Servikal ve Torakal Radikülopatilerde Cerrahi Tedavi
Özet
Servikal radikülopati, spinal sinir sıkışmasıyla oluşan ve genellikle üst ekstremite ağrısı ile sensorimotor bozukluklarla seyreden bir sendromdur. Hastaların çoğunda bulgular konservatif tedavilerle kendi kendini sınırladığından, cerrahi dışı yöntemlere yeterli zaman tanınmalıdır. Ameliyatsız tedavilerin yetersiz kaldığı durumlarda cerrahi seçenekler değerlendirilir. "Altın standart" olarak kabul edilen Anterior Servikal Diskektomi ve Füzyon (ASD-F), hastaların semptomlarını hızla giderir ancak komşu segment hastalığı gibi olumsuz etkilere yol açabilir. Bu olumsuz etkilerden kaçınmak için geliştirilen Servikal Disk Protezi (SDP), omurga hareketliliğini her üç planda da koruyan etkili bir alternatiftir. Ön servikal yapıların yaralanma riskini önleyen Posterior Servikal Laminoforaminotomi (PSL) ise minimal invaziv yöntemlerle uygulanabilen, eklem hareketini koruyan ve füzyon gerektirmeyen diğer bir başarılı tekniktir. Torakal radikülopatiler ise nadir görülmekte olup, en sık nedeni olan torakal disk hernilerinin cerrahi tedavisi teknik olarak zor, komplikasyonlara açık ve yüksek morbiditeye sahiptir. Cerrahi yaklaşım seçimi; disk seviyesine, kalsifikasyon durumuna ve fıtığın yerleşimine göre anterior, posterolateral veya lateral olarak belirlenir.
Cervical radiculopathy is a syndrome caused by spinal nerve compression, presenting with upper extremity pain and sensorimotor disorders, and since findings are self-limiting in most patients, adequate time should be given to conservative methods before considering surgery, which is indicated when non-surgical treatments fail. Anterior Cervical Discectomy and Fusion (ACDF), considered the "gold standard," rapidly relieves symptoms but carries risks like adjacent segment disease, leading to the development of Cervical Disc Arthroplasty (CDA) as an effective alternative that preserves motion in all three planes. Posterior Cervical Laminoforaminotomy (PCL) is another successful, non-fusion technique that can be performed minimally invasively, avoiding injury to anterior cervical structures while maintaining joint mobility. Thoracic radiculopathies are rare, and the surgical treatment of thoracic disc herniations—their most common etiology—is technically challenging, prone to complications, and associated with high morbidity. The choice of optimal surgical approach is determined as anterior, posterolateral, or lateral, depending on the disc level, presence of calcification, and location of the herniation within the canal.3
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