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Lumbale Bandscheibenendoprothesen: Indikationen, Biomechanik, Typen und radiologische Kriterien

Lumbar disc arthroplasty: indications, biomechanics, types, and radiological criteria

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Zusammenfassung

Die lumbale Bandscheibenendoprothese (LBEP) wurde entwickelt, um ein schmerzhaftes lumbales Bewegungssegment unter Vermeidung der Nachteile einer Fusionsoperation zu behandeln. Erste klinische Ergebnisse der LBEP zeigen eine signifikante Reduktion der Rückenschmerzen und eine signifikante Verbesserung in den disability scores.

Die radiologische Diagnostik ist wichtiger Bestandteil der präoperativen Abklärung. Es sollten Nativaufnahmen der LWS mit Funktionsaufnahmen zur Beurteilung der noch erhaltenen Segmentbeweglichkeit und eine CT zum Nachweis bzw. Ausschluss von Spondylarthrosen, eines Morbus Baastrup und anderer möglicher Schmerzursachen angefertigt werden, außerdem ein MRT zum Nachweis des Wasserverlustes der Bandscheibe, Ausschluss größerer Prolabierungen oder zur Darstellung von Aktivierungszeichen.

Die postoperative radiologische Diagnostik sollte Nativaufnahmen in 2 Ebenen und im späteren Verlauf Funktionsaufnahmen beinhalten. Eine ideal eingesetzte LBEP sollte im a.p. Bild mittig zentriert und in der Seitaufnahme dorsal nahe der Wirbelkörperhinterkante abschließen. Bei Fehllage drohen segmentale Hyperlordose und ungleiche Belastung mit der Gefahr der Einsinterung und der Migration.

Abstract

Lumbar total disc replacement (TDR) was developed to treat a painful degenerative lumbar motion segment while avoiding the disadvantages of fusion surgery, such as adjacent segment instabilities. Early clinical results with TDR have shown a significant reduction in low back pain and a significant improvement in disability scores. When compared to fusion, the results with TDR tend to be superior in the short-term follow-up and initial rehabilitation is faster. The radiological assessment is an integral part of the preoperative work-up. Plain X-rays of the lumbar spine should be complemented by flexion – extension views in order to assess residual segmental mobility. Computed tomography is used to exclude osteoarthritis of the zygapophyseal joints, Baastrup’s disease (kissing spines) and other sources of low back pain. Magnetic resonance imaging is useful to exclude substantial disc protrusions; it allows for the detection of disc dehydration and bone marrow edema in the case of activated spondylochondrosis. If osteoporosis is suspected, an osteodensitometry of the lumbar spine should be performed. Postoperative plain X-rays should include antero-posterior and lateral views as well as flexion – extension views in the later postoperative course. Measurements should determine the disc space height in the lateral view, the segmental and total lumbar lordosis as well as the segmental mobility in the flexion – extension views. The ideal position of a TDR is exactly central in the ap-view and close to the dorsal border of the vertebral endplates in the lateral view. Malpositioning may cause segmental hyperlordosis and unbalanced loading of the endplates with the risk of implant subsidence and migration.

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Authors and Affiliations

  1. Orthopädische Klinik und Poliklinik, Klinikum Großhadern der Ludwig-Maximilians-Universität, München

    A. Baur-Melnyk & M. F. Reiser

  2. Institut für Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität, München

    C. Birkenmaier

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  1. A. Baur-Melnyk
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  2. C. Birkenmaier
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Correspondence to C. Birkenmaier.

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Baur-Melnyk, A., Birkenmaier, C. & Reiser, M.F. Lumbale Bandscheibenendoprothesen: Indikationen, Biomechanik, Typen und radiologische Kriterien. Radiologe 46, 768–778 (2006). https://doi.org/10.1007/s00117-006-1356-9

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