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Navigation bei lumbalen Eingriffen: Wann ist sie sinnvoll?

Navigation in lumbar spinal surgery: When is it useful?

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Zusammenfassung

Hintergrund

Die spinale Navigation hat sich seit ihren Anfängen Mitte der 1990er-Jahre stark weiterentwickelt und ist mittlerweile bei Operationen an der Lendenwirbelsäule (LWS) weit verbreitet. Trotzdem hat sich die Technik noch nicht als Standard durchgesetzt.

Anwendungsmöglichkeiten

Zusätzlich zur klassischen Anwendung bei lumbalen Pedikelschraubeninstrumentationen lässt sich die Navigationstechnik, insbesondere in Kombination mit der intraoperativen 3‑D-Bildgebung, in einem breiten Indikationsspektrum und bei sämtlichen LWS-Zugängen nutzen. Besonders hilfreich ist die Navigationstechnik bei minimalinvasiven Operationen. Das Konzept der „total navigation“ beinhaltet einen effizienten Einsatz der Technik vom Hautschnitt an und zielt auf eine komplette Elimination der Strahlenexposition für das Operationsteam.

Vorteile und Pitfalls

Hohe Genauigkeit und geringe Strahlenbelastung des Operationsteams sind unstrittige Vorteile navigierter Operationen, während Zeitersparnis und ökonomischer Nutzen noch belegt werden müssen. Regelmäßiger Einsatz und ein standardisierter Workflow sind wesentlich für eine sichere und effektive Nutzung der lumbalen Navigation.

Zusammenfassung

Die lumbale Navigationstechnik hat bereits heute einen hohen Stellenwert, trotzdem erfordert die komplexe Technik ein intensives Training. Mit Verbesserung des Nutzerkomforts und der Bildqualität wird sich die spinale Navigation in Zukunft noch weiterverbreiten.

Abstract

Background

Spinal navigation has evolved greatly since its implementation in the mid-1990s and is now widely used in lumbar spine surgery. However, navigation is not yet accepted as a standard technique.

Applications

In addition to the classic use in lumbar pedicle screw instrumentation, navigation technology, especially in combination with intraoperative 3D imaging, can be applied in a wide range of indications and in all lumbar approaches. The technology is particularly helpful in minimally invasive operations. The concept of “total navigation” stands for an efficient use of the technique from skin incision on and aims at complete elimination of radiation exposure for the surgical team.

Advantages and pitfalls

High accuracy and low radiation exposure of the OR team are indisputable advantages of navigated operations, while time savings and economic benefits are yet to be demonstrated. Regular use and standardized workflow are essential for the safe and effective application of lumbar navigation.

Summary

Currently, lumbar navigation technology is already of great importance, yet the complex technology requires intensive training. With improved user comfort and image quality, spinal navigation will continue to spread in the future.

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Abbreviations

ACS-NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

ALIF :

„Anterior lumbar interbody fusion“

AO :

Arbeitsgemeinschaft für Osteosynthesefragen

ASIA :

American Spinal Injuries Association

BWK :

Brustwirbelkörper

CT :

Computertomographie

K-Draht:

Kirschner-Draht

KM :

Kontrastmittel

LWK :

Lendenwirbelkörper

LWS :

Lendenwirbelsäule

MALT :

„Mucosa associated lymphoid tissue“

MIS :

„Minimally invasive surgery“

MRT :

Magnetresonanztomographie

OLIF :

„Oblique lateral interbody fusion“

OR :

Odds Ratio

PLF :

„Posterolateral lumbar fusion“

PLIF :

„Posterior lumbar interbody fusion“

TLIF :

„Transforaminal lumbar interbody fusion“

XLIF :

„Extreme lateral interbody fusion“

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Danksagung

Die Autoren bedanken sich bei Prof. Dr. Roger Härtl, Director of Spinal Surgery, Weill Cornell Brain and Spine Center, New York, USA. Er stellte freundlicherweise das Material für zwei klinische Fälle zur Demonstration der Anwendungsmöglichkeiten der Navigation zur Verfügung.

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  1. Neurochirurgische Klinik, Justus-Liebig-Universität Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    K. Schöller &  F. Jablawi

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  1. K. Schöller
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Correspondence to K. Schöller.

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K. Schöller gibt an, dass er Vortragshonorare der Firmen Medicon und Baxter erhielt. F. Jablawi gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schöller, K., Jablawi, F. Navigation bei lumbalen Eingriffen: Wann ist sie sinnvoll?. Orthopäde 48, 59–68 (2019). https://doi.org/10.1007/s00132-018-03671-9

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