E|O
Transkript
E|O
www.spinetr.com /20%(5'¾6.+(51¾6¾7$1,07$1,&(55$+¾ 7('$9¾(1'¾.$6<21/$5, /20%(5%g/*('((1'26.23,<$5',0/, <$./$À,0/$5 /20%(5(1'26.23¾.¾17(5/$0¾1$5<$./$À,0 7(.1¾.+$67$6(d¾0¾g1(5¾/(5 /20%(5(1'26.23¾.&(55$+¾1¾1 .203/¾.$6<21/$5, 75$16)25$0¾1$/<$./$À,07(.1¾. +$67$6(d¾0¾g1(5¾/(5 6$1$77$9(%¾/¾0'(0¾1¾0$/¾=0 7h5.1g52À¾5h5-¾'(51(¼¾ 63¾1$/9(3(5¾)(5¾.6¾1¾5&(55$+¾6¾ g¼5(7¾09((¼¾7¾0*58%8%h/7(1¾ 7(008=6D\¿ 7h5.1g52À¾5h5-¾'(51(¼¾ 63¾1$/9(3(5¾)(5¾.6¾1¾5&(55$+¾6¾ g¼5(7¾09((¼¾7¾0*58%8 %h/7(1¾ 7(008=6$<, 7h5.1g52À¾5h5-¾'(51(¼¾ 63¾1$/9(3(5¾)(5¾.6¾1¾5&(55$+¾6¾ g¼5(7¾09((¼¾7¾0*58%8 <g1(7¾0.858/8 'U(UNDQ.DSWDQR½OX 0DrmDrD hniYersitesi 7¿p )DNOtesi 1|roÁirrMi $nDEiOim 'DO¿ ¾stDnEXO erNDnNDptDnoJOX#JmDiO.com ¾oLQGHNLOHU ¾oLQGHNLOHU 'U.DGLU.RWLO ¾stDnEXO (½itim Ye $rDÁt¿rmD +DstDnesi 1|roÁirrMi .Oini½i )DtiK ¾stDnEXO NDGirNotiO#JmDiO.com 'U&QH\W7HPL] %DÁNDn¿n0esDM¿ ....................................3 (Git|rn 0esDM¿ ....................................4 /omEer 'isN +ernisi 7Dn¿m 7Dn¿ &errDKi 7eGDYi (nGiNDs\onODr¿ ............. &eODO %D\Dr hniYersitesi 7¿p )DNOtesi 1|roÁirrMi $nDEiOim 'DO¿ 0DnisD cXne\ttemi]#JmDiO.com 'U7DKVLQ(UPDQ dXNXroYD hniYersitesi 7¿p )DNOtesi 1|roÁirrMi $nDEiOim 'DO¿ $GDnD GrtDKsinermDn#JmDiO.com 'Ug]NDQ$WHÁ /omEer (nGosNopiN ¾nterODminDr <DNODÁ¿m 7eNniN+DstD 6eoimi gneriOer.............................................. ¾stDnEXO (sen\Xrt hniYersitesi (sencDn +DstDnesi %e\in Ye 6inir &errDKisi .Oini½i ¾stDnEXO Dteso]NDn#KotmDiO.com 7rDnsIorDminDO <DNODÁ¿m 7eNniN+DstD 6eoimigneriOer............. $nNDrD 1XmXne (½itim Ye $rDÁt¿rmD +DstDnesi 1|roÁirrMi .Oini½i $nNDrD DOiGDOJic#\DKoo.com /omEer %|OJeGe (nGosNopi <DrG¿mO¿ <DNODÁ¿mODr ......................................... /omEer (nGosNopiN &errDKinin .ompOiNDs\onODr¿ ............................... 6DnDttD Ye %iOimGe 0inimDOi]m ..........3 'U$OL'DOJ¿o 'U¾ONHU6ROPD] *$7$ 7¿p )DNOtesi 1|roÁirrMi $nDEiOim 'DO¿ (tOiN $nNDrD soOmD]iONer#KotmDiO.com <D]¿ODU¿QLoHUL½LQGHQ\D]DUODUVRUXPOXGXU <$=,À0$$'5(6¾ 7h5. 1g52À¾5h5-¾ '(51(¼¾ 7DÁNent &DGGesi 34 %DKoeOieYOer $nNDrD 7eO 3 4 )DNs 3 4 (mDiO inIo#tXrNnorosirXrMi.orJ.tr :eE www.tXrNnorosirXrMi.orJ.tr www.spinetr.com 2 %XOXÁ 7DsDr¿m Ye 0DtEDDc¿O¿N +i]metOeri 7eO 3 44 $1.$5$ www.EXOXstDsDrim.com.tr EDÁNDQ¿Q PHVDM¿ EDÁNDQ¿Q mesDM¿ 1 3URI'U(UNDQ.$37$12¼/8 'e½erOi 0esOeNGDÁODr¿m /omEer GisN Kernisi JnON prDti½imi]Ge en ooN NDrÁ¿ODÁt¿½¿m¿] pDtoOoMiOerGenGir. &errDKi NDrDr¿ YerGi½imi]Ge NXOODn¿ODcDN \|ntemOerGen en \D\J¿n¿ miNroOomEer GisNeNtomi oOsD GD OomEer GisN cerrDKisinGe enGosNop NXOODn¿m¿ Kem KDstDODr Kem Ge Ei] KeNimOer tDrDI¿nGDn GDimD iOJi X\DnG¿rm¿Át¿r. %Otenimi]in . sD\¿s¿nGD OomEer GisN Kernisine minimDO inYD]iI \DNODÁ¿mODrGDn ´/omEer enGosNopiN interODminDr \DNODÁ¿m trDnsIorDminDO \DNODÁ¿m Ye OomEer enGosNop \DrG¿mO¿ \DNODÁ¿mODrµ tDrt¿Á¿ODcDNt¿r. +er G|nemGe Eir NonX\X enine Eo\XnD tDrt¿ÁmD\¿ KeGeIOeGi½imi] EOtenimi]i Ne\iIOe oNXmDn¿] GiOeNOerimi]Oe. 6D\J¿ODr sXnDr¿m. 3URI'U(UNDQ.$37$12¼/8 71'er 636&* <|netim .XrXOX %DÁNDn¿ 3 HGLW|UQmesDM¿ HGLW|UQ PHVDM¿ 2 'U$OL'$/*,d 'e½erOi 0esOeNtDÁODr¿m +er Jeoen Jn teNnoOoMinin \DÁDm¿m¿]¿ IDrNO¿ EioimOerGe etNiOeGi½ine tDn¿N oOmDNtD\¿]. (OEette Ni EX Ge½iÁim t¿p DODn¿nGD GD \erini EXOmDNtD Ye \eni teGDYi \|ntemOeri JnGemimi]e JirmeNteGir. %XnODr JeneOOiNOe cerrDKi teGDYi s¿rDs¿nGD Ei] cerrDKODr¿n sonrDs¿nGD ise KDstDODr¿m¿]¿n NonIorXnX Drt¿rmD\D \|neOiN oOmDNtDG¿r. %X X\JXODmDODr¿n Eir N¿sm¿ NOiniN X\JXODmDODrGD NDrÁ¿O¿½¿n¿ EXODmDGDn XnXtXOmDNOD EirOiNte enGosNopiN GisN cerrDKisi son 3 \¿OGD JiGereN JeOiÁmeNte Ye \D\J¿nODÁmDNtDG¿r. %X NDpsDmGD OomEer enGosNopiN GisN cerrDKisini IDrNO¿ X\JXODmD \|ntemOeri iOe EirOiNte eOe DOmD\¿ DmDoODG¿N. $\r¿cD ioinGe EXOXnGX½XmX] NOiniNOerin G¿Á¿nD o¿NDrDN EX X\JXODmDODrD Eir Ge sDnDtsDO \|nGen EDNDO¿m isteGiN. 6D½O¿NO¿ Ye mXtOX JnOer GiOe½i iOe« 'U$OL'$/*,d 4 E|OP 3 Dr. Mert À$+¾12¼/8 6LYDV1XPXQH+DVWDQHVL%H\LQYH6LQLU&HUUDKLVL.OLQL½L6LYDV /20%(5'¾6.+(51¾6¾ 7$1,07$1,&(55$+¾7('$9¾ (1'¾.$6<21/$5, B eO D½r¿s¿ insDnODr¿n t¿EEi \DrG¿m DOG¿NODr¿ sD½O¿N proEOemOeri s¿rDODmDs¿nGD en st s¿rDODrGD \er DO¿r. /omEer GisN KerniOeri Ee\in Ye sinir cerrDKisi poOiNOiniNOerine EDÁYXrmD neGenOeri DrDs¿nGD \ine iON s¿rDODrGDNi EeO D½r¿s¿ neGenOerinGen Eiri oOXp tm EeO D½r¿ODr¿n¿n -5·ni oOXÁtXrXr . BX neGenOe E\N iÁ Jc Ye mDGGi ND\¿pODrD \oO DomDNtDG¿r. TANIM /omEer GisN KerniDs\onX en EDsit ÁeNOi\Oe interYerteErDO GisN GoNXsXnX oOXÁtXrDn \Dp¿ODrGDn DnnXOXs IiEro]Xs YeYe\D nXNOeXs pXOpo]XsXn spinDO NDnDO ioine Go½rX \er Ge½iÁtirmesi ÁeNOinGe tDn¿mODnDEiOir . /omEer GisN Kernisi GisN GeMenerDs\onX srecinGe JeOiÁen Eir pDtoOoMi oODrDN NDEXO eGiOmeNteGir. /omEer GisN GeMenerDs\onX \DÁODnmD iOe EeNOenen oOD½Dn Eir GXrXmGXr. $ncDN DÁ¿r¿ \NOenmeOer spinDO trDYmDODr NonMenitDO DnomDOiOer siJDrD ioiciOi½i GiDEetes meOOitXs Ye YDsNOer pDtoOoMiOer NDn GoODÁ¿m¿nGD Eo]XNOXNODr \DrDtDrDN interYerteErDO GisN GoNXsXnXn EesOenmesini Eo]DrODr Ye interYerteErDO GisN GeMenerDs\onX JeOiÁiminin K¿]ODnmDs¿nD \oO DoDrODr. 9erteErD NorpXsODr¿ DrDs¿nGD EXOXnDn interYerteErDO GisNOer omXrJD cismine \NOenen enerMi\i Eir DOt mesDIe\e GenJeOi ÁeNiOGe iOetirOer. ¾nterYerteErDO GisNOeri DnnXOXs IiEro]Xs oODrDN isimOenGiriOen oo½XnOX½X tip , NoOODMenGen oOXÁDn YisNoeODstiN ODmeOOerGen nXNOeXs pXOpo]Xs DG¿ YeriOen tip ,, NoOODMen Ye KiGroIiOiN oODn proteoJOiNDnGDn \o½Xn io nNOeer tDEDNDGDn son pODN Gi\e isimOenGiriOen N¿N¿rGDN Eir \Dp¿GDn oOXÁXr. 'isN GeMenerDs\onX iOerOeGiNoe nNOeXs pXOpo]Xs Ye son pODNtD GDKD ID]OD orDnGD EXOXnDn tip ,, NoOODMen \erini tip , NoOODMene DnnXOXs IiEro]XstD GDKD ID]OD EXOXnDn tip , NoOODMen ise \erini tip ,, NoOODMene E¿rDN¿r Ye GisN \Dp¿s¿n¿n sD½ODm temeOOeri Eo]XOmXÁ oOXr ,. 1NOeXs pXOpo]Xs sX ioeri½ini ND\EeGereN GDKD NXrX Eir KDO DO¿r Ye \NseNOiN ND\E¿nD X½rDr. +\DOin N¿N¿rGDN ise NDOsiIi\e oODrDN GiII]\on iOe EesOenen GisNin GiII]\onXnX Eo]Dr. 'isNin sX ND\Eetmesi iOe K¿]ODnDn GiII]\on Eo]XNOX½X sonXcX GD GisN ioeri½inGeNi oNsiMen miNtDr¿ D]DO¿r. %|\Oece GisN ioerisinGeNi EDs¿nc¿ Ye JerJinOi½i sD½OD\Dn proteoJOiNDn¿n sente]ini D]DOt¿p \¿N¿m¿n¿ Drtt¿rDn DnDeroEiN metDEoOi]mD sreci EDÁODr. 3roteoJOiNDn miNtDr¿n¿n D]DOmDs¿ iOe Ge GisN KcreOerinin sX miNtDr¿ D]DO¿r. +creOerGe \¿N¿m metDEoOitOeri DrtDr Ye EX \¿N¿m metDEoOitOeri GiII]\onXn GDKD GD Eo]XOmDs¿nD neGen oOXr 5,. 7m EXnODr¿n X]Dnt¿s¿ oODrDN NoOODMen \Dp¿n¿n Ge½iÁmesi iOe DnnXOer \¿rt¿N Ye son pODNODrGD IissrOer ortD\D o¿NDr. 1NOeXs pXOpo]XstDNi sX ND\E¿ iOe intrDGisNDO EDs¿no D]DOmDs¿ sonXcX GD DnnXOer JerJinOiN D]DO¿r. .oOODMen \Dp¿s¿ Eo]XOmXÁ DnnXOer IiEriOOer DrDs¿nGDNi \¿rt¿NODr Ye son pODNODrGDNi IissrOer JeniÁOe\ereN interYerteErDO GisN nNOeXsXnXn Kerni\e oOmDs¿n¿ K¿]ODnG¿r¿r 4. $\r¿cD GisN \NseNOi½inin D]DOmDs¿ sonXcX 5 OiJDment JerJinOi½inin D]DODrDN ODNsite oOXÁmDs¿n¿n GD GisN KerniDs\onXnX NoOD\ODÁt¿rG¿½¿ \Dp¿ODn oDO¿ÁmDODrGD J|steriOmiÁtir ,. /RPEHUGLVNKHUQLVLQGHWHUPLQRORML $nnXOXs IiEro]XsXn Dnteri\orX posteri\orXnD J|re GDKD JoOGr. 3osteri\or OonJitXGinDO OiJDmentin en JoO oOGX½X \erGe ortD KDtt¿r. BX \]Gen DnnXOXsXn posteroODterDO N¿sm¿ Jcne J|re \Nn orDnt¿s¿] N¿sm¿n¿ pD\ODÁ¿r. BXnD ED½O¿ oODrDN OomEer GisN KerniDs\onODr¿n¿n oo½X posteri\orGD ortD KDtt¿n ODterDOinGe JeOiÁir. 6pinDO NDnDOD tDÁmD ÁeNOine J|re bulging, protrüzyon, ekstrüzyon, sekestrasyon 2rtD KDt iOe iOiÁNisine J|re median, paramedian, lateral, foraminal, ekstraforaminal TANI ¾nsDnODr¿n \DNODÁ¿N ·i \DÁDmODr¿n¿n KerKDnJi Eir G|neminGe EeO D½r¿s¿nGDn ÁiND\etoi oOXrODr . BX NDGDr \D\J¿n Eir ÁiND\etin OomEer GisN KernisinGe Ge en s¿N \DN¿nmD oOmDs¿ neGeni\Oe D\¿r¿c¿ tDn¿GD J|] |nnGe tXtXOmDs¿ JereNen EirooN pDtoOoMi IDset eNOem KDstDO¿NODr¿ sponGiOoOiste]is GeMenerDtiI NDOoDeNOem KDstDO¿NODr¿ poOin|ropDtiOer DnNiOo]Dn sponGiOit spinDO osteomi\eOit JiEi enIeNsi\|] KDstDO¿NODr YerteErD tm|rOeri YE. meYcXttXr. BX \]Gen KDstDn¿n |\Nsnn i\i irGeOenmesi GetD\O¿ Eir n|roOoMiN mXD\ene \Dp¿OmDs¿ Ye rDG\oOoMiN J|rntOemeOerOe tDn¿n¿n GesteNOenmesi JereNir. g\N /omEer GisN Kernisi ioin Jeno-ortD \DÁ erNeN cinsi\et DiOeseO \DtN¿nO¿N mesOeN JeoiriOmiÁ trDYmD Ye siJDrD iomeN \D\J¿n risN IDNt|rOeri DrDs¿nGDG¿r. EDcDN D½r¿s¿ oODEiOir. BDcDN D½r¿s¿ GDKD ooN NDOoDGDn EDÁOD\¿p X\OX½Xn DrNDs¿nGDn topX½D NDGDr inen si\DtDOMi ÁeNOinGeGir D\r¿cD IemorDOMi ÁeNOinGe Ge oODEiOece½i XnXtXOmDmDO¿G¿r. $½r¿ODr JeneOOiNOe D½¿r \N NDOG¿rmD GÁme D½¿r eJ]ersi] JiEi Eir trDYmD sonrDs¿ EDÁODr. +DstDODr |]eOOiNOe ooN KDreNetOi oOmDN isteme]Oer. dnN otXrmD Ye |ne e½iOme iOe GisN ioerisinGeNi EDs¿no DrtDcD½¿nGDn D½r¿ODrGD JiGereN DrtDr. $\r¿cD |Nsrme ¿N¿nmD Ye KDpÁ¿rmD JiEi intrDGisNDO EDs¿nc¿ Drtt¿rDcDN YDOsDOYD KDreNetOeri Ge D½r¿\¿ Drtt¿rDEiOir Ye tm EXnODr OomEer GisN Kernisini DNOD JetirmeOiGir. 'X\sDO \DN¿nmDODr EDs¿ DOt¿nGDNi sinir N|Nnn GermDtomXnD X\DcDN EioimGe EDcD½¿n \Dn tDrDI¿nGD D\DN tDEDn¿nGD X\OX½Xn |n \]nGe oODn X\XÁXNOXN NeoeOenme Ye\D NDr¿ncDODnmD JiEi \DN¿nmDODrG¿r. BDcDN YeYe\D D\DNtD NXYYet ND\E¿ iOe DOt riner sistem ÁiND\etOeri enGerGir. .XYYet ND\E¿ oODn KDstDODr \rrNen D\DNODr¿n¿n tDN¿OG¿½¿n¿ D\DN EiOe½inin ioe G|nG½n Ye\D merGiYen o¿NDrNen ]orODnG¿NODr¿n¿ EeOirtirOer. hriner sistem ÁiND\etOeri oODn KDstDODr ise JeneOGe EX ÁiND\etOeri sorXOmDG¿½¿ srece EeOirtme]Oer. 6orXOGX½XnGD ise D]DOm¿Á mesDne GX\XsX iOe EirOiNte s¿N tXYDOete Jitme iGrDr¿n EoÁDOmDmD Kissi Ye\D iGrDr NDo¿rmDGDn EDKseGerOer. $ncDN iGrDr NDo¿rmD ÁiND\eti oODn KDstDODrGD DciO cerrDKi JiriÁim JereNtiren NDXGD eTXinD senGromX GiNNDtOi Eir ÁeNiOGe sorJXODnmDO¿G¿r. .DXGD(TXLQD6HQGURPX .ODsiN oODrDN JenitDO E|OJe\i tXtDn ¶e½er· tDr]¿nGD Ye\D \DmD ÁeNOinGe Dneste]i tipiN EXOJXGXr riner retDnsi\on en ooN EXOXnDn EeOirtiGir. ¾GrDr retDnsi\onX oODn KDstDODrGD tDÁmD inNontinDns¿ oODEiOir. do½XnOXNOD Oe]\on seYi\esinin DOt¿nGD motor NXYYetsi]OiN Ye Gerin tenGon reIOeNsi ND\E¿ oOXÁDEiOir. *eneOGe E\N ortD KDt GisNOerine ED½O¿ JeOiÁen DciO Eir NOiniN GXrXmGXr. (n s¿N EDÁYXrX ÁiND\eti oODn EeO D½r¿s¿ DnnXOXs IiEro]XsXnXn sinir X\Dr¿m¿ Do¿s¿nGDn ]enJin oOmDs¿nD ED½O¿G¿r. BeO D½r¿s¿nD eÁOiN eGen EDcDN D½r¿ODr¿ GDKD ooN rDGiNOer ND\nDNO¿ oOXp sinir N|Nne EDs¿ Ye EXnXnOD EirOiNte JeOiÁen enIODmDs\on sonXcX oOXr. $½r¿ ÁiND\eti iOe EDÁYXrDn KDstDODrD D½r¿n¿n sresi D½r¿n¿n \D\¿O¿m ÁeNOi trDYmD |\Ns YDOsDOYD mDneYrDODr¿ Ye YcXt KDreNetOeri iOe D½r¿n¿n iOiÁNisi sorXOmDO¿G¿r. .RQXV0HGOODULV6HQGURPX 2mXriOiN JeneOGe /- GisN seYi\esinGe sonODn¿r. BX E|OJeGe Ye\D \DN¿n¿nGD EDs¿ oOXÁtXrDn Eir pDtoOoMi JeOiÁti½inGe sDntrDO GisN KerniOeri tm|r trDYmD NDnDmD D½r¿n¿n |n pODnGD oOmD\¿p otonomiN EeOirtiOerOe EirOiNte EiODterDO simetriN GX\X Ye motor ND\¿pODr¿n¿n J|rOG½ DciO Eir NOiniN GXrXmGXr. /omEer GisN KernisinGe EeO D½r¿s¿ JeneOOiNOe DniGen EDÁOD\Dn DrD DrD ÁiGGetOenen JiGereN DrtDn Eir D½r¿G¿r. 6¿N oOmDsD GD EeO D½r¿s¿ oOmDGDn sDGece NDOoD Ye\D 0XD\HQH.XYYet ND\E¿nD ED½O¿ Ge½iÁen \r\Á tDr]¿ GÁN D\DN \r\Á Ye EDs¿ DOt¿nGDNi N|N rDKDtODmD\D X\JXn DntDOMiN postr J|rOeEiOir. Laseque belirtisi - SLR (Düz bacak germe testi): +DstD sXpine po]is\onGD\Nen etNiOenen eNstremite D½r¿ oOXÁDnD NDGDr EiOeNten tXtXODrDN NDOG¿r¿O¿r. Gerecenin DOt¿nGD test po]itiItir. 6DGece EeO D½r¿s¿ \eterOi Ge½iOGir. BDcDN D½r¿s¿ Ye D½r¿n¿n GD½¿O¿m¿nGD pDreste]i JeOiÁir. /omEer GisN Kernisi ioin GX\DrO¿ 4 spesiIiNtir 5. dDprD] G] EDcDN Jerme testi )DMers]GDKn testi $½r¿ oOmD\Dn EDcDNtD 6/5 NDrÁ¿ EDcDN D½r¿s¿nD neGen oOXr. $NsiOOer GisN ioin |nemOi Eir EXOJXGXr. 6/5·Gen GDKD spesiIiNtir. 3 Femoral germe testi: +DstD prone po]is\onGD \DtDr. .DOoD eNOemi eNstDnsi\onD JetiriOirNen Gi] IOeNsi\onD JetiriOir. 7est po]itiIOi½inGe X\OXN |n \]nGe Ye Gi]in meGiDO N¿sm¿nGD D½r¿ oOXr. hst OomEer GisN KerniOeri ioin |nemOi Eir EXOJXGXr. 4 %RZVWULQJ LÁDUHWL 6/5 iOe D½r¿ oOXÁtX½XnGD NDOoD IOeNsi\onGD tXtXOXrNen Gi]in IOeNsi\onD JetiriOmesi. 6i\DtiN D½r¿s¿ D]DO¿rNen NDOoD D½r¿s¿ GeYDm eGer. .DOoD D½r¿s¿ iOe si\DtDOMi D\r¿m¿nGD NXOODn¿O¿r. 5 FABER/Patrick testi: )OeNsi\on $BNsi\on Ye (NsternDO 5otDs\on ioin NXOODn¿ODn isimGir. .DOoD Ye Gi] IOeNsi\onD JetiriOir. /DterDO mDOOeoO NDrÁ¿ Gi] ]erine NonXOXr. $\n¿ tDrDItDNi Gi] EDst¿r¿O¿r. $½r¿ oOXr ise NDOoD eNOemi KDstDO¿½¿n¿ J|sterir. 6inir N|N EDs¿s¿nGD N|tOeÁme oOmD]. BX 5 test G¿Á¿nGD nDGir oODrDN NXOODn¿ODn nDI]iJer testi crDm testi Oemp testi Ye ErDJDrG testi JiEi Jerme testOeri Ge meYcXttXr. 0otor NXYYet mXD\enesi tm NDs JrXpODr¿ mXD\ene eGiOmeOiGir. 3rDtiN oODrDN topXN stnGe \rme /5 N|Nnn pDrmDN XoODr¿nGD \rme 6 N|Nnn o|meOip NDONmD KDreNetOeri /4 Ye st N|NOerin NXYYet GXrXmXnX EeOirtir 7DEOo . 'X\X mXD\enesi GX\X NXsXrODr¿n¿ Ge½erOenGirmeN DG¿nD sXEMeNtiI Eir mXD\eneGir. BDs¿ DOt¿nGDNi sinir N|N Ye\D N|NOerine X\Dn Kipoeste]i sDptDn¿r 7DEOo . 5eIOeNs 0XD\enesi /5 sinir N|Nne KDs Eir reIOeNs \oNtXr. (tNiOenen /4 sinir N|NnGe pDteOOD reIOeNsi 6 sinir N|NnGe ise DÁiO reIOeNsi D]DO¿r 7DEOo . *|UQWOHPH<|QWHPOHUL 'ireNt *rDIiOer /omEer GisN Kernisinin tDn¿s¿nGD |nceOiNOi terciK eGiOen Eir \|ntem Ge½iOGir. BeO D½r¿s¿n¿n D\¿r¿c¿ tDn¿s¿nGD NXOODn¿ODEiOir. 'eMenerDs\onD ED½O¿ GisN mesDIesinGe D]DOmD son pODNODrGD G]ensi]OiN osteoIitOer J|rOeEiOir. 6cKmorO noGOOeri tespit eGiOeEiOir. 7DEOR.|N EDs¿s¿nD ED½O¿ EeOirti Ye EXOJXODr $½U¿Q¿Q\D\¿O¿P¿ 3DUHVWH]LYH\DGX\X ND\E¿ 0RWRU]D\¿IO¿N 5HIOHNVOHUGHD]DOPD YH\DND\EROPD / $Ot NDr¿n NDs¿N Ye\D st |n io X\OXN $Ot NDr¿n inJXinDO E|OJe ¾OiopsoDs +ipoJDstriN NremDsteriN / .Ds¿N |n Ye\D io X\OXN gn Ye io X\OXN ¾OiopsoDs YeYe\D X\OXN DGGXNt|rOeri .remDsteriN / gn X\OXN Ye\D Gi] gn X\OXN Ye Gi] .XDGriseps X\OXN DGGXNt|rODr¿ 3DteOOD / 'i] DOt¿ io EDcDN Ye\D io mDOOeoO ¾o EDcDN .XDGriseps X\OXN DGGXNt|rOeri tiEiDOis Dnterior 3DteOOD / $rND G¿Á X\OXN G¿Á EDcDNtDn D\DN s¿rt¿nD '¿Á EDcDN Ye D\DN s¿rt¿nGDn EDÁpDrmD½D +DmstrinJOer peroneXsODr tiEiDOis posterior JOXteXs meGiXs <oN 6 $rND X\OXN G¿Á mDOOeoO $rND EDcDN D\DN G¿Á¿ son iNi pDrmDN +DmstrinJOer JOXteXs mDNsimXs $ÁiO .|N 'isNoJrDIi 'eMenerDtiI GisNi oODn KDstDODrGD GinDmiN Eir tDn¿ \|ntemiGir. 'isN mesDIesinGe intrDGisNDO EDs¿nc¿n Drtt¿r¿OmDs¿ iOe oOXÁtXrXODn D½r¿ DrDc¿O¿½¿\OD GisN mesDIesi EeOirOenir. $nnXOXs IiEro]XstDNi \¿rt¿NODr¿n tespitinGe NXOODn¿O¿r. 7estin sensitiYitesi -5 DrDs¿nGDG¿r 3. 'isN Kernisinin tDn¿s¿nGDn ]i\DGe teGDYi pODnODmDs¿ ioin NXOODn¿ODEiOir. 3 BiOJisD\DrO¿ 7omoJrDIi B7 /omEer GisN Kernisi tDn¿s¿n¿n NonXOmDs¿nGD Jnm]Ge s¿N terciK eGiOen Eir J|rntOeme Ge½iOGir. g]eOOiNOe 05* oeNiOeme\en mDn\etiN DODnD Jirmesi sDN¿ncDO¿ prote]Oi Ye NDOp piOi oODn KDstDODr iOe NDpDO¿ DODn NorNXsX oODn KDstDODrGD NXOODn¿O¿r. 'isN tDrDI¿nGDn n|rDO IorDmenin NDpDnmDs¿ epiGXrDO \D½ GoNXsX GemDrNDs\on KDtt¿n¿n ND\EoOmDs¿ GisN \]e\inin NonYeNsOeÁmesi Ye YDNXm Ienomeni sDptDnDEiOir. 4 0DJnetiN 5e]onDns *|rntOeme 05* *nm]Ge GisN Kernisinin tespitinGe DOt¿n stDnGDrt NonXmXnD JeOmiÁtir. $nnXOXs IiEro]Xs \Dp¿s¿n¿ GXrDO Nesenin GXrXmXnX sinir N|N EDs¿s¿n¿ IorDmen-Kerni\e GisN iOiÁNisini OiJDmentOeri 05 mi\eOoJrDIi iOe s¿Y¿ GinDmi½ini oeÁitOi sin\DO |]eOOiNOeri iOe GisN ioerisinGeNi sX ND\E¿ tespitinGe E\N NoOD\O¿N sD½ODmDNtDG¿r. 5 0i\eOoJrDIi ¾nYD]iI Eir \|ntem oOmDs¿ neGeni\Oe B7 Ye 05·GDn sonrD NXOODn¿m¿ D]DOm¿Át¿r. /omEer GisN Kernisi meYcXt ise eNstrDGXrDO GoOmD GeIeNti J|rOr. 2perDs\on sonrDs¿ iOO 3 D\GD 05 \DnO¿Á J|rnt YereEiOece½inGen mi\eOoJrDIi terciK eGiOeEiOir. (OeNtromi\eOoJrDIi (0* /omEer GisN KernisinGe tDn¿ No\GXrXcX oOmDNtDn ]i\DGe GDKD ooN D\r¿c¿ tDn¿ ioin NXOODn¿O¿r. $\r¿cD J|rntOeme iOe NOiniN EXOJXODr¿n X\XÁmDmDs¿ GXrXmODr¿nGD N|N EDs¿s¿ Ye N|N seYi\esini EeOirOemeGe \DrG¿mc¿ Eir testtir. &(55$+¾7('$9¾(1'¾.$6<21/$5, /omEer GisN Kernisi tDn¿s¿ NonXODn KDstDODrGD Go½rX teGDYi pODnODmDs¿ ioin ÁX sorXODr sorXOmDO¿G¿r +DstDn¿n DciO cerrDKi JiriÁime iKti\Dc¿ YDr m¿" +DstD opere oOmDGDn GD teGDYi eGiOeEiOir mi" 3 +DstD\¿ opere etmeOi mi\i]" .DXGD eTXinD senGromX YeYe\D iOerOe\ici motor GeIisiti oODn KDstDODrD mXtODND DciO cerrDKi JiriÁim \Dp¿OmDs¿ JereNmeNteGir. $\r¿cD EX iNi GXrXm OomEer GisN KernisinGe Nesin cerrDKi enGiNDs\onODr¿G¿r. $ncDN EX KDstD JrXEX OomEer GisN Kernisi oODn tm KDstDODr ioerisinGe NoN Eir N¿sm¿ NDpsDmDNtDG¿r. *eri\e NDODn E\N E|Omn teGDYi pODnODmDs¿ KkOk tDrt¿ÁmDO¿G¿r. *|receOi cerrDKi teGDYi enGiNDs\onODr¿ - 4- KDItDO¿N NonserYDtiI teGDYi\e rD½men ceYDp DO¿nDmD\Dn - BDcDN Jerme testOerinGe po]itiIOiNOe EirOiNte EeOirJin sensorimotor GeIisit - 5DGiNOer EDcDN D½r¿s¿ oODn KDstDGD GDr NDnDO ]emininGe OomEer GisN Kernisi - 7eNrDrOD\Dn n|roOoMiN GeIisitOerin oOmDs¿ )DNDt r|ODtiI cerrDKi enGiNDs\onODr GD tDrt¿ÁmDODr¿ D]DOtmDm¿Át¿r. g]eOOiNOe D½r¿s¿ Jeome\en KDstDGD teGDYinin ne NDGDr srmesi JereNti½i NonserYDtiI teGDYinin iON EDÁYXrXOmDs¿ JereNen teGDYi \|ntemi oOXp oOmDG¿½¿ OomEer GisN Kernisinin Go½DO se\ri Jere½i cerrDKi\e JereN oOXp oOmDG¿½¿ cerrDKi sonXoODr¿ etNiOe\en IDNt|rOer cerrDKinin ]DmDnODmDs¿ Ye cerrDKinin EDÁDr¿s¿nGD KDstD psiNoOoMisinin \eri KkOk tDrt¿ÁmDO¿G¿r. /omEer GisN Kernisi oOXp si\DtDOMisi oODn KDstDODr¿n E\N Eir oo½XnOX½XnXn D½r¿ODr¿ EirNDo D\ ioerisinGe D]DOmDNtD Ye\D tDmDmen JeomeNteGir. $ncDN oDO¿ÁmDODr¿n KioEiri teGDYi DOmDm¿Á OomEer GisN KerniOerinin Go½DO se\rini Nesin s¿n¿rODr ioerisine soNmDmDNtDG¿r. dnN EX tr KDstDODr¿n oo½X NonserYDtiI teGDYi sonrDs¿nGD N|N isNemisinin Ye inIODmDs\onXnXn D]DOmDs¿ iOe i\iOeÁirOer. $\r¿cD Kerni\e OomEer GisNOerin ]DmDn ioerisinGe spontDn reJrese oOGX½XnX J|steren \D\¿nODrGD JiGereN DrtmD\D EDÁODm¿Át¿r . 6eNestre Ye eNstrGe oOmXÁ GDKD E\N Kerni\e GisNOerin GDKD ooN NoOeEiOece½ini J|steren \D\¿nODr GD meYcXttXr . BX GXrXmGD cerrDKi teGDYi\i ne ]DmDn Ye ni\e terciK etmeOi\i]" BX sorX\X \Dn¿tODmDN ioin NonserYDtiI Ye cerrDKi teGDYiOeri NDrÁ¿ODÁt¿rDn oDO¿ÁmDODr¿ inceOemeN Go½rX oODEiOir. \¿O¿nGD \D\¿nODnDn OXmEDr GisN Kernisi sonXcX JeOiÁen si\DtDOMinin cerrDKi Ye NonserYDtiI teGDYiOerinin NDrÁ¿ODÁt¿r¿OG¿½¿ \D]¿ODr¿n sistemDtiN GerOemesinGe |]eOOiNOe 5 \D]¿ ]erinGe GXrXOmXÁtXr. BX \D]¿ODrGDn Eiri erNen cerrDKi \Dp¿Om¿Á YDNDODr iOe X]Dm¿Á NonserYDtiI teGDYi sonrDs¿ cerrDKi JereNen YDNDODr¿n NDrÁ¿ODÁt¿r¿OmDs¿ Eir Gi½eri cerrDKi iOe epiGXrDO enMeNsi\on \Dp¿Om¿Á YDNDODr¿n NDrÁ¿ODÁt¿r¿OmDs¿ Gi½er o ise cerrDKi iOe JeneO NonserYDtiI teGDYi NDrÁ¿ODÁt¿r¿O- mDs¿G¿r. (rNen cerrDKinin X]Dm¿Á NonserYDtiI teGDYi\e J|re GDKD i\i Ye N¿sD sreGe D½r¿ Do¿s¿nGDn rDKDtODmD sD½ODG¿½¿ tespit eGiOmiÁtir. &errDKi Ye JeneO NonserYDtiI teGDYi DrDs¿nGD ise - seneOiN sreote EeOirJin IDrN sDptDnmDG¿½¿ EeOirtiOmeNteGir. $ncDN oeÁitOi N¿s¿tODmDODr neGeni\Oe GÁN NDn¿t G]e\Oi oDO¿ÁmD oOGX½X GD |]eOOiNOe EeOirtiOmiÁtir . 5 \¿O¿nGD \D\¿nODnDn Ye metD-DnDOi] iOe \Dp¿ODn Eir Gi½er sistemDtiN GerOemeGe OomEer GisN Kernisi sonXcX opere eGiOen DtOetOer iOe NonserYDtiI teGDYi eGiOen DtOetOerin sporD G|nÁOeri 4 D\r¿ oDO¿ÁmD DrDÁt¿r¿ODrDN NDrÁ¿ODÁt¿r¿Om¿Át¿r. &errDKi Ye NonserYDtiI teGDYi DrDs¿nGD EeOirJin IDrN EXOXnDmDm¿Át¿r. $ncDN EX oDO¿ÁmDn¿n GD GÁN NDn¿t G]e\Oi oOGX½X |]eOOiNOe EeOirtiOmiÁtir . 3 \¿O¿nGD rDnGomi]e NontroOO \Dp¿ODn Eir oDO¿ÁmDGD ise si\DtDOMi ioin \Dp¿Om¿Á cerrDKi Ye NonserYDtiI teGDYinin 5 \¿OO¿N NDrÁ¿ODÁt¿r¿OmDO¿ sonXoODr¿ \D\¿nODnm¿Át¿r. 'i½er oDO¿ÁmDODrGD oOGX½X JiEi EX oDO¿ÁmDGD GD 5 \¿OO¿N tDNipte X]Dm¿Á NonserYDtiI teGDYi iOe erNen cerrDKi DrDs¿nGD DnODmO¿ IDrN EXOXnDmDm¿Át¿r. 8]Xn G|nem NonserYDtiI teGDYi DODcDN oODn KDstDODrD GD X]Xn G|nemGe cerrDKi JereNeEiOece½i |]eOOiNOe EeOirtiOmiÁtir 4). $\r¿cD OomEer GisN KerniDs\onX ioin cerrDKi Ye NonserYDtiI teGDYinin NDrÁ¿ODÁt¿r¿OmDs¿nGD en JeniÁ oDpO¿ Ye X]Xn G|nemOi oDO¿ÁmDODr¿nGDn Eiri oODn 7Ke 6pine 3Dtient 2Xtcomes 5eseDrcK 7riDO 63257·¿n iONi senesinGe \D\¿nODnm¿Át¿r. (n D] KDItD semptomODr¿ GeYDm eGen 5 KDstDn¿n rDstJeOe cerrDKi Ye NonserYDtiI teGDYi\e \|nOenGiriOmesi sonrDs¿nGDNi sene ioinGe iON sonXoODr Do¿s¿nGDn EeOirJin IDrN EXOXnDmDm¿Át¿r $½r¿ Ii]iNseO GisIonNsi\on 2swetr\ 'isDEiOit\ ¾nGe[ JiEi Do¿ODrGDn. +DstDODrD sorXODn G]eOme iÁe EDÁODmD JiEi sorXODrGD ise cerrDKi iOe teGDYi oODn KDstDODr¿n sonXoODr¿n¿n GDKD i\i oOGX½X tespit eGiOmiÁtir. $\n¿ oDO¿ÁmDn¿n 4 \¿O¿nGD \D\¿nODnDn \¿OO¿N sonXoODr¿nGD GD cerrDKi \Dp¿ODn JrXEXn GDKD i\i JeOiÁme ND\Getti½i sDptDnm¿Át¿r grn $½r¿ sNDODODr¿ pXDn ]erinGen pXDn DOt¿nGD oODrDN ND\GeGiOmiÁtir. $ncDN tm YeriOere EDN¿OG¿½¿nGD ise 4 \¿O iOe \¿O DrDs¿nGD EeOirJin IDrN sDptDnDmDm¿Át¿r 5. 7m EX oDO¿ÁmDODrGDn Eir o¿NDr¿m \DpDcDN oOXrsDN OiterDtrn cerrDKi teGDYinin NonserYDtiI teGDYi\e Nesin stnO½n NDn¿tOD\DcDN iNnD eGici GDKD niteOiNOi oDO¿ÁmDODrD KkOk iKti\Dc¿ oOGX½XGXr. 8]Xn G|nem ID\GD G]e\ine EDN¿OG¿½¿nGD teGDYiOer DrDs¿ IDrN oOmDsD GD erNen G|nemGe \Dp¿ODn cerrDKi iOe KDstDODr¿n D½r¿- ODr¿n¿n GDKD K¿]O¿ i\iOeÁti½i Ye KD\Dt NonIorODr¿n¿n GDKD oDEXN normDOe G|nG½ Eir JeroeNtir. doN ÁiGGetOi D½r¿ODr¿ oODn KDstDODrGD iON - KDItD NonserYDtiI teGDYinin GeneneEiOece½i KDstDODr¿n 3. D\GDn sonrD cerrDKi G¿Á¿ teGDYiOerGen ID\GD J|rme ÁDns¿n¿n D]DODEiOece½i EeOirtiOmeNteGir. $\r¿cD DOt¿ D\ ioerisinGe opere oOmD\Dn KDstDODrGD GD cerrDKi mGDKDOeGen ID\GD J|rme iKtimDOOerinin D]DODcD½¿n¿n DOt¿ oi]iOmeNteGir ,). \¿O¿nGD 4 KDstD iOe OomEer GisN Kernisi cerrDKisi sonrDs¿nGDNi X]Xn G|nem tDNipOerinGe NOiniN IDNt|rOerin etNisinin DrDÁt¿r¿OG¿½¿ Eir oDO¿ÁmDGD ise D\O¿N ÁiND\et sresi oODn KDstDODr¿n ·inGe tDtmin eGici sonXoODr DO¿nmDs¿nD rD½men 3 D\GDn ID]OD sreGir ÁiND\eti oODn KDstDODrGD EX orDn¿n 5·\e GÁt½ J|rOmeNteGir. $\n¿ oDO¿ÁmDGD |]eOOiNOe D\GDn GDKD N¿sD sre EDcDN D½r¿s¿ oODn KDstDODr¿n cerrDKi sonrDs¿ seneOiN Ye 5- seneOiN tDNipOerinin GDKD tDtmin eGici GXrXmGD oOGX½X GD EeOirtiOmeNteGir 3. .onserYDtiI teGDYinin sresi Ye cerrDKinin ]DmDnODmDs¿ G¿Á¿nGD cerrDKinin sonXoODr¿n¿ etNiOe\en IDNt|rOer DrDs¿nGD GisN Kernisinin oOXÁ ÁeNOi Ye \eriGe |nemOiGir. grne½in eNstrGe GisN Kernisi oODn KDstDODrGD cerrDKi sonrDs¿ KDstD memnXni\etinin GDKD i\i oOGX½X EeOirtiOmeNteGir ). $\r¿cD 9 senesinGe \Dp¿ODn 5 KDstDO¿N prospeNtiI Ye B7-05 iOe \Dp¿ODn rDG\oOoMiN GereceOenGirmeOi oDO¿ÁmDGD GD oOGX½X JiEi sDntrDO GisN KerniOi KDstDODrGD cerrDKi EDÁDr¿ orDn¿n¿n GÁN oOGX½X EeOirtiOmeNteGir . (NstrGe GisN Kernisinin Ye\D seNestre GisN Kernisinin oOmDs¿ Ye Kerni\e GisNin ortD KDttDn GDKD ODterDOGe oOmDs¿ N|N EDs¿s¿ \DpDrDN rDGiNOer semptomODr¿n JeOiÁmesine neGen oOXr. BX tip GisN KerniOerinin semptomODr¿ Ye mXD\ene EXOJXODr¿ GDKD EeOirJinGir. BX GXrXmGD GD KDstDODr¿n cerrDKiGen ID\GD J|rme iKitimDOi DrtDr 9. BX \]Gen IDrNO¿ sinir N|N mXD\ene EXOJXODr¿ sDptDnDn Ye EeOirJin rDGiNOer ÁiND\etOeri oOmD\Dn KDstDODrGD cerrDKi NDrDr YerirNen GiNNDt eGiOmeOiGir. +DstDn¿n Jeoirece½i cerrDKinin proJno]XnX etNiOe\en IDNt|rOerGen Eiri Ge /DseTXe Jerme testiGir. 4 senesinGe \Dp¿ODn prospeNtiI Eir oDO¿ÁmDGD OomEer GisNeNtomi sonrDs¿ proJno]X etNiOe\en IDNt|rOer inceOenmiÁtir. g]eOOiNOe /DseTXe po]itiIOi½inin cerrDKiGen ID\GD J|reEiOirOi½i D]DOtt¿½¿ sDptDnm¿Át¿r 3. $ncDN NontrODterDO /DseTXe Jerme testi po]itiIOi½inin cerrDKi teGDYinin EDÁDr¿s¿nGD oOXmOX Eir IDNt|r oOGX½X GD EeOirtiOmeNteGir . 9 /omEer GisN KernisinGe EDÁDr¿\¿ etNiOe\en en |nemOi IDNt|rOerGen Eiri Ge KDstDn¿n psiNoOoMiN GXrXmXGXr. 'epres\on tDn¿s¿ oODn KDstDODrGD OomEer GisNeNtomi sonrDs¿ EDÁDr¿ orDn¿ GÁmeNteGir. /iterDtrGe EDÁDr¿s¿] sonXoODr¿n 5·sinGen ID]ODs¿n¿ GD seNonGer ND]Dno sD½ODmDN iste\en Ye psiNoOoMiN sorXnODr¿ oODn KDstDODr¿n NDpsDG¿½¿n¿ tespit eGen oDO¿ÁmDODr EXOXnmDNtDG¿r 3,4. *nm]e NDGDr rDnGomi]e rDnGomi]e oOmD\Dn NDrÁ¿ODÁt¿rmDO¿ N¿sD Ye\D X]Xn G|nem tDNipOi EirooN oDO¿ÁmD \D\¿nODnm¿Á oOsD GD tm EX oDO¿ÁmDODrD EDNt¿½¿m¿]GD Nesin Eir sonXcD YDrmDN ]orGXr. BX \]Gen OomEer GisN Kernisi oODn KDstDODrGD cerrDKi teGDYiGe r|ODtiI cerrDKi enGiNDs\onODr¿ JnceOOi½ini NorXmDNtDG¿r. g]eOOiNOe cerrDK¿n NOiniN tecrEesi iOe EirOiNte KDstDGDn DO¿nDcDN sD½O¿NO¿ Eir DnDmne] Ye n|roOoMiN mXD\ene cerrDKi NDrDr DOmDGD NoOD\O¿N sD½OD\DcDNt¿r. 8\JXn cerrDKi enGiNDs\on No\XOGX½XnGD GD cerrDKinin EDÁDr¿s¿ Ye KDstD memnXni\eti DrtDcDNt¿r. .$<1$./$5 . $tODs 6- .eOOer 5B :X <$ 'e\o 5$ 6inJer '(. /onJterm oXtcomes oI sXrJicDO DnG nonsXrJicDO mDnDJement oI sciDticD seconGDr\ to D OXmEDr Gisc KerniDtions \eDr resXOts Irom tKe mDine OXmEDr spine stXG\. 6pine 3KiOD 3D 9 $pr 5 3 9-35 5 . BXttermDnn *5. /XmEDr Gisc KerniDtion reJression DIter sXccessIXO epiGXrDO steroiG inMection. - 6pinDO 'isorG 7ecK 5 49- 3. &oOOis -6 *DrGnen :-. /XmEDr GiscoJrDpK\.- 1eXrosXrJ 9 45- 9 4. 'DYis 5$. $ OonJ term DnDO\sis oI 94 sXrJicDOO\ treDteG KerniDteG OXmEDr Giscs. - 1eXrosXrJ 45- 994 5. 'oitD 0 .DnDtDni 7 +DrDGD 7 0i]Xno .. ,mmXnoKistoOoJic stXG\ oI tKe rXptXreG interYerteErDO Gisc oI tKe OXmEDr spine. 6pine 35-4 99 . +DOOGin . /inG B 5|nnEerJ . *|tKOin - *DGeKoOt*|tKOin * =opJD B BrisE\ +. 7Kree-GimensionDO rDGioOoJicDO cODssiIicDtion oI OXmEDr Gisc KerniDtion in reODtion to sXrJicDO oXtcome. ,nt. 2rtKop -Xn 333539 . +DnOe\ (. 6XrJicDO inGicDtion DnG tecKniTXes. 7Ke internDtionDO societ\ Ior tKe OXmEDr spine. 7Ke /XmEDr 6pine nG eG. 3KiOeGeOpKiD :B 6DXnGers 49-54 99 . +irDED\DsKi 6 .XmDno . 7sXiNi 7 (JXcKi 0 ,NeGD 6 $ GorsDOO\ GispODceG Iree IrDJment oI OXmEDr Gisc KerniDtion DnG its interestinJ KistoOoJic IinGiJs. $ cDse report. 6pine 5 3-33 99 9. ,onceDn 60. /XmEDr interYerteErDO Gisc KerniDtion IoOOowinJ e[perimentDO intrDGiscDO pressXre increDse. $ctD 1eXrocKir :ien 4 9- . ¾pOiNoio½OX $&. /omEer GisN cerrDKisinGe cerrDKi teGDYi enGiNDs\onODr¿ Ye ]DmDnODmD. 7rN 1|roÁirXrMi 'erne½i 6pinDO Ye 3eriIeriN 6inir &errDKisi *rXEX <D\¿nODr¿ 1o 5-9 . -DcoEs :&+ YDn 7XOGer 0 $rts 0 5XEinstein 60 YDn 0iGGeONoop 0 2steOo 5 9erKDJen $ .oes B 3eXO :&. 6XrJer\ YersXs conserYDtiYe mDnDJement oI sciDticD GXe to D OXmEDr KerniDteG Gisc D s\stemDtic reYiew. (Xr 6pine - $pr 4 53- . .DnJ -' 6teIDnoYic-5Dcic 0 0c,nt\re /$ *eorJescX +, (YDns &+. 7owDrG D EiocKemicDO XnGerstDnGinJ oI D KXmDn interYerteErDO Gisc GeJenerDtion DnG KerniDtion. &ontriEXtions oI nitric o[iGe interOeXNins prostoJODnGin ( DnG mDtri[ metDOOoproteinDses. 6pine 53 99 3. .oKOEoecN * *reineO .9 3iotrowsNi :3 /eiEetseGer 0 .romEKot]-5einGO 0 1eXKoIer 5 6cKmiG $ .OinJer 5. 3roJnosis oI mXOtiIDctoriDO oXtcome in OXmEDr Giscectom\ D porspectiYe OonJitXGinDO stXG\ inYestiJDtinJ pDtients witK Gisc proODpse. &Oin - 3Din 1oY-'ec 455- 4 4. /eTXin 0B 9erEDDn ' -DcoEs :&+ BrDnG 5 BoXmD *- 9DnGertop :3 3eXO :&. 6XrJer\ YersXs proOonJeG conserYDtiYe treDtment Ior sciDticD 5 \eDr resXOts oI D rDnGomi]eG controOOeG triDO. B0- 2pen 3 3 5. /Xrie -' 7osteson 7' 7osteson $1$ =KDo : 0orJDn 76 $EGX :$ +erNowit] + :einstein -1. 6XrJicDO YersXs nonoperDtiYe treDtment Ior OXmEDr Gisc KerniDtion. 6pine 39 3 4 . 0Drtin 0' Bo[eOO &0 0DOone '*. 3DtKopK\sioOoJ\ oI OXmEDr Gisc GeJenerDtion D reYiew oI tKe OiterDtXre. 1eXrosXrJ )ocXs 3 ( . 1erOicK $* Boos 1 :iest $eEi 0. ,mmXnoOocDOi]Dtion oI mDMor interstitiDO coOODJen t\pes in KXmDn OXmEDr interYerteErDO Giscs oI YDrioXs DJe. 9ircKows $rcK 43 - 99 . 3enJ B +Do - +oX 6. 3ossiEOe pDtKoJenesis oI pDinIXO inetrYerteErDO Gisc GeJenerDtion. 6pine 35 5- 9. 3ere]-&rXet 0- 6DmDrt]is '. /XmEDr GeJenerDtiYe GisN GiseDse. $tODs oI neXrosXrJicDO tecKniTXes spin DnG peripKerDO nerYes. 1ew <orN 7Kieme 555- . 3ostDccKini ). 0DnDJement oI KerniDtion oI tKe OXmEDr Gisc. - Bone -oint 6XrJ Br -B 5- 999 . 5eimDn 03 6\OYDin - /oXGon -. *ooGe $. 5etXrn to sport DIter open DnG microGiscectom\ sXrJer\ YersXs conserYDtiYe treDtment Ior OXmEDr Gisc KerniDtion D s\stemDtic reYiew witK metD-DnDO\sis. Br - 6ports 0eG 2ct 5 . 6DNDi 7 7sXMi 7 $sD]XmD 7 <Dto < 0DtsXEDrD 2 1emoto . 6pontDneoXs resoption in recXrrent inGXrDO OXmEDr Gisc KerniDtion. $ cDse report. - 1eXrosXrJ 6pine 54- 3. 6iOYerpODts . /inG B =opJD B +DOOGin . *eOOersteGt 0 BrisE\ + 5XtEerJ /. &OinicDO IDctors oI importDnce Ior oXtcome DIter OXmEDr Gisc KerniDtion sXrJer\ OonJ term IoOOow-Xp. (Xr 6pine - 99 459- 4. 7KomDs 110 5eD */ :einstein 35. $nDtom\ DnG pDtKopK\sioOoJ\ oI DcTXireG spinDO Oesions. ,n (GwDrG &. Ben]eO eG. 6pine 6XrJer\ 7ecKniTXes &ompOicDtion $YoiGDnce DnG 0DnDJement nG eG. 3KiODGeOpKiD (OseYier -99 5 5. 7opODmDo½OX + 2IOXo½OX $.(. /omEer GisN KerniOeri. .orIDO¿ ( =iOeOi 0. eG 7rN 1|roÁirXrMi 'erne½i <D\¿nODr¿ 7emeO 1|roÁirXrMi .itDE¿ &iOt 49 . 9ernDn-5oEerts B 3DtKoOoJ\ oI interYerteErDO Giscs DnG DpopK\seDO Moints. 7Ke OXmEDr spine DnG EDcN pDin 3rG (G. (GinEXrJK 9 . 9Xcetic 1 6Yensson 2. 3K\sicDO siJns in OXmEDr GisN KerniD. &Oin 2rtKop 333 9- 99 . =iOeOi 0. /omEer GisN KDstDO¿½¿nGD teGDYi enGiNDs\onODr¿ Ye KDstD \|netimi. =iOeOi 0 g]er $) eG.. 2mXriOiN Ye 2mXrJD &errDKisi &iOt .BDsN¿ ¾]mir 0etD BDs¿m 0Dt. +i]metOeri 4- E|OP 'U*|UNHP$/.,5 /20%(5(1'26.23¾.¾17(5/$0¾1$5 <$./$À,07(.1¾.+$67$6(d¾0¾g1(5¾/(5 *¾5¾À *nm]Ge minimDO inYD]iY cerrDKi teNniNOer D]DOm¿Á postoperDtiI D½r¿ erNen i\iOeÁme \Dp¿Á¿NO¿N Ye neGEe GoNXsXnXn GDKD D] oOXÁmDs¿ No]metiN Do¿GDn GDKD i\i J|rnt\e sDKip oOmDODr¿ Do¿s¿nGDn terciK eGiOmeNteGir -4. 'oOD\¿s¿ iOe spinDO cerrDKiGe Ge minimDO inYD]iY \|ntem DrD\¿ÁODr¿ KioEir ]DmDn JnceOOi½ini \itirmemiÁtir 5. /omEer GisN cerrDKisinGe minimDO inYD]iY \DNODÁ¿mODrD JeoiÁ <DÁDrJiO Ye &DspDr·¿n KDOen JnceO oODrDN s¿NoD X\JXODnDn miNroGisNeNtomi\i tDn¿mODmDs¿ iOe EDÁODm¿Át¿r . 93·te .DmEin Ye *eOOmDn posteroODterDO perNtDn enGosNopiN \DNODÁ¿m¿ tDn¿mODm¿Át¿r . (nGosNopiN \DNODÁ¿mODr DmeOi\Dt¿n Kem JeneO Dneste]i Kem Ge OoNDO Dneste]i DOt¿nGD \Dp¿ODEiOmesine oODnDN sD½ODm¿Át¿r 9. 3osteroODterDO \DNODÁ¿mGD en |nemOi N¿s¿tOD\¿c¿ IDNt|rOer iOiDN NDnDt Ye miJrDtXDr GisN KerniOeriGir -5. $\r¿cD IorDmen oDp¿ DOt OomEer seYi\eOerGe /4-5 /5-6 D]DOmDNtD Ye N|N \DrDODnmDs¿ risNi oOXÁmDNtDG¿r . BX N¿s¿tODmDODrD Eir o|]m oODrDN posterior enGosNopiN \DNODÁ¿mODr JeOiÁtiriOmiÁtir -9. =DmDn ioinGe teNnoOoMi Ye cerrDKi teNni½in JeOiÁtiriOmesi sonXcXnGD \¿O¿nGD 5Xetten Ye &Koi tDrDI¿nGDn tDm enGosNopiN interODminDr \DNODÁ¿m tDn¿mODnm¿Át¿r . &(55$+¾$/(7/(5 7Dm enGosNopiN interODminDr GisN cerrDKisinGe cerrDKi s¿rDs¿nGD J|rÁ DODn¿n¿ Drtt¿rmDN ioin 5 Do¿O¿ enGos Nop NXOODn¿OmDNtDG¿r. B|\Oece DmeOi\Dt sDKDs¿n¿n GDKD i\i J|rOmesi sD½ODnm¿Át¿r. (nGosNop riMit \Dp¿O¿G¿r. BX enGosNoptDNi oDO¿ÁmD NDnDO¿n¿n oDp¿ sistemOere J|re IDrNO¿O¿N J|stermeNOe EirOiNte 35-4 mm·Gir. 2ptiN N¿s¿m seri KDOGe Gi]iOmiÁ OensOer Ye KDYD EoÁOXNODr¿nGDn oOXÁtXrXODrDN en X\JXn J|rntnn oOXÁtXrXOmDs¿ sD½ODnm¿Át¿r . BX \Dp¿ ENOme cerrDKi DOetOerin GiNNDtsi]ce oDO¿ÁmD NDnOne \erOeÁtiriOmesi \D GD steriOi]Ds\on |ncesi temi]Oeme s¿rDs¿nGD GiNNDt eGiOmemesi KDOinGe Eo]XOmDNtD Ye J|rntnn N|t oOmDs¿nD \oO DomDNtDG¿r. dDO¿ÁmD N¿O¿I¿n¿n enGosNopX sert KDreNetOerGen NorXmDN eO KDreNetOerine \DrG¿mc¿ oOmDN Ye NoniN Xo \Dp¿s¿ iOe N|N eNDrtDs\onXnX sD½ODmD iÁOeYOeri YDrG¿r. $\G¿nODtmD ioin so½XN ¿Á¿N ND\nD½¿ NXOODn¿OmDNtDG¿r. $meOi\Dt s¿rDs¿nGD sreNOi Ye EeOirOi Eir EDs¿notD serXm Ii]\oOoMiN irriJDs\onX \Dp¿ODrDN opti½in XcXnXn NDnOD NirOenmesi |nOenir Ye en X\JXn J|rÁ sD½ODn¿r. BX irriJDs\on D\r¿cD KemostD] ioin NXOODn¿ODn \NseN Jce sDKip rDG\oIreNDns 5) proEXnXn n|rDO \Dp¿ODrD ]DrDr Yermesini enJeOOer. 0iNroGisNeNtomiGe Ge NXOODn¿ODn pXncK GiseNt|r mDNDs Nerrison ronJeXr JiEi DOetOer enGosNopXn \Dp¿s¿nD X\JXn oODrDN tDsDrODnm¿Á ÁeNiOGe NXOODn¿OmDNtDG¿r. BX cerrDKi teNniNte N|N eNDrt|r Ye Nrete iKti\Do \oNtXr. &(55$+¾7(.1¾. +DstD \] st po]is\onGD DmeOi\Dt mDsDs¿nD DO¿n¿r. 2mX]ODrD Ye peOYise MeO GesteNOer NonDrDN torDNs Ye EDt¿n ioi EDs¿nc¿n DrtmDs¿ enJeOOenir. $meOi\Dt mDsDs¿n¿n &-NoOOX sNopinin $3 Ye ODterDO po]is\onODrGD oeNim \DpmDs¿nD X\JXn [-¿Á¿nODr¿nD JeoirJen tDr]GD tDsDrODnm¿Á oOmDs¿ JereNir. $meOi\DtD EDÁODmDGDn |nce sNopinin steriO |rt iOe |rtOmesi Etn NDmerD ED½ODnt¿ODr¿n¿n \Dp¿OmDs¿ J|rnt NXOesi Ye sNopi monit|rnn cerrDK¿ \ormD\DcDN ÁeNiOGe Ye Kepsini D\n¿ DnGD J|reEiOece½i ÁeNiOGe \erOeÁtiriOmesi JereNir. +DstD\¿ steriO Eir ÁeNiOGe |rtmeGe NXOODn¿ODn Gre\pin cerrDKi DODnGD EiriNen \¿NDmD sX\XnX s¿]G¿rmD\DcDN D\n¿ ]DmDnGD sDKD\¿ ¿sODtmD\DcDN ÁeNiOGe sDNODmD E|OmeOi \Dp¿\D sDKip oOmDs¿ cerrDKi eNiEin DmeOi\Dt NonIorXnX Drtt¿r¿r. $meOi\DtD $3 sNopi eÁOi½inGe insi]\on \erinin EeOirOenmesi iOe EDÁODn¿r. ¾nsi]\on GisN KerniDs\onXnXn oOGX½X tDrDItD interODminDr DrDO¿N tespit eGiOGiNten sonrD oODEiOGi½ince ortD KDttD \DN¿n \Dp¿OmDO¿G¿r. 'DKD sonrD \D GD 5 nXmDrD Eistrinin GiNe\ KDreNeti iOe \Dp¿ODn insi]\on \eterOiGir. ¾nsi]\on \DpDrNen Gerin IDs\Dn¿nGD NesiOmesine oDO¿Á¿OmDO¿ DncDN ]D\¿I KDstDODrGD GXrD \DrDODnmDs¿ risNinin oOGX½X XnXtXOmDmDO¿G¿r. 'DKD sonrD GiODtDt|r Ye GiODtDt|rn ]erinGen Ge oDO¿ÁmD N¿O¿I¿ \erOeÁtiriOir. /DterDO sNopi iOe GiODtDt|r Ye oDO¿ÁmD N¿O¿I¿n¿n \eri NontroO eGiOir. 6Nopi ODterDO po]is\onGD NiOitOenir. 'iODtDt|r o¿NDr¿O¿r. (nGosNop oDO¿ÁmD N¿O¿I¿nD \erOeÁtiriOir. (nGosNop NDmerDs¿nGD NDrÁ¿m¿]D iON o¿NDn DnDtomiN \Dp¿ pDrDspinDO DGDOeOerGir. 3XncK Ye 5) \DrG¿m¿\OD pDrDspinDO DGeOeOer DO¿nDrDN OiJDmDntXm IODYXmD XODÁ¿O¿r. BX DÁDmDGD J|rereN Ye cerrDKi DOet iOe KisseGereN st Ye DOt ODminD ODterDOGe IDset eNOem tespit eGiOir. BX DÁDmDGD KDstDn¿n NemiN \Dp¿s¿ oDO¿ÁmD N¿O¿I¿n¿n spinDO NDnDOD Jirmesine i]in Yerme\eceN ÁeNiOGe GDr oOGX½X tespit eGiOirse Nerrison ronJeXr \D GD enGosNopiN GriOO iOe IDset eNOem tDrDI¿ JeniÁOetiOeEiOir. )ODYXm meGiDOGen IDset eNOeme Go½rX X]DnDn oYDO ÁeNOi neGeni iOe enGosNopiN miNropXncK iOe JYenOi Eir ÁeNiOGe DncDN meGiDOGen ODterDOe Go½rX NesiOeEiOmeNteGir. )ODYXmXn D\r¿cD siYri XoOX mDNDs iOe NesiOereN meGiDOGe spinDO NDnDOD XODÁt¿NtDn sonrD miNroNerrison iOe ODterDOe Go½rX Do¿OG¿½¿ cerrDKi teNniNOerGe tDn¿mODnm¿Át¿r. 0eGiDOGe IODYXm NesiOirNen spinDO NDnDOD \DNODÁ¿OG¿½¿nGD memErDn|] Eir J|rnt\e sDKip oOXr Ye EX ÁeNiOGe spinDO NDnDOD XODÁ¿OmDN ]ere oOXnGX½X DnODÁ¿O¿r. 0eGiDOGe IODYXm NesiOereN spinDO NDnDOD XODÁt¿NtDn sonrD miNropXncK ODterDOe Go½rX oeYriOir oenesi IODYXmD otXrtXODrDN IDset \|nnGe 3-5 mm X]XnOX½XnGD Kori]ontDO Nesi \Dp¿O¿r. 6pinDO NDnDOD XODÁ¿OG¿½¿nGD iON J|rnt epiGXrDO \D½ GoNXsXGXr. 3XncK \DrG¿m¿\OD EX \D½ GoNXsX DO¿nDEiOir. 'DKD sonrD spinDO NDnDOGD KerKDnJi Eir JiriÁim \DpmDGDn |nce epiGXrDO YenOerin NDnD\DrDN J|rntm] Eo]mDmDs¿ ioin 5) iOe NoDJXOe eGiOmesi JereNir. )ODYXmXn Do¿OmDs¿ \D½ GoNXsXnXn eNsi]e eGiOmesini tDNiEen GXrD Ye N|N tDn¿nmDO¿G¿r. .|N om]XnGDn GiseNt|r \DrG¿m¿ iOe meGiDOe moEiOi]e eGiOir. dDO¿ÁmD N¿O¿I¿n¿n NoniN XcX N|Nn ODterDOine \erOeÁtiriOir. dDO¿ÁmD N¿O¿I¿ G|nGrOG½nGe N|N Ye GXrD eNDrte eGiOmiÁ oOXr Ye GisN mesDIesine JYenOi Eir ÁeNiOGe XODÁ¿Om¿Á oOXr. (NstrGe GisN Kernisi GireNt oODrDN o¿NDr¿ODEiOir. doN E\N pDroDODr 5) iOe \DN¿ODrDN NoOtOeEiOir \D GD oDO¿ÁmD N¿O¿I¿ DsistDn tDrDI¿nGDn sDEit tXtXOXrNen pDroD enGosNop iOe EirOiNte G¿ÁDr¿ o¿NDr¿ODEiOir. *eneOOiNOe minimDO inYD]iY spinDO cerrDKi mDntDOitesi Jere½i protrGe GisN mDter\DOi meYcXt DnnXOer \¿rt¿N NXOODn¿ODrDN o¿NDr¿OmD\D oDO¿Á¿O¿r. $ncDN EX ÁeNiOGe EDÁDr¿ODmD]sD miNropXncK NXOODn¿ODrDN DnnXOer GeIeNt JeniÁOetiOeEiOir Ye mesDIe\e EX ÁeNiOGe JiriOeEiOir. .|N GeNomprese eGiOGiNten sonrD nNs KerniDs\onX |nOemeN DmDc¿\OD mesDIe\e JiriOereN Eir miNtDr GisNeNtomi \Dp¿ODEiOir. $ncDN DJresiI Eir ÁeNiOGe GisN EoÁDOt¿OmD\D oDO¿Á¿OmD]. /DterDO sNopiGe GisN mesDIesinGeNi cerrDKi DOetin GerinOi½i J|rOeEiOir. dDO¿ÁmD NDnO miJre pDroDODr¿ o¿NDrmDN ioin NrDn\DO Ye NDXGDO \|nGe KDreNet ettiriOeEiOir. 5 Do¿O¿ enGos- ÀHNLO ¾nsi]\on \erinin sNopi iOe EeOirOenmesi. 3 ÀHNLO)ODYXm Do¿OmDs¿ sonrDs¿ J|rnm. ' 'XrD ..|N '+'isN Kernisid.dDO¿ÁmD N¿O¿I¿. Oeri iOe opere eGiOeEiOir DncDN enGosNopiN \DNODÁ¿mODr¿n Eir |½renme e½risi oOGX½X XnXtXOmDmDO¿G¿r. 7rDnsIorDminDO teNniN OiJDment \D GD NemiN re]eNsi\onX JereNtirmeGi½i ioin Ii]\oOoMiN \oO oODrDN tDn¿mODnm¿Át¿r Ye mmNnse tm GisN KerniOerinin trDnsIorDminDO \oOOD \Dp¿OmDs¿ |neriOmeNteGir 3. $ncDN trDnsIorDminDO \oOXn iOiDN NDnDt miJre GisN KerniOeri DOt seYi\eOerGe IorDmenin GDr oOmDs¿ JiEi N¿s¿tOD\¿c¿ IDNt|rOeri meYcXttXr 3 5 . /omEer GisN Kernisi YDNDODr¿nGD /4-5 Ye /5-6 seYi\eOerinin en s¿N J|rOen seYi\eOer oOmDs¿ interODminDr teNni½in NXOODn¿m s¿NO¿½¿n¿ Drtt¿rmDNtDG¿r 9 4-. 'DKD st OomEer seYi\eOerGe interODminDr pencerenin GDrDOmDs¿ oDO¿ÁmD N¿O¿I¿n¿n spinDO NDnDOD \erOeÁtiriOmesini enJeOOer . BX GXrXmGD IODYXm Do¿OmDGDn |nce \NseN GeYirOi enGosNopiN GriOO Ye Nerrison NXOODn¿ODrDN Eir miNtDr NemiN re]eNsi\onX \Dp¿O¿r Ye JereNOi DnDtomiN Do¿NO¿N sD½ODnm¿Á oOXr 9. g1(5¾/(5 (nGosNopiN OomEer GisN cerrDKisinin |½renme eYresinGe sDE¿rO¿ oOmDN ooN |nemOiGir. +er ne NDGDr interODminDr \DNODÁ¿mGD DnDtomiN \oO miNroGisNeNtomi iOe Een]erOiN J|sterse Ge monit|re EDNDrNen eO-J|] NoorGinDs\onXnX sD½ODmDN oDO¿ÁmD N¿O¿I¿n¿n NontroO 5) iOe KemostD]¿ sD½ODmDN EX cerrDKi teNni½in ]orOD\¿c¿ N¿s¿mODr¿G¿r. 6Nopi enGosNopiN OomEer GisN cerrDKisinGe EXOXnGX½XmX] NonXmX EiOmemi]Ge Ei]e \DrG¿mc¿ oODn en |nemOi DrDot¿r. $½r¿ teGDYisi ioin NXOODn¿ODn enMeNsi\on teGDYiOerini X\JXODmDN sNopinin etNin NXOODn¿m¿n¿ NoOD\ODÁt¿r¿r. ÀHNLO .|N Ye GXrD eNDrte eGiOGiNten sonrD J|rnm. d. dDO¿ÁmD N¿O¿I¿ '+'isN Kernisi < <D½ GoNXsX. Nop sD\esinGe IorDmen JiriÁi J|rntOeneEiOir. .errison \DrG¿m¿\OD IorDminotomi \Dp¿ODEiOir. 8]Dm¿Á YDNDODrGD N|N eNDrtDs\onXnD DrD YermeN Ye irriJDs\on EDs¿nc¿n¿ mmNn oODn en GÁN seYi\eGe tXtmDN |nemOiGir. +$67$6(d¾0¾ *eneO DnODmGD cerrDKi teGDYi enGiNDs\onX oODn Ker KDstD tDm enGosNopiN OomEer GisN cerrDKisi \|ntem4 (nGosNopiN OomEer GisN cerrDKisinGe oDO¿ÁmD NDnDO¿n¿n ioinGeNi cerrDKi DOetOer sDGece iOeri Jeri KDreNet ettiriOeEiOir. dDO¿ÁmD N¿O¿I¿ ise N¿s¿tO¿ miNtDrGD cerrDKi DODnGD KDreNet NDEiOi\etine sDKiptir. &errDKi DOeti ENereN NXOODnmD\D oDO¿ÁmDN DOete ]DrDr YermeNten EDÁND Eir iÁe \DrDmD\DcDNt¿r. g½renme eYresinGe NDGDYrD NXrsODr¿nD NDt¿OmDN EX DmeOi\DtODr¿n s¿N \Dp¿OG¿½¿ NOiniNOerGe J|]Oemci oODrDN EXOXnmDN DmeOi\DtODrGD DsistDn oODrDN EXOXnmDN |nemOiGir. BDÁODnJ¿otD seoiOen YDNDODr¿n EDsit oOmDs¿ DYDntDM sD½ODr. $meOi\Dt s¿rDs¿nGD \DÁDnDEiOeceN KerKDnJi Eir NompOiNDs\on \D GD ]orOXNtD miNroGisNeNtomi\e JeoiOeEiOmeOiGir. .$<1$./$5 . &KenJ 7 /iX 7 =KDnJ * 3enJ ; =KDnJ ;. 'oes minimDOO\ inYDsiYe sXrJer\ improYe sKort-term recoYer\ in totDO Nnee DrtKropODst\" &OinicDO ortKopDeGics DnG reODteG reseDrcK. 435-4. . *eorJeson .( 5oEertson '-. 0inimDOO\ inYDsiYe sXrJer\ in tKe neonDte reYiew oI cXrrent eYiGence. 6eminDrs in perinDtoOoJ\. 43-. 3. <DnJ 0 <Do 0 :DnJ * ;iDo & :X < =KDnJ + et DO. &ompDrison oI postoperDtiYe TXDOit\ oI OiIe Ior pDtients wKo XnGerJo DtriDO m\[omD e[cision witK roEoticDOO\ DssisteG YersXs conYentionDO sXrJer\. 7Ke -oXrnDO oI tKorDcic DnG cDrGioYDscXODr sXrJer\. 555-. 4. :eEer B5 *roE ' 'YorDN - 0Xntener 0. 3osterior sXrJicDO DpproDcK to tKe OXmEDr spine DnG its eIIect on tKe mXOtiIiGXs mXscOe. 6pine. 9955-. 5. -DiNXmDr 6 .im '+ .Dm $&. +istor\ oI minimDOO\ inYDsiYe spine sXrJer\. 1eXrosXrJer\. 55 6XppO6-4. . &DspDr :. $ new sXrJicDO proceGXre Ior OXmEDr Gisc KerniDtion cDXsinJ Oess tissXe GDmDJe tKroXJK D microsXrJicDO DpproDcK. . $GY 1eXrosXrJ. 944² . . <DsDrJiO 0. 0icrosXrJicDO operDtion oI KerniDteG OXmEDr Gisc. $GY 1eXrosXrJ. 94. . .DmEin 3 *+. 3ercXtDneoXs ODterDO Giscectom\ oI tKe OXmEDr spine $ preOiminDr\ report. &OinicDO ortKopDeGics DnG reODteG reseDrcK. 934²3. 9. &Ken +7 7sDi &+ &KDo 6& .Do 7+ &Ken <- +sX +& et DO. (nGoscopic Giscectom\ oI /5-6 Gisc KerniDtion YiD Dn interODminDr DpproDcK 3rospectiYe controOOeG stXG\ XnGer OocDO DnG JenerDO DnestKesiD. 6XrJicDO neXroOoJ\ internDtionDO. 93. . <eXnJ $7 7soX 30. 3osteroODterDO enGoscopic e[cision Ior OXmEDr Gisc KerniDtion 6XrJicDO tecKniTXe oXtcome DnG compOicDtions in 3 consecXtiYe cDses. 6pine. -3. . /ee 6+ .DnJ B8 $Kn < &Koi * &Koi <* $Kn .8 et DO. 2perDtiYe IDiOXre oI percXtDneoXs enGoscopic OXmEDr Giscectom\ D rDGioOoJic DnDO\sis oI 55 cDses. 6pine. 3(5-9. . 5Xetten 6 .omp 0 *oGoOiDs *. $ 1ew IXOO-enGoscopic tecKniTXe Ior tKe interODminDr operDtion oI OXmEDr Gisc KerniDtions XsinJ -mm enGoscopes prospectiYe -\eDr resXOts oI 33 pDtients. 0inimDOO\ inYDsiYe neXrosXrJer\ 0,1. 49-. 3. /ee 6 .im 6. /ee 6+ .im :- &Koi :& &Koi * et DO. 3ercXtDneoXs enGoscopic OXmEDr Giscectom\ Ior miJrDteG Gisc KerniDtion cODssiIicDtion oI Gisc miJrDtion DnG sXrJicDO DpproDcKes. (XropeDn spine MoXrnDO oIIiciDO pXEOicDtion oI tKe (XropeDn 6pine 6ociet\ tKe (XropeDn 6pinDO 'eIormit\ 6ociet\ DnG tKe (XropeDn 6ection oI tKe &erYicDO 6pine 5eseDrcK 6ociet\. 343-. 4. &Koi * /ee 6+ /oNKDnGe 3 .onJ B- 6Kim &6 -XnJ B et DO. 3ercXtDneoXs enGoscopic DpproDcK Ior KiJKO\ miJrDteG intrDcDnDO Gisc KerniDtions E\ IorDminopODstic tecKniTXe XsinJ riJiG worNinJ cKDnneO enGoscope. 6pine. 335(5-5. 5. &Koi .& .im -6 5\X .6 .DnJ B8 $Kn < /ee 6+. 3ercXtDneoXs enGoscopic OXmEDr Giscectom\ Ior /5-6 Gisc KerniDtion trDnsIorDminDO YersXs interODminDr DpproDcK. 3Din pK\siciDn. 354-5. . 0in -+ .DnJ 6+ /ee -B &Ko 7+ 6XK -. 5K\X ,-. 0orpKometric DnDO\sis oI tKe worNinJ ]one Ior enGoscopic OXmEDr Giscectom\. -oXrnDO oI spinDO GisorGers tecKniTXes. 53-5. . )oOe\ .7 60. 0icroenGoscopic Giscectom\. 7ecK 1eXrosXrJ. 9933². . 'estDnGDX -. $ speciDO GeYice Ior enGoscopic sXrJer\ oI OXmEDr Gisc KerniDtion. 1eXroOoJicDO reseDrcK. 99939-4. 9. 5Xetten 6 .omp 0 0erN + *oGoOiDs *. 8se oI newO\ GeYeOopeG instrXments DnG enGoscopes IXOO-enGoscopic resection oI OXmEDr Gisc KerniDtions YiD tKe interODminDr DnG ODterDO trDnsIorDminDO DpproDcK. -oXrnDO oI neXrosXrJer\ 6pine. 5-3. . &Koi * /ee 6+ 5DitXrNer 33 /ee 6 &KDe <6. 3ercXtDneoXs enGoscopic interODminDr Giscectom\ Ior intrDcDnDOicXODr Gisc KerniDtions Dt /5-6 XsinJ D riJiG worNinJ cKDnneO enGoscope. 1eXrosXrJer\. 5 6XppO21659- GiscXssion 21659-. . 0iOOer 5$. (nGoscopic instrXmentDtion eYoOXtion pK\sicDO principOes DnG cOinicDO Dspects. BritisK meGicDO EXOOetin. 9433-5. . 5Xetten 6 .omp 0 0erN + *oGoOiDs *. )XOOenGoscopic interODminDr DnG trDnsIorDminDO OXmEDr Giscectom\ YersXs conYentionDO microsXrJicDO tecKniTXe D prospectiYe rDnGomi]eG controOOeG stXG\. 6pine. 33993-9. 3. 5Xetten 6 .omp 0 *oGoOiDs *. $n e[treme ODterDO Dccess Ior tKe sXrJer\ oI OXmEDr Gisc KerniDtions insiGe tKe spinDO cDnDO XsinJ tKe IXOO-enGoscopic XniportDO trDnsIorDminDO DpproDcK-tecKniTXe DnG prospectiYe resXOts oI 43 pDtients. 6pine. 535-. 4. 3DppDs &7 +DrrinJton 7 6onntDJ 9.. 2Xtcome DnDO\sis in 54 sXrJicDOO\ treDteG OXmEDr Gisc KerniDtions. 1eXrosXrJer\. 993-. 5. 6DOeniXs 3 /DXrent /(. 5esXOts oI operDtiYe treDtment oI OXmEDr Gisc KerniDtion. $ sXrYe\ oI pDtients. $ctD ortKopDeGicD 6cDnGinDYicD. 943-4. . BDttie 0& 9iGemDn 7. /XmEDr Gisc GeJenerDtion epiGemioOoJ\ DnG Jenetics. 7Ke -oXrnDO oI Eone DnG Moint sXrJer\ $mericDn YoOXme. 6XppO 3-9. . :DnJ B /X * 3DteO $$ 5en 3 &KenJ ,. $n eYDOXDtion oI tKe OeDrninJ cXrYe Ior D compOe[ sXrJicDO tecKniTXe tKe IXOO enGoscopic interODminDr DpproDcK Ior OXmEDr Gisc KerniDtions. 7Ke spine MoXrnDO oIIiciDO MoXrnDO oI tKe 1ortK $mericDn 6pine 6ociet\. -3. 5 E|OP 'U7LPXU<,/',5,0'U$OL<,/0$='Ro'U+DVDQ6HUGDU,À,. 2UGXhQLYHUVLWHVL7¿S)DNOWHVL%H\LQYH6LQLU&HUUDKLVL$QDELOLP'DO¿2UGX 75$16)25$0¾1$/<$./$À,0 7(.1¾.+$67$6(d¾0¾g1(5¾/(5 *¾5¾À L omEer GisN KerniDs\onX -3 orDn¿nD sDKip preYeODns iOe cerrDKi teGDYi JereNsinimine neGen oODn en \D\J¿n spinDO pDtoOoMiN GXrXmGXr 3. 7m OomEer GisN KerniDs\onODr¿n¿n ·ini ise eNstrDIorDminDO OomEer GisN KerniDs\onX oOXÁtXrmDNtDG¿r . *nm]Ge IorDminDO Ye eNstrDIorDminDO GisN KerniDs\onODr¿n¿n cerrDKi teGDYisinGe Drt¿N EirooN merNe]Ge \D\J¿n oODrDN minimDO inYD]iY cerrDKi \|ntemOer NXOODn¿OmDNtDG¿r. 7rDnsIorDminDO enGosNopiN GisNeNtomi teNni½inin cerrDKi s¿rDs¿nGD GDKD ID]OD GoNX EtnO½n NorXmDs¿ GDKD D] NDnDmD\D seEep oOmDs¿ cerrDKi sonrDs¿ G|nemGe Ge KDstD\D GDKD erNen moEiOi]Ds\on sD½OD\DrDN JnON \DÁDnt¿s¿nD G|nme imNDn¿ sXnmDs¿ Ye cerrDKi\e ED½O¿ oODrDN JeOiÁen IiEro]ise ED½O¿ sorXnODr¿n GDKD D] J|rOmesi neGeni\Oe |nemOi DYDntDMODr¿ EXOXnmDNtDG¿r 3. 75$16)25$0¾1$/(1'26.23¾. 63¾1$/&(55$+¾¾d¾1&(55$+¾ <$./$À,09(7(.1¾. .DmEin 93·te DrtrosNopiN GisNeNtomi\i Ye trDnsIorDminDO \DNODÁ¿m ioin NXOODn¿ODn JYenOi oJeni .DmEin oJeni tDn¿mODm¿Át¿r. $rG¿nGDn enGosNopi teNni½i \ine .DmEin 2niN Ye 0DtKeXs tDrDI¿nGDn moGiIi\e eGiOereN JeOiÁtiriOmiÁtir . .DmEin Ye DrNDGDÁODr¿ IorDminDO Ye eNstrDIorDminDO GisN KerniDs\onODr¿n¿n cerrDKi teGDYisinGe DrtrosNo piN GisNeNtomi teNni½i iOe . orDn¿nGD EDÁDr¿ EiOGirmiÁOerGir. Lew Ye DrNDGDÁODr¿n¿n oDO¿ÁmDs¿nGD ise trDnsIormDinDO perNtDn|] enGosNopiN GisNeNtomi iOe 5 orDn¿nGD EDÁDr¿ EiOGiriOmiÁtir . 7rDnsIorDminDO \DNODÁ¿mGD posterior spinDO cerrDKi iOe X½rDÁDnODr¿n DO¿Á¿N oOGX½X pDrDYerteErDO NDs pODnODr¿ spin|] o¿N¿nt¿ ODminD Ye OiJDmentXm IODYXm JiEi DnDtomiN \Dp¿ODrGDn IDrNO¿ oODrDN ODterDO pODnGD IorDmen DnDtomisi |nem Dr]etmeNteGir. 7rDnsIorDminDO JiriÁimGe NDteGiOen \oOODr s¿rDs¿\OD ciOt ciOtDOt¿ GoNX torDNoOomEer IDs\D psoDs mDMor TXDGrDtXs OXmEorXm iOe ereNt|r spinD NDsODr¿n¿n OiIOeri Ye GorsoODterDO N|ÁeGen DnOXs oOmDNtDG¿r. &errDKi DOetOerin DnXOXsXn GorsoODterDOGeNi JiriÁi \eri .DmEin tDrDI¿nGDn tDn¿mODnm¿Á oODn oJen ÁeNOinGeNi JYenOi cerrDKi DnDtomiN E|OJeGir . 7rDnsIorDminDO JiriÁimOerin EDÁDr¿s¿ |nceOiNOe EX DnDtomiN E|OJenin i\i EiOinmesi esDs¿nD GD\DnmDNtDG¿r 5. .DmEin oJeni 'orsoODterDO GisNin ]erinGe EXOXnDn Eir GiN oJen DODn¿ oODrDN tDn¿mODnm¿Át¿r. hoJenin KipotenDr NenDr¿n¿ o¿NDn sinir N|N tDEDn¿n¿ NDXGDO YerteErDn¿n speri\orX meGi\DO GiN NenDr¿n¿ ise GXrD oOXÁtXrmDNtDG¿r ÀeNiO . $nteroODterDO oODrDN DÁD½¿\D Go½rX inen oDprD]OD\Dn N|N Ye GXrDmDter Ye\D 5 GereceOiN enGosNop iOe J|rOeEiOmeNteGir. d¿NDn N|N ise \ine 5 GereceOiN enGosNop \DrG¿m¿\OD enGosNop Ye oDO¿ÁmD NDnOnn NrDn\eOe oeYriOmesi iOe tDn¿mODnDEiOmeNteGir . &HUUDKL7HNQLN $meOi\Dt oGDs¿ enGosNopi Ye sNopi monit|rOerini cerrDK¿n rDKDtoD \orXcX oOmDNs¿]¿n J|reEiOmesi ioin \erOeÁimi Ye G]enOenmesi |nemOiGir. $meOi\Dt mDsDs¿n¿n Ye GisN pDtoOoMisinin tDrDI¿nD J|re cerrDK¿n po]is\onX Kem & NoOOX\X Kem Ge enGosNop monit|rn D\n¿ ]DmDnGD J|reEiOece½i ÁeNiOGe D\DrODnmDO¿G¿r ÀeNiO . 7erciKen enGosNop monit|r cerrDK¿n tDm GiN oODrDN NDrÁ¿s¿nGD oOmDO¿ Kemen \Dn¿nGD & NoOOX monit|r \erOeÁtiriOmeOiGir. &-NoOOXnXn DmeOi\Dt mDsDs¿n¿n NonXmXnD J|re Kem \Dn Kem Ge |n-DrND J|rnt DODEiOeceN ÁeNiOGe DOt¿nD G|nGrOeEiOeceN ÁeNiOGe G]enOenir. 2perDs\on NXOODn¿ODn enGosNopi sisteminin oDO¿ÁmD tDr]¿nD Ye cerrDK¿n tecrEe YeYe\D terciKine ED½O¿ oODrDN KDstD \Dn \DtDr Ye\D \]st po]is\onGD \Dp¿ODEiOir ÀeNiO 3. *eneO Dneste]i DOt¿nGD \DNODÁ¿m JeroeNOeÁtiriOmeNOe EirOiNte iÁOem s¿rDs¿nGD oODs¿ sinir KDsDr¿nGDn NDo¿nmDN ioin KDstD\OD sreNOi iOetiÁim NXrmDN iste\en cerrDKODr OoNDO Dneste]i\i Ye N¿smi seGDs\onX terciK eGeEiOmeNteGirOer. 7rDnsIorDminDO E|OJe\e \Dp¿ODcDN JiriÁimGe & NoOOXnXn Go½rX ÁeNiOGe NXOODn¿m¿ ooN |nemOiGir. 'DKD |nce GiDJnostiN Ye teGDYi DmDoO¿ \Dp¿ODn enMeNsi\onODr¿n trDnsIorDminDO E|OJe\e oODn DnDtomiN \DtN¿nO¿½D NDtN¿s¿ oODcDNt¿r. /DWHUDO7UDQVIRUDPLQDO<DNODÁ¿P BX \|ntem posteroODterDO JiriÁime J|re GDKD Kori]DntDO Eir JiriÁimGir. *eneO Dneste]i iOe \]st ÀHNLO .DmEin oJeni. hoJenin KipotenDr NenDr¿n¿ o¿NDn sinir N|N tDEDn¿n¿ NDXGDO YerteErDn¿n speriorX GiN NenDr¿n¿ ise GXrD Ye oDprD]OD\Dn N|N oOXÁtXrmDNtDG¿r po]is\onGD \Dp¿O¿r. +DstD iOe sreNOi iOetiÁimGe NDOmDN iste\en cerrDKODr tDrDI¿nGDn seGDs\on iOe OoNDO Dneste]i terciK eGiOeEiOmeNteGir. LoNDO Dneste]i iOe iÁOem \Dp¿O¿rNen DnXOXsXn ]enJin sinirseO innerYDs\onX neGeni\Oe D½r¿\D GX\DrO¿ oOGX½X XnXtXOmDmDO¿G¿r. 3osteroODterDO JiriÁ \|nteminGe KDstDn¿n DnDtomisine ED½O¿ oODrDN ortD KDtt¿n \DNODÁ¿N oODrDN - cm ODterDOinGen Ye .5- 3 Gerece Do¿\OD JiriOmeNteGir ÀeNiO 4 . (piGXrDO E|OJe\e spinDO NDnDOGD GDKD i\i Eir J|rÁ imNDn¿ Ye oDO¿ÁmD DODn¿ sD½OD\D- ÀHNLO $meOi\Dt mDsDs¿n¿n Ye GisN pDtoOoMisinin tDrDI¿nD J|re cerrDK¿n po]is\onX Kem & NoOOX\X Kem Ge enGosNop monit|rn D\n¿ ]DmDnGD J|reEiOece½i ÁeNiOGe D\DrODnmDO¿G¿r. ÀHNLO +DstD po]is\onXnGD JeneO terciK \]st po]is\on oOmDNtDG¿r. EiOmeN ioin 5etten Ye DrN. posteroODterDO JiriÁe J|re GDKD X]DN mesDIeGen GDKD Kori]DntDO JiriÁimi terciK etmeNteGirOer 9. LDterDO trDnsIorDminDO JiriÁimGe |]eOOiNOe st seYi\e OomEer E|OJe\e JiriÁim s¿rDs¿nGD oODs¿ io orJDn KDsDrODnmDs¿ Ye torDNs \DrDODnmDs¿nD i]in YermemeN ioin operDs\on |ncesi JereNOi EiOJisD\DrO¿ tomoJrDIi J|rntOeri iOe KDstD\D oeNiOen mDn\etiN re]onDns J|rntOemeOerinin GiNNDtOi inceOenmesi |nemOiGir. <]st po]is\onGD ODterDO sNopi J|rntsnGe IDset eNOem DrND NenDrODr¿ iÁDretOenereN JYeniOir JiriÁ oi]Jisi EeOirOenir ÀeNiO 5. 6Nopi |n DrND po]is\onD DO¿nDrDN JiriÁ \Dp¿ODcDN GisN mesDIesinGe NorpXs N¿N¿rGDN son XoODr¿ EiriEirine pDrDOeO oODcDN ÁeNiOGe D\DrODn¿r. *iriÁ \Dp¿ODcDN GisN seYi\esi EeOirOenince ODterDOe Go½rX Eir oi]Ji oeNiOereN NesiÁim noNtDs¿ iÁDretOenir ÀeNiO . JDXJe DtrDYmDtiN Eir spinDO i½ne iOe KeGeIOenen noNtD\D |n DrND JrDIiGe sNopi NontroO iOe iOerOenir. +eGeIOenen E|OJe |n DrND JrDIiGe miGpeGiNOer oi]Ji\e NDGDr iOerOenir Ye ODterDO J|rnt DO¿nDrDN spinDO i½nenin DnXOXs GorsDOinGe oOGX½X NontoO eGiOir. BX DÁDmDGD NontrDst mDGGe iOe NDr¿Át¿r¿Om¿Á inGiJoNDrmin Eo\Ds¿ nNOeXs pXOposXsD enMeNte eGiOir. ¾ntrDoperDtiI GisNoJrDIi proseGr Kerni\e IrDJmDnODr¿n inGiJoNDrmin iOe Eo\DnDrDN enGosNopiN J|rntOeme DOt¿nGD tDn¿nmDs¿n¿ sD½ODmDNtDG¿r . ¾½ne po]is\onX Go½rXODn¿ncD i½nenin ioinGen N¿ODYX] teO iOerOetiOir. BX iOerOetme sNopi Kem |n-DrND Kem Ge \Dn po]is\onD DO¿nDrDN \Dp¿O¿r Ye teOin \DNODÁ¿N oODrDN ortD KDtt¿ Jeoti½i J|rOr. &iOt insi]\onX iOe N¿ODYX] teO ]erinGen NDnOO JeniÁOetici \erOeÁtiriOir Ye JeniÁOeticinin sNopi NontroO iOe ÀHNLO 3osteroODterDO JiriÁ \|nteminGe KDstDn¿n DnDtomisine ED½O¿ oODrDN ortD KDtt¿n \DNODÁ¿N oODrDN - cm ODterDOinGen Ye .5- 3 Gerece Do¿\OD JiriOmeNteGir. ÀHNLO <]st po]is\onGD ODterDO sNopi J|rntsnGe IDset eNOem DrND NenDrODr¿ iÁDretOenereN JYeniOir JiriÁ oi]Jisi EeOirOenir. GisNe JiriÁ E|OJesinGe oOGX½XnGDn emin oOXnXncD teO o¿NDrt¿O¿r. &iOt insi]\onXnXn GiODtDt|r Ye oDO¿ÁmD NDnOnn JeoiÁine i]in YereceN NDGDr JeniÁ DncDN DOetOerin insi]\on \erinGe NontroOs] KDreNetini enJeOOe\eceN NDGDr NoN oOmDs¿nD |]en J|steriOmeOiGir. BX DmDoOD NXOODn¿ODn sistemOerin |]eOOi½ine J|re mm·OiN Nesi \eterOiGir. 'iODtDt|r ]erinGen XcX \D\YDn NesiOmiÁ oDO¿ÁmD NDnO |n-DrND Ye \Dn sNopi iOe NontroO eGiOereN \erOeÁtiriOir Ye GiODtDt|r o¿NDrt¿O¿r ÀeNiO . dDO¿ÁmD NDnOnn \erOeÁtiriOmesi iOe Drt¿N enGosNop NXOODn¿ODEiOir. 'eYDmO¿ sX irriJDs\onX DOt¿nGD Ye enGosNopiN GireNt J|rntOeme iOe cerrDKi iÁOeme EDÁODn¿r ÀeNiO . &errDKi DOetOerin IDrNO¿O¿½¿nD ED½O¿ oODrDN rDG\oIreNDns Noter iOe KemostD] sD½ODn¿r 3. ¾ON EDÁtD cerrDK sXEDnXODr Ye intrDGisNDO EoÁOX½X enGosNopiN oODrDN J|rr. 'isNeNtomi iOe mesDIeGe GeNompres\on sD½ODn¿r. <eterOi GeNompres\onXn sD½ODnmDs¿ GireNt J|rntOeme Dn¿nGD posterior OonJitXGinDO OiJDment JiEi EeOirOi DnDtomiN \Dp¿ODr¿n GDKD J|rnr KDOe JeOmesi epiGXrDO DODn¿n i]Oenmesi Ye |]eOOiNOe irriJDs\onOD OiJDmDn¿n pXOsDtiO KDreNetinin J|rOmesi iOe NOiniN tecrEe Drtt¿NoD mmNn oOmDNtDG¿r . (NVWUDIRUDPLQDO\DNODÁ¿P (NstrDIorDminDO Ye IDrODterDO \erOeÁimOi GisN KerniOerinGe IrDJmDnte GisNin o¿NDn N|Nn normDO ÀHNLO BeOirOenen GisN seYi\esinGen ODterDOe Go½rX Eir oi]Ji oeNiOereN NesiÁim noNtDs¿ iÁDretOenir. ÀHNLO dDO¿ÁmD NDnO ioinGen enGosNop sisteminin \erOeÁtiriOmesi. 9 eNstrDIorDminDO \DNODÁ¿m¿n JereNOiOi½i Ye etNinOi½ine \|neOiN oDO¿ÁmDODr EXOXnmDNtDG¿r . +$67$6(d¾0¾ ÀHNLO dDO¿ÁmD NDnOnn ioinGen miNropDnoOD cerrDKi GeNompres\onXn sD½ODnmDs¿. DnDtomiN po]is\onXnX Ge½iÁtireEiOece½i XnXtXOmDmDO¿G¿r. BX GXrXmODrGD IorDminDO JYenOi oJenin o¿NDn N|N iOe \DN¿n iOiÁNiGe oODcD½¿ GÁnOereN oDO¿ÁmD NDnOnn ODterDO IorDminDO \erOeÁimGeNi JiEi \erOeÁtiriOmesi mnNn oOmD\DcDNt¿r. LomEer mDn\etiN re]onDns J|rntOemeGe |]eOOiNOe 7 D½¿rO¿NO¿ NesitOerGe sDJitDO Ye DNsi\eO pODnODrGD o¿NDn N|Nn IrDJmDnte pDroD\D ED½O¿ po]is\on Ge½iÁiNOi½i GiNNDtOice inceOenmeOiGir 4. $nDtomiN pODnODr ]erinGe JereNOi oDO¿ÁmD\¿ \Dpt¿NtDn sonrD ODterDO IorDminDO \|ntemGe oOGX½X JiEi spinDO i½ne iOe |n-DrND Ye \Dn sNopi NontroOnGe EirD] GDKD NDXGDO peGiNOe Go½rX \|neOereN JiriÁ sD½ODn¿r. 'iODtDt|r NDnO NDXGDO peGiNO Ye o¿NDn IDset NoOX EirOeÁme noNtDs¿nD NonXmODnG¿r¿O¿r. .¿ODYX] teO o¿NDrt¿ODrDN oDO¿ÁmD NDnO \erOeÁtiriOir Ye sX irriJDs\onX DOt¿nGD enGosNopiN J|rntOeme Ye cerrDKi iÁOeme EDÁODn¿r ÀeNiO . 6pinDO i½ne GiODtDt|r Ye oDO¿ÁmD NDnOnn Go½rX po]is\onOD \erOeÁtiriOmesi iOerOeme \Dp¿ODn Ker KDreNette |n DrND sNopi J|rntOeme iOe Ye Kemen ODterDO sNopi iOe NontroO eGiOereN 3 Eo\XtOX oODrDN DnDtomiN NonIiJrDs\onD KDNim oODrDN \Dp¿OmDNtDG¿r. BX \DNODÁ¿mGD oDO¿ÁmD NDnO Ye enGosNop cerrDK¿n eOinGe serEest oODrDN tXtXOGX½X ioin Gi½er ODterDO IorDminDO \|nteme J|re oDO¿ÁmDs¿ EDÁODnJ¿otD GDKD ]or oOmDNtDG¿r. )Dr ODterDO GisN KerniOerinGe (nGosNopiN GisNeNtomi DrtDn Gene\im Ye EiriNim iOe JeOiÁen teNnoOoMi\e pDrDOeO oODrDN Ker Jeoen Jn GDKD GD \D\J¿nODÁmDNtDG¿r. *iGereN miNroGisNeNtomi iOe DrDs¿nGDNi enGiNDs\on s¿n¿rODmDs¿ NDpDnmDNtDG¿r. $ncDN enGosNopiN \DNODÁ¿mODr¿n stDnGDrt miNrocerrDKi e½itimi NDpsDm¿nGD oOmDmDs¿ Eir e½itim sreci Ye |½renme e½risini JereNtirmeNteGir. 'i½er \DnGDn GisN IrDJmDn¿n¿n NDnDO ioinGeNi \erOeÁimi meGiDO peDrDmeGiDn ODterDO IDr-ODterDO KDstDGDn KDstD\D Ge½iÁen DnDtomiN IDrNO¿O¿NODr enGosNopiN \|ntemin interODminDr posteroODterDO Ye\D trDnsIorDminDO oODrDN EeOirOenmesinGe |nemOiGir. 'isN pDroDs¿n¿n NrDn\eO Ye NDXGDO \erOeÁimOi oOmDs¿ NDOsiIi\e oOmDs¿ |]eOOiNOe L5-6 mesDIeOerine \DNODÁ¿mGD iOiDN NDnDG¿n oDO¿ÁmD \oOX ]erinGe oOmDs¿ trDnsIorDminDO \DNODÁ¿m ioin s¿n¿rODmDODrD seEep oOmDNtDG¿r. &insi\et IDrNO¿O¿½¿nD ED½O¿ oODrDN erNeN KDstDODrGD peOYis \Dp¿s¿n¿n Ge½erOenGiriOmesi |nemOiGir. 6¿NO¿NOD erNeN KDstDODrGD L4-5 IorDminDO E|OJenin iOiDN NDnDt tDrDI¿nGDn |rtOeEiOece½i XnXtXOmDmDO¿G¿r . BX JiEi GXrXmODrGD Kerni\e GisNin \erOeÁimine J|re trDnsIorDminDO \DNODÁ¿m \erine interODminDr \DNODÁ¿m GDKD X\JXn oODEiOeceNtir. g]eOOiNOe GisN IrDJmDn¿n¿n NrDni\eOGe st peGiNOn DOt XcXnX Jeoti½i Ye NDXGDOGe DOt peGiNOn ortDs¿n¿ Jeoti½i GXrXmODrGD trDnsIorDminDO JiriÁ terciK eGiOmemeOiGir . g1(5¾/(5 (nGosNopiN \|ntemin en |nemOi |]eOOi½i |½renme sresinin X]Xn oOmDs¿G¿r. .ompOiNDs\onODrGDn NDo¿nmDN ioin DnDtomiN EiOJinin DmeOi\Dt i]Oem Ye NDGDYrD e½itimOerinin \eri ooN E\Ntr. (nGosNopiN \|ntemin rXtin oODrDN X\JXODnG¿½¿ NOiniNOerGe tecrEe pD\ODÁ¿m¿nGD EXOXnmDN sNopi NXOODn¿m¿n¿n sDGece mesDIe tD\ini oODrDN Ge½iO |]eOOiNOe trDnsIorDminDO JiriÁimOerGe seri oODrDN Kem |n-DrND Kem ODterDO po]is\onD DO¿nDrDN 3 Eo\XtOX DnDtomi\e KDNim oOmDN |nem Dr]etmeNteGir. 3reoperDtiI J|rntOeme tetNiNOerinin GetD\O¿ inceOemesi ooN |nemOiGir. )orDminDO pencere\e Go½rX \DNODÁ¿m EDÁDr¿O¿ sonXcXn en |nemOi |JesiGir. 7rDnsIorDminDO enGosNopiN \DNODÁ¿mGD sDntrDO Ye sXEDrtiNOer \erOeÁimOi Kerni\Ds\on YDrO¿½¿nGD meGiDO peGiNOer oi]Ji\e GDKD Kori]DntDO \DNODÁ¿m IorDminDO Ye IDr ODterDO Kerni\Ds\onODr ioin ODterDO peGiNOer oi]Ji\e GDKD GiN Eir \DNODÁ¿m JereNti½i XnXtXOmDmDO¿G¿r. L- Ye L-3 st seYi\e Kerni\Ds\onODr ioin GDKD ODterDOGe NDODn Nesi Ye GisNe GiN Eir \DNODÁ¿m L4-5 Ye L5-6 JiEi GDKD DOt \erOeÁimOi Kerni\Ds\onODrGD GDKD Kori]DntDO Ye meGiDO \DNODÁ¿m NXOODn¿OmDO¿G¿r . (nGosNopiN \|nteme \eni EDÁOD\DcDNODr ioin miNroGisNeNtomiGe EeOirOi Eir tecrEe\e sDKip oOmDn¿n mXtODN oOGX½X KDt¿rODt¿ODrDN \DN¿nmD sresi nispeten GDKD N¿sD Ye si\DtDOMisi EeO D½r¿s¿nD J|re GDKD EeOirJin Jeno \DÁtDNi NDOsiIi\e GisNi EXOXnmD\Dn JeoiriOmiÁ operDs\on |\Ns oOmD\Dn IDset KipertroIisi Ye ODterDO reses senGromX oOmD\Dn KDstDODr¿n EeOirOenmesi GDKD X\JXn oODcDNt¿r. .$<1$./$5 . $Kn < 7rDnsIorDminDO percXtDneoXs enGoscopic OXmEDr Giscectom\ tecKnicDO tips to preYent compOicDtions. ([pert 5eY 0eG 'eYices. -XO943 . *DErieOe 3. -DsperD *inD 0. )rDnciscoD $OEert ( 7eOIeiDn &OinicDO sXccess oI trDnsIorDminDO enGoscopic Giscectom\ witK IorDminotom\ $ retrospectiYe eYDOXDtion. &OinicDO 1eXroOoJ\ DnG 1eXrosXrJer\ 5 9² 95 3 3. *iEson $ODstDir -.1. -onDtKDn *. &owie 0enno ,prenEXrJ 7rDnsIorDminDO enGoscopic spinDO sXrJer\ 7Ke IXtXre ¶JoOG stDnGDrG· Ior Giscectom\" $ reYiew. 7Ke 6XrJeon 9-9 4. -DnJ -6 $n 6+ Lee 6+ 7rDnsIorDminDO 3ercXtDneoXs (nGoscopic 'iscectom\ in tKe 7reDtment oI )orDminDO DnG ([trDIorDminDO LXmEDr 'isc +erniDtions. - 6pinDO 'isorG 7ecK 9oOXme 9 1XmEer 5 -XO\33-343 5. -i : 3DrN. +ee 6 1Dm 6 .\oXnJ &Ko +ee -in -XnJ B\eonJ -X Lee .DmEins 7riDnJOe $pproDcK oI LXmEDr 7rDnsIorDminDO (piGXrDO ,nMection witK 6pinDO 6tenosis. $nn 5eKDEiO 0eG. 'ec 35 33² 43 . .DmEin 3 *eOOmDn +. 3ercXtDneoXs ODterDO Giscectom\ oI tKe OXmEDr spine. $ preOiminDr\ report. &OinicDO 2rtKopDeGics 934²3. . .DmEin 3 2·Brien ( =KoX L et DO $rtKroscopic microGiscectom\ DnG seOectiYe IrDJmentectom\. &Oin 2rtKop 345²99 . Lew 60 0eKDOic 7) )DJone .L 7rDnsIorDminDO percXtDneoXs enGoscopic Giscectom\ in tKe treDtment oI IDr-ODterDO DnG IorDminDO OXmEDr Gisc KerniDtions. 1eXrosXrJ 6pine 94 ² 9. 5Xetten 6 .omp 0 *oGoOiDs * $n e[treme ODterDO Dccess Ior tKe sXrJer\ oI OXmEDr Gisc KerniDtions insiGe tKe spinDO cDnDO XsinJ tKe IXOO-enGoscopic XniportDO trDnsIorDminDO DpproDcK-tecKniTXe DnG prospectiYe resXOts oI 43 pDtients. 6pine 3KiOD 3D 9.1oY 5 35-5 . 5Xetten 6 .omp 0 0erN + *oGoOiDs *. 8se oI newO\ GeYeOopeG instrXments DnG enGoscopes IXOOenGoscopic resection oI OXmEDr Gisc KerniDtions YiD tKe interODminDr DnG ODterDO trDnsIorDminDO DpproDcK. - 1eXrosXrJ 6pine. -Xn5-3 . 5Xetten 6 .omp 0 0erN + *oGoOiDs * )XOOenGoscopic interODminDr DnG trDnsIorDminDO OXmEDr Giscectom\ YersXs conYentionDO microsXrJicDO tecKniTXe D prospectiYe rDnGomi]eG controOOeG stXG\. 6pine 3KiOD 3D 9. $pr 339939 . 6DsDni 0 2]er $) 2NtenoJOX 7 &DnEXODt 1 6DrioJOX $&. 3ercXtDneoXs enGoscopic Giscectom\ Ior IDr ODterDO OXmEDr Gisc KerniDtions prospectiYe stXG\ DnG oXtcome oI pDtients. 0inimDOO\ ,nYDsiYe 1eXrosXrJer\ 5 9² 3. <eXnJ $7 7soX 30. 3osteroODterDO enGoscopic e[cision Ior OXmEDr Gisc KerniDtion. 6pine²3 E|OP 8]P'U.DGLU2.7$< <UG'Ro'U1XUL(UDOSd(7¾1$/32 1 1 0HKPHW$NLI¾QDQ(½LWLP$UDÁW¿UPD+DVWDQHVL%H\LQYH6LQLU&HUUDKLVL.OLQL½LÀDQO¿XUID 2 dXNXURYDhQLYHUVLWHVL7¿S)DNOWHVL%H\LQYH6LQLU&HUUDKLVL$QDELOLP'DO¿$GDQD /20%(5%g/*('((1'26.23¾<$5',0/, <$./$À,0/$5 *¾5¾À B e\in Ye sinir cerrDKisinin peN ooN DODn¿nGD oOGX½X JiEi OomEer GisN cerrDKisi NonXsXnGD GD enGosNopiN \|ntemOer son \¿OODrGD |ne o¿NmDNtDG¿r. (nGosNopiN OomEer GisN cerrDKisinGe tDriI eGiOmiÁ oeÁitOi \|ntemOer YDrG¿r 3 BXnODr¿n DrDs¿nGD GD en \eni oODn \|ntem 9 \¿O¿nGD 2erteO Ye DrNDGDÁODr¿ tDrDI¿nGDn tDn¿mODnDn enGosNopiN GisNeNtomi sistemiGir . BX sistem NDsODr¿n GiODtDs\onXnX sD½ODmDN DmDc¿ iOe oeÁitOi JeniÁOiNte GiODtDt|rOer oDO¿ÁmD NDnO Ye 3 optiN ioeren enGosNoptDn oOXÁmDNtDG¿r ÀeNiO . (nGosNop Ye oDO¿ÁmD NDnO DmeOi\Dt mDsDs¿nD Eir tXtXcX iOe sDEitOenmeNte Ye sisteme eNOenen Eir irriJDs\on sistemi iOe DmeOi\Dt esnDs¿nGD enGosNopXn J|rntsnn temi]Oenmesi sD½ODnmDNtDG¿r. $0(/¾<$77(.1¾¼¾ ¾nterODminDr enGosNopiN GisNeNtomi cerrDKi teNniN JeneO oODrDN stDnGDrt Eir miNroGisNeNtomi\e Een]erOiN J|sterir. Btn operDs\onODr JeneO Dneste]i DOt¿nGD KDstD prone po]is\onGD iNen X\JXODn¿r. LomEer GisNin EXOXnGX½X GisN mesDIesinin Ki]Ds¿nGD ortD KDttD pDrDOeO oODcDN ÁeNiOGe .-. cm· OiN Eir ciOt insi]\onX ÀeNiO & X\JXODnG¿NtDn sonrD IDsi\DGD Eir GeOiN Do¿O¿r ÀeNiO D. BXnX tDNiEen oeÁitOi Eo\ODrGDNi GiODt|rOer NXOODn¿ODrDN pDrDYerteErDO DGDOeOer ioerisinGe EX GeOiN JeniÁOetiOir ÀeNiO (). <eterince JeniÁ Eir \oO Do¿OG¿N A B ÀHNLO (Ds\ *2 sistemi. $ deÁitOi JeniÁOiNteNi GiODt|rOer B) .5 cm JeniÁOi½inGeNi oDO¿ÁmD NDnO Ye iNi D\r¿ Eo\XttD sDEit Ye IOeNsiEO ² Ee\D] oNOD J|steriOen 3 HopNins roG Oens optiN. tDn sonrD enGosNopiN oDO¿ÁmD NDnO \erOeÁtiriOir ÀeNiO *. <DnGDn DO¿nDn Eir sNopi J|rnts iOe \erOeÁim \eri NontroO eGiOir ÀeNiO H Ye oDO¿ÁmD NDnO enGosNop tXtXcX iOe sDEitOenir. (nGosNopiN iÁOem EimDnXeO cerrDKi teNniNOe X\JXODn¿r ÀeNiO 3. (nGosNop \erOeÁtiriOGiNten sonrD ODminDn¿n sertOi½i KisseGiOereN \eri tespit eGiOir ÀeNiO 4$. ¾nterODminDr pencere |nnGeNi \XmXÁDN GoNX Drt¿NODr¿ temi]Oenir ÀeNiO 4B&. LiJDmentXm IODYXm ortD\D o¿NDr¿O¿r ÀeNiO 4D Ye insi]e eGiOir ÀeNiO 5$. Bir .errison 5onJeXr \D GD JereNOiOiN KDOinGe \NseN GeYirOi motor eOmDs Xo NXOODn¿ODrDN interODminDr pencere JeniÁOetiOir ÀeNiO A B C D ) E G + ÀHNLO$ $Nsi\DO Nesit 7 seNDns mDn\etiN re]onDns J|rntOemesinGe L5-6 mesDIesinGe sD½ meGioODterDO seNestre GisN Kernisi B) $\n¿ GisN Kernisinin sDJitDO NesitteNi J|rnts Ee\D] oNOD J|steriOen. C) &iOt insi]\onX D) )Ds\Dn¿n GeOinmesi E-F) 3DrDYerteErDO DGDOeOerin GiODtDs\onX * dDO¿ÁmD NDnOnn \erOeÁtiriOmesi + <Dn sNopi J|rnts iOe mesDIenin NontroO. 3 5B. BXnX tDNiEen GXrD ortD\D No\XOXr ÀeNiO 5&. DisNin proODEe oOGX½X N¿s¿m Ye N|N D\¿rt eGiOGiNten sonrD ÀeNiO 5D seNestre pDroD eNsi]e eGiOir ÀeNiO B& Ye GisN mesDIesi EoÁDOt¿O¿r. *ereNOiOiN KDOinGe N|N eNDrt|r NXOODn¿ODrDN GXrD Ye N|N eNDrte eGiOeEiOir ÀeNiO 5). 2perDs\on sonXnGD GXrDO sDN Ye N|Nn GeNomprese oOXp oOmDG¿NODr¿n¿n NontroO \Dp¿O¿r ÀeNiO D. dDO¿ÁmD NDnO o¿NDr¿OG¿NtDn sonrD ciOt insi]\onXnXn .5 iOe . cm DrDs¿nGD Eir E\NONte oOGX½X tespit eGiOir ÀeNiO ). +$67$6(d¾0¾ ÀHNLO BimDnXeO miNrocerrDKi teNniN. (nGosNopXn Ye oDO¿ÁmD NDnOnn DmeOi\Dt mDsDs¿nD sDEitOenmesi. 4 A B C D (nGosNopi sistemOerine DO¿ÁmD sreci J|] |nne DO¿nDrDN EDÁODnJ¿otD Jeno \DÁtD NDOsiIi\e oOmDm¿Á GisNOeri terciK etmeN X\JXn oODcDNt¿r. 7ecrEe Drtt¿NoD miNroGisNeNtomi iOe \Dp¿ODEiOeceN tm OomEer GisN KerniOerinGe IDr ODterDO GisN KerniOeri Ge GDKiO X\JXODnDEiOmeNteGir DncDN pDrDmeGiDn GisN KerniOerinGe DO¿nDn sonXoODr ooN GDKD i\iGir. $\r¿cD Kem sDntrDO spinDO steno]ODrGD XniODterDO \DNODÁ¿mOD EiODterDO GeNompres\on Ye\D teN seDnstD EirGen ID]OD seYi\e GeNompres\onX \Dp¿ODEiOmeNteGir Kem Ge IorDminDO steno] oOJXODr¿nGD \eterOi GeNompres\on sD½ODnDEiOmeNteGir. ÀHNLO $ (nGosNop \erOeÁtiriOGiNten sonrD ODminDn¿n \erinin tespit eGiOmesi B-C) ¾nterODminDr pencere |nnGeNi \XmXÁDN GoNX Drt¿NODr¿n¿n temi]Oenmesi D) LiJDmentXm IODYXmXn ortD\D o¿NDr¿OmDs¿. A B C D E ) ÀHNLO$ LiJDmentXm IODYXmXn insi]\onX B) ¾nterODminDr pencerenin JeniÁOetiOmesi C) DXrDn¿n eNspo]e eGiOmesi D) DisNin proODEe oOGX½X N¿sm¿n GisseNt|r NXOODn¿ODrDN tespit eGiOmesi E) (piGXrDO YenOerin NoDJODs\onX F) .|N eNDrt|rnn \erOeÁtiriOmesi Ye seNestre GisNin eNspo]e eGiOmesi. 5 A B C D E ) ÀHNLO $ 6eNestre GisNin sinir KooNX iOe serEestOeÁtiriOmesi B-C) 6eNestre GisNin Iorseps NXOODn¿ODrDN eNsi]\onX D) DXrDO sDN¿n Ye N|Nn GeNomprese oOGX½X J|]Oeni\or E) 4 cm E\NO½nGeNi eNsi]e eGiOen GisN IrDJmDn¿ F) &iOt insi]\onXnXn JeniÁOi½i . cm Eo\XtXnGD. g1(5¾/(5 (nGosNopi \DrG¿mO¿ miNroGisNeNtomi teNni½i cerrDKODr Do¿s¿nGDn Ge½erOenGiriOGi½inGe stDnGDrt EimDnXeO miNroGisNeNtomi teNni½ine Een]erOi½i neGeni iOe Gi½er enGosNopiN \|ntemOere J|re |½renimi GDKD NoOD\ Ye GDKD JYeniOir Eir \|ntem oODrDN |ne o¿NmDNtDG¿r. Di½er enGosNopiN \|ntemOerGe oOGX½X JiEi GDKD D] GoNX trDYmDs¿nD \oO DomDNtD DmeOi\Dt sonrDs¿ G|nemGe GDKD D] D½r¿ ÁiND\etine neGen oOmDNtD Ye KDstDODr¿n GDKD N¿sD sreGe JnON \DÁDmODr¿nD Ye oDO¿ÁmD KD\DtODr¿nD G|neEiOmeOerine imNDn sD½ODmDNtDG¿r. <NseN GeYirOi tXr NXOODn¿m¿nD oODnDN sD½ODmDs¿ GD Gi½er \|ntemOere J|re Eir Gi½er DYDntDM¿G¿r. $ncDN EimDnXeO oDO¿ÁmD\¿ sD½ODmDN ioin oDO¿ÁmD NDnOnn GDKD JeniÁ oOmDN ]orXnGD oOmDs¿ neGeni iOe ciOt insi]\onX Gi½er enGosNopiN \|ntemOere J|re GDKD JeniÁ oOmDNtDG¿r. ÀX DnD NDGDr \Dp¿ODn oDO¿ÁmDODrGD EX \|ntemOe DO¿nDn sonXoODr¿n ooN \] JO- Grc oOGX½X J|rOmeNteGir . $ncDN Ken] \eterOi sD\¿GD oDO¿ÁmD \Dp¿OmDm¿Át¿r. ¾OerOe\en G|nemOerGe GDKD ID]OD KDstD sD\¿s¿n¿ ioeren GDKD NDpsDmO¿ oDO¿ÁmDODr iOe GDKD JYeniOir sonXoODr eOGe eGiOeceNtir. .$<1$./$5 . 2erteO -0 0onGorI < *DDE 05 $ new enGoscopic spine s\stem tKe Iirst resXOts witK ©(Ds\ *2ª. $ctD 1eXrocKir :ien 59-33 9 . 5Xetten 6 .omp 0 *oGoOiDs * $ 1ew IXOOenGoscopic tecKniTXe Ior tKe interODminDr operDtion oI OXmEDr Gisc KerniDtions XsinJ -mm enGoscopes prospectiYe -\eDr resXOts oI 33 pDtients. 0inim ,nYDsiYe 1eXrosXrJ 49- 3. 5\DnJ <0 2erteO 0) 0D\IrDnN L *iOsEDcK -0 5oKGe 9 7rDnsmXscXODr trocDr tecKniTXe - minimDO Dccess spine sXrJer\ Ior IDr ODterDO OXmEDr Gisc KerniDtions. 0inim ,nYDsiYe 1eXrosXrJ 55343 E|OP 6LQHP$.$<6DLW1$'(5¾ 6D½O¿N%LOLPOHULhQLYHUVLWHVLhPUDQL\H(½LWLPYH$UDÁW¿UPD+DVWDQHVL%H\LQYH6LQLU&HUUDKLVL.OLQL½L¾VWDQEXO /20%(5(1'26.23¾.&(55$+¾1¾1 .203/¾.$6<21/$5, ( nGosNopiN GisNeNtomiOerGe stDnGDrt X\JXODmDODrD J|re DmeOi\Dt sresi GDKD N¿sD GoNX trDYmDs¿ GDKD D] Ye NompOiNDs\on orDn¿ GDKD GÁNtr. HDstD JnON DNtiYiteOerine NoOD\cD Jeri G|neEiOir Ye postoperDtiI KerKDnJi Eir reKDEiOitDs\on sreci JereNme]. *nm]Ge trDnsIorDminDO Ye interODminDr enGosNopiN JiriÁimOer NXOODn¿OmDNtDG¿r. 7rDnsIorDminDO enGosNopiN JiriÁimGe minimDO GoNX KDsDr¿ oOmDNtDG¿r. <ine interODminDr JiriÁimOerGen sonrDNi teNrDr Do¿O¿ÁODrGDNi DmeOi\Dt EXOJXODr¿n¿n GD GesteNOeGi½i JiEi epiGXrDO sNDr GoNXsX J|rOme] Ye\D ooN KDIiI G]e\Ge oOXÁXr. BX \D]¿GD Ker iNi JiriÁimOerGeNi NompOiNDs\onODr N¿sDcD J|]Gen JeoiriOeceNtir. 75$16)25$0¾1$/(1'26.23¾. '¾6.(.720¾1¾1.203/¾.$6<21/$5, 7rDnsIorDminDO enGosNopiN GisNeNtominin NompOiNDs\onODr¿ DÁD½¿GDNi JiEiGir % 9DsNOer KDsDr % 3eritoneDO Ye DEGominDO KDsDr % 1|rDO KDsDr % DXrDO KDsDr B26 NDoD½¿ % ¾nIeNsi\on % Di]este]i % (nstrmDn N¿r¿OmDs¿ % 3soDs KemDtomX % 5e]iG % 5eNrrens (nGosNopiN GisNeNtomi DmeOi\DtODr¿nGDn sonrD \eni Eir n|roOoMiN EXOJX \D GD pDre]i JeOiÁme orDn¿ ooN GÁNtr Ye .5 - 3. DrDs¿nGD Ge½iÁmeNteGir. DXrDO KDsDr JeOiÁme iKtimDOi YDrsD GD oeYre DnDtomiN \Dp¿ODr¿n NorXnmXÁ oOmDs¿ neGeni\Oe EX \DrDODnmDn¿n ciGGi Eir Ee\in omXriOiN s¿Y¿s¿ IistOne G|nÁme iKtimDOi \oN GeneceN NDGDr D]G¿r. <]e\eO \DrD proEOemi JeOiÁme risNi Ge stDnGDrt DmeOi\DtODrD orDnOD ooN GÁNtr. .onYDnsi\oneO miNrosNopiN GisNeNtomiOerin se\reN J|rOen DmD ciGGi Eir NompOiNDs\onX oODn E\N GDmDr \DrDODnmDODr¿n¿n Dort iOiDN Drter Ye\D YenOer JiEi teoriN oODrDN enGosNopiN DmeOi\DtODrGD GD J|rOme iKtimDOi YDrG¿r DncDN EXJne GeN sDGece iNi oOJXGD EiOGiriOmiÁtir. 7rDnsIorDminDO enGosNopiN JiriÁimOerGe EDt¿n ioi orJDn \DrDODnmDs¿ GD sDGece EirNDo oOJXGD EiOGiriOmiÁtir. 7rDnsIorDminDO enGosNopiN GisNeNtominin ciGGi Eir |½renme e½risi oOGX½X ooN sD\¿GD oDO¿ÁmDGD J|steriOmiÁtir. :DnJ Ye Lee ¶nin \rttNOeri oDO¿ÁmDODrGD \DNODÁ¿N ·Áer YDNDGD trDnsIorDminDO enGosNopiN GisNeNtomi X\JXODm¿Á NonYDnsi\oneO \|ntemOere J|re NompOiNDs\on orDnODr¿n¿n ciGGi oODrDN GÁt½ EiOGiriOmiÁtir. .ompOiNDs\on orDn¿ trDnsIorDminDO enGosNopiN GisNeNtomiGe -35 iNen JeOeneNseO cerrDKiGe EX orDn oODrDN EiOGiriOmiÁtir 3-4. 7rDnsIorDminDO enGosNopiN GisNeNtomi \|ntemi iOe nNs orDn¿ esNi Eir oDO¿ÁmDGD miNroGisNeNto- miGe 5 oODrDN EiOGiriOmiÁtir . $ncDN \Dp¿ODn \eni oDO¿ÁmDODrGD trDnsIorDminDO enGosNopiN GisNeNtomi \|ntemi iOe \Dp¿ODn operDs\onODrGD nNs orDnODr¿nGD miNroGisNeNtomi\e orDnOD GDKD mit Yerici JeOiÁmeOer J|rOmeNteGir 5-. <eXnJ Ye HooJODnG·¿n oDO¿ÁmDODr¿nGD trDnsIorDminDO enGosNopiN GisNeNtomi sonrDs¿ reNrrens orDn¿ 5 oODrDN EiOGiriOmiÁtir --9. 6on oDO¿ÁmDODr enGosNopiN OomEer GisNeNtomiGe nNs orDn¿n¿n 3. miNroGisNeNtomiGe ise 5- oOGX½XnX ortD\D No\mXÁtXr. 7rDnsIorDminDO enGosNopiN GisNeNtominin ciGGi Eir |Jrenme e½risi oOGX½X ooN sD\¿GD oDO¿ÁmDGD J|steriOmiÁtir. BX seEepOe cerrDK¿n Gene\imi Drtt¿NoD nNs orDnODr¿n¿n D]DOG¿½¿ i]OenmiÁtir. 7rDnsIorDminDO enGosNopiN GisNeNtomi sonrDs¿ nNs orDn¿n¿n GDKD GÁN oOmDs¿n¿n Eir Gi½er seEeEi oODrDN sNDr GoNXsX JeOiÁiminin GDKD D] oOmDs¿ GÁnOeEiOir. 1|rDO KDsDr insiGDns¿ enGosNopiN OomEer GisNeNtomi . Ye miNroGisNeNtomi . \|nteminGe Een]erGir. 6inir N|N \DrDODnmD orDn¿ .- . DrDO¿½¿nGD EiOGiriOmiÁtir . LomEer GisN Kernisi Ye\D OomEer GDr NDnDO neGeni\Oe N|N Ye GXrDO Nese s¿N¿Á¿N oOG¿½XnGDn B26 GDKD D] EXOXnXr. BX seEepOe ¿s¿ reten ODser EipoODr Ye 5) JiEi ciKD]ODr¿ GDKD GiNNDtOi NXOODnmDN JereNmeNteGir. 7rDnsIorDminDO enGosNopiN GisNeNtomi \|ntemi iOe KioEir n|rDO \DrDODnmD EiOGiriOmemiÁtir. DXrDO KDsDr oOXÁXmXnGD trDnsIorDminDO enGosNopiN GisNeNtomiGe orDn . iNen EX orDn miNroGisNeNtomiGe ·Gir. <eXnJ Ye 7soX oDO¿ÁmDODr¿nGD GXrDO \DrDODnmD risNini 3 oODrDN EiOGirmiÁOerGir 3-. B\N GXrDO \DrDODnmDODr rDpor eGiOmemiÁtir 3. $O¿nDEiOeceN |nOem operDs\on esnDs¿nGD DÁ¿r¿ OD]er NXOODn¿m¿nGDn NDo¿nmDNt¿r. 1DGir J|rOen Eir NompOiNDs\on oODn NDO¿c¿ GX\X GeIisit orDn¿ oODrDN EiOGiriOmiÁtir 4-5. BXnXn \Dn¿nGD Gi]este]i en \D\J¿n postoperDtiI NompOiNDs\on oOXp YDNDODr¿n 5-·XnGD J|rOmeNteGir 4-5 Ye nereGe\se Ker ]DmDn JeoiciGir. BXnXn seEeEi tDm oODrDN DnODÁ¿ODmDm¿Á oOXp GorsDO N|N IXrNDO sinirOer NomÁXOX½XnGD oOXÁDn KemDtom ND\nDNO¿ oOGX½X GÁnOmeNteGir. 5Xtin steroiG enMeNsi\onXnXn Gi]este]i orDn¿n¿ D]DOtt¿½¿ EiOinmeNteGir. 3ostoperDtiI Gi]este]i J|rOen KDstDODrGD teGDYiGe DntienIODmDtXYDr DMDnODr *DEDpentin sempDtiN sinir EOoNODr¿ GÁnOmeOiGir. 7rDnsIorDminDO enGosNopiN JiriÁimOerGe EDt¿n ioi orJDn \DrDODnmDs¿ sDGece EirNDo oOJXGD EiOGiriOmiÁtir. BXnODr NontrODterDO reter \DrDODnmDs¿ NDO¿n ED½¿rsDN neNro]X Ye NoOon perIorDs\onX iOe psoDs DEsesi sponGiOoGisNit oOJXODr¿G¿r. 2rJDn \DrDODnmDs¿nGDn NDo¿nmDN DmDc¿\OD oDO¿Á¿ODcDN trDse iOe DEGomen ioeri½i iOiÁNisini inceOemeN JereNmeNteGir. 7rDnsIorDminDO enGosNopiN GisNeNtomi X\JXODmDODr¿nGD EeOirJin YDsNOer \DrDODnmD oOXÁmDmDNOD EerDEer sDGece Eir NDo oOJXGD rDpor eGiOmiÁtir. BXnODr GD siJmoiG Drter \DrDODnmDs¿ soO iOiDN Yen \DrDODnmDs¿ oOJXODr¿G¿r. 0iNroGisNeNtomi \|nteminGe EX orDn .45 Gir. 9DsNOer KDsDrGDn NDo¿nmDN DmDc¿\OD ODterDO sNopi J|rntOemesi iOe DnDtomiN \Dp¿ODr Ye EirEirOeri\Oe oODn iOiÁNiOeri Ge½erOenGiriOmeOiGir. 7m cerrDKi JiriÁimOer sonrDs¿nGD J|rOeEiOen ortDN NompOiNDs\on oODn enIeNsi\on orDn¿ miNroGisNeNtomiOerGe .3-.9 iNen enGosNopiN OomEer GisNeNtomi sonrDs¿ .4 tr. $septiN GisNit J|rOme s¿NO¿½¿ septiN GisNitten GDKD ID]ODG¿r. $septiN GisNit JeOiÁiminGe enG-pODte KDsDr¿ sorXmOX tXtXOmDNtDG¿r. $\r¿cD OiterDtrGe DGet pi\oMeniN psoDs Dpsesi EiOGiriOmiÁtir. (nIeNsi\on JeOiÁimini en D]D inGirJemeN DmDc¿\OD steriOi]Ds\on NXrDOODr¿nD X\XOmDO¿ proIiODNtiN DntiEi\otiN X\JXODnmDO¿ ciOt Ye sXEGermDO GoNXODrOD temDstDn NDo¿n¿ODrDN enstrmDnODr Eir NDnOGen soNXOmDO¿G¿r. 2perDs\on esnDs¿nGD enstrmDn N¿r¿OmDs¿ s|] NonXsX oODEiOir. 7eOesNop KXN Ye Iorseps N¿r¿ODEiOir. B|\Oe Eir GXrXmGD pDroDODr mDn\etiN roG Ye\D Iorseps iOe DO¿nmDO¿G¿r. 5e]iG GisN oOXÁDEiOeceN Eir Gi½er NompOiNDs\onGXr. 6¿NO¿NOD E\N sDntrDO GisNOer Ye ooN E\N IrDJmDn YDrO¿½¿ seEeEi\Oe J|rOmeNteGir. <eterOi GisNeNtomi X\JXODnmDO¿G¿r. ¾17(5/$0¾1$5(1'26.23¾. '¾6.(.720¾1¾1.203/¾.$6<21/$5, ¾nterODminDr enGosNopiN GisNeNtominin NompOiNDs\onODr¿ DÁD½¿GDNi JiEiGir )Dset KDsDr¿ DXrDO KDsDr DisNit 9 5eNrrens 3ersistDn pDreste]i HemDtom 1|rDO KDsDr Hem NXOODn¿ODn cerrDKi NoriGorXn miNroGisNeNtomi iOe D\n¿ oOmDs¿ Kem Ge X\JXODnDn iÁOemin D\n¿ oOmDs¿ EeNOeniOen NompOiNDs\onODr¿ GD Een]er N¿OmDNtDG¿r. Her ne NDGDr enGosNopinin rXtin oODrDN NXOODn¿OG¿½¿ NOiniNOerGen o¿NDn \D\¿nODrGD NompOiNDs\on orDnODr¿ GÁN oODrDN EiOGiriOse Ge |½renme e½risine pDrDOeO oODrDN EDÁODnJ¿otD NompOiNDs\on orDnODr¿n¿n miNroGisNeNtomiGen ID]OD oODEiOece½i XnXtXOmDmDO¿G¿r. .$<1$./$5 . :DnJ B LX * 3DteO $$ 5en 3 &KenJ ,. $n eYDOXDtion oI tKeOeDrninJ cXrYe Ior D compOe[ sXrJicDO tecKniTXe tKe IXOO enGoscopic interODminDr DpproDcK Ior OXmEDr Gisc KerniDtions. 6pine - e3. . Lee D< Lee 6H. LeDrninJ cXrYe Ior percXtDneoXs enGoscopic OXmEDr Giscectom\. 1eXroO 0eG &Kir 7oN\o 4933e. 3. 7]DDn :& 7rDnsIorDminDO percXtDneoXs enGoscopic OXmEDr Giscectom\. &KDnJ *XnJ 0eG - 334 4. 5Xetten 6 .omp 0 0erN H *oGoOiDs * )XOOenGoscopic interODminDr DnG trDnsIorDminDO OXmEDr Giscectom\ YersXs conYentionDO microsXrJicDO tecKniTXe D prospectiYe rDnGomi]eG controOOeG stXG\. 6pine 33 93-39 5. 1eOOensteiMn - 2steOo 5 BDrteOs 5 3eXO : 9Dn 5B YDn 70.7rDnsIorDminDO enGoscopic sXrJer\ Ior s\mptomDtic OXmEDr Gisc KerniDtions D s\stemDtic reYiew oI tKe OiterDtXre. (Xr 6pine - 9e4. . HermDntin )8 3eters 7 4XDrtDrDro L .DmEin 3. $ prospectiYe rDnGomi]eG stXG\ compDrinJ tKe resXOts oI open Giscectom\ witK tKose oI YiGeo-DssisteG DrtKroscopic microGiscectom\. - Bone -t 6XrJ $m 99995e5. 3 . <eXnJ $7 7soX 30 3osteroODterDO enGoscopic e[cision Ior OXmEDr Gisc KerniDtion sXrJicDO tecKniTXe oXtcome DnG compOicDtions in 3 censecXtiYe cDses. 6pine -3 . HooJODnG 7 6cKXEert 0 0iNOit] B 5Dmire] $ 7rDnsIorDminDO posteroODterDO enGoscopic Giscectom\ witK or witKoXt tKe comEinDtion oI D Oow-Gose cK\mopDpDin D prospectiYe rDnGomi]eG stXG\ in consecXtiYe cDses. 6pine 3 (9-(9 9. HooJODnG 7 YDn Gen BreNeO-DiMNstrD . 6cKXEert 0 0iNOit] B (nGoscopic trDnsIorDminDO Giscectom\ Ior recXrrent OXmEDr Gisc KerniDtion D prospectiYe coKort eYDOXDtion oI consecXtiYe cDses. 6pine 33 93- . &Koi , $Kn -2 6o :6 Lee 6- &Koi ,- .im H. ([itinJ root inMXr\ in trDnsIorDminDO enGoscopic Giscectom\ preoperDtiYe imDJe consiGerDtions Ior sDIet\. (Xr 6pine 3 4-4. . $Kn < Lee H< Lee 6H Lee -H. DXrDO teDrs in percXtDneoXs enGoscopic OXmEDr Giscectom\. (Xr 6pine - 5e4 . *otIr\G $ $YDn]i 2. $ s\stemDtic reYiew oI rDnGomiseG cOinicDO triDOs XsinJ posterior Giscectom\ to treDt OXmEDr Gisc KerniDtions. ,nt 2rtKop 933e. 3. &KiX -& 3osteroODterDO enGoscopic tKorDcic Giscectom\ ,n (nGoscopic spine sXJer\ DnG instrXmentDtion .im D )ressOer 5 5eJDn - eGs 7Kieme 0eGicDO 3XEOisKer 1ew <orN 1< 4 4-5 4. 1eOOensteiMn - 2steOo 5 BDrteOs 5 3eXO : 9Dn 5o\en B 9Dn 7XOGer 0 7rDnsIorDminDO enGoscopic sXrJer\ Ior OXmEDr stenosis D s\stemDtic reYiew. (Xr 63 - 9 9- 5. -DnJ -6 $n 6H Lee 6H 7rDnsIorDminDO percXtDneoXs enGoscopic Giscectom\ in tKe treDtment oI IorDminDO DnG e[trDIorDminDO OXmEDr GisN KerniDtions - 6pinDO DisorG 7ecK 95 33-43 E|OP 'Ro'U$OL¾KVDQg.7(1 $GDQD1XPXQH(½LWLPYH$UDÁW¿UPD+DVWDQHVL%H\LQYH6LQLU&HUUDKLVL.OLQL½L$GDQD 6$1$77$9(%¾/¾0'(0¾1¾0$/¾=0 0¾1¾0$/¾676$1$7,1'2¼8À8 0inimDOi]m moGern sDnDt Ye m]iNte N|Neni 9·ODrD NDGDr JiGen sDGeOiN Ye nesneOOi½i |n pODnD o¿NDrDn Eir DN¿mG¿r. $B& 6DnDt¿ 0inimDO 6DnDt JiEi tDEirOerOe Ge Dn¿O¿r . $meriND·GD 9·O¿ Ye 9·Oi \¿OODrGD etNiOi oODn 0inimDOi]m sDnDtsDO Eioimin DÁ¿r¿ \DO¿nO¿½¿n¿ sDYXnXr. 0inimDOi]m teriminin iON Ne] 95 \¿O¿nGD ´$rt 0DJD]inµ GerJisinGe 5icKDrG :oOOKeim tDrDI¿nGDn NXOODn¿OG¿½¿ tDKmin eGiOmeNteGir . BDÁND Eir J|rÁe J|re BDrEDrD 5ose·Xn ´$rt in $mericDµ GerJisinin (Nim 95 tDriKOi sD\¿s¿nGD \D\¿nODG¿½¿ ´$B& $rtµ EDÁO¿NO¿ \D]¿s¿G¿r. BX \D]¿GD \eni Eir sDnDt e½iOiminGen s|] eGiOmeNte Ye $B& $rt JiEi Eir DGODnG¿rmD Eenimsenme\ince D\n¿ \D]¿GD NXOODn¿ODn ´minimXmµ s|]c½ ´minimDOi]mminimDO Drtµ NDYrDm¿ oODrDN NXOODn¿OmD\D EDÁODnm¿Át¿r. 7erim sDnDt¿n EioimOerini |]eOOiNOe Ge m]iN Ye J|rseO sDnDtODr¿ niteOemenin \Dn¿nGD BDXKDXs eNoO GeYDm¿ EioiminGe sD\¿ODEiOeceN DncDN sonrDs¿nGD post-moGern sDnDt DnOD\¿Á¿ ioinGe Ge½erOenGiriOeEiOeceN sDnDtD \eni Eir estetiN DnOD\¿Á sDnDt IeOseIesi Ye NDYrDmsDOODÁt¿rmD\¿ Jetiren Eir sDnDt DN¿m¿ oODcDNt¿r 3. 0inimDOi]m |nceOiNOe D] iOe \etinmeN eOGeNi s¿n¿rO¿ oODnDNODrOD \oOD o¿NmDN Ye \Dp¿t¿ EX oeroeYe ioerisinGe NXrmD\D oDO¿ÁmDN GemeNtir. (NonomiN oODrDN ortD\D No\DcDN pDrDsDO Jcn] \oNsD NoOmeN ioin temeO |½eOere inmeN NDo¿n¿OmD] Eir GXrXmGXr. $nODt¿mGD etNi\i oo½DOtmDN ioin |½eOerin sD\¿s¿ D]DOt¿OsD GD ioeriNOeri eNsiOtiOmemeOi DNsine NorXnmDO¿G¿r. 5enJi Ye Eioimi en D]D Ye temeO |½eOere inGirJemeN KDttD NXOODn¿ODn mDO]emenin \DOn¿]cD NenGi renJinGen \DrDrODnmDN \Dp¿tODr¿ Nompo]is\onODrD \NOenen iIDGeOerGen Dr¿nG¿rmDN 0inimDOistOer·in temeO tXtXmX oOmXÁtXr. do½X sDnDto¿ \Dp¿tODr¿n¿ Eir NimOiNten Ge Dr¿nG¿rmDN ioin ´isimsi]µ oODrDN tDn¿mODm¿Á D\r¿nt¿ODr Ye iNinciO |½eOer mmNn oOGX½X NDGDr D]DOt¿ODrDN DnD |½e ortD\D o¿NDrt¿OmD\D oDO¿Á¿Om¿Át¿r 4. 6$1$77$0¾1¾0$/¾=0 0inimDOi]min Go½XÁX GD GDKD |nceNi sDnDt DN¿mODr¿ JiEi onODrOD etNiOeÁime JirereN oOJXnODÁm¿Á Eir sDnDt DnOD\¿Á¿G¿r. Do½mDs¿nGD |ncON eGen sDnDt DN¿mODr¿n¿n ortDN |]eOOi½i JeroeNoiOiN nesneOOiN iÁOeYseOOiN sDGeciOiN JiEi oOXÁXmODrGDn EesOenmeOeriGir. 5|nesDns·tDNi D\G¿nODnmDGDn sonrD retim ÁeNOinGeNi Ge½iÁim Ye teNniN JeOiÁmeOer sDnD\i GeYrimini ortD\D o¿NDrt¿r. (nGstri Ye mDNine\Oe \eni tDn¿ÁDn insDn sDYDÁtDn sonrD \eni Eir Gn\D G]eni Ye JeroeNOiN NXrmDN ]orXnGDG¿r. 0oGerni]min ortD\D o¿N¿Á¿ DsO¿nGD EX EXnDO¿mO¿ Ye NDrmDÁ¿N G|nemin sonXcXGXr. DDGDi]m Ge ´Ker Áe\ DnODms¿]µ srreDOi]mGe ise ´DnODms¿] JeroeNµ oOXr. $meriND·n¿n ]enJinOeÁip sDnDt ortDm¿nD \Dt¿r¿m \DpmDs¿ sDnDt¿n Drt¿N DO¿nDn sDt¿ODn Eir mDO Eir nesne oOGX½X oOJXsXnX \DrDt¿r. 9·ODr¿n sonXnGD Eir JrXp Jeno sDnDto¿ EX GXrXmXn G¿Á¿nGD JnON monoton Ye NDODEDO¿N \DÁDnt¿n¿n ioinGen NopmDN ioin topOXmcD NoOD\cD DnODmODnG¿r¿ODEiOeceN imJeOeri NXOODnmDODr¿ JereNti½i NDrDr¿n¿ DO¿rODr. $rtDn teNnoOoMinin \DrDtmD\D EDÁODG¿½¿ s¿N¿c¿ NDODEDO¿N K¿]OD DrtDn tm oOXÁXmODr NDrÁ¿s¿nGD topOXmXn \orXOmD\D EDÁODmDs¿ G¿ÁDYXrXmcXOXNtDn sonrD pop Drt¿ Go½XrXr. 3op Drt JnGeOiN oODn¿ sDnDtD soNmD\D oDO¿Á¿r. 0inimDO $rt·¿n ortD\D o¿N¿Á IeOseIesi J|rseO sDnDttD pop Drt·tDn 3 sonrD tNetim NOtrne GD\DO¿ oOmD\Dn sDnDtD \eni Eir EDN¿Á Do¿s¿ ND]DnG¿rmDNt¿r 3. BXnD neGen iKti\Do GX\XOmXÁtXr" $mDo i]Oe\icinin NDYrDm NDrmDÁDs¿n¿ ortDGDn NDOG¿rmDNt¿r. .|Nten oOmDsD GD EX ciGGi Eir estetiN Ge½iÁimGir. BeONi Ge JittiNoe DrtDn teNnoOoMinin \DrDtmD\D EDÁODG¿½¿ s¿N¿c¿ NDODEDO¿½¿ GD½¿tmD\¿ istemeN EDÁ neGenGir. dnN K¿]OD DrtDn Etn oOXÁXmODr NDrÁ¿s¿nGD topOXmODr GD \orXOmD\D EDÁODm¿Át¿r. 7DEii Ni EX K¿]¿n o¿NDrG¿½¿ JrOt insDnODr¿ ÁDÁN¿nD oeYiri\or Ye strese soNX\orGX. ¾Áte EX stresin iODc¿ sDNin :VSKHUZHȘH!)LU:WYLUN2SH\Z3LPKVYM;OYLLPU*VYU-PLSK=P[VU4LYJOL:\HYLa3V\aHV :VSKHUZHȘH!;PT4\SJHU`/HYY`3PLILY1HPTL=PUHZ 3 :VSKHUZHȘH!9HPULY4\SSLY4HY[PU.VTTLS:OHKV^.HTLZ3LVU[QL^ Ye GÁnme\i |½tOe\ici \Dp¿s¿\OD minimDOi]mGi . 0inimDOi]m Ge sDnDt IeOseIe\Oe GDKD ooN |rtÁme\e EDÁODr. <o½Xn tempo ioinGeNi insDnODr¿n eYOeri tDsDr¿m temi]OiN Ye G]en oODrDN G¿Á Gn\DGDNi NDrmDÁDGDn X]DN NDOmDO¿G¿r. HerKDnJi Eir Áe\in J|rnG½ JiEi oOmDs¿ NXrDm¿n¿ ÁiGGetOe sDYXnXr. <Dn¿OsDmD\D \er YermemeN KDttD EXnX DKODNs¿]O¿N sD\mDN KioEir Áe\e oOGX½XnGDn EDÁND iIDGe tDÁ¿tmDmDN stiOin s¿N¿ s¿N¿\D ED½ODnG¿½¿ prensipOerin EDÁ¿nGD JeOir. )D]ODO¿NODrGDn |nemsi] D\r¿nt¿ODrGDn Ge½ersi] \DnODrGDn EirinciO |½eOerGen NXrtXOmDN Dr¿nmDN GDKD temeO GDKD |]seO GDKD EirinciO |½eOere \etmeN 34. %¾/¾0'(0¾1¾0$/¾=0 7DriK Eo\XncD EiOim sDnDt¿ GesteNOemiÁ sDnDttD EiOimi GesteNOemiÁtir. BiOim sDnDttDn Ye\D IeOseIeGen X]DNODÁt¿½¿nGD JeOiÁme Ye NenGini \eniOeme Jcn ND\EetmiÁtir. 6DnDttD JeOiÁen minimDOist DN¿m NenGisini N¿sD sreGe EiOimGe Ge J|stermiÁtir. BiOimGe Ge JiGereN DrtDn ÁeNiOGe minimDOist \DNODÁ¿mODr |n pODnD o¿NmD\D EDÁODm¿Át¿r. *eOiÁen teNnoOoMi iOe EirOiNte DmeOi\DtODrGD NXOODn¿ODn DOetOerin JeOiÁmesi DmeOi\Dt sreOerini N¿sDOtm¿Á KDstDODr¿n NonIorXnX Drtt¿rm¿Á KDstDODr¿n GDKD N¿sD sreGe i\iOeÁmeOerine Ye KDstDneGe GDKD D] sre NDOmDODr¿nD neGen oOmXÁtXr. Bir ooN KDstD Drt¿N DmeOi\Dt oOGXNtDn Ye\D KerKDnJi Eir iÁOemGen sonrD D\n¿ Jn Ye\D ertesi Jn tDEXrcX eGiOmeNte KDttD iÁOerine G|nmeNteGirOer. (sNiOerin ´B\N cerrDK E\N DoDrµ DnOD\¿Á¿ Jnm]Ge tDm tersine G|nmÁtr. $rt¿N - cm GeOiNOerGen tm EDt¿nD omX]D Gi]e Ee\ine Ye\D J|½s EoÁOX½XnD JiriOmeNte Ker trO DmeOi\DtODr EX GeOiNOerGen soNXODn EorXODr DrDc¿O¿½¿\OD E\N Eir EDÁDr¿ iOe \Dp¿OmDNtDG¿r. 7¿ptDNi EX minimDOist X\JXODmDODr ´minimDO inYD]iY \DNODÁ¿mODrµ oODrDN DGODnG¿r¿OmDNtDG¿r. BX \DNODÁ¿mGD temeO IeOseIe en D] ]DrDrOD en ID]OD ID\GDn¿n nDs¿O sD½ODnDcD½¿G¿r. BX minimDOist \DNODÁ¿m ÁeNOi Kem cerrDK Do¿s¿nGDn E\N NoOD\O¿NODr sD½ODmDNtD Kem GD KDstD Do¿s¿nGDn GDKD rDKDt oOmDNtDG¿r. HDstDODr GDKD D] D½r¿ GX\mDNtD DmeOi\DttDn sonrDNi G|nemOeri GDKD rDKDt JeomeNte Ye iÁOerine ooN N¿sD sreGe G|nereN normDO \DÁDmODr¿nD GeYDm etmeNteGirOer. Be\in &errDKisinGe minimDO inYD]iY JiriÁimOerin \ine 9·O¿ \¿OODrGD 3roI. Dr. *D]i <DÁDrJiO·in miNrosNoEX Ee\in Ye GisN cerrDKisinGe NXOODnmDs¿\OD EDÁODG¿½¿ s|\OeneEiOir. 9 \¿O¿nGD <DÁDrJiO Ye &DspDr GisNeNtomi\i miNrocerrDKi \|ntemOe \Dpm¿ÁODrG¿r. 95 \¿O¿nGD HiMiNDtD omXrJDGD minimDO inYD]iY cerrDKinin temeOini oOXÁtXrDn IOorosNopi\i NXOODnDrDN perNtDn GisNeNtomi teNni½ini tDn¿mODm¿Át¿r. B|\Oece GDKD D] GoNX KDsDr¿ sD½ODnm¿Át¿r. <DÁDrJiO·in D\n¿ \¿OODrGD JeOiÁen minimDO sDnDttDn etNiOenmesi E\N oODs¿G¿r. 33 6DnDt EiOim Ye IeOseIe IDrNO¿ GisipOinOer oOmDODr¿nD rD½men G|nem G|nem EirEirOerini GesteNOerOer ED]en EirEirinin ioine JeoerOer Ye ED]en Ge EirEirOerini Nop\D eGerOer. BirinGeNi G|nemseO eNoO Ye\D |½reti Gi½erOerini Ge ioine DODEiOir Ye \oOODr¿nD EirEirOerini JoOenGirereN GeYDm eGerOer. 6DnDttDNi minimDOi]m iOe EiOimGeNi minimDO inYD]iY \DNODÁ¿mODr GD E|\Oe oOmXÁtXr. 6DnDttDNi minimDOist DN¿m¿n DnD |½esi oODn D] iOe \etinmeN JereNsi] mDO]emeOerGen NDo¿nmDN DnODt¿mGDNi etNi\i oo½DOtmDN ioin |½eOerin sD\¿s¿n¿ D]DOtmDN GDKD eNonomiN oOmDN JiEi NDYrDmODr EiOimGe NenGisini KDstDn¿n YcXt EtnO½n en D] KDsDrOD en etNiOi Eir ÁeNiOGe NorXmDN Ye en N¿sD ]DmDnGD sD½O¿½¿nD NDYXÁtXrmDN oODrDN NDrÁ¿O¿N EXOmXÁtXr. 6218d g]eOOiNOe t¿p EiOiminGe cerrDKi sDnDt oODrDN NDEXO eGiOir. BXnGD t¿p sDnDt Ye IeOseIenin EirEirini etNiOemesi 34 YDrG¿r. 8]XncD Eir sreGir DrDs¿ Do¿ODn EiOim IeOseIe Ye sDnDt¿n minimDOi]m NDYrDm¿ etrDI¿nGD teNrDr EirEirOerini EXOmDODr¿ n|roÁirrMi |]eOinGe \eni Eir NDYrDm oODn minimDO inYD]iY JiriÁimOerin JeOiÁmesine NDtN¿ sD½ODG¿½¿ s|\OeneEiOir. .$<1$./$5 . tr.wiNipeGiD.orJwiNi0inimDOi]m . g]NDn (ro½OX. www.Iotoritim.com...o]NDn-eroJOX-minimDO-Drt-minimDOi]m 3. 1Dnc\ $]DrEDG. www.ms[ODEs.orJ...4394-sDnDtDNimODri-minimDOi]m-minimDO-sDnDt 4. 0eKmet 6erGDr. <irmi IiOm \irmi Geneme. 6|]cNOer <D\¿nODr¿ ¾stDnEXO 5. 0eKGi 6DsDni)DKir g]er. 6pinDO 0inimDO ¾nYD]iY &errDKi <|ntemOer. 7emeO 1|roÁirrMi. &iOt-. $nNDrD sD\ID 43