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ALIF- und PLIF-Interposition bei low-grade isthmischen Spondylolisthesen L5/S1

Langzeitvergleich der interkorporellen Fusionstechnik (ALIF – PLIF)

ALIF and PLIF interposition in low-grade isthmic spondylolisthesis L5/S1

Longterm-Comparison of interbody fusion techniques (ALIF – PLIF)

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Zusammenfassung

Einleitung

Zur operativen Versorgung von Spondylolisthesen stehen konkurrierend hauptsächlich die dorsoventrale Versorgung (ALIF) und die rein dorsale Operationstechnik (PLIF) zur Verfügung. Aufgrund des zusätzlichen Risikos und der Belastung des Zweiteingriffs wurde die langjährig angewandte dorsoventrale Fusionstechnik mehrheitlich zugunsten der rein dorsalen Versorgung aufgegeben. Ziel der Studie war es, die Langzeitergebnisse beider Versorgungstechniken klinisch gegenüberzustellen.

Material und Methode

138 Patienten wurden mit isthmischer Spondylolyse L5/S1 Grad Meyerding I–III eingeschlossen, hiervon konnten 72 Patienten ausgewertet werden (ALIF-Gruppe 25 Patienten – PLIF-Gruppe 47 Patienten). Das Follow-up betrug 7,9 Jahre (ALIF-Gruppe) und 5,6 Jahre (PLIF-Gruppe). Vergleichende Daten wurden für Listhesegrad, Operationsdauer, Krankenhausverweildauer, ODI, VAS, Medikamentenkonsum, Dauer der Rekonvaleszenz, Wiederaufnahme der Berufstätigkeit und der sportlichen Aktivitäten erhoben.

Ergebnisse

Die OP-Zeiten und der Krankenhausaufenthalt waren in der ALIF-Gruppe deutlich länger. Die postoperative ODI-Minderung war vergleichend in der PLIF-Gruppe deutlicher, jedoch nicht signifikant, größer. Die VAS reduzierte sich in beiden Untersuchungsgruppen. 36,8 % der Patienten der ALIF-Gruppe und 44,7 % der Patienten der PLIF-Gruppe gaben eine Schmerzmittelreduktion an. Die Rekonvaleszenz betrug jeweils 16 Wochen. 29 % der PLIF- und 9 % der ALIF-Patienten gaben keine Beschwerdebesserung an. Ein Wiedereintritt ins Berufsleben gelang in der ALIF-Gruppe nach 149 Tagen, in der PLIF-Gruppe nach 178 Tagen. 31 % der PLIF-Patienten und 13 % der ALIF-Patienten schafften keine Berufsrückkehr. Respondylodesen und Wundrevisionen waren in der PLIF-Gruppe erhöht, Anschlussdegenerationen traten in der ALIF-Gruppe vermehrt auf.

Diskussion

Für die ALIF- und PLIF-Operationstechnik ergeben sich postoperativ deutliche Reduktionen des Schmerzausmaßes und des Schmerzmittelgebrauchs. Bei gleicher Rekonvaleszenzdauer waren die Wiederaufnahme des Berufs, die Krankenhausverweil- und die Operationsdauer sowie der ODI-Score unterschiedlich. Ein eindeutiger Vorteil eines der beiden Verfahren konnte nicht dargestellt werden.

Abstract

Introduction

For the treatment of isthmic spondylolisthesis two alternative interbody fusion techniques are available, the dorsoventral interposition in ALIF technique and the dorsal access interposition in PLIF technique. Due to the complications of anterior lumbar surgery and in order to avoid a second operation, the dorsoventral fusion technique is becoming uncommon and mainly a pure dorsal supply is performed. The aim of the study was to compare the clinical long-term results of both treatment techniques.

Materials and methods

138 patients were treated surgically between 2003 and 2012 in symptomatic isthmic spondylolysis in L5/S1 with a Meyerding degree of I–III. 72 patients were evaluated finally (ALIF n = 25 and PLIF n = 47). The average follow-up period was 7.9 years for the ALIF group and 5.6 years for the PLIF group. In both groups the average drug consumption, duration of recovery, resumption of work and resumption of sport activities was recorded.

Results

The results showed an extended time of surgery and a prolonged hospitalization of 5.4 days for the ALIF group. The ODI had a greater improvement in the PLIF group but this difference was not significant. The VAS was reduced in both groups. 36.8 % of the ALIF group and 44.7 % of the PLIF group reported a reduced pain medication postoperatively. The average recovery was 16 weeks for both groups. 29 % of PLIF and 9 % of ALIF patients had no pain relief. ALIF patients were able to get back to work after 149 days and the PLIF patients after 178 days. 31 % of the PLIF group and 13 % of the ALIF group were not able to return back to work. Revisions of fusion and the rate of wound revisions were increased in the PLIF group, adjacent segment diseases occurred more frequently in the ALIF group.

Conclusion

Both treatment and fusion techniques (ALIF/PLIF) were able to achieve a significant pain relief and reduced consumption of pain medication postoperatively. The recovery period was similar in both groups, but there were differences regarding the date of return to work, hospitalization, duration of surgery and ODI score. Neither of the two methods could show a definite advantage.

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Authors and Affiliations

  1. Abteilung für Wirbelsäulenorthopädie, Orthopädische Universitätsklinik Friedrichsheim gGmbh, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland

    C. Fleege, M. Arabmotlagh, W. Rother, M. Rauschmann & M. Rickert

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  1. C. Fleege
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  2. M. Arabmotlagh
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  3. W. Rother
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  4. M. Rauschmann
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Correspondence to C. Fleege.

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Interessenkonflikt

C. Fleege, M. Arabmotlagh, W. Rother, M. Rauschmann und M. Rickert geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der Ethik-Kommission des Universitätsklinikums Frankfurt, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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C. Fleege und M. Arabmotlagh haben zu gleichen Teilen zu der Arbeit beigetragen.

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Fleege, C., Arabmotlagh, M., Rother, W. et al. ALIF- und PLIF-Interposition bei low-grade isthmischen Spondylolisthesen L5/S1. Orthopäde 45, 760–769 (2016). https://doi.org/10.1007/s00132-016-3311-4

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  • DOI: https://doi.org/10.1007/s00132-016-3311-4

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