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Operative Orthopädie und Traumatologie

, Volume 25, Issue 1, pp 31–46 | Cite as

Dekompression der lumbalen Rezessusstenose

Endoskopische, interlaminäre Technik
  • S. Ruetten
  • M. Komp
  • P. Hahn
  • S. Oezdemir
Operative Techniken

Zusammenfassung

Operationsziel

Dekompression der lumbalen Rezessusstenose in vollendoskopischer Technik mittels interlaminärem Zugang.

Indikationen

Lumbale Rezessusstenose aufgrund ligamentärer, ossärer, diskogener Kompression und/oder Zysten der Zygapophysealgelenke.

Kontraindikationen

Reine Rückenschmerzen, korrekturbedürftige Instabilität/Deformität, reine Foramenstenose.

Operationstechnik

Einbringen einer Operationshülse zum interlaminären Fenster. Unter endoskopischer Sicht Resektion komprimierender knöcherner/ligamentärer Strukturen sowie von Osteophyten und Anulusanteilen.

Weiterbehandlung

Sofortige Mobilisation, isometrische/koordinative Übungen, ab der 3. Woche funktionelle Übungen, ab der 6. Woche Kraftaufbau.

Ergebnisse

Insgesamt 192 Patienten wurden vollendoskopisch oder mikrochirurgisch operiert und mindestens über 2 Jahre nachuntersucht. Es zeigte sich eine signifikante Verbesserung. Schwerere Komplikationen traten bei 5% auf und waren in der endoskopischen Gruppe signifikant reduziert. Mittels Dekompression und/oder Fusion wurden 5 Patienten revidiert. 89% der Patienten würden den Eingriff wiederholen lassen.

Schlüsselwörter

Spinalkanalstenose Rezessusstenose Operative Dekompression Endoskopische Operationsmethoden Mikrochirurgie 

Decompression of lumbar lateral spinal stenosis

Full-endoscopic, interlaminar technique

Abstract

Objective

Decompression in lumbar recess stenosis in a full-endoscopic technique using an interlaminar approach.

Indications

Lumbar recess stenosis due to ligamentous, osseous, discogenic compression, and/or juxta-facet cysts.

Contraindications

Pure back pain, instability/deformity requiring correction, pure foraminal stenosis.

Surgical technique

Introduction of a surgical sleeve to the intralaminar window. Endoscopic resection of compressing bony/ligamentary structures and also of osteophytes or parts of annulus.

Postoperative management

Immediate mobilization, isometric/coordination exercises, functional exercises from week 3, building up strength from week 6.

Results

A total of 192 patients underwent full-endoscopic surgery or microsurgery and were followed up over a minimum of 2 years. A significant improvement was revealed. Serious complications occurred in 5% and were significantly reduced in the endoscopic group. Five patients were revised with decompression and/or fusion. Eighty-nine percent would undergo the operation again.

Keywords

Spinal stenosis Recess stenosis Surgical decompression Endoscopic surgical procedures Microsurgery 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie der St. Vincenz Gruppe RuhrSt. Anna Hospital Herne/Marien-Hospital WittenHerneDeutschland

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