Artikel
Dorsal stabilization of the thoracolumbar spine with a hybrid-system using peek rods, interbody graft support and topping-off technique – a prospective observation (preliminary results)
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Autoren
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Haiko Pape
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Deutschland
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Florian Ringel
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Deutschland
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Michael Behr
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Deutschland
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Bernhard Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Deutschland
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Michael Stoffel
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Deutschland
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: 11–22% (bi-/trisegmental) of patients with multisegmental lumbar instabilities ± stenosis need reoperation in the index or adjacent level within 2 years after surgery, when treated with dynamic stabilisation and decompression. Therefore we established a novel treatment strategy for these patients: Dorsal stabilization using peek rods with at least one rigid level (TLIF) and at least one dynamic level (PEEK rod only) in a topping-off technique was implemented.
Methods: Between September 2009 and March 2010, 27 consecutive patients (11=m; 16=f, mean age 68,2 years) were treated with the hybrid system for painful degenerative segmental instability ± spinal stenosis. In 17 patients, bisegmental stabilization was performed, 9 patients received a trisegmental stabilization and 1 patient a four-level stabilization. In 21 cases, one interbody graft was implanted (20x TLIF, 1x ALIF in a second operation), in 6 cases two interbody grafts were implanted (11x TLIF, 1x PLIF).
The preoperative workup included radiological (MRI and myelography/CT) and clinical parameters (general/neurological examination, visual analogue scale (VAS), Oswestry disability index (ODI), Roland Morris Disability Index (MDI), Karnofsky Performance Status Scale (KPSS).
The patients were reevaluated both at discharge and after 3 months (neurological status, VAS, ODI, RMDI, KPSS and patient satisfaction). Data were collected in a prospective observational design. Two patients were excluded due to a failed back syndrome.
Results: Our novel concept using the hybrid system with peek rods, interbody graft support and topping-off was performed as first-tier surgery in 15 cases and as second-tier therapy in 12 cases, additional decompression was performed in 16 cases.
This concept led to a significant reduction of back pain-related disability (ODI pre-op 54%; post-op 32%, RMDI pre-op 14,1, RMDI post-op 9,5) and improvement of both pain (VAS pre-op 7,1; post-op 3,7) and mobility (KPSS pre-op 69,6 ; post-op, 78,5 ).
Mean postoperative stay in the hospital was 8,4 days.
Early reoperation was necessary in 1 patient (symptomatic misplaced screws). Until now, 12 patients have been evaluated at a follow-up of 3 months postoperatively (ODI 32, RMDI 7,8, KPSS 79,2). At the 3-month follow-up, there were neither signs of screw loosening or breakage, nor signs of adjacent segment disease or increased instabilities. The rate of satisfied patients at the time of discharge was 92,5%.
Conclusions: Our novel concept to treat multisegmental instabilities using dorsal stabilization with the hybrid system as described above has proven to be safe and effective early after surgery. During our preliminary follow-up, the treatment effect seems durable without implant loosening or breakage.
