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Operative Therapie bei Spondylolyse und Spondylolisthese

Surgical therapy for spondylolysis and spondylolisthesis

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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.

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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

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