aans 2011 yunus aydin
DESCRIPTION
Presented at the American Association of Neurosurgery 2011 annual meeting by Prof. Dr. Yunus AYDIN: Preservation of segmental motion with anterior contralateral cervical microdiskectomy and interbody fat, a prospective studyTRANSCRIPT
![Page 1: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/1.jpg)
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
![Page 2: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/2.jpg)
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).
![Page 3: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/3.jpg)
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
![Page 4: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/4.jpg)
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,
![Page 5: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/5.jpg)
Zenker hand retractors & Bayonet Kambin microcurettes
![Page 6: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/6.jpg)
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.
![Page 7: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/7.jpg)
![Page 8: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/8.jpg)
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
![Page 9: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/9.jpg)
Clinical outcomes were assessed using
the
Neck Disability Index (NDI) and
Short Form-36 (SF-36).
OUTCOME MEASUREMENT
![Page 10: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/10.jpg)
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
![Page 11: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/11.jpg)
In group 2 (with fat graft):
Follow-up radiological studies revealed healing without fusion in
group 2 patients.
RESULTS Cont’d.
![Page 12: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/12.jpg)
• 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.
![Page 13: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/13.jpg)
Neck Disability Index
Scores decreased
significantly in both early
and late follow-up
evaluations.
(t = -1.789, p = 0.077)
RESULTS Cont’d.
![Page 14: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/14.jpg)
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.
![Page 15: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/15.jpg)
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
![Page 16: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/16.jpg)
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.
![Page 17: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/17.jpg)
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.
![Page 18: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/18.jpg)
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.
![Page 19: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/19.jpg)
7 - 10 Years7 - 10 Years
Case SamplesCase Samples
(2(2 levels levels))
![Page 20: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/20.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 21: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/21.jpg)
Pre-Pre-opop
Post-Post-opop
![Page 22: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/22.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 23: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/23.jpg)
7 - 10 Years7 - 10 Years
Case SamplesCase Samples
(1(1 level level))
![Page 24: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/24.jpg)
Pre-op.
Post-op.
*with fat graft
![Page 25: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/25.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 26: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/26.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 27: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/27.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 28: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/28.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 29: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/29.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 30: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/30.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 31: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/31.jpg)
Pre-Pre-op.op.
Post-Post-op.op.
![Page 32: Aans 2011 Yunus Aydin](https://reader033.vdocuments.pub/reader033/viewer/2022061211/54796117b4af9fb9158b4818/html5/thumbnails/32.jpg)
THANK YOUQ & A