Zusammenfassung
Hintergrund
Die Entwicklung der interkorporellen Fusionsverfahren erstreckt sich mittlerweile über viele Jahrzehnte und ist noch immer nicht abgeschlossen.
Diskussion
Aufgrund der Abwesenheit von entsprechenden Implantaten erfolgten die initialen Fusionen durch Dekortizierung der dorsalen und lateralen Strukturen der Wirbelsäule und anschließendes Anlagern von autologem Knochenmaterial. Trotz passabler Fusionsergebnisse manifestierte sich das Bestreben nach einer besseren Primärstabilität und höheren Fusionsraten. Zudem verbreitete sich auch das Verständnis, dass der primär lasttragende Anteil der Wirbelsäule ventral im Bereich des Corpus der Wirbelkörper liegt. Diese Überlegungen führten letztendlich zur Entwicklung der PLIF-Technik (posteriore lumbale interkorporelle Fusion), die unter Cloward 1953 deutlich an Popularität gewann. Nach Ausräumung des Bandscheibenfaches interpositionierte er Beckenkammknochenblöcke zwischen die Wirbelkörper, die sich entsprechend verklemmten. Basierend auf dieser Technik und diesen Überlegungen erfolgte in den 1970er Jahren die Entwicklung von intervertebralen Implantaten. Der sog. „Bagby Basket“ war der erste intervertebrale Cage, der zunächst bei Pferden mit „Wobbler-Syndrom“ eingesetzt wurde. Weitere Meilensteine in der Verbesserung des Cagedesigns schlossen sich an, was zur Herstellung vielzähliger Implantatformen und -materialien führte. Das Elastizitätsmodul der intersomatischen Implantate näherte sich durch moderne Werkstoffe immer mehr dem von Knochen an, so dass ein Einsintern der Cages reduziert und die Fusionen weiter gesteigert werden konnten. Durch den Einsatz von Schrauben-Stab-Systemen konnte die Primärstabilität zusätzlich weiter gesteigert werden, sodass die dorsale Instrumentierung heute den Standard im Rahmen von PLIF (posteriore lumbale interkorporelle Fusion)- und TLIF-Prozeduren (transforaminale lumbale interkorporelle Fusion) darstellt. Das von Harms beschriebene TLIF-Verfahren war eine neue Modifikation und konnte Komplikationen bei lumbalen Fusionen minimieren sowie die Invasivität des Eingriffs reduzieren.
Schlussfolgerung
Heutzutage steht uns eine Vielzahl unterschiedlichster Implantate und Implantationstechniken zur Verfügung, was die interkorporelle Fusion in PLIF- und TLIF-Technik zu sicheren und erfolgreichen Verfahren macht.
Abstract
Background
The development of interbody fusion now stretches over many decades and is still not complete.
Discussion
Due to the lack of appropriate implants, the initial fusions were performed via decortication of the dorsal and lateral structures of the spine, followed by placement of an autograft. Despite acceptable fusion results, better primary stability and higher fusion rates were desired. In addition, it became known that the primary load-bearing of the spine is located ventrally in the area of the corpus of the vertebrae. These considerations led to the development of the PLIF technique that was introduced by Cloward in 1953 and gained significantly in popularity. After removal of the intervertebral disc, he positioned iliac crest bone blocks between the vertebral bodies. Based on this technique and these considerations, intervertebral implants were developed in the 1970s. The so-called Bagby Basket was the first intervertebral cage that was initially used in horses with wobbler syndrome. Other milestones in the improvement of the cage designs followed, resulting in the production of different implant shapes and materials. The elastic modulus of the interbody implants approached by modern materials became more and more similar to bone, so that subsidence of cages reduced and the fusion rate could be further increased. The primary stability could be further increased with screw–rod systems, so that dorsal instrumentation became the standard in the context of PLIF and TLIF procedures today. The TLIF procedure described by Harms was a new modification and minimized complications of lumbar fusions and reduced the invasiveness of the procedure.
Conclusion
Nowadays a wide variety of implants and implantation techniques are available, making interbody fusions in PLIF and TLIF techniques safe and successful procedures.
Literatur
Albee FH (1911) Transplantation of a portion of the tibia into the spine for Pott’s disease. JAMA 57:885–886
Bagby GW (1988) Arthrodesis by the distraction-compression method using a stainless steel implant. Orthopedics 11:931–934
Bagby G (1999) The Bagby and Kuslich (BAK) method of lumbar interbody fusion. Spine 24:1857
Barnes B, Rodts GE Jr, Haid RW Jr et al (2002) Allograft implants for posterior lumbar interbody fusion: results comparing cylindrical dowels and impacted wedges. Neurosurgery 51:1191–1198 (discussion 8)
Blume H, Rojas CH (1981) Unilateral lumbar interbody fusion (posterior approach) utilizing dowel graft. J Neurol Orthop Surg 2:171–175
Bosworth DM (1942) Clothespine or inclusion graft for spondylolisthesis or laminal defects of the lumbar spine. Surg Gynecol Obstet 75:593–599
Brantigan JW, Steffee AD (1993) A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976) 18(14):2106–2107
Brantigan JW, Steffee AD, Geiger JM (1991) A carbon fiber implant to aid interbody lumbar fusion. Mechanical testing. Spine 16:S277–S282
Brantigan JW, McAfee PC, Cunningham BW, Wang H, Orbegoso CM (1994) Interbody lumbar fusion using acarbon fiber cage implant versus allograft: an investigational study in thespanish goat. Spine 19:1436–1444
Brantigan JW, Neidre A, Toohey JS (2004) The Lumbar I/F Cage for posterior lumbar interbody fusion with the variable screw placement system: 10-year results of a food and drug administration clinical trial. Spine J 4(6):681–688
Briggs H, Milligan P (1944) Chip fusion of the low back following exploration of the spinal canal. J Bone Joint Surg 26:125–130
Brodke DS, Dick JC, Kunz DN et al (1997) Posterior lumbar interbody fusion. A biomechanical comparison, including a new threaded cage. Spine 22:26–31
Butts M, Kuslick S, Bechtold J (1987) Biomechanical analysis of a new method for spinal interbody fusion. American Society of Mechanical Engineers, Boston
Campbell WC (1939) An operation for extra-articular fusion of sacroiliac joint. Surg Gynecol Obstet 45:218–219
Cloward RB (1952) The treatment of ruptured lumbar intervertebral disc by vertebral body fusion. III. Method of use of banked bone. Ann Surg 136(6):987–992
Cloward RB (1953) The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 10:154–168
Cloward RB (1985) Posterior lumbar interbody fusion updated. Clin Orthop Relat Res 193:16–19
Davis H (1994) Increasing rates of cervical and lumbar spine surgery in the United States, 1979–1990. Spine 19:1117–1123 (discussion 23–4)
Dick W, Kluger P, Magerl F, Woersdörfer O, Zäch G (1985) A new device for internal fixation of thoracolumbar and lumbar spine fractures: the ‚fixateur interne‘. Paraplegia 23(4):225–232
El-Masry MA, Khayal H, Salah H (2008) Unilateral transforaminal lumbar interbody fusion (TLIF) using a single cage for treatment of low grade lytic spondylolisthesis. Acta Orthop Belg 74(5):667–671
Foley KT, Holly LT, Schwender JD (2003) Minimally invasive lumbar fusion. Spine 15(suppl):26–35
Freeman BJ, Licina P, Mehdian SH (2000) Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients. Eur Spine J 9:42–46
Gelalis ID, Kang JD (1998) Thoracic and lumbar fusions for degenerative disorders: rationale for selecting the appropriate fusion techniques. Orthop Clin North Am 29(4):829–842
Ghormley RK (1933) Low back pain, with special reference to the articular facets, with presentation of an operative procedure. JAMA 101:1773–1777
Grant BD, Hoskinson JJ, Barbee DD, Gavin PR, Sande RD, Bayly WM (1985) Ventral stabilization for decompression of caudal cervical spine cord compression in the horse. Read at the Annual Convention of the American Association of Equine Practitioners, Toronto, Ontario, Canada, 30:1985
Hadra BE (1975) The classic: wiring of the vertebrae as a means of immobilization in fracture and Potts' disease. Berthold E. Hadra. Med Times and Register, Vol22, May 23, 1891. Clin Orthop Relat Res 112:4–8
Harms JG, Jeszenszky D (1998) Die posteriore, lumbale, interkorporelle Fusion in unilateraler transforaminaler Technik. Orthop Traumatol 10:90–102
Harms J, Tabasso G (1999) Instrumented spinal surgery: principles and technique. Thieme, Stuttgart, S 20
Harms J, Behle BA, Böhm H et al (1996) Lumbosacral fusion with Harms instrumentation. In: Margulies JY, Floman Y, Farcy JPC, Neuwirth MG. Lumbosacral and spinopelvic fixation. Lippincott-Raven, Philadelphia, S 529–538
Harrington PR (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am Am 44:591–610
Harrington PR (1967) Instrumentation in spine instability other than scoliosis. S Afr J Surg 5:7–13
Hibbs RA (1911) An operation for progressive spinal deformities. New York Med J 93:1013–1016
Humphreys SC, Hodges SD, Patwardhan AG et al (2001) Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine 26:567–571
Jang J, Lee S (2005) Minimally invasive transforaminal lumbar interbody fusion with ipsilateral pedicle screw and contralateral facet screw fixation. J Neurosurg Spine 3(3):218–223
Jaslow IA (1946) Intercorporal bone graft in spinal fusion after disc removal. Surg Gynecol Obstet 82:215–218
Kandziora F (2003) Habilitationsschrift. Einfluss von Cagedesign, Carrier-Systemen und Wachstumsfaktoren auf die intervertebrale Spondylodese. Berlin 2003. http://edoc.hu-berlin.de/habilitationen/kandziora-frank-2003-10-23
King D (1948) Internal fixation for lumbosacral fusion. J Bone Joint Surg [Am] 30:560–565
Kuslich SD, Ulstrom CL, Griffith SL, Ahern JW, Dowdle JD (1998) The Bagby and Kuslich method of lumbar interbody fusion. History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial. Spine (Phila Pa 1976) 23(11):1267–1278
Magerl FP (1984) Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 189:125–141
McKenzie-Forbes A (1922) The operative treatment of scoliosis. J Bone Joint Surg Am 4:446–452
Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–225
O'Brien JP, Dawson MH, Heard CW, Momberger G, Speck G, Weatherly CR (1986) Simultaneous combined anterior and posterior fusion. A surgical solution for failed spinal surgery with a brief review of the first 150 patients. Clin Orthop Relat Res 203:191–195
Peng CW, Yue WM, Poh SY, Yeo W, Tan SB (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 34(13):1385–1389
Ray CD (1997) Threaded titanium cages for lumbar interbody fusions. Spine 22:667–679
Rhee JM, Wiesel SW, Boden SD, Flynn JM (2013) Operative techniques in spine surgery. Wolters Kluwer, S 184
Resnick DK, Choudhri TF, Dailey AT et al (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine 2:673–678
Roy-Camille R, Roy-Camille M, Demeulenaere C (1970) Osteosynthesis of dorsal, lumbar, and lumbosacral spine with metallic plates screwed into vertebral pedicles and articular apophyses. Presse Med 78(32):1447–1448
Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18(Suppl):S1–S6
Steffee AD, Sitkowski DJ (1988) Posterior lumbar interbody fusion and plates. Clin Orthop Relat Res 227:99–102
Steffen T, Tsantrizos A, Fruth I, Aebi M (2000) Cages: designs and concepts. Eur Spine J 9(Suppl. 1):S89–S94
Tajima N, Chosa E, Watanabe S (2004) Posterolateral lumbar fusion. J Orthop Sci 9:327–333
Taneichi H, Suda K, KajinoT, Matsumura A, Moridaira H, Kaneda K (2006) Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-yearfollow-up period. J Neurosurg Spine 4(3):198–205
Wang JC, Mummaneni PV, Haid RW (2005) Current treatment strategies for the painful lumbar motion segment: posterolateral fusion versus interbody fusion. Spine 30:S33–S43
Watkins MB (1953) Posterolateral fusion of the lumbar and lumbosacral spine. J Bone Joint Surg Am 35-A(4):1014–1018
Watkins MB (1959) Posterolateral bonegrafting for fusion of the lumbar and lumbosacral spine. J Bone Joint Surg Am 41-A(3):388–396
Weiner BK, Fraser RD (1998) Spine update lumbar interbody cages. Spine (Phila Pa 1976) 23(5):634–640
Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE (1968) The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 50:919–926
Wolff J (1986) The law of bone remodelling (trans: Maquet P, Furlong R). Springer, Berlin
Zhou J, Wang B, Dong J, Li X, Zhou X, Fang T, Lin H (2011) Instrumented transforaminal lumbar interbody fusion with single cage for the treatment of degenerative lumbar disease. Arch Orthop Trauma Surg 131(9):1239–1245
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J. Harms ist der Entwickler des im Text benannten Harms Cage. M. Rickert, M. Rauschmann, C. Fleege, E. Behrbalk und J. Harms geben an, dass kein Interessenkonflikt besteht.
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Rickert, M., Rauschmann, M., Fleege, C. et al. Interkorporelle Fusionsverfahren an der Wirbelsäule. Orthopäde 44, 104–113 (2015). https://doi.org/10.1007/s00132-015-3076-1
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DOI: https://doi.org/10.1007/s00132-015-3076-1
Schlüsselwörter
- Implantationstechnik
- Fusion, posteriore lumbale interkorporelle
- Fusion, transforaminale lumbale interkorporelle
- Bandscheibe
- Elastizitätsmodul