fekti vardır. En sık görüldüğü seviye L5-S1’dir.
Tedavide
öncelikle konservatif yöntemler denenmelidir. Bu teda-
vi yöntemlerinin başarısız olduğu durumlarda cerrahi
tedavi uygulanmalıdır. Cerrahi tedavi füzyon ve enstrü-
mantasyondur. Radiküler bulguların olduğu durumlar-
da sinir köklerine dekompresyon yapılmalıdır [59].
Yeşim Gökçe Kutsal
Başarısız bel cerrahisi sendromu nedir?
Selçuk Palaoğlu
Lumbosakral spinal cerrahi sonrası bel ve/veya ra-
diküler ağrının sürmesine başarısız bel cerrahisi send-
romu denir. Özellikle dejeneratif hastalıklarda preope-
ratif dönemde hasta seçimi ve en uygun tedavi ve
yöntemin belirlenmesi ve uygulanması çok önemlidir.
Bu grup hastalarda uzun bir süre konservatif tedavi
yöntemlerinin uygulanması gerekir. Cerrahi tedavi
çok basit bir dekompresyon olabileceği gibi füzyon ve
enstrümantasyon da olabilir. Omurga ve omurilik cer-
rahisinde revizyon cerrahisinin morbiditesinin ilk
ameliyatlara göre çok daha fazla olduğunu unutma-
mak gerekir [60].
Yeşim Gökçe Kutsal
Tüm bireyler toplum içinde aktif olma ve üretme
şansına ve hakkına sahip olmalıdır. Bu anlamda özellik-
le genç erişkin popülasyonda ciddi iş gücü kaybına ne-
den olan bel ağrılarını multidisipliner anlamda; kap-
samlı olarak ve derinlemesine irdeleyen araştırmalara
gereksinim duyulmaktadır. Her tıbbi sorun ve uygula-
manın ayrıcalıkları vardır ve sorunlara çözüm üretme
noktasında değişik uzmanlık dallarının sadece kendi
bilgi ve deneyimleri değil, ayrıca bunların çok yönlü
paylaşımı da hem akademik yaşama, hem de hastalara
sunulan sağlık hizmetine olumlu yansıyacaktır.
Kaynaklar
1.
Koes BW, van Tulder MW, Thomas S. Diagnosis and treat-
ment of low back pain. BMJ 2006; 332:1430-4.
2.
Hazard RG. Low-back and neck pain diagnosis and treat-
ment. Am J Phys Med Rehabil 2007; 86(Suppl):59-68.
3.
Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;
344:363-70.
4.
Krismer M, van Tulder M. Low back pain (non-specific).
Best Prac Res Clin Rheumatol 2007; 21:77-91.
5.
Indahl A. Low back pain: diagnosis, treatment, and progno-
sis. Scand J Rheumatol 2004; 33:199-209.
6.
Carragee EJ, Hannibal M. Diagnostic evaluation of low back
pain. Orthop Clin North Am 2004; 35:7-16.
7.
Tulder MW van, Koes B, Bombardier C. Low back pain. Best
Pract Res Clin Rheum 2002; 16:761-75.
8.
Airaksinen O, Brox JI, Cedrashi C, et al. European guideli-
nes for the management of chronic nonspecific low back
pain. Eur Spine J 2006; 15:192-300.
9.
Başgöze O. Bel muayenesi. Beyazova M, Gökçe-Kutsal Y,
editörler. Ankara: Güneş Kitabevi, 2000; 337-45.
10. Kinkade S. Evaluation and treatment of acute low back pa-
in. Am Fam Physician 2007; 75:1181-8.
11. Van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Spi-
nal radiographic findings and nonspecific low back pain. A
systematic review of observational studies. Spine 1997;
22:427-34.
12. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment
of low back pain: a joint clinical practice guideline from
the American College of Physicians and the American Pain
Society. Ann Int Med 2007; 147:478-91.
13. Negrini S, Giovannoni S, Minozzi S, et al. Diagnostic thera-
peutic flow-charts for low back patients: the Italian guide-
lines. Eur Medicophys 2006; 42:151-70.
14. Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al.
Magnetic resonance imaging of the lumbar spine in peop-
le without back pain. N Engl J Med 1994; 331:69-73.
15. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Ab-
normal magnetic resonance scans of the lumbar spine in
people without back pain. J Bone Joint Surg Am 1990;
72:403-8.
16. Saal JA, Saal JS, Herzog RJ. Natural history of lumbar inter-
vertebral disc extrusions treated nonoperatively. Spine
1990; 15:683-6.
17. Bush K, Cowan N, Katz DE, Gishen P. The natural history
of sciatica associated with disc pathology: a prospective
study with clinical and independent radiologic follow-up.
Spine 1992; 17:1205-12.
18. Modic MT, Obuchowski NA, Ross NS, et al. Acute low back
pain and radiculopathy: MR imaging findings and their
prognostic role and effect on outcome. Radiology 2005;
597-604.
19. Weber H, Holme I, Amlie E. The natural history of acute sci-
atica with nerve root symptoms in a double-blind placebo-
controlled trial evaluating the effect of piroxicam. Spine
1993; 18:1433-8.
20. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for
acute low-back pain and sciatica. Cochrane Database Syst
Rev 2004; CD001254.
21. Engers A, Jellema P, Wensing M, van der Windt DA, Grol R,
van Tulder MW. Individual patient education for low back
pain. Cochrane Database Syst Rev 2008; 23:CD004057.
22. French SD, Cameron M, Walker BF, Reggars JW, Esterman
AJ. Superficial heat or cold for low back pain. Cochrane Da-
tabase Syst Rev 2006; CD004750.
23. Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder
MW. Non-steroidal anti-inflammatory drugs for low back
pain. Cochrane Database Syst Rev 2008; CD000396.
24. Negrini S, Giovannoni S, Minozzi S, et al. Diagnostic thera-
peutic flow-charts for low back patients: the Italian guide-
lines. Eur Medicophys 2006; 42:151-70.
192
Gökçe Kutsal, ‹nan›c›, Karl› O¤uz, Alanay ve Palao¤lu
H
A C E T T E P E
T
I P
D
E R G ‹ S ‹
25. van Tulder M, Touray T, Furlan A, Solway S, Bouter L. Coch-
rane Back Review Group. Muscle relaxants for nonspecific
low back pain: a systematic review within the framework of
the Cochrane Collaboration. Spine 2003; 28:1978-92.
26. Martell BA, O’Connor PG, Kerns RD, et al. Systematic revi-
ew: opioid treatment for chronic back pain: prevalence, ef-
ficacy, and association with addiction. Ann Intern Med
2007; 146:116-27.
27. Koes B, van Tulder M. Low back pain (acute). BMJ Clin Evid
2006; 04:1619-33.
28. Hazard RG. Low-back and neck pain diagnosis and treat-
ment. Am J Phys Med Rehabil 2007; 86(Suppl):59-68.
29. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG.
Spinal manipulative therapy for low back pain. A meta-
analysis of effectiveness relative to other therapies. Ann In-
tern Med 2003; 138:871-81.
30. Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C,
Thompson J. Treatment- and cost-effectiveness of early in-
tervention for acute low-back pain patients: a one-year
prospective study. J Occup Rehabil 2003; 13:1-9.
31. van Tulder M, Koes B. Low back pain (chronic). BMJ Clin
Evid 2006; 04:1634-53.
32. Grabois M. Management of chronic low back pain. Am J
Phys Med Rehabil 2005; 84(Suppl 3):29-41.
33. Urquhart DM, Hoving JL, Assendelft WW, Roland M, van
Tulder MW. Antidepressants for non-specific low back pa-
in. Cochrane Database Syst Rev 2008; CD001703.
34. Ribeiro LH, Jennings F, Jones A, Furtado R, Natour J. Effec-
tiveness of a back school program in low back pain. Clin
Exp Rheumatol 2008; 26:81-8.
35. van der Windt D, Hay E, Jellema P, Main C. Psychosocial in-
terventions for low back pain in primary care: lessons lear-
ned from recent trials. Spine 2008; 33:81-9.
36. Raspe H. Management of chronic low back pain in 2007-
2008. Curr Opin Rheumatol 2008; 20:276-81.
37. Haldeman S, Dagenais S. What have we learned about the
evidence-informed management of chronic low back pain.
Spine J 2008; 8:266-77.
38. Bundschuh CV. Imaging of the postoperative lumbosacral
apine. Neuroimag Clin North Am 1993; 3:499-516.
39. Yuh WTC, Zachar CK, Barloon TC, et al. Vertebral compres-
sion fractures: distinction between benign and malign ca-
uses with MR imaging. Radiology 1989; 151:1185-92.
40. Baur A, Stabler A, Bruning R, et al. Diffusion-weighted MR
imaging of bone marrow: differentiation of benign versus
pathologic compression fractures. Radiology 1998; 207:
349-56.
41. Castillo M, Arbelaez A, Smith KJ, Fisher LL. Diffusion-we-
ighted MR imaging offers no advantage over routine non-
contrast MR imaging in the detection of vertebral metasta-
ses. AJNR Am J Neuroradiol 2000; 21:948-53.
42. Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips
RS. Patterns and perceptions of care for treatment of back
and neck pain: results of a national survey. Spine 2003;
28:292-7.
43. Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;
344:363-70.
44. Pengel LHM, Herbert RD, Maher CG, Refshauge KM. Acute
low back pain: Systematic review of its prognosis. BMJ
2003; 327:323-7.
45. Carey TS, Garrett JM, Jackman A, Hadler N. Recurrence and
care seeking after acute back pain: results of a long-term
follow-up study. North Carolina Back Pain Project. Med Ca-
re 1999; 37:157-64.
46. Linton SJ. A review of psychological risk factors in back and
neck pain. Spine 2000; 25:1148-56.
47. Refshauge KM, Maher CG. Low back pain investigations
and prognosis: a review. Br J Sports Med 2006; 40:494-8.
48. Frymoyer JW, Pope MH, Clements JH, et al. Risk factors in
low back pain: an epidemiological survey. J Bone Joint Surg
1983; 65A:213-8
49. Eismont FJ, Currier B. Current concepts review: surgical
management of lumbar intervertebral disc disease. J Bone
Joint Surg 1989; 71A:1266-9.
50. Harrop JS, Youssef JA, Maltenfort M, et al. l. Lumbar adja-
cent segment degeneration and disease after arthrodesis
and total disc arthroplasty. Spine 2008; 33:1701-7.
51. Zigler J, Delamarter R, Spivak JM. Results of the prospecti-
ve, randomized, multicenter Food and Drug Administrati-
on investigational device exemption study of the ProDisc-
L total disc replacement. Spine 2007; 32:1155-62.
52. Masuda K, Imai Y, Okuma M ve ark. Osteogenic protein-1
injection into a degenerated disc induces the restoration of
disc height and structural changes in the rabbit anular
puncture model. Spine 2006; 31:742-54.
53. Grob D, Humke T, Dvorak J. Degenerative lumbar spinal
stenosis: decompression with and without arthrodesis. J
Bone Joint Surg 1995; 77A:1036-41.
54. Kondrashov DG, Hannibal M, Hsu KY, et al. Interspinous
process decompression with the X-STOP device for lumbar
spinal stenosis: a 4-year follow-up study. J Spinal Disord
Tech 2006; 19:323-7.
55. Yeung AT, Yeung CA. Minimally invasive techniques for the
management of lumbar disc herniation. Orthop Clin North
Am 2007; 38:363-72.
56. Riesenburger RI, David CA. Lumbar microdiscectomy and
microendoscopic discectomy. Minim Invasive Ther Allied
Technol 2006; 15:267-70.
57. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus
nonsurgical treatment for lumbar degenerative spondylo-
listhesis. N Engl J Med 2007; 356:2257-70.
58. Kluba T, Dikmenli G, Dietz K, Giehl JP, Niemeyer T. Com-
parison of surgical and conservative treatment for degene-
rative lumbar scoliosis. Arch Orthop Trauma Surg. 2009;
129:1-5. Epub 2008 Jun 17.
59. Kalichman L, Kim DH, Li L, Guermazi A, Berkin V, Hunter
DJ. Spondylolysis and spondylolisthesis: prevalence and as-
sociation with low back pain in the adult community-ba-
sed population. Spine 2009; 34:199-205.
60. Hazard RG. Failed back surgery syndrome: surgical and
nonsurgical approaches. Clin Orthop Relat Res 2006; 443:
228-32.
193
Bel a¤r›lar›
C i l t 3 9 • S a y › 4 • 2 0 0 8