Komparativna studija efikasnosti Isobar TTL i Isobar EVO sistema u lečenju lumbalnih degenerativnih bolesti i njihovog uticaja na degeneraciju susednih segmenata
Sažetak
Uvod/Cilj. Lumbalne degenerativne bolesti (lumbar degenerative diseases – LDD) su bolesti koje nastaju usled normalnog starenja i degeneracije lumbalne kičme. Pored konzervativnih terapija, hirurške procedure postaju neophodne da bi se postigli zadovoljavajući klinički ishodi. Cilj rada bio je da se proceni efikasnost Isobar TTL i Isobar Evolution (EVO) sistema dinamičke unutrašnje stabilizacije u lečenju LDD, kao i njihov uticaj na degeneraciju susednog segmenta. Metode. Istraživanje je obuhvatilo 78 obolelih od LDD, lečenih primenom sistema unutrašnje dinamičke stabilizacije Isobar TTL ili Isobar EVO. Bolesnici su bili podeljeni u dve grupe: TTL (n = 40) i EVO (n = 38). Procena bola pomoću skorova vizuelne analogne skale (VAS) i Oswestry Disability Index (ODI), kao i procena efikasnosti prema modifikovanim MacNab kriterijumima sprovedeni su preoperativno, 1 i 3 meseca postoperativno, kao i na završnom kontrolnom pregledu. Preoperativno i nakon poslednjeg kontrolnog pregleda mereni su obim pokreta (range of motion – ROM) i odnos intervertebralnog prostora (intervertebral space ratio – IVSR). Rezultati. Za skoro dve godine 37 bolesnika iz TTL grupe i 33 iz EVO grupe završila su sve kontrolne preglede. Nakon operacije, skorovi VAS i ODI u obe grupe značajno su se poboljšali u poređenju sa preoperativnim vrednostima (p < 0,05). Hirurška efikasnost u TTL i EVO grupama ocenjena je korišćenjem modifikovanih MacNab kriterijuma kao odlična ili dobra (91,89% i 93,94%, redom). Preoperativne vrednosti ROM i IVSR nisu se razlikovale između grupa (p > 0,05). Na poslednjem kontrolnom pregledu EVO grupa imala je značajno veći ROM nego TTL grupa (4,46 ± 1,19° vs. 2,58 ± 0,71°; p < 0,05), a ROM susednih segmenata u TTL grupi bio je značajno veći nego u EVO grupi (6,74 ± 1,55° vs. 5,83 ± 1,32°; p < 0,05). IVSR operisanih i okolnih segmenata nije se značajno promenio od preoperativnog do poslednjeg kontrolnog pregleda (p > 0,05). Takođe, nije bilo značajne razlike u IVSR između dve grupe za operisane i susedne segmente na poslednjem kontrolnom pregledu (p > 0,05). Zaključak. Sistemi dinamičke stabilizacije Isobar TTL i Isobar EVO pokazali su dobar klinički učinak. Sposobnost Isobar EVO sistema da ograniči pokretljivost susednih segmenata može doprineti sprečavanju njihove degeneracije.
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