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Transforaminale lumbale interkorporelle Fusion zur Versorgung der degenerativen Spondylolisthese

Transforaminal lumbar interbody fusion for the treatment of degenerative spondylolisthesis

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Zusammenfassung

Hintergrund

Die degenerative Spondylolisthese (DS) ist eine häufige Ursache chronisch rezidivierender Lumbalgien sowie radikulärer Beinschmerzen. Bei einer Fusion sollten symptomatische degenerierte Nachbarsegmente („degenerative disc disease“, DDD) einbezogen werden. In dieser Arbeit wird die tansforaminale lumbale interkorporelle Fusion (TLIF) hinsichtlich ihrer Ergebnisse bei Patienten mit monosegmentaler degenerativer Spondylolisthese und einem degenerierten Anschlusssegment untersucht.

Material und Methoden

Es handelte sich um 28 Patienten mit monosegmentaler DS und einem symptomatischen Anschlusssegment mit DDD (alle bisegmental dorsal instrumentiert und fusioniert, ventral 14 bisegmentale TLIF, 14 monosegmentale TLIF). Die Werte der visuellen Analogskala (VAS) Schmerz und des Oswestry Disability Index (ODI) wurden ermittelt, außerdem erfolgte eine radiometrische Auswertung prä- und 12 Monate postoperativ. Weiter wurde die vergleichende Subanalyse der bi- mit monosegmentaler interkorporeller Abstützung vorgenommen.

Ergebnisse

Die Schmerzreduktion war signifikant (VAS von 8,7 auf 3,1), der ODI verbesserte sich ebenfalls signifikant von 63 auf 28%. Radiologisch wurden die Segmenthöhe und das Wirbelgleiten (Etagen mit TLIF und Spondylolisthese) signifikant verbessert. Die bisegmentale ventrale Abstützung zeigte gegenüber der monosegmentalen Vorgehensweise eine signifikant bessere Relordosierung.

Schlussfolgerung

Bei monosegmentaler DS mit symptomatischem Anschlusssegment stellt die Versorgung der Spondylolisthese mittels TLIF ein sicheres und effektives Verfahren dar. In der klinischen Ergebnislage zeigt sich für das degenerierte Nachbarsegment kein Unterschied zwischen der zusätzlichen interkorporellen Abstützung und der alleinigen dorsalen Fusion. Allerdings ergeben sich durch eine zusätzliche ventrale Abstützung Vorteile für die Relordosierung des Segments, sodass mögliche langfristige Effekte zugunsten der bisegmentalen TLIF diesbezüglich untersucht werden sollten.

Abstract

Introduction

Degenerative spondylolisthesis (DS) is a common cause of lumbal and lumbosacral pain as well as radicular pain. Retention and fusion is a good treatment option. Some patients have a symptomatic adjacent degenerative disc disease (DDD) in addition to DS. In these cases the adjacent segments should be fused as well. There are different techniques of fusion available, such as posterior with instrumentation or additional anterior support. This study evaluated results of transforaminal lumbar interbody fusion (TLIF) in patients with monosegmental DS and adjacent DDD.

Material and methods

A total of 28 patients with monosegmental DS and adjacent DDD were included into the study (all patients with bisegmental posterior instrumentation and fusion, 14 patients 1 level TLIF, 14 patients 2 level TLIF). Before surgery and 12 months after surgery the following measurements were made: pain (visual analog scale VAS), Oswestry disability index (ODI) and plain radiographs with radiometric analysis. In a sub-analysis patients with 1 and 2 level TLIF were compared.

Results

Pain reduction (average VAS from 8.7–3.1) and ODI (63% to 28%) showed significant improvements. Radiometric analysis showed a significant disc height reconstruction and a significant reduction of spondylolisthesis (TLIF level with spondylolisthesis). Bisegmental anterior support showed a significantly better relordosation compared to monosegmental anterior support. The complication rate was 21.4% including hemorrhages, dura leakage, wound infection and adjacent segment degeneration. There were no fatal complications.

Discussion

The TLIF procedure is a safe and effective treatment for monosegmental DS with adjacent symptomatic DDD. Clinical results (pain, function) show no difference between both kinds of fusion (dorsal fusion and instrumentation versus dorsal fusion with instrumentation and TLIF) for the adjacent DDD. However, additional anterior support is more effective for relordosation of the segment. This could have impact on the mid-term and long-term outcome or in cases of adjacent segment fusion.

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Authors and Affiliations

  1. Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland

    M. Quante, H. Kesten, A. Richter & H. Halm

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  1. M. Quante
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  2. H. Kesten
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  3. A. Richter
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  4. H. Halm
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Correspondence to M. Quante.

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Quante, M., Kesten, H., Richter, A. et al. Transforaminale lumbale interkorporelle Fusion zur Versorgung der degenerativen Spondylolisthese. Orthopäde 41, 153–162 (2012). https://doi.org/10.1007/s00132-011-1832-4

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  • DOI: https://doi.org/10.1007/s00132-011-1832-4

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