gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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?

Meeting Abstract

Suche in Medline nach

  • corresponding author Michael Winking - Neurochirurgische Klinik, Universitätsklinikum Gießen, Klinikstr. 29, 35385 Gießen
  • D. Daentzer - Neurochirurgische Klinik, Universitätsklinikum Gießen, Klinikstr. 29, 35385 Gießen

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.03.12

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0178.shtml

Veröffentlicht: 23. April 2004

© 2004 Winking et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


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.