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Bedeutung des sagittalen Profils bei Revisionseingriffen an der Wirbelsäule

Importance of sagittal alignment in spinal revision surgery

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Zusammenfassung

Die Nichtberücksichtigung des sagittalen Profils bei primären stabilisierenden Wirbelsäulenoperationen ist ein häufiger Grund für Revisionsoperationen. Dementsprechend ist bei der Notwendigkeit einer Revision eine Berücksichtigung bzw. Wiederherstellung des sagittalen Profils der Wirbelsäule zu beachten. Die physiologische Einstellung des fusionierten Bereichs sollte auch den nichtinstrumentierten Abschnitten der Wirbelsäule kranial und kaudal der Spondylodese eine segmentale physiologische Profilierung ermöglichen.

Bei Patienten mit einer physiologischen Schwerpunktlinie und einer normalen sakralen Inklination ist die Inzidenz einer Anschlussinstabilität am geringsten. Eine sagittale Imbalance nach durchgeführter Revision ist ein Risikofaktor für das Wiederauftreten einer Pseudarthrose nach einer Revisionschirurgie. Vor allem bei Pseudarthrosen führt ein kombiniertes Vorgehen zu einer höheren Effektivität bei der Wiederherstellung der sagittalen Balance und zu einer verbesserten Fusionsrate.

Abstract

Ignoring the sagittal profile in primary spinal fusion surgery is a common reason for revision surgery. Therefore, it is important that in cases of spinal revision surgery the sagittal alignment is realized. The physiological alignment of the instrumented spine should also indirectly influence the profile of the non-stabilized spine cranial and caudal to the fusion.

Patients with normal C7 plumb-line and a physiological sacral inclination have a lower incidence of adjacent segment degeneration. Sagittal imbalance after revision surgery is a risk factor for recurrent pseudarthrosis. In cases of pseudarthrosis a combined approach may be more effective in realizing sagittal balance und enhancing rates of fusion.

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Authors and Affiliations

  1. Praxis für Wirbelsäulenerkrankungen und Wirbelsäulenchirurgie, Hohlstr. 192, CH-8004, Zürich, Schweiz

    C. Klöckner & R. Spur

  2. Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Sektion Wirbelsäulenchirurgie, Klinikum der Ruprecht-Karls-Universität, Heidelberg, Deutschland

    B. Wiedenhöfer

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  1. C. Klöckner
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  2. R. Spur
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  3. B. Wiedenhöfer
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Correspondence to C. Klöckner.

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Klöckner, C., Spur, R. & Wiedenhöfer, B. Bedeutung des sagittalen Profils bei Revisionseingriffen an der Wirbelsäule. Orthopäde 40, 713–718 (2011). https://doi.org/10.1007/s00132-011-1802-x

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