PLIF und ALIF zur operativen Therapie der degenerativen lumbalen Instabilität

Lemcke, Johannes; Klötzer, S; Klötzer, R; Meier, Ullrich

doi:10.1055/s-2007-960512

Cited by 10 publications

(11 citation statements)

References 18 publications

(20 reference statements)

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“…Although a number of studies have reported good clinical outcomes after lumbar fusion, 24–26,29 our clinical results were clearly unsatisfactory for patients. Only 50% were pleased with the outcome.…”

Section: Discussionmentioning

confidence: 70%

Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine

2010

Orthop Rev

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In the treatment of multilevel degenerative disorders of the lumbar spine, spondylodesis plays a controversial role. Most patients can be treated conservatively with success. Multilevel lumbar fusion with instrumentation is associated with severe complications like failed back surgery syndrome, implant failure, and adjacent segment disease (ASD). This retrospective study examines the records of 70 elderly patients with degenerative changes or instability of the lumbar spine treated between 2002 and 2007 with spondylodesis of more than two segments. Sixty-four patients were included; 5 patients had died and one patient was lost to follow-up. We evaluated complications, clinical/radiological outcomes, and success of fusion. Flexion-extension and standing X-rays in two planes, MRI, and/or CT scans were obtained pre-operatively. Patients were assessed clinically using the Oswestry disability index (ODI) and a Visual Analogue Scale (VAS). Surgery performed was dorsolateral fusion (46.9%) or dorsal fusion with anterior lumbar interbody fusion (ALIF; 53.1%). Additional decompression was carried out in 37.5% of patients. Mean follow-up was 29.4±5.4 months. Average patient age was 64.7±4.3 years. Clinical outcomes were not satisfactory for all patients. VAS scores improved from 8.6±1.3 to 5.6±3.0 pre- to post-operatively, without statistical significance. ODI was also not significantly improved (56.1±22.3 pre- and 45.1±26.4 post-operatively). Successful fusion, defined as adequate bone mass with trabeculation at the facets and transverse processes or in the intervertebral segments, did not correlate with good clinical outcomes. Thirty-five of 64 patients (54%) showed signs of pedicle screw loosening, especially of the screws at S1. However, only 7 of these 35 (20%) complained of corresponding back pain. Revision surgery was required in 24 of 64 patients (38%). Of these, indications were adjacent segment disease (16 cases), pedicle screw loosening (7 cases), and infection (one case). At follow-up of 29.4 months, patients with radiographic ASD had worse ODI scores than patients without (54.7 vs. 36.6; P<0.001). Multilevel fusion for degenerative disease still has a high rate of complications, up to 50%. The problem of adjacent segment disease after fusion surgery has not yet been solved. This study underscores the need for strict indication guidelines to perform lumbar spine fusion of more than two levels.

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Section: Discussionmentioning

confidence: 70%

Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine

2010

Orthop Rev

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“…Unterschiede der Fusionsraten bez. der Zugangstechniken wie ALIF oder PLIF sowie den verwendeten Cage-Systemen sind gemäß Literatur nicht festzustellen [2,3,[15][16][17]. Bei unseren Patienten wurde ausschließlich autologer Knochen von den resezierten Facettengelenken oder bei Dekompressionen von der Lamina ohne erkennbare Nachteile verwendet.…”

Section: Diskussion !unclassified

“…Bei unseren beiden Patientengruppen konnte postoperativ eine gute Wiederherstellung der durchschnittlichen intervertebralen Distanz mit nur geringem Korrekturverlust 1 Jahr postoperativ festgestellt werden. Diese Ergebnisse sind auch vergleichbar mit den Ergebnissen von Lemcke et al [17] mit der ALIF-und PLIF-Technik. Im Vergleich zu Gruppe 1 war in Gruppe 2 die präoperative intervertebrale Distanz im Durchschnitt geringfügig kleiner (Gruppe 1: 3,6 mm, Gruppe 2: 2,8 mm).…”

Section: Diskussion !unclassified

“…Insgesamt ergaben sich bei unseren Patienten in beiden Gruppen eine etwa 70%ige Reduzierung des Rücken-und Beinschmerzes sowie der Einschränkung durch Wirbelsäulenbeschwerden 1 Jahr nach der Operation. Im Vergleich zur Literatur [17,19,20] waren in unserer Studie ähnliche Ergebnisse für die Schmerzskalen sowie für den Oswestry Score nach Spondylodesen zu finden. In unserer Studie zeigte sich mit einer Schraubenfehllage, einer Anschlussdegeneration sowie einer Wundheilungsstörung eine intra-und postoperative Komplikationsrate von 5 %.…”

Section: Diskussion !unclassified

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Gibt es segmentabhängige Unterschiede bei lumbalen Spondylodesen? – Vergleich der Segmente L IV/V und L V/S I bei der transforaminalen lumbalen interkorporellen Fusion (TLIF)

Linhardt¹,

Grifka

Benditz

2015

Z Orthop Unfall

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In patients with contraction osteochondrosis in segment L V/S I, spondylodesis in segment L V/S I is - for anatomical reasons - more likely to be linked to reversible nerve irritations than with segment L IV/V. In some cases, conversion from TLIF on ALIF is necessary. In patients with degenerative spine disease, TLIF in segments L IV/V and L V/S I is absolutely accepted as a safe and up-to-date procedure.

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“…Patientenzufriedenheit der Gesamtgruppe in Abhängigkeit vom Geschlecht. 6% bezogen auf das Gesamtkollektiv entspricht den Feststellungen von Fritzell et al[4] mit 33% und Lemcke et al[22]. Eine hohe Korrelation besteht auch zwischen den Ergebnissen des Oswestry-Scores und der visuellen Analogskala.…”

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Therapeutische Effizienz langstreckiger Fusionen im Bereich der LWS

Riesner

Matzen²,

Mlinarić³

et al. 2008

Z Orthop Unfall

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PLIF und ALIF zur operativen Therapie der degenerativen lumbalen Instabilität

Abstract: With regard to the indications and contraindications the PLIF as well as the ALIF is accepted unquestioningly as an up-to-date method.

Cited by 10 publications

References 18 publications

Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine

Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine

Gibt es segmentabhängige Unterschiede bei lumbalen Spondylodesen? – Vergleich der Segmente L IV/V und L V/S I bei der transforaminalen lumbalen interkorporellen Fusion (TLIF)

Therapeutische Effizienz langstreckiger Fusionen im Bereich der LWS

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