ALT SERVİKAL VERTEBRAL PEDİKÜLLERİNDE BİLGİSAYARLI TOMOGRAFİ İLE YAPILAN MORFOMETRİK ÖLÇÜMLER Morphometric Measurements With Computerized Tomography in Lower Cervical Vertebral Pedicules

OZET Servikal omurganin yapisal ve islevsel butunlugunu travma, dejenerasyon, tumoral ve infeksiyoz hastaliklar bozabilirler. Instabilite ayrica, cesitli nedenlerle yapilan cerrahi girisimlerden sonra da iyatrojenik olarak da gorulebilir. Servikal instabilite hafif norolojik kusurlardan, agir norolojik defisitlere hatta olume neden olabilecek ciddi bir durumdur. Tedavisi noral ve vaskuler yapilarin dekompresyonunu, normal anatomik dizilimin tekrar saglanmasini ve rijid bir fiksasyonu gerektirir. Uzun sure immobilizasyon, traksiyon ve eksternal fiksatorler gibi ortez kullanimi seklindeki konservatif tedaviler, bazi olgularda uygulaniyor olsa da gelisen cerrahi ve enstrumantasyon sistemleri gunumuzde cerrahi ile saglanan internal fiksasyonu one cikarmistir. Pedikul vidalari ile son derece guclu stabilizasyon saglanir. Bu nedenle torakolomber omurgada en sik kullanilan enstruman olan pedikul vidalarinin son yillarda servikal bolgede de kullanimina baslanmistir. Ince pedikul yapisi ve vertebral arterin yakin komsulugu servikal bolgede pedikul vidalarinin kullanimini zorlastiran faktorlerdir. Komplikasyonsuz bir cerrahi icin bolge anatomisinin son derece iyi bilinmesi, vida giris noktalarinin, acilarinin, vida genislik ve derinliklerinin olculere uygun sekilde secilmesi sarttir. Olcumlerimizde pedikul kalinliklarinin kranio-kaudal yonde arttigini, 3.5 mm vida kalinliginin genel olarak uygun oldugu, pedikul yuksekliklerinin pedikul kalinliklarindan fazla oldugunu gorduk. Pedikul transvers acilarini 30-45o arasinda olctuk. Olcumler hem kisiye hem de olculen seviyeye gore farkliliklar gostermektedir. Bu durum, cerrahi oncesi radyolojik yontemlerle yapilacak bir planlamanin pedikul vidalamasindaki onemini gosterir. Anahtar Kelimeler: Vertebra; Pedikul; Morfometrik ABSTRACT Trauma, dejeneration, tumoral and infectional diseases may get demaged to integrity of structural and functional cervical spine. And also, instability may be seen as an iatrogenic after the surgery. Servical instability is a situation that may cause minimal neurologic order to high neurologic deficit and even it may cause to death. Treatment requires vascular and neural structures of decompression, providing again of normal anatomic order and a rigid fixation. Even so conservative treatment which is usage of as an orthesis as a long time immobilization, traction and external fixator, is implemented in some cases, it puts forward internal fixation, which is provided with surgery today, with the help of devoloping surgery and instrumentation systems. With the pedicle screws are provided strong stabilization for that reason, in recent years pedicle screws which are used in thoracolumbar spine, are started to be used cervical region. It’s slim pedicle structure and the nearer of vertebral artery are made difficult to usage of pedicle screws in cervical region. Surgery which is not involved in complication, needs to be well-known the region of anatomy, screw entrance points, angles, wideness and deepness must be choosen as a suitable form. According to our measurements, the pedicle thickness increase towards craniocaudale, 3.5 mm screw thickness is suitable for surgery and pedicle highnesses are more than pedicle thicknesses. We measure that pedicle transverse angles are 30-45o. Measurements may be different for every level and each person. This situation shows the importance of planning in computerized tomography imaging before the surgery. Key Words: Vertebra; Pedicule; Morphometric