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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Hybrid stabilization with rigid segments and “topping-off” for multi-level degenerative instability – Short-term follow-up results of a series of 200 consecutive patients

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  • Haiko Pape - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • Thomas Obermüller - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • Maria Wostrack - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • Ehab Shiban - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • Florian Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • Bernhard Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.11.08

doi: 10.3205/14dgnc068, urn:nbn:de:0183-14dgnc0684

Published: May 13, 2014

© 2014 Pape et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Following a dorsal lumbar stabilization and decompression operation for degenerative instability, a multitude of patients need reoperations in the adjacent segment or due to hardware failure. We established a hybrid stabilization treatment strategy for patients with multi-level degenerative lumbar instabilities by combining an internal fixator and interbody graft support (XLIF/ALIF/TLIF) for at least one rigid level and a cranial “topping-off” (no intercorporal fusion) in order to reduce the reoperation rate and the prevalence of ASD.

Method: Between September 2009 and August 2013, we treated 200 consecutive patients with this hybrid system for painful multi-level degenerative instabilities. The instrumentation included only symptomatic levels, the dynamic topping-off is meant to work as a transition zone to the asymptomatic levels. The preoperative workup included radiological (MRI and myelography/CT) and clinical parameters (general/neurological examination, visual analogue scale (VAS), Oswestry disability index (ODI) and Roland Morris Disability Index (RMDI). The patients are reevaluated both at discharge, after 3, 6 and 12 months (3FU, 12FU, 24FU). Data are collected in a prospective observational design.

Results: Postoperatively, both pain (VAS pre-op 7,8; post-op 3,4) and back pain-related disability were reduced (ODI pre-op 52,2; post-op 30,6; RMDI pre-op 20,6; post-op 13,5). Due to CSF leakage, symptomatic misplaced screws and epidural hematoma, early reoperation was necessary in 13 patients. A 3FU was performed in 182 patients (18 lost to FU; VAS: 3,1 ;ODI 24,4; RMDI 11,1). So far, 145 patients were eligible for the 12FU (24 lost to FU; VAS: 3,5; ODI 26,2; RMDI 11,5) and 98 patients were eligible for the 24FU (13 lost to FU; VAS: 3,6; ODI 28,0; RMDI 11,9). Due to screw loosening (n=14, n=5 in topping-off level), cage dislocation (n=2) and ASD (n=10), 26 patients needed a reoperation.

Conclusions: The implantation of this hybrid internal fixator combining spondylodesis and dynamic stabilization with cranial “topping-off” seems effective in regards to reducing LBP and associated disability. With regard to hardware-failure, ASD and complication rate, the results of the short-term follow-up are favourable.