Spondiloz ve Spondilolistezis
Özet
Spondiloz ve spondilolistezis, vertebranın ağrı, miyelopati ve radikülopati ile ortaya çıkan dejeneratif hastalıklarıdır. Fleksiyon ve ekstansiyonun yoğun olduğu servikal ve lomber bölgelerde sık görülürler. Servikal spondiloz, sagital spinal kanal çapının daralmasıyla karakterize olup boyun ağrısı ve nörolojik defsitlere yol açabilir. Spondilolistezis ise pars interartikularis kusuru olmadan veya buna bağlı olarak bir omur gövdesinin diğeri üzerinde kaymasıdır. Lomber spondiloz genellikle L5 vertebra düzeyinde mekanik bel ağrısıyla kendini gösterirken; lomber spondilolistezis en sık L4-5 seviyesinde oluşur ve nörojenik kladikasyoya neden olabilir. Tanıda direkt grafi, BT ve MRG gibi nörogörüntüleme yöntemleri ile elektrofizyolojik incelemeler kullanılır. Tedavi yaklaşımı başlangıçta aktivite modifikasyonu, korse, fizik tedavi ve analjezikleri içeren konservatif yöntemlerden oluşur. Ancak 3 ila 6 aydan uzun süren medikal tedaviye yanıtsızlık, ilerleyici nörolojik defisitler veya sfinkter kusurları gelişmesi durumunda cerrahi müdahale endikedir.
Spondylosis and spondylolisthesis are degenerative diseases of the vertebra manifested by pain, myelopathy, and radiculopathy, which are most commonly observed in the cervical and lumbar regions where flexion and extension are intense. Cervical spondylosis is characterized by the narrowing of the sagittal spinal canal diameter, leading to neck pain and neurological deficits, whereas spondylolisthesis involves the slippage of one vertebral body over another, either with or without a pars interarticularis defect. Lumbar spondylosis generally manifests as mechanical low back pain at the L5 vertebra level, while lumbar spondylolisthesis occurs most frequently at the L4-5 level and can cause neurogenic claudication. Diagnosis is established through neuroimaging methods such as direct radiography, computed tomography, and magnetic resonance imaging, alongside electrophysiological examinations. The treatment approach is initially conservative, encompassing conservative methods including activity modification, bracing, physical therapy, and analgesics. However, surgical intervention is indicated in cases of unresponsiveness to medical treatment lasting longer than 3 to 6 months, or upon the development of progressive neurological deficits or sphincter dysfunction.
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