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Hybridversorgung mit Fusion und interlaminärem Implantat zur Verkürzung der Spondylodesestrecke und Protektion der symptomatischen Anschlussdegeneration

Klinisches Langzeit-Follow-up

Hybrid stabilization technique with spinal fusion and interlaminar device to reduce the length of fusion and to protect symptomatic adjacent segments

Clinical long-term follow-up

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Zusammenfassung

Einleitung

Die Festlegung des Spondylodeseausmaßes bei lumbalen degenerativen Erkrankungen ist oft dadurch erschwert, dass im Anschlusssegment geringergradige Pathologien vorliegen, bei denen eine Fusion übertherapiert erscheint, bei einer alleinigen Dekompression jedoch die Sorge besteht, dass das Segment durch multifaktorielle Einflüsse einer raschen Degeneration unterliegt. Eine Therapieoption stellt die Hybridversorgung aus Fusion und Interposition eines interlaminären Implantats im Anschlusssegment dar. Ziel der Studie war es, das klinische Langzeit-Outcome nach alleiniger Spondylodese gegen das Hybridmodell mit einem interlaminären Topping-off-Implantat zu vergleichen.

Material und Methode

Eine retrospektive Datenanalyse untersuchte 25 Patienten, die zwischen 2003 und 2010 mit der Topping-off-Methode versorgt wurden. Durch ein Matched-case-controlled-Verfahren wurden 25 deckungsgleiche Patienten als Kontrollgruppe aufgenommen. Bei einem durchschnittlichen Nachuntersuchungszeitraum von 43 Monaten wurden prä- und postoperative Daten zum Schmerzausmaß, ODI, SF-36 sowie klinische Parameter, wie Bein-Rücken-Schmerz, Gehstrecke und subjektive Zufriedenheit, abgefragt.

Ergebnisse

Postoperative Schmerzreduktion, die Reduktion des ODI-Scores sowie die subjektive Zufriedenheit fielen in der Hybridgruppe im Vergleich zur Kontrollgruppe signifikant höher aus. Im SF-36-Score hatte die Hybridgruppe höhere Werte ohne Signifikanz. Die Gehstreckenauswertung zeigte keine signifikanten Unterschiede.

Diskussion

Im Vergleich zur alleinigen Spondylodese zeigen die Ergebnisse nach Hybridversorgung in vielen Bereichen signifikant bessere Werte auf. In der häufigen Situation einer lumbalen Fusionsoperation und der Notwendigkeit einer Dekompression im Anschlusssegment bei vorliegender Spinalkanalstenose oder moderaten Spondylarthrose, stellt die Versorgung des Anschlusssegments mit einem interlaminären Implantat somit eine berechtigte Therapieoption mit gutem klinischen Outcome dar. Die Verkürzung der Spondylodesestrecke sowie die Erzeugung eines stufenweisen Bewegungsübergangs kann hiermit erreicht werden.

Abstract

Introduction

Determination of the extent of spinal fusion for lumbar degenerative diseases is often difficult due to minor pathologies in the adjacent segment. Although surgical intervention is required, fusion seems to be an overtreatment. Decompression alone may be not enough as this segment is affected by multiple factors such as destabilization, low grade degeneration and an unfavorable biomechanical transition next to a rigid construct. An alternative surgical treatment is a hybrid construct, consisting of fusion and implantation of an interlaminar stabilization device at the adjacent level. The aim of this study was to compare long-term clinical outcome after lumbar fusion with a hybrid construct including an interlaminar stabilization device as “topping-off”.

Materials and methods

A retrospective analysis of 25 lumbar spinal fusions from 2003 to 2010 with additional interlaminar stabilization device was performed. Through a matched case controlled procedure 25 congruent patients who received lumbar spinal fusion in one or two levels were included as a control group. At an average follow-up of 43 months pre- and postoperative pain, ODI, SF-36 as well as clinical parameters, such as leg and back pain, walking distance and patient satisfaction were recorded.

Results

Pain relief, ODI improvement and patient satisfaction was significantly higher in the hybrid group compared to the control group. SF-36 scores improved in both groups but was higher in the hybrid group, although without significance. Evaluation of walking distance showed no significant differences.

Discussion

Many outcome parameters present significantly better long-term results in the hybrid group compared to sole spinal fusion. Therefore, in cases with a clear indication for lumbar spinal fusion with the need for decompression at the adjacent level due to spinal stenosis or moderate spondylarthrosis, support of this segment with an interlaminar stabilization device demonstrates a reasonable treatment option with good clinical outcome. Also, the length of the fusion construct can be reduced allowing for a softer and more harmonic transition.

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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. Rickert, I. Werner, M. Rauschmann & M. Arabmotlagh

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Correspondence to C. Fleege.

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Interessenkonflikt

C. Fleege, M. Rickert, I. Werner, M. Rauschmann und M. Arabmotlagh geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der Ethik-Kommission des Universitätsklinikums Frankfurt (252/11), 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. Rickert haben zu gleichen Teilen zu der Arbeit beigetragen.

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Fleege, C., Rickert, M., Werner, I. et al. Hybridversorgung mit Fusion und interlaminärem Implantat zur Verkürzung der Spondylodesestrecke und Protektion der symptomatischen Anschlussdegeneration. Orthopäde 45, 770–779 (2016). https://doi.org/10.1007/s00132-016-3312-3

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