Article

Die perkutane Implantation eines interspinösen Spacers an der Lendenwirbelsäule

Wirbelsäulenzentrum, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547 München, Germany
Operative Orthopädie und Traumatologie (Impact Factor: 0.47). 01/2010; 22(5):495-511. DOI: 10.1007/s00064-010-1004-4

ABSTRACT Operationsziel
Perkutane Implantation eines interspinösen Spacers an
der Lendenwirbelsäule (LWS) zur Erweiterung des Spinalkanals
sowie zur Entlastung der Wirbelgelenke und der
Bandscheibe bei dynamischen lumbalen Spinalstenosen
sowie gelenk- und/oder bandscheibenbedingten Rückenschmerzen
durch segmentale Distraktion des betroffenen
lumbalen Bewegungssegmentes. Das Verfahren dient als
temporäre Alternative zu invasiveren OP-Verfahren.

Indikationen
Zentrale, laterale und foraminale dynamische lumbale
Spinalstenose.
Diskogener/arthrogener Rückenschmerz.
Symptomatische segmentale Hyperlordose.
Bandscheibendegeneration mit dynamischer Retrolisthese
und Spontanreposition in Flexion.
Interspinöser Schmerz, sog. Baastrup-Phänomen oder
Kissing-Spines’.

Kontraindikationen
Osteoporose.
Conus-/Cauda-Symptomatik.
Strukturelle Spinalstenose.
Degenerative und/oder idiopathische Spondylolisthese.
Deformitäten.
Relative Kontraindikationen:
Dorsale Voroperation im gleichen Segment.

Operationstechnik
Perkutane, minimal invasive Implantation eines interspinösen
Spacers (InSpaceTM, Synthes, Oberdorf, Switzerland)
zur segmentalen Distraktion.

Weiterbehandlung
Funktionell ohne Restriktionen.

Ergebnisse
Gute klinische Ergebnisse bei 42 Patienten nach 2 Jahren.
Bei 76% subjektive Patientenzufriedenheit. Keine zugangsbedingten
Komplikationen. Vermeidung des invasiveren
Alternativeingriffes bei 76,2% der Patienten.

Surgical Goal
Surgical treatment of dynamic lumbar spinal stenosis and
discogenic/arthrogenic low back pain with a new percutaneous
interspinous spacer as a therapeutic alternative to
more invasive standard procedures.

Indications
Central, lateral and foraminal dynamic lumbar spinal
stenosis.
Discogenic and arthrogenic (facet osteoarthritis) low back
pain.
Symptomatic, segmental hyperlordosis.
Disc degeneration with dynamic (reducible) retrolisthesis.
Interspinous pain (‚Kissing-Spines’).

Contraindications
Osteoporosis.
Conus-/Cauda-syndrome.
Structural spinal stenosis.
Spondylolisthesis (degenerative and/or isthmic).
Deformities.
Previous posterior operation in index segment.

Surgical Technique
Percutanous, minimally invasive implantation of an interspinous
spacer (InSpaceTM, Synthes, Oberdorf, Switzerland).

Postoperative Management
Early unrestricted mobilization.

Results
Good early results (after 2 year follow-up) in 42 patients
with 76% subjective patient satisfaction rate. No approach
related complications. Avoidance of the more invasive alternative
procedure (decompression, fusion, total disc replacement)
in 76.2% of the patients.

Schlüsselwörter
Spinalstenose-Interspinöse Spacer-Rückenschmerz-Perkutaner Zugang

Key Words
Spinal stenosis-Interspinous spacer-Low back
pain-Percutaneous approach

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