.
The mean follow-up time: 10 years (range 1 to 16 years).
at conventional right side
procedures, the left foramina can be
approached easier from the right
side!.
• Technique based on opening the
opposite of the brachialgia which
supports the better visualization of
the foraminal area.
SIMPLY THE BEST !
CONTRALATERAL APPROACH
SURGICAL TECHNIQUE
• Performed at the contralateral side of the radiculopathy,
• 2 cm. transvers skin incision,
• Only 10 mm. wide mini-size Zenker hand retractor, no spreader,
• The longus colli muscles are not stripped,
• Narrow opening through ALL,
• No bone and cartilage removal,
• The disc material is removed with bayonet microcurettes and
punches down to the PLL,
Zenker hand retractors & Bayonet Kambin microcurettes
SURGICAL TECHNIQUE
• Lateral parts of annulus fibrosus
not shaved extensively!
• Removal of all posterior & lateral
osteophytes,
• Opening of PLL,
• Transuncal foraminotomy,
• Interbody fat graft replacement
is performed.
FOLLOW-UP
• All patients were followed-up regularly at intervals of 1,
3, 6, 12 months, and were followed up annually
thereafter.
• Routine radiological investigations, including periodic
dynamic x-ray
Clinical outcomes were assessed using
the
Neck Disability Index (NDI) and
Short Form-36 (SF-36).
OUTCOME MEASUREMENT
In group 1 (without fat graft):
Despite fusion procedures were not performed, spontaneous
radiological fusion signs were obtained in 12% of group 1
patients.
RESULTS
In group 2 (with fat graft):
Follow-up radiological studies revealed healing without fusion in
group 2 patients.
RESULTS Cont’d.
• Despite the kyphosis seen at the treated levels, the
overall alignment between C2 and C7 did not change
significantly in group 1 (without fat graft)
• The kyphosis were not seen at the treated levels in
group 2 (with fat graft)
• The ROM increased significantly in group 2 (with fat
graft) (p < 0,05).
RESULTS Cont’d.
Neck Disability Index
Scores decreased
significantly in both early
and late follow-up
evaluations.
(t = -1.789, p = 0.077)
RESULTS Cont’d.
Short Form 36
Physical Function (F = 199, P < .0001), Physical Role (F= 402,264 P < .0001), Bodily Pain (F = 242, P < .0001), General Health (F = 685, P < .0001), Vitality/Energy (F= 356,266 P < .0001), Social Function (F= 139, P < .0001), Emotional Role (F = 135, P < .0001), Mental Health (F= 125,P < .0001)
Scores demonstrated significant improvement in long-term
follow-up results in the all areas
RESULTS Cont’d.
16 years succesfull history shows that:
Our really minimal invasive technique provides
• better and direct exposure of the pathology,
• preservation of motion segment (NO functional loss),
• going back to work in shorter time with short hospital stay,
• esthetic result,
• lower cost..
CONCLUSION
16 years succesfull history shows that:
Contralateral approach & intervertebral fat graft prevents
• adjacent segment disease,
• serious complications of the instrumentation,
• long term side effects of the foreign materials in body..
CONCLUSION Cont’d.
DISCUSSIONThe advantages of preserving the mobile segment are widely
accepted.
•Advocates of disc replacements base their arguments on this
thesis. If disc replacements could have actually achieved the
desired results, it would have been great.
•Our technique is the less costly approach with less
complications that achieves the results intended with disc
replacements.
DISCUSSION
The fat graft plays an important role in achieving the desired
results by preventing unintended spontaneous bone
fusions.
Already acknowledged multi-potent transformation ability of
fat cell raises great curiosity about its long-term
transformations in intervertebral space.
7 - 10 Years7 - 10 Years
Case SamplesCase Samples
(2(2 levels levels))
Pre-Pre-op.op.
Post-Post-op.op.
Pre-Pre-opop
Post-Post-opop
Pre-Pre-op.op.
Post-Post-op.op.
7 - 10 Years7 - 10 Years
Case SamplesCase Samples
(1(1 level level))
Pre-op.
Post-op.
*with fat graft
Pre-Pre-op.op.
Post-Post-op.op.
Pre-Pre-op.op.
Post-Post-op.op.
Pre-Pre-op.op.
Post-Post-op.op.
Pre-Pre-op.op.
Post-Post-op.op.
Pre-Pre-op.op.
Post-Post-op.op.
Pre-Pre-op.op.
Post-Post-op.op.
Pre-Pre-op.op.
Post-Post-op.op.
THANK YOUQ & A