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Wiederherstellung der sagittalen Balance bei der Versorgung thorakaler und lumbaler Wirbelkörperfrakturen

Restoration of sagittal balance in treatment of thoracic and lumbar vertebral fractures

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Zusammenfassung

Die posttraumatische Kyphose (PTK) kann die Folge einer übersehenen Fraktur, einer falsch indizierten konservativen Behandlung oder einer falsch durchgeführten operativen Therapie sein. Ebenso tritt sie als schicksalhafter Verlauf einer adäquat durchgeführten Behandlung auf. Der Vermeidung der PTK kommt eine große Bedeutung zu, da die nachfolgenden operativen Eingriffe aufwendig sind. In der operativen Therapie sind eine sorgfältige Planung und eine große chirurgische Erfahrung mit ventralen und dorsalen Revisionseingriffen notwendig. Auch müssen die verschiedenen Osteotomietechniken beherrscht werden, welche die Korrektur sowohl der lokalen als auch globalen Deformität ermöglichen. Auch Kenntnisse der sagittalen und der spinopelvinen Balance sind unabdingbar bei der Behandlung der PTK. Die eigenen Erfahrungen als auch die Literaturergebnisse zeigen, dass nur bei Beachtung sowohl der biomechanischen Gesetzmäßigkeiten als auch bei Wiederherstellung der sagittalen Balance gute Langzeitergebnisse bei geringen Komplikationen erzielt werden können.

Abstract

Posttraumatic kyphosis (PTK) is a possible consequence of a missed fracture, a wrong indication for conservative therapy or an inadequate surgical technique but PTK can also be a complication after adequate surgery. Avoidance of PTK is of importance because subsequent surgical therapy can be extensive. A thorough planning as well as surgical experience with anterior and posterior revision cases is necessary. The various types of osteotomy which allow correction of local as well as global deformities should also be mastered. Knowledge of the principles of sagittal balance and spinopelvic parameters are indispensable in the treatment of PTK. Our experience and results from the literature show that a good long-term outcome with limited complications can only be achieved when considering the biomechanical principles as well as restoration of sagittal balance.

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Literatur

  1. Oda I, Cunningham B, Buckley R et al (1999) Does spinal kyphotic deformity influence the biomechanical characteristics of the adjacent motion segment? Spine 24:2139–2146

    Article  PubMed  CAS  Google Scholar 

  2. Buchowski J, Kuhns C, Bridwell K et al (2008) Surgical management of posttraumatic thoracolumbar kyphosis. Spine J 8:666–677

    Article  PubMed  Google Scholar 

  3. Defino H, Canto F (2007) Low thoracic and lumbar burst fractures: radiographic and functional outcomes. Eur Spine J 16:1934–1943

    Article  PubMed  Google Scholar 

  4. Schoenfeld A, Wood K, Fisher C et al (2010) Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech 23:e1–e8

    Article  PubMed  Google Scholar 

  5. Benli I, Kaya A, Uruc V et al (2007) Minimum 5-year follow-up surgical results of post-traumatic thoracic and lumbar kyphosis treated with anterior instrumentation. Spine 32:986–994

    Article  PubMed  Google Scholar 

  6. Rohlmann A, Klöckner C, Bergmann G (2001) The biomechanics of kyphosis. Orthopade 30:915–918

    Article  PubMed  CAS  Google Scholar 

  7. Böhler L (1932) Wirbelbrüche und Wirbelverrenkungen. In: Böhler L (Hrsg) Die Technik der Knochenbruchbehandlung. Maudrich, Wien, S 377

  8. Stoltze D, Harms J, Boyaci B (2008) Correction of post-traumatic and congenital deformities. Indications, techniques, results. Orthopade 37:321–338

    Article  PubMed  CAS  Google Scholar 

  9. Koller H, Acosta F, Hempfing A et al (2008) Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J 17:1073–1095

    Article  PubMed  Google Scholar 

  10. Klöckner C, Hofmann A, Weber U (2001) Post-traumatic kyphosis of the thoracic and lumbar spine. Orthopade 30:947–954

    Article  PubMed  Google Scholar 

  11. Oda I, Cunningham BW, Buckley RA et al (1999) Does spinal kyphotic deformity influence the biomechanical characteristics of the adjacent motion segment? An in vivo model study. Spine 24:2139–2146

    Article  PubMed  CAS  Google Scholar 

  12. Kumar M, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319

    Article  PubMed  CAS  Google Scholar 

  13. Acaroglu E, Schwab F, Farcy J (1996) Simultaneous anterior and posterior approaches for correction of late deformity due to thoracolumbar fractures. Eur Spine J 5:56–62

    Article  PubMed  CAS  Google Scholar 

  14. Abel R, Gerner H, Smit C et al (1999) Residual deformity of the spinal canal in patients with traumatic paraplegia and secondary changes of the spinal cord. Spinal Cord 37:14–19

    Article  PubMed  CAS  Google Scholar 

  15. Brodbelt A, Stoodley M (2003) Post-traumatic syringomyelia: a review. J Clin Neurosci 10:401–408

    Article  PubMed  CAS  Google Scholar 

  16. Van der Roer N, de Lange E, Bakker F et al (2005) Management of traumatic thoracolumbar fractures: a systematic review of the literature. Eur Spine J 14:527–534

    Article  Google Scholar 

  17. Vaccaro A, Silber J (2001) Post-traumatic spinal deformity. Spine 26:S111–S118

    Article  PubMed  CAS  Google Scholar 

  18. Thomas K, Bailey C, Dvorak M et al (2006) Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review. J Neurosurg Spine 4:351–358

    Article  PubMed  Google Scholar 

  19. Verheyden A, Hölzl A, Ekkerlein H et al (2011) Recommendations for the treatment of thoracolumbar and lumbar spine injuries. Unfallchirurg 114:9–16

    Article  PubMed  CAS  Google Scholar 

  20. Berven S, Deviren V, Smith J et al (2003) Management of fixed sagittal plane deformity: outcome of combined anterior and posterior surgery. Spine 28:1710–1715, discussion 6

    PubMed  Google Scholar 

  21. Berven S, Deviren V, Smith J et al (2001) Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine 26:2036–2043

    Article  PubMed  CAS  Google Scholar 

  22. Schmidt S, Thomann K, Rauschmann M (2010) Deformities following spinal injury at the thoracolumbar junction. Orthopade 39:256–263

    Article  PubMed  CAS  Google Scholar 

  23. Boulay C, Tardieu C, Hecquet J et al (2006) Sagittal alignement of the spine and pelvis: regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422

    Article  PubMed  CAS  Google Scholar 

  24. Chang K, Leng X, Zhao W et al (2011) Quality control of reconstructed sagittal balance for sagittal imbalance. Spine 36:E186–E197

    Article  PubMed  Google Scholar 

  25. Koller H, Zenner J, Ferraris L et al (2009) Sagittale Balance und posttraumatische Fehlstellungen der Brust- und Lendenwirbelsäule. Orthop Unfallchir uptodate 4:277–320

    Article  Google Scholar 

  26. Knop C, Fabian H, Bastian M et al (2001) Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine 26:88–99

    Article  PubMed  CAS  Google Scholar 

  27. Schnake K, Kandziora F (2010) Correction of posttraumatic kyphosis of the thoracolumbar spine with modified pedicle subtraction osteotomy. Eur Spine J 19:2231–2232

    Article  PubMed  Google Scholar 

  28. Oner F, van Gils A, Faber J et al (2002) Some complications of common treatment schemes of thoracolumbar spine fractures can be predicted with magnetic resonance imaging: prospective study of 53 patients with 71 fractures. Spine 27:629–636

    Article  PubMed  CAS  Google Scholar 

  29. McLain R (2004) Functional outcomes after surgery for spinal fractures: return to work and activity. Spine 29:470–477

    Article  PubMed  Google Scholar 

  30. Katscher S, Verheyden A, Gonschorek O et al (2003) Thoracolumbar spine fractures after conservative and surgical treatment. Dependence of correction loss on fracture level. Unfallchirurg 106:20–27

    Article  PubMed  CAS  Google Scholar 

  31. Roberson J, Whitesides T (1976) Surgical reconstruction of late post-traumatic thoracolumbar kyphosis. Spine 10:307–312

    Article  Google Scholar 

  32. Gertzbein S (1992) Scoliosis Research Society. Multicenter spine fracture study. Spine 17:528–540

    Article  PubMed  CAS  Google Scholar 

  33. Malcolm B, Bradford D, Winter R et al (1981) Post-traumatic kyphosis. A review of forty-eight surgically treated patients. J Bone Joint Surg [Am] 63:891–899

    Google Scholar 

  34. Chang K, Chen Y, Lin C et al (2005) Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis. Spine 30:1674–1681

    Article  PubMed  Google Scholar 

  35. Kim W, Lee E, Jeon S et al (2006) Correction of osteoporotic fracture deformities with global sagittal imbalance. Clin Orthop Relat Res 443:75–93

    Article  PubMed  Google Scholar 

  36. Glassman S, Bridwell K, Dimar J et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Zentrum für Wirbelsäulenchirurgie, Werner-Wicker-Klinik, 34537, Bad Wildungen, Deutschland

    A. Hempfing, J. Zenner, L. Ferraris, O. Meier & H. Koller

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  1. A. Hempfing
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  2. J. Zenner
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  3. L. Ferraris
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  4. O. Meier
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  5. H. Koller
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Correspondence to A. Hempfing.

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Hempfing, A., Zenner, J., Ferraris, L. et al. Wiederherstellung der sagittalen Balance bei der Versorgung thorakaler und lumbaler Wirbelkörperfrakturen. Orthopäde 40, 690–702 (2011). https://doi.org/10.1007/s00132-011-1796-4

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  • DOI: https://doi.org/10.1007/s00132-011-1796-4

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