Artikel
Minimally invasive transpedicular stabilisation via a lateral dorsal paraspinal approach with transforaminal lumbar interbody fusion
Minimal-invasive transpedikuläre Stabilisation über einen lateralen dorsalen paraspinalen Zugang mit transforaminaler lumbaler interkorporeller Fusion
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Autoren
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U. Vieweg
- Zentrum für Wirbelsäulenstabilisationen, Neurochirurgische Klinik, Leopoldina Krankenhaus, Schweinfurt
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Retrospective analysis of the minimally invasive transpedicular stabilisation via a lateral dorsal paraspinal approach with microsurgical transforaminal lumbar interbody fusion (TLIF).
Methods: Twenty-eight patients with degenerative disorders of the lumbar spine, mean age 67 (52 – 82) years were operated using a posterior polyaxial fixation system (S4 Spinal System, B. Braun – Aesculap) and a banana-shaped transforaminal lumbar interbody fusion device. The lateral dorsal paraspinal approach was performed using the CASPAR MLD retractor system (B. Braun – Aesculap). Three patients were operated on two levels and 25 patients on one level. We analysed the average operation time, the blood loss, complications, post – operative pain reduction according to the VAS score and the time of mobilisation after the operation. The screw positioning and reduction of a spondylolisthesis were determined from plain radiographs and CT-scans.
Results: The average operation time was 85 minutes and the average blood loss was 160ml. There was only one nerve root irritation with dyaesthesia. Only one day after operation 26 patients were immediately mobilised. The average pain rate according to the VAS score was praeoperatively 7 (range: 6 - 8) and seven days after operation 2 (range:0 - 3). A good screw positioning and complete reduction of a spondylolisthesis could be proven postoperatively by image control.
Conclusions: The lateral Wiltse approach with a posterior polyaxial fixation device in combination with the microsurgical TLIF technique represents a minimally invasive procedure. The first clinical results are convincing. To perform this technique it is necessary to have experience with the use of a microscope and the TLIF-technique.
