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Erweiterte transforaminale lumbale intersomatische Fusion zur Korrektur kyphotisch fixierter lumbaler Segmente und lumbaler Hypolordosen

Correction of kyphotic fixed lumbar segments and hypolordosis with the transforaminal lumbar interbody fusion technique

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Zusammenfassung

Operationsziel

Lordosierung einer segmentalen oder globalen lumbalen Hypolordose zur Korrektur der sagittalen Imbalance.

Indikationen

Kyphotisch fixierte lumbale Segmente; degenerative, postinfektiöse oder posttraumatische lumbale Hypolordosen mit sagittaler Imbalance.

Kontraindikationen

Morbus Bechterew; Zustände mit ausgedehnten retroperitonealen Adhäsionen.

Operationstechnik

Über einen monoportalen transforaminalen Zugang erfolgt ein anteriores und laterales Release von Anulus und vorderem Längsband zur segmentalen Korrektur eines in Kyphose fixierten lumbalen Segments. Die Ergänzung einer V‑förmigen dorsalen Osteotomie ermöglicht eine segmentale Lordosierung von bis zu über 20° und damit Korrektur einer globalen sagittalen Fehlstellung.

Weiterbehandlung

Korsettfreie Mobilisation ab 1. postoperativen Tag mit physiotherapeutischer Begleitung. Sportverbot für 3–4 Monate.

Ergebnisse

Insgesamt 33 kyphotisch fixierte lumbale Segmente bei 25 Patienten konnten über einen monoportalen transforaminalen Zugang vollständig mobilisiert werden. Durchschnittlich konnte dadurch eine segmentale Lordosierung von 11,4° erreicht werden. Bei 10 Patienten mit ergänzender dorsaler Osteotomie konnte das Segment durchschnittlich um 19° (Spanne 14–29°) korrigiert werden. Intra- und postoperativ kam es zu keinen vaskulären oder neurologischen Schäden. Bei der radiologischen Nachkontrolle mindestens 6 Monate postoperativ kam es zu einem geringen Lordoseverlust um durchschnittlich 1° (Spanne 0–3°).

Abstract

Objective

Correction of a segmental or global lumbar hypolordosis to improve a sagittal imbalance.

Indications

Lumbar segments fixed in kyphosis; degenerative or posttraumatic hypolordotic deformity of the lumbar spine with sagittal imbalance.

Contraindications

Bechterew disease; extended adhesions in the retroperitoneum.

Surgical technique

Segmental correction of a kyphotic fixed segment using a unilateral transforaminal approach to release the annulus and anterior longitudinal ligament. With an additional posterior V‑shaped osteotomy, a segmental correction of more than 20° could be achieved to improve a global sagittal imbalance.

Postoperative management

Back-friendly mobilisation starting the first day after surgery with support of a physiotherapist. No sports for 3–4 months.

Results

In all, 25 patients with 33 kyphotic fixed lumbar segments were treated using a complete anterior release of the annulus and anterior longitudinal ligament via a unilateral transforaminal approach. This enabled a lordosizing correction of the segment between 5° and 29° (mean 11.4°) without any neurological or vascular complications. A total of 10 patients treated with an additional posterior osteotomy were corrected 14–29° (mean 19°). There was a loss of reduction of the lordotic correction (mean 1°; range 0–3°) in the X‑ray control at a minimum follow-up of 6 months (range 6–33 months).

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Authors and Affiliations

  1. Orthopädische Wirbelsäulenchirurgie, Berit Paracelsus-Klinik AG, Voegelinsegg 5, 9042, Speicher, Schweiz

    F. Lattig

  2. Klinik für Neurochirurgie, Bundeswehrkrankenhaus, Koblenz, Deutschland

    E. Stettin

  3. Orthopädische Universitätsklinik am RKU Ulm, Ulm, Deutschland

    S. Weckbach

Authors
  1. F. Lattig
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  2. E. Stettin
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  3. S. Weckbach
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Corresponding author

Correspondence to F. Lattig.

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Interessenkonflikt

F. Lattig, E. Stettin und S. Weckbach geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

M. Hessmann, Fulda

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J. Kühn, Mannheim

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Lattig, F., Stettin, E. & Weckbach, S. Erweiterte transforaminale lumbale intersomatische Fusion zur Korrektur kyphotisch fixierter lumbaler Segmente und lumbaler Hypolordosen. Oper Orthop Traumatol 30, 210–222 (2018). https://doi.org/10.1007/s00064-018-0532-1

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