Skip to main content
Log in

Perkutane minimalinvasive Instrumentierung der Wirbelsäule

Percutaneous minimally invasive stabilization for treatment of spinal fractures

  • Leitthema
  • Published:
Trauma und Berufskrankheit


Nach Etablierung der minimalinvasiven ventralen Zugänge erfolgt die dorsale Instrumentierung der Wirbelsäule unter Nutzung neuer Implantate zunehmend in perkutaner minimalinvasiver Technik. Hauptvorteil dabei sind die Schonung der autochthonen Rückenmuskulatur sowie ein deutlich reduzierter intraoperativer Blutverlust, wodurch sich eine raschere Rehabilitationsfähigkeit ergibt. Die perkutane Instrumentierung der Wirbelsäule ist zur Versorgung traumatischer Wirbelsäulenverletzungen, der operativen Stabilisierung bei Spondylitis/Spondylodiszitis sowie bei Instabilitäten der Wirbelsäule aufgrund von Metastasen und Tumoren geeignet. Sie ist über den gesamten Bereich Wirbelsäule möglich. Für den oberen Brustwirbelsäulenbereich muss die präzise Draht- und Schraubenplatzierung intraoperativ durch dreidimensionale Bildgebung kontrolliert werden. Die Reposition erfolgt bei dieser Technik nicht durch Hebelwirkung über die eingebrachten Schrauben, sondern indirekt. Außer Luxationsverletzungen und hochinstabilen Rotationsverletzungen lassen sich alle Fehlstellungen reponieren und minimalinvasiv perkutan instrumentieren. Eine evtl. erforderliche spinale Dekompression erfolgt über eine separate mediane Inzision zur Laminektomie.


Having established minimally invasive anterior approaches in spinal surgery, dorsal stabilization of the spine is now also increasingly being performed using percutaneous minimally invasive techniques and newly designed implants. The main advantages of this method include protection of the back muscles as well as a significant reduction of intraoperative blood loss. The percutaneous technique is appropriate for the stabilization of traumatic spinal injuries, spondylitis/spondylodiscitis or spine instability caused by metastases or tumors. Percutaneous insertion of the screws can be performed in the entire spinal region from the thoracic (Th1) to the sacral (S1) spine. For the cranial parts of the thoracic spine (Th1-Th4) three-dimensional imaging is required intraoperatively to ensure the correct positioning of the K-wires and the screws. In contrast to the open technique, reduction is achieved indirectly and not by a leverage effect of the inserted screws. With the exception of luxation injuries and highly unstable rotation injuries all malpositions can be corrected by closed reduction and percutaneous minimally invasive stabilization. If required, spinal decompression can be performed using a separate median incision for laminectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5


  1. Anand N, Baron EM, Thaiyanathan G et al (2008) Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study. J Spinal Disord Tech 21:459–467

    Article  PubMed  Google Scholar 

  2. Beck M, Mittelmeier T, Gierer P et al (2009) Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures. Eur Spine J 18(10):1469–1477

    Article  PubMed  Google Scholar 

  3. Beisse R, Potulski M, Bühren V von (2001) Endoscopic techniques for the managment of spinal trauma. Eur J Trauma 6:275–291

    Google Scholar 

  4. Blattert TR, Katscher S, Josten C (2011) Perkutane Techniken an der Brust- und Lendenwirbelsäule. Unfallchirurg 114:17–25

    Article  PubMed  CAS  Google Scholar 

  5. Gejo R, Matsui H, Kawaguchi Y et al (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24:1023–1028

    Article  PubMed  CAS  Google Scholar 

  6. Grass R, Biewener A, Dickopf A et al (2006) Perkutane dorsale versus offene Instrumentation bei Frakturen des thorakolumbalen Übergangs. Eine vergleichende prospektive Untersuchung. Unfallchirurg 109(4):297–305

    Article  PubMed  CAS  Google Scholar 

  7. Hu SS (2004) Blood loss in adult spinal surgery. Eur Spine J [Suppl 1] 13:3–5

    Google Scholar 

  8. Huang QS, Chi YL, Wang XY et al (2008) Comparative percutaneous with open pedicle screw fixation in the treatment of thoracolumbar burst fractures without neurological deficit. Zhonghua Wai Ke Za Zhi 46(2):112–114

    PubMed  Google Scholar 

  9. Kantelhardt SR, Martinez R, Baerwinkel S et al (2011) Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 20(6):860–668

    Article  PubMed  Google Scholar 

  10. Kim DY, Lee SH, Chung SK, Lee HY (2005) Comparison of multifidus muscle atrophy and trunk extension muscle strenght: perctaneous versus open pedicle screw fixation. Spine 24:1023–1028

    Google Scholar 

  11. Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a metaanalysis. Spine 32:11–120

    Article  Google Scholar 

  12. Koutsoumbelis S, Hughes A, Girardi F et al (2011) Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Joint Surg Am 93:1627–1633

    Article  PubMed  Google Scholar 

  13. Kumbhare D, Parkinson W, Dunlop B (2008) Validity of serum creatinin kinase as a measure of muscle injury produced by lumbar spine surgery. J Spinal Disord Tech 21(1):49–54

    Article  PubMed  Google Scholar 

  14. Lehmann W, Ushmaev A, Ruecker A et al (2008) Comparison of open versus percutaneous pedicle screw insertion in a sheep model. Eur Spine J 17:857–863

    Article  PubMed  CAS  Google Scholar 

  15. Liebermann ICH, Hardenbrook MA, Wang JC, Guyer RD (2011) Assesment of pedicle screw placement accuracy, procedure time, and radiation exposure using a miniaure robotic guidance system. J Spinal Disord Tech May 19. [Epub ahead of print]

  16. Paoadopoulos EC, Girardi FP, Sama A et al (2005) Accuracy of single-time, multilevel registration in image-guided spinal surgery. Spine J 5(3):263–267

    Article  Google Scholar 

  17. Prokop A, Löhlein F, Chmielnicki M, Vollbracht J (2009) Minimalinvasive perkutane Instrumentationen bei Wirbelfrakturen. Unfallchirurg 112:621–628

    Article  PubMed  CAS  Google Scholar 

  18. Rodriquez-Vela J, Lobo-Escolar A, Joven-Aliaga E et al (2009) Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion. Eur Spine J 18:1194–1201

    Article  Google Scholar 

  19. Samama CM, Langeron O, Rosencher N et al (2002) Aprotinin versus placebo in major orthopedic surgery: a randomized, double-blinded, dose-ranging study. Anesth Analg 95:287–293

    PubMed  CAS  Google Scholar 

  20. Schoenfeld AJ, Ochoa LM, Bader JO, Belmont J Jr (2011) Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the national surgical quality improvement program. J Bone Joint Surg Am 93:1577–1582

    Article  PubMed  Google Scholar 

  21. Schwarzenbach O, Berlemann U, Jost B et al (1997) Accuracy of computer-assisted pedicle screw placement. An in vivo comuted tomography analysis. Spine 22(4):452–458

    Article  PubMed  CAS  Google Scholar 

  22. Verheyden AP (2011) Thorakolumbale Wirbelsäule. Unfallchirurg 114:8

    Article  PubMed  CAS  Google Scholar 

  23. Wang HW, Li CQ, Zhou Y et al (2010) Percutaneos pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using sextant system: an analysis of 38 cases. Chin J Traumatol 3(3):137–145

    Google Scholar 

Download references


Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations


Corresponding author

Correspondence to S. Matschke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matschke, S. Perkutane minimalinvasive Instrumentierung der Wirbelsäule. Trauma Berufskrankh 13, 253–259 (2011).

Download citation

  • Published:

  • Issue Date:

  • DOI: