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Dynamische Versorgung der Lendenwirbelsäule

Klinische und biomechanische Analyse der Erfolgsfaktoren

Dynamic instrumentation of the lumbar spine

Clinical and biomechanical analysis of success factors

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Zusammenfassung

Der lumbale Bandscheibenersatz und die posteriore dynamische Stabilisierung stellen alternative Verfahren zur Spondylodese dar, die das Risiko der Anschlussdegeneration mindern sollen. Der Bandscheibenersatz ist bei reiner Diskopathie ohne Beteiligung der Facettengelenke indiziert. Das LWS-Becken-Gleichgewicht beeinflusst die Biomechanik des Implantats: Beckeninzidenz, Sakrumneigung, Segmentlordosen und das mittlere Drehzentrum müssen berücksichtigt werden. Die dynamische Stabilisierung ist bei moderater Diskopathie und Facettendegeneration, degenerativer Spondylolisthese ersten Grades mit hypermobilem Segment und bei der dynamischen Spinalkanalstenose indiziert. Die Kombination der kaudalen Spondylodese und der kranialen dynamischen Stabilisierung stellt die Lordose bei Mehretageneingriffen besser ein, was der Anschlussdegeneration vorbeugt. Bei großer Beckeninzidenz und Sakrumneigung sollte L5-S1 aufgrund hoher Scherkräfte durch eine Spondylodese versorgt werden.

Abstract

Total disc replacement and posterior dynamic stabilization represent alternatives to lumbar spinal fusion which should reduce the risk of adjacent segment degeneration. Disc replacement is indicated for pure discopathy without facet joint degeneration. Spinopelvic balance influences the implant’s biomechanics. Therefore pelvic incidence, sacral slope, segmental lordosis and the mean axis of rotation need to be considered. Dynamic stabilization is indicated in moderate discopathy and facet joint degeneration, in degenerative spondylolisthesis grade I with a hypermobile segment and in dynamic lumbar stenosis. The combination of caudal fusion and cranial dynamic stabilization allows a better maintenance of lordosis with multiple level instrumentation and prevents adjacent segment degeneration. If pelvic incidence and sacral slope are high, L5-S1 should be fused because of elevated shear forces.

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Authors and Affiliations

  1. Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, 1, Place de l’Hôpital, B.P. 426, F-67091, Strasbourg Cedex, Frankreich

    Y.P. Charles, A. Walter, S. Schuller & J.-P. Steib

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  1. Y.P. Charles
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  2. A. Walter
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  3. S. Schuller
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  4. J.-P. Steib
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Correspondence to Y.P. Charles.

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Charles, Y., Walter, A., Schuller, S. et al. Dynamische Versorgung der Lendenwirbelsäule. Orthopäde 40, 703–712 (2011). https://doi.org/10.1007/s00132-011-1800-z

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  • DOI: https://doi.org/10.1007/s00132-011-1800-z

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