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Minimal-invasive transforaminale lumbale interkorporelle Fusion

Minimally invasive transforaminal lumbar interbody fusion

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Zusammenfassung

Operationsziel

Fusion und Stabilisation lumbaler Bewegungssegmente in einer minimal-invasiven Technik.

Indikationen

Degenerative Bandscheibenerkrankungen, Segmentdegenerationen, degenerative Spondylolisthesen, isthmische Spondylolisthesen, Pseudarthrosen, andere spinale Instabilitäten, Bandscheibenvorfall, Revisionsoperationen bei Postnukleotomiesyndrom, neuroforaminale Stenosen, Facettenarthrose.

Kontraindikationen

Höhergradige Spondylolisthesen (Meyerding Grad III und IV, Spondyloptosen), Notwendigkeit bilateraler Wurzeldekompression, Wirbelkörperfrakturen, Tumoren, höhergradige spinale Instabilitäten, primäre spinale Deformitäten, Multi-level-Pathologien.

Operationstechnik

Ipsilateraler minimal-invasiver Zugang zur Lendenwirbelsäule (LWS) mithilfe eines selbsthaltenden tubulären Retraktorsystems, partielle oder vollständige Facettektomie, Implantation von Pedikelschrauben und des TLIF(„transforaminal lumbar interbody fusion“)-Cages unter Schonung der Nervenwurzeln, Fusion, kontralaterale Pedikelschraubeninsertion in minimal-invasiver oder perkutaner Technik.

Weiterbehandlung

Postoperative Mobilisation nach physiotherapeutischer Anleitung, Röntgenkontrolle nach Mobilisation (LWS im Stehen, 2 Ebenen), Follow-up-Untersuchung (klinisch und radiologisch) nach 6 bis 12 Wochen sowie 1 Jahr postoperativ.

Ergebnisse

Fusionsrate >90 %, vergleichbar mit der offenen TLIF. Komplikationsraten niedriger als bei offener TLIF. Kürzere Bestrahlungszeiten und -dosen, niedrigerer intraoperativer Blutverlust. Geringes chirurgisches Trauma führt zu kürzerer Hospitalisationszeit und Arbeitsunfähigkeit. Signifikante Reduktion des ODI (Oswestry Disability Index) und VAS(visuelle Analogskala)-Scores.

Abstract

Objective

Instrumented fusion of lumbar motion segments using a minimally invasive technique.

Indications

Degenerative disc disease, segmental degeneration, degenerative spondylolisthesis, isthmic spondylolisthesis, pseudarthrosis, other spinal lumbar instabilities, disc prolapse, revision for failed back surgery syndrome, unilateral neuroforaminal stenosis, facet joint arthrosis.

Contraindications

High-grade spondylolisthesis (Meyerding grades III/IV, spondyloptosis), bilateral nerve root compression, vertebral fractures, tumors, high-grade spinal instabilities, primary spinal deformities, multilevel pathologies.

Surgical technique

Ipsilateral minimally invasive approach using a self-retaining tubular retractor system, partial or complete facetectomy, insertion of pedicle screws, transforaminal lumbar interbody fusion (TLIF) cage insertion preserving nerve roots, fusion, contralateral insertion of pedicle screws using a minimally invasive or percutaneous technique.

Postoperative management

Mobilization with physiotherapy, followed by standing plain x‑ray examinations, clinical and radiological follow-up at 6–12 weeks and 1 year postoperatively.

Results

Fusion rates >90%, comparable to open TLIF. Complication rates lower than open TLIF. Shorter radiation exposure during surgery, lower blood loss. Less surgical trauma leads to shorter hospitalization time and earlier return-to-work. Oswestry Disability index (ODI) scores and visual analog scale (VAS) scores significantly decreased.

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Authors and Affiliations

  1. Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland

    Christoph-Heinrich Hoffmann &  Frank Kandziora

Authors
  1. Christoph-Heinrich Hoffmann
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Correspondence to Christoph-Heinrich Hoffmann.

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C.-H. Hoffmann und F. Kandziora geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Mayer, München

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R. Himmelhan, Mannheim

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Hoffmann, CH., Kandziora, F. Minimal-invasive transforaminale lumbale interkorporelle Fusion. Oper Orthop Traumatol 32, 180–191 (2020). https://doi.org/10.1007/s00064-020-00660-0

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  • DOI: https://doi.org/10.1007/s00064-020-00660-0

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