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Implantatspezifische Zugänge: Activ-L

Keel-Implants: Activ-L

Operative Orthopädie und Traumatologie volume 22, pages 608–619 (2010)Cite this article

Zusammenfassung

Das Activ-L-Implantat (B. Braun/Aesculap, Tuttlingen, Deutschland) ermöglicht einen minimalinvasiven endoprothetischen Bandscheibenersatz der Lendenwirbelsäule (LWS). Verankerung mittels Spikes, Keel oder einer Kombination aufgrund seines modularen Designs möglich. Translation in begrenztem Ausmaß durch ein UHMWPEInlay möglich. Frühe klinische Ergebnisse sind mit bereits etablierten Implantatkonzepten vergleichbar.

Operationsziel

Restauration der Funktion des lumbalen Bewegungssegments mit anhaltender Schmerzreduktion und normaler Belastbarkeit. Rasche klinische Reintegration des Patienten in Berufs- und Privatleben.

Indikationen

Gescheiterte konservative Behandlung bei nachgewiesener Bandscheibendegeneration eines oder mehrerer Bewegungssegmente und Ausschluss einer nicht diskogenen Schmerzursache.

Kontraindikationen

Spondylitiden und Diszitiden des Segmentes, Frakturen, Wirbelkörpermetastasen, Z. n. Fusionsoperationen, Osteoporose, metabolische Knochenerkrankungen, schwere Allgemeinerkrankungen, allgemeine Kontraindikationen, die gegen einen abdominellen Eingriff sprechen, unklare lumbale Schmerzzustände.

Operationstechnik

Minimalinvasiver ventraler Zugang zur Lendenwirbelsäule, Darstellen der ventralen Zirkumferenz des Segmentes, Ausräumen des Zwischenwirbelraumes, Höhenbestimmung mit dem Probeimplantat, Festlegung, ob Keel- oder Spike-Verankerung individuell für jede Endplatte, Implantation der Prothese in der Mittellinie, Röntgenkontrollen, Wundverschluss.

Weiterbehandlung

Mobilisation 6 Stunden postoperativ, stabilisierende Physiotherapie ab der 3. Woche postoperativ.

Ergebnisse

Veröffentlichte klinische und radiologische Ergebnisse decken sich mit den bereits publizierten Ergebnissen der Literatur für andere Prothesentypen. Publizierte Ergebnisse von In-vitro-Untersuchungen des Polyethylenabriebs zeigen einen signifikant niedrigeren Abrieb als bei vergleichbaren Implantattypen, was unter Umständen am Testverfahren liegen kann.

Abstract

Due to its modular design, the Activ-L total disc replacement (B. Braun/Aesculap, Tuttlingen, Germany) allows for a flexible anchoring concept either with spikes or one or two keels. It has a semiconstraint design which allows for some movement of a UHMWPE inlay. The minimal invasive surgical technique is highly standardized. Early clinical results are comparable to established disc-replacement devices.

Objective

Aim of the surgery is lasting pain relief and complete restauration of segmental mobility without affection of adjacent motion segments.

Indications

Mono- or multisegmental lumbar disc degeneration leading to low-back pain, refractory to conservative treatment.

Contraindications

Infections of vertebra or disc-space, fractures, prior fusion surgery of the affected motion segments, malignancy, osteoporosis, metabolic bone disease, severe conditions affecting general health, conditions prohibitive for anterior abdominal surgery, unclear or non-discogenic low-backpain.

Surgical Technique

Minimal-invasive anterior approach to the lumbar spine, removal of nucleus and cartilagenous endplates, sizing with trial implant, decision about spike or keel anchoring concept, implantation of prosthesis, xray-control, wound closure.

Postoperative Management

Bed-rest for 6 hours, stabilizing physiotherapy 3 weeks postoperative.

Results

Level-3 evidence shows early clinical results comparable with published data from previous implants, particle wear of inlay is significantly lower, possibly due to different testing protocols.

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Author information

Affiliations

  1. Abteilung für Wirbelsäulenchirurgie, Hessingpark-Clinic, Augsburg, Germany

    Karsten Wiechert

  2. Abteilung für Wirbelsäulenchirurgie, Hessingpark-Clinic, Hessingstraßse 17, 86199, Augsburg, Germany

    Karsten Wiechert

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  1. Karsten Wiechert
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Correspondence to Karsten Wiechert.

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Zeichner: Rüdiger Himmelhan, Heidelberg

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Wiechert, K. Implantatspezifische Zugänge: Activ-L. Orthop Traumatol 22, 608–619 (2010). https://doi.org/10.1007/s00064-010-1005-3

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Schlüsselwörter

  • Lendenwirbelsäule
  • Bandscheibenersatz
  • Activ-L
  • Operationstechnik

Key Words

  • Lumbar spine
  • Total disc replacement
  • Activ-L disc
  • Surgery