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Vordere Spondylodesen an der unteren Halswirbelsäule

Winkelinstabile vs. winkelstabiler Platte, reine Spongiosa vs. trikortikalem Span

Anterior cervical fusion in the lower cervical spine

Locked vs nonlocked screw plate, pure cancellous bone vs tricortical strut

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Zusammenfassung

Stellungsveränderungen von Spondylodesen gefährden den Behandlungserfolg beträchtlich. Experimentell wurde gesichert, dass die kleinste, belastungsinduzierte Stabilitätsverminderung in Konstrukten aus winkelinstabiler H-Platte + Spongiosa auftritt. Untersucht wurden 485 konsekutiv versorgte Patienten mit 700 Segmenten, eingeteilt in 4 Gruppen: 1. winkelinstabile H-Platte mit autologer Spongiosa, 2. winkelinstabile H-Platte mit trikortikalem Span (autolog), 3. winkelstabile Platten mit trikortikalem Span, 4. Cage mit reiner Spongiosa. Die Kontrolle der Ausheilung erfolgte protokollgemäß mit konventionellen Röntgenaufnahmen und stichprobenartig mit einer CT-Untersuchung. Die sicherste und schnellste Verknöcherung (6 Wochen) bildete sich in Konstrukten aus winkelinstabiler H-Platte + autologer Spongiosa (klinisch-radiologisch in 77% der Patienten, p=0,00001). Die Verwendung trikortikaler Späne verzögerte den knöchernen Durchbau in allen Konstrukten. Die winkelstabilen Plattenspondylodesen heilten sehr verzögert (nach etwa einem Jahr) aus. Die mit Cage und Spongiosa angefertigten Spondylodesen heilten auch verzögert, aber sicherer aus. Die Pseudarthrosenrate betrug 0% in den Gruppen 1 und 4 sowie 4,5 bzw. 21% in den Gruppen 2 und 3.

Abstract

Physical alterations in cervical fusions endanger healing. Experimentally we determined less stability loss in fixations using cancellous bone grafts than in those using tricortical grafts. Four hundred eighty-five Patients underwent anterior cervical fusion, for a total of 700 Segments. Patients were divided into four groups: (1) nonlocked H plate with autogenous cancellous bone, (2) nonlocked H plate with autogenous tricortical graft, (3) locked cervical plate with tricortical graft, and (4) stand-alone cage with cancellous bone. Evaluations included X-ray and random CT scan examinations. Our results suggest that anterior cervical fusions using nonlocked H screw plate systems with pure autogenous cancellous bone grafts provide the fastest (6 weeks) and most secure bone healing (P=0.00001), whereas fixations using nonlocked or locked screw plate systems and tricortical autograft require prolonged healing and develop nonunions more frequently. Complete consolidation was achieved using stand-alone cages filled with pure autogenous cancellous bone, but bony healing was delayed due to the cage. Rate of nonunions were: groups 1 and 4 0%, and groups 2 and 3 4.5% and 21%, respectively.

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  1. Abteilung für Unfallchirurgie der Medizinischen Universität Albert Szent-Györgyi, Semmelweis u. 6., 6725, Szeged, Ungarn

    L. Sándor

  2. Universitätsklinik für Neurochirurgie der Medizinischen Fakultät der Universität zu Szeged, Szeged, Ungarn

    P. Barzo, A. Kuncz & P. Elek

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  1. L. Sándor
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  2. P. Barzo
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  3. A. Kuncz
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Correspondence to L. Sándor.

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Die jetzt vorliegende Arbeit ist die erweiterte Version eines Referats, welches in Salzburg (10. bis 11. März 2006) während des 42. AO-Symposiums „Wirbelsäule“ (organisiert von der AO-International in Zusammenarbeit mit AOSPINE, Österreich) gehalten wurde.

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Sándor, L., Barzo, P., Kuncz, A. et al. Vordere Spondylodesen an der unteren Halswirbelsäule. Chirurg 79, 461–473 (2008). https://doi.org/10.1007/s00104-007-1454-x

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