Skip to main content
SpringerLink
Log in

Operative Therapie bei Spondylolyse und Spondylolisthese

Surgical therapy for spondylolysis and spondylolisthesis

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die Therapie der Spondylolyse und Spondylolisthese stellt angesichts der Vielfalt der Behandlungsmöglichkeiten hohe Anforderungen an den behandelnden Arzt. Ein einheitliches, standardisiertes Behandlungskonzept ist bisher nicht etabliert. Die geeignete Therapieform hängt jeweils von verschiedenen Parametern und den eigenen Erfahrungen ab. Neben Lysespaltrekonstruktionen („direct repair“) bei Spondylolyse und geringradiger Spondylolisthese stehen je nach Patientenalter und Schweregrad des Abrutsches dorsale, ventrale und kombiniert dorsoventrale Operationen mit oder ohne Instrumentation zur Wahl.

Komplikationen wie Pseudarthrose und Progression des Abrutsches entwickeln sich in bestimmten Prozentsätzen, sind jedoch nicht signifikant mit klinischen Symptomen korreliert. Dekompressionen sind vor allem bei hochgradigem Abrutsch mit vorliegender neurologischer, und insbesondere motorischer Ausfallsymptomatik indiziert. Die Reposition des Abrutsches birgt ein erhöhtes neurologisches Risiko.

Die In-situ-Fusion ohne Instrumentation zeigt auch bei mittelschweren und schweren Abrutschgraden gute klinische Ergebnisse mit hohen Fusionsraten ohne erhöhtes Progredienz- und Pseudarthroserisiko und stellt in vielen Fällen eine effektive, sichere und ökonomische Behandlungsoption dar.

Abstract

The therapy for spondylolysis and spondylolisthesis is challenging in view of the large variety of treatment options. A general, standardized therapeutic concept has still not been established. Adequate therapy depends on different parameters and personal experience. Beside direct repair surgery of spondylolysis and low grade spondylolisthesis, dorsal, ventral and combined dorsoventral surgery, with or without instrumentation, are indicated depending on patients age and severity of the slip.

Complications such as pseudarthrosis and progression of the slip develop in a given percentage of cases, but these are not significantly correlated with clinical symptoms. Decompression is necessary in high grade slippage with neurologic impairment, especially paresis. Reposition is associated with a higher risk of neurologic complications.

Fusion in situ without instrumentation, even in moderate and severe spondylolisthesis, shows good clinical results with high fusion rates and without the increased risk of progression and pseudarthrosis. In many cases, it is an effective, safe and economic therapeutic option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1 a
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8 a
Abb. 9
Abb. 10
Abb. 11
Abb. 12

Literatur

  1. Axelsson P, Johnsson R, Stromqvist B, Arvidsson M, Herrlin K (1994) Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2–7) years. Acta Orthop Scand 65: 309–314

    PubMed  Google Scholar 

  2. Buck JE (1970) Direct repair of the defect in spondylolisthesis. J Bone Joint Surg Br 52: 432–437

    PubMed  Google Scholar 

  3. Burkus JK, Lonstein JE, Winter RB et al. (1992) Long term evaluation of adolescents treated operatively for spondylolisthesis. J Bone Joint Surg Am 47-A: 693–704

  4. Boxall D, Bradford DS, Winter RB, Moe JH (1979) Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 61: 479–495

    PubMed  Google Scholar 

  5. Bradford DS (1979) Treatment of severe spondylolisthesis. A combined approach for reduction and stabilization. Spine 4: 423–429

    PubMed  Google Scholar 

  6. Dick W, Elke R (1997) Die Bedeutung des sagittalen Profils und der Reposition bei der Spondylolisthesis Grad III–V. Orthopäde 26: 774–780

  7. Fabris DA, Constantini S, Nena U (1996) Surgical treatment of severe L5–S1 spondylolisthesis in children and adolescents: results of intraoperative reduction, posterior interbody fusion and segmental pedicle fixation. Spine 21: 728–733

    Article  PubMed  Google Scholar 

  8. Frederickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP (1984) The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 66: 699–707

    PubMed  Google Scholar 

  9. Freeman BL, Donati L (1989) Spinal arthrodesis for severe spondylolisthesis in children and adolescents. J Bone Joint Surg Am 71: 594–598

    PubMed  Google Scholar 

  10. Fritzell P, Hagg O, Wessberg P, Nordwall A, The Swedish Lumbar Spine Study Group (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish Lumbar Spine Study Group. Spine 27: 1131–1141

    Article  PubMed  Google Scholar 

  11. Gill GG, White HL (1963) Surgical treatment of spondylolisthesis without spine fusion. J Bone Joint Surg Am 45 A: 666

    Google Scholar 

  12. Gillet P, Petit M (1999) Direct repair of spondylolysis without spondylolisthesis, using a rod-screw construct and bone grafting of the pars defect. Spine 24: 1252–1256

    Article  PubMed  Google Scholar 

  13. Grezgorzewski A, Kumar SJ (2000) In situ posterolateral spine arthrodesis for grades III, IV and V spondylolisthesis in children and adolescents. J Ped Orthop 20(4): 506–511

    Article  Google Scholar 

  14. Harms J (2000) Wirbelsäulenchirurgie. In: Reichel H, Zwipp H, Hein W (Hrsg) Wirbelsäulenchirurgie. Steinkopff, Darmstadt

  15. Harris IE, Weinstein SL (1987) Long-term follow-up of patients with grade-III and IV spondylolisthesis. J Bone Joint Surg Am 69: 960–969

    PubMed  Google Scholar 

  16. Hasler C, Dick W (2002) Spondylolyse und Spondylolisthese im Wachstumsalter. Orthopäde 31: 78–87

  17. Hefti F (1997) Direktverschraubung der Spondylolyse mit der Hakenschraube. Orthopäde 26: 769–773

  18. Hensinger RN (1989) Curent concepts review. Spondylolysis and spondylolisthesis in children and adolescents. J Bone Joint Surg Am 71: 1098

    PubMed  Google Scholar 

  19. Hohmann F, Stürz H (1997) Differentialindikation zur lumbosakralen Fusions- und Repositionsoperation beim Wirbelgleiten. Orthopäde 26: 781–789

  20. Hu SS, Bradford DS, Transfeld EE, Cohen M (1996) Reduction of high-grade spondylolisthesis using Edwards instrumentation. Spine 21: 367–371

    Article  PubMed  Google Scholar 

  21. Jaeger M, Seller K, Raab E, Krauspe R, Wild A (2003) Clinical outcome in monosegmental fusion of lumbal instabilities, instrumented versus non instrumented. Med Sci Monit 9: 324–327

    Google Scholar 

  22. Johnson JR, Kirwan EO (1983) The long-term results of fusion in situ for severe spondylilisthesis J Bone Joint Surg Br 65: 43–46

    Google Scholar 

  23. Krismer M, Auckenthaler T, Gruber R, Wimmer C, Sterzinger W, Ogon M (1997) Lumbale Fusion bei Erwachsenen — dorsal oder kombiniert ventral/dorsal? Orthopäde 26: 568–571

  24. Laurent LE, Einola S (1961) Spondylolisthesis in children and adolescents. Acta Orthop Scand 31: 45–62

    PubMed  Google Scholar 

  25. Laurent LE, Osterman K (1976) Operative treatment of spondylolisthesis in young patients. Clin Orthop Relat Res 117: 85–91

    PubMed  Google Scholar 

  26. Lonstein JE (1999) Spondylisthesis in children. Cause, natural history, and management. Spine 24: 2640–2648

    Article  PubMed  Google Scholar 

  27. Louis R (1988) Pars interarticularis reconstruction for spondylolysis by plate and screws with grafting without arthrodesis. Rev Chir Orthop 74: 549–557

    PubMed  Google Scholar 

  28. Magerl F (1982) External skeletal fixation of the lower thoracic and lumbar spine. In: Uthoff HK (ed) Current concepts of external fixation of fractures. Springer, Berlin Heidelberg New York, p 353

  29. Meyerding HW (1932) Spondylolisthesis: surgical treatment and results. Surg Gynecol Obstet 54: 371–377

    Google Scholar 

  30. Morscher E, Gerber B, Fasel J (1984) Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma 103: 175–178

    Article  Google Scholar 

  31. Muschik M, Zippel H, Perka C (1997) Surgical management of severe spondylolisthesis in children nd adolescents: anterior fusion in situ versus anterior spondylodesis with posterior transpedicular instrumentation and reduction. Spine 17: 2036–2042

    Article  Google Scholar 

  32. Newman PH (1963) The etiology of spondylolisthesis. J Bone Joint Surg Br 45: 39

    Google Scholar 

  33. Nicol RO, Scott JHS (1986) Lytic spondylolysis. Repair by wiring. Spine 11: 1027

    PubMed  Google Scholar 

  34. Östermann K, Lindholm TS, Laurent LE (1976) Late results of removal of the loose element (Gill’s operation) in the treatment of lytic lumbar spondylolisthesis. Clin Orthop 117: 121

    Google Scholar 

  35. Östermann K, Schlenzka D, Poussa M, Seitsalo S, Virta L (1993) Isthmic spondylolisthesis in symptomatic subjects, epidemiology, and natural history with special reference to disc abnormality and mode of treatment. Clin Orthop 297: 65–70

    Google Scholar 

  36. Peek RD, Wiltse LL, Reynolds JB, Thomas JC, Guyer DW, WiddelI EH (1989) In situ arthrodesis without decompression for grade-III or IV isthmic spondylolisthesis in adults who have severe sciatica. J Bone Joint Surg Am 71: 62–68

    PubMed  Google Scholar 

  37. Poussa M, Schlenzka D, Seitsalo S, Ylikoski M, Hurri H, Österman K (1993) Surgical treatment of severe isthmic spondylolisthesis in adolescents. Reduction or fusion in situ. Spine 18: 894–901

    PubMed  Google Scholar 

  38. Rosenberg NJ (1975) Degenerative spondylolisthesis: Predisposing factors. J Bone Joint Surg Am 57: 467–474

    PubMed  Google Scholar 

  39. Salib RM, Pettine KA (1993) Modified repair of a defect in spondylolysis or minimal spondylolisthesis by pedicle screw, segmental wire fixation and bone grafting. Spine 18: 440–443

    PubMed  Google Scholar 

  40. Schlenzka D (1997) Die Spondyliosthesis im Kindes- und Jugendalter. Orthopäde 26: 760–768

  41. Seitsalo S, Österman K, Hyvärinen H, Schlenzka D, Poussa M (1990) Severe spondylolisthesis in children and adolescents: a long-term review of fusion in situ. J Bone Joint Surg Br 72: 259–265

    PubMed  Google Scholar 

  42. Seitsalo S, Österman K, Hyvarinen H, Tallroth K, Schlenzka D, Poussa M (1991) Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients. Spine 16: 417–421

    PubMed  Google Scholar 

  43. Velikas EP, Blackburne JS (1981) Surgical treatment of spondylolisthesis in children and adolescents. J Bone Joint Surg Br 63: 67–70

    PubMed  Google Scholar 

  44. Wild A, Jaeger M, Webb JK (2001) Kontinuierliche Reposition und Fusion mittels Fixateur extern bei Spondyloptosen. Z Orthop Ihre Grenzgeb 139: 152–156

    Article  PubMed  Google Scholar 

  45. Wiltse LL, Newman PH, Macnab I (1976) Classification of spondylolysis and spondylolisthesis. Clin Orthop 117: 23

    PubMed  Google Scholar 

  46. Wiltse LL, Winter RB (1983) Terminology and measurements of spondylolisthesis. J Bone Joint Surg Am 65: 768–772

    PubMed  Google Scholar 

  47. Wiltse LL, Rothman LG (1989) Spondylolisthesis: Classification, diagnosis, and natural history. Semin Spine Surg 1 (2): 78–94

    Google Scholar 

  48. Wimmer C, Krismer M, Gluck H, Sterzinger W, Ogon M (1997) Vor- und Nachteile des retroperitonealen und transperitonealen Zugangs zur Fusion der präsakralen Bandscheibe. Orthopäde 26: 563–567

  49. Wittenberg RH, Willburger RE, Krämer J (1998) Spondylolyse und Spondylolisthese – Diagnose und Therapie. Orthopäde 27: 51–63

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Orthopädische Universitätsklinik Leipzig

    A. Wild & K. Seller

  2. Orthopädische Universitätsklinik Düsseldorf

    R. Krauspe

  3. Orthopädische Universitätsklinik Leipzig, Semmelweisstraße 10, 04103, Leipzig

    A. Wild

Authors
  1. A. Wild
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Seller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Krauspe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Wild.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wild, A., Seller, K. & Krauspe, R. Operative Therapie bei Spondylolyse und Spondylolisthese. Orthopäde 34, 995–1006 (2005). https://doi.org/10.1007/s00132-005-0837-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-005-0837-2

Schlüsselwörter

Keywords

Search

Navigation