Operativno lečenje kalcifikovane torakalne diskus hernije: prikaz slučaja metodom prirodne fuzije nakon dekompresije kičmenog kanala

  • Bojan Jelača University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0003-3243-3196
  • Nebojša Lasica University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0002-4600-7756
  • Jagoš Golubović University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0001-5524-246X
  • Filip Pajičić University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0002-8460-1350
  • Milorad Bijelović University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Surgery, Novi Sad, Serbia https://orcid.org/0000-0002-0977-5780
  • Djula Djilvesi University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0003-3131-7855
DOI: https://doi.org/10.2298/VSP240513067J
Ključne reči: hernija diskusa;, kičmena moždina, kompresija;, kičma, fuzija pršljenova;, hirurgija, operativne procedure;, toraks.

Sažetak


Uvod. U literaturi je opisano nekoliko načina pristupa torakalnom segmentu kičmenog stuba, ali postoji još uvek mnogo dilema u vezi sa tim šta je najbolje učiniti nakon završene diskektomije, bez obzira na izabrani hirurški pristup. Incidencija postoperativne kifoze je veća ako se izvodi posteriorni hirurški pristup kičmenom stubu, a ne postoje jasno definisane indikacije za primenu intervertebralne fuzije (IF) nakon anteriornog pristupa. Cilj rada bio je da se istakne nizak morbiditet transtorakalnog multidisciplinarnog pristupa, kao i potencijalno rešenje za dobru, prirodnu IF susednih pršljenova bez proširivanja i produženog trajanja same hirurške procedure. Prikaz bolesnika. Kod bolesnice stare 44 godina nađena je izražena prednja kompresivna mijelopatija izazvana kalcifikovanom torakalnom diskus hernijom u prostoru između pršljena T10-11. Izveden je minimalno invazivni, otvoreni, transtorakalni pristup sa dekompresijom kičmenog kanala na navedenom nivou i u istom aktu je postignuta IF autolognim graftom rebra. Uprkos relativno niskoj incidenciji postoperativne nestabilnosti kičmenog stuba, ne treba da se zanemari potreba za IF i sprečavanje dugoročnih komplikacija. Kontrolni pregled torakolumbalnog segmenta magnetnom rezonancom pokazao je da više nema kompresije kičmene moždine a takođe je pokazao i dobru IF bez povećanja kifoze. Zaključak. Velika hernijacija torakalnog diskusa je retka i hirurški veoma zahtevna. Prednji transtorakalni pristup omogućava jasnu ekspozicju relevantnih struktura i smatra se minimalno invazivnim. Prednosti naknadne IF nakon transtorakalnog hirurškog pristupa uvek treba uzeti u obzir za svakog bolesnika ponaosob, čime se postoperativni morbiditet svodi na minimum.

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Objavljeno
2024/11/29
Broj časopisa
Vol. 81 Br. 11 (2024): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika