Research Article
PDF Zotero Mendeley EndNote BibTex Cite

Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi

Year 2021, Volume 60, Issue 3, 281 - 287, 13.09.2021
https://doi.org/10.19161/etd.990678

Abstract

Amaç: Open-door servikal laminoplasti multipl seviye servikal myelopatisi olan hastalar için standart cerrahi seçenektir. Cerrahide laminanın bir tarafına lineer laminektomi yapılırken, karşı tarafa menteşe halini alacak şekilde kemik drillemesi yapılır. Lineer laminektomi yapılan taraf kaldırılırken diğer tarafta menteşe kırıkları meydana gelebilir. Bu kırıkların oluşmaması için olası risk faktörlerini incelemeyi amaçladık. Gereç ve Yöntemler: 2013-2018 yılları arasında open-door servikal laminoplasti operasyonu geçiren olguların dosyaları, radyolojik görüntüleri, laboratuvar sonuçları retrospektif olarak incelendi. Bulgular: Çalışmaya opere edilen 54 erkek, 24 kadın olmak üzere 78 hasta dahil edildi. Hastaların yaş ortalaması 57,8 ± 11,6 idi. Operasyon öncesi hastaların Modifiye JOA (Japanese Orthopedic Association) servikal miyelopati skorları 16,2 ± 2,1 olarak geldi. Operasyon öncesi kan Ca++ değerlerine bakıldığında 9,3 ± 0,5 mg/dl idi. Hastaların Pavlov oranı ortalaması 0,7 ± 0,2 idi. Laminalar 26 olguda sağ taraftan, 52 olguda sol taraftan açıldı. Toplam 304 lamina açıldı. Operasyon sonrası çekilen kontrol servikal BT’lerde 42 hastada lamina menteşe kırığı vardı. Menteşe kırığı olmayan hasta sayısı 36 idi. Toplamda 89 lamina seviyesinde kırık vardı. Cerrahi sonrası çekilen servikal BT’ler incelendiğinde laminaların açılma açısı (OA) ortalaması 30,6 ± 8,9 derece olarak ölçüldü. Lamina açılma açısının menteşe kırığına anlamlı ölçüde etki ettiği gözlendi. Lamina menteşe kırığı olan hastalarda OA 32,3 ± 9 (p<0,05) derece iken, olmayan hastalarda OA ortalama açısı 28,7 ± 8,3 (p<0.05) olarak bulundu. Sonuç: Open-door servikal laminoplasti sırasında lamina açılma açısının fazlalığı menteşe kırıkları oluşması olasılığını artırmaktadır. Operasyon öncesi gerekli ölçümlerin yapılması ameliyat sırasında menteşe kırıklarının meydana gelme riskini azaltacaktır. Bu da hem operasyon sırasında komplikasyon riskini azaltacak hem de ameliyat sonrası dönemde hasta konforunu artıracaktır.

References

  • Chen H, Liu H, Zou L, Li T, Gong Q, Song Y, et al. Effect of Mini-plate Fixation on Hinge Fracture and Bony Fusion in Unilateral Open-door Cervical Expansive Laminoplasty. Clin Spine Surg. 2016;29(6):E288-95.
  • Byard RW, Langlois N, Gilbert JD. Positive "water test"-an external indicator of base of skull hinge-ring fracture. J Forensic Sci. 2010;55(2):519-20.
  • Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94.
  • Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976). 1988;13(7):870-6.
  • Satomi K, Nishu Y, Kohno T, Hirabayashi K. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976). 1994;19(5):507-10.
  • Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976). 1996;21(17):1969-73.
  • Steinmetz MP, Resnick DK. Cervical laminoplasty. Spine J. 2006;6(6 Suppl):274S-81S.
  • Uematsu Y, Tokuhashi Y, Matsuzaki H. Radiculopathy after laminoplasty of the cervical spine. Spine (Phila Pa 1976). 1998;23(19):2057-62.
  • Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K. Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976). 2001;26(17):1890-4; discussion 5.
  • Chen H, Liu H, Deng Y, Gong Q, Li T, Song Y. Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation. Medicine (Baltimore). 2016;95(2):e2292.
  • Cho SH, Lee JH, Chough CK, Joo WI, Park HK, Lee KJ, et al. Hinge Fracture during Cervical Open-door Laminoplasty: Does it Affect Clinical and Radiographic Outcomes? Korean J Spine. 2014;11(2):45-51.
  • Lee DH, Kim H, Lee CS, Hwang CJ, Cho JH, Cho SK. Clinical and radiographic outcomes following hinge fracture during open-door cervical laminoplasty. J Clin Neurosci. 2017;43:72-6.
  • Park YK, Lee DY, Hur JW, Moon HJ. Delayed hinge fracture after plate-augmented, cervical open-door laminoplasty and its clinical significance. Spine J. 2014;14(7):1205-13.
  • Nordin BE. Calcium and osteoporosis. Nutrition. 1997;13(7-8):664-86.
  • Zhang X, Zhang Y, Duan D, Xie H. A Novel Drill Navigation Template Combines Preoperative Simulation in Expansive Open-Door Laminoplasty. World Neurosurg. 2018;118:e758-e65.
  • Meng Y, Wang X, Chen H, Hong Y, Wu T, Wang B, et al. Risk Factors for Significant Intraoperative Blood Loss During Unilateral Expansive Open-Door Cervical Laminoplasty for Cervical Compressive Myelopathy. World Neurosurg. 2018;114:e1253-e60.
  • Lee JH, Chough CK. Risk Factors for Hinge Fracture Associated with Surgery Following Cervical Open-Door Laminoplasty. Korean J Neurotrauma. 2018;14(2):118-22.
  • Hur JW, Park YK, Kim BJ, Moon HJ, Kim JH. Risk Factors for Delayed Hinge Fracture after Plate-Augmented Cervical Open-Door Laminoplasty. J Korean Neurosurg Soc. 2016;59(4):368-73.

Evaluation of risk factors affecting development of hinge fracture complications related to open-door cervical laminoplasty technique

Year 2021, Volume 60, Issue 3, 281 - 287, 13.09.2021
https://doi.org/10.19161/etd.990678

Abstract

Aim: Open-door cervical laminoplasty is the standard surgical option for patients with multipl levels cervical myelopathy. In this surgical technique, while linear laminectomy is performed on one side of the lamina, bone is drilled to form a hinge on the opposite side. Hinge fractures may occur on the other side while lifting the linear laminectomy side. Our study aimed to examine possible risk factors for preventing these fractures. Materials and Methods: The patients’ files, radiological images, and laboratory results who underwent cervical laminoplasty between 2013-2018 were retrospectively analyzed. Results: A total of 78 patients, 54 males and 24 females, were included in the study. The mean age of the patients was 57.8±11.6 years. The mean modified Japanese Orthopedic Association (JOA) cervical myelopathy scores of the patients before the operation were 16.2±2.1. When the pre-operative blood Ca values were examined, the mean value was 9.3±0.5 mg/dl. The mean Pavlov ratio of the patients was 0.7±0.2. Laminas were opened from the right side in 26 cases and from the left side in 52 cases. A total of 304 laminae were opened. In post-operative control cervical CTs, 42 patients had lamina hinge fractures, and the number of patients without hinge fracture was 36. There were 89 fractures in total at the lamina level. When post-operative cervical tomography images were examined, the mean opening angle (OA) of the laminas was 30.6±8.9 degrees. The opening angle of the lamina was determined to affect the hinge fracture significantly. While OA was 32.3±9 degrees in patients with lamina hinge fracture, it was found to be 28.7±8.3 in patients without fractures (p <0.05). Conclusion: During open-door cervical laminoplasty, the excessive opening angle of the lamina increases the possibility of hinge fractures. Pre-operative necessary measurements will reduce the risk of hinge fractures during surgery. This evaluation will reduce the risk of complications during the operation and increase patient comfort in the post-operative period.

References

  • Chen H, Liu H, Zou L, Li T, Gong Q, Song Y, et al. Effect of Mini-plate Fixation on Hinge Fracture and Bony Fusion in Unilateral Open-door Cervical Expansive Laminoplasty. Clin Spine Surg. 2016;29(6):E288-95.
  • Byard RW, Langlois N, Gilbert JD. Positive "water test"-an external indicator of base of skull hinge-ring fracture. J Forensic Sci. 2010;55(2):519-20.
  • Takeuchi R, Ishikawa H, Kumagai K, Yamaguchi Y, Chiba N, Akamatsu Y, et al. Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification of lateral hinge fracture. Arthroscopy. 2012;28(1):85-94.
  • Hirabayashi K, Satomi K. Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976). 1988;13(7):870-6.
  • Satomi K, Nishu Y, Kohno T, Hirabayashi K. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976). 1994;19(5):507-10.
  • Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976). 1996;21(17):1969-73.
  • Steinmetz MP, Resnick DK. Cervical laminoplasty. Spine J. 2006;6(6 Suppl):274S-81S.
  • Uematsu Y, Tokuhashi Y, Matsuzaki H. Radiculopathy after laminoplasty of the cervical spine. Spine (Phila Pa 1976). 1998;23(19):2057-62.
  • Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K. Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976). 2001;26(17):1890-4; discussion 5.
  • Chen H, Liu H, Deng Y, Gong Q, Li T, Song Y. Multivariate Analysis of Factors Associated With Axial Symptoms in Unilateral Expansive Open-Door Cervical Laminoplasty With Miniplate Fixation. Medicine (Baltimore). 2016;95(2):e2292.
  • Cho SH, Lee JH, Chough CK, Joo WI, Park HK, Lee KJ, et al. Hinge Fracture during Cervical Open-door Laminoplasty: Does it Affect Clinical and Radiographic Outcomes? Korean J Spine. 2014;11(2):45-51.
  • Lee DH, Kim H, Lee CS, Hwang CJ, Cho JH, Cho SK. Clinical and radiographic outcomes following hinge fracture during open-door cervical laminoplasty. J Clin Neurosci. 2017;43:72-6.
  • Park YK, Lee DY, Hur JW, Moon HJ. Delayed hinge fracture after plate-augmented, cervical open-door laminoplasty and its clinical significance. Spine J. 2014;14(7):1205-13.
  • Nordin BE. Calcium and osteoporosis. Nutrition. 1997;13(7-8):664-86.
  • Zhang X, Zhang Y, Duan D, Xie H. A Novel Drill Navigation Template Combines Preoperative Simulation in Expansive Open-Door Laminoplasty. World Neurosurg. 2018;118:e758-e65.
  • Meng Y, Wang X, Chen H, Hong Y, Wu T, Wang B, et al. Risk Factors for Significant Intraoperative Blood Loss During Unilateral Expansive Open-Door Cervical Laminoplasty for Cervical Compressive Myelopathy. World Neurosurg. 2018;114:e1253-e60.
  • Lee JH, Chough CK. Risk Factors for Hinge Fracture Associated with Surgery Following Cervical Open-Door Laminoplasty. Korean J Neurotrauma. 2018;14(2):118-22.
  • Hur JW, Park YK, Kim BJ, Moon HJ, Kim JH. Risk Factors for Delayed Hinge Fracture after Plate-Augmented Cervical Open-Door Laminoplasty. J Korean Neurosurg Soc. 2016;59(4):368-73.

Details

Primary Language Turkish
Subjects Health Care Sciences and Services
Journal Section Research Articles
Authors

Gökhan GÜRKAN This is me (Primary Author)
Department of Neurosurgery, Katip Celebi University Atatürk Training and Research Hospital, Izmir
0000-0003-1839-1014
Türkiye


İsmail KAYA This is me
Department of Neuroseurgery, Dumlupinar University Kutahya Evliya Celebi Training and Research Hospital, Kutahya,
0000-0002-5117-8066
Türkiye


Murat ATAR This is me
Department of Neuroseurgery, Istanbul Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul,
0000-0001-6047-2956
Türkiye


İnan UZUNOGLU This is me
Department of Neurosurgery, Katip Celebi University Atatürk Training and Research Hospital, Izmir,
0000-0001-5859-0443
Türkiye


İlker Deniz CİNGOZ This is me
Department of Neuroseurgery, Dumlupinar University Kutahya Evliya Celebi Training and Research Hospital, Kutahya,
0000-0002-0452-7606
Türkiye


Murat SAYIN This is me
Department of Neuroseurgery, Ozel Saglik Hospital, Izmir,
0000-0001-8745-2656
Türkiye


Nurullah YÜCEER This is me
Department of Neurosurgery, Katip Celebi University Atatürk Training and Research Hospital, Izmir,
0000-0003-3509-9939
Türkiye

Publication Date September 13, 2021
Application Date October 21, 2020
Acceptance Date March 30, 2021
Published in Issue Year 2021, Volume 60, Issue 3

Cite

Bibtex @research article { etd990678, journal = {Ege Tıp Dergisi}, issn = {1016-9113}, eissn = {2147-6500}, address = {}, publisher = {Ege University}, year = {2021}, volume = {60}, pages = {281 - 287}, doi = {10.19161/etd.990678}, title = {Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi}, key = {cite}, author = {Gürkan, Gökhan and Kaya, İsmail and Atar, Murat and Uzunoglu, İnan and Cingoz, İlker Deniz and Sayın, Murat and Yüceer, Nurullah} }
APA Gürkan, G. , Kaya, İ. , Atar, M. , Uzunoglu, İ. , Cingoz, İ. D. , Sayın, M. & Yüceer, N. (2021). Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi . Ege Tıp Dergisi , 60 (3) , 281-287 . DOI: 10.19161/etd.990678
MLA Gürkan, G. , Kaya, İ. , Atar, M. , Uzunoglu, İ. , Cingoz, İ. D. , Sayın, M. , Yüceer, N. "Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi" . Ege Tıp Dergisi 60 (2021 ): 281-287 <http://egetipdergisi.com.tr/en/pub/issue/64760/990678>
Chicago Gürkan, G. , Kaya, İ. , Atar, M. , Uzunoglu, İ. , Cingoz, İ. D. , Sayın, M. , Yüceer, N. "Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi". Ege Tıp Dergisi 60 (2021 ): 281-287
RIS TY - JOUR T1 - Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi AU - Gökhan Gürkan , İsmail Kaya , Murat Atar , İnan Uzunoglu , İlker Deniz Cingoz , Murat Sayın , Nurullah Yüceer Y1 - 2021 PY - 2021 N1 - doi: 10.19161/etd.990678 DO - 10.19161/etd.990678 T2 - Ege Tıp Dergisi JF - Journal JO - JOR SP - 281 EP - 287 VL - 60 IS - 3 SN - 1016-9113-2147-6500 M3 - doi: 10.19161/etd.990678 UR - https://doi.org/10.19161/etd.990678 Y2 - 2021 ER -
EndNote %0 Ege Journal of Medicine Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi %A Gökhan Gürkan , İsmail Kaya , Murat Atar , İnan Uzunoglu , İlker Deniz Cingoz , Murat Sayın , Nurullah Yüceer %T Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi %D 2021 %J Ege Tıp Dergisi %P 1016-9113-2147-6500 %V 60 %N 3 %R doi: 10.19161/etd.990678 %U 10.19161/etd.990678
ISNAD Gürkan, Gökhan , Kaya, İsmail , Atar, Murat , Uzunoglu, İnan , Cingoz, İlker Deniz , Sayın, Murat , Yüceer, Nurullah . "Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi". Ege Tıp Dergisi 60 / 3 (September 2021): 281-287 . https://doi.org/10.19161/etd.990678
AMA Gürkan G. , Kaya İ. , Atar M. , Uzunoglu İ. , Cingoz İ. D. , Sayın M. , Yüceer N. Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi. EJM. 2021; 60(3): 281-287.
Vancouver Gürkan G. , Kaya İ. , Atar M. , Uzunoglu İ. , Cingoz İ. D. , Sayın M. , Yüceer N. Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi. Ege Tıp Dergisi. 2021; 60(3): 281-287.
IEEE G. Gürkan , İ. Kaya , M. Atar , İ. Uzunoglu , İ. D. Cingoz , M. Sayın and N. Yüceer , "Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi", Ege Tıp Dergisi, vol. 60, no. 3, pp. 281-287, Sep. 2021, doi:10.19161/etd.990678