Artikel
Combined ventro-dorsal fixation of lumbar spine instability - A treatment option for elder patients?
Kombinierte ventrodorsale Stabilisierung von Instabilitäten der lumbalen Wirbelsäule - Eine Behandlungsoption bei älteren Patienten?
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Autoren
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Michael Winking
- Neurochirurgische Klinik, Universitätsklinikum Gießen, Klinikstr. 29, 35385 Gießen
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D. Daentzer
- Neurochirurgische Klinik, Universitätsklinikum Gießen, Klinikstr. 29, 35385 Gießen
| Veröffentlicht: | 23. April 2004 |
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Gliederung
Text
Objective
Patients with lumbar instability suffer from distinct local and radicular pain, sometimes with neurological deficit. For pain reduction, nerve root decompression is necessary, however segmental instability mostly increases. Due to screw breakage, isolated dorsal fixation combined with hemi- or laminectomy represents an insufficient stabilization technique. Combined dorsal instrumentation with ventral interbody fusion will give an adequate static situation. In a retrospective study we analysed our results in elder patients operated with combinded ventro-drosal fixation for lumbar pseudospondylolithesis correlated to dorsal fixation with dorsal interbody bone grafting.
Methods
In each study group we included 40 patients elder than 65 years. All patients were suffering from a pseudospondylolisthesis. Preoperative pain free walking was reduced to less than 50m. Myelography showed a pseudospondylolisthesis combined with narrowing of the AP dimension of the spinal canal. In all patients dorsal instrumentation was performed first. One group received bone grafting with autologous bone from the lamina and spinous process during the same operation. The second group received interbody fusion with autologous bone from the iliac crest after a short interval (10 days) by a ventro-lateral retroperitoneal approach.
Results
Immediately after operation all patients were mobilized without external orthesis. Pain on the VAS-scale was significantly reduced in both groups. Six weeks after operation all patients were able to move for more than 200m. After six months patients of both groups had a significant improvement in quality of life assessed by the OLBPD-Questionnaire. After one year radiological examination showed an insufficient bone fusion in single dorsally operated patients in 17%. In ventro-dorsal operated patients pseudarthrosis was observed in 0%. Perioperative complications in both groups were identical (4.5%).
Conclusions
Sequential ventro-dorsal fixation using autologous bone graft reaches a better bony fusion and is a safe method also for treatment of pseudospondylolisthesis in elder patients.
