gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Clinical and radiographic outcome of minimally invasive decompression, TLIF and percutaneous pedicle screw insertion in stenotic spondylolisthesis with severe facet joint osteoarthritis

Meeting Abstract

  • Eleftherios Archavlis - Neurochirurgische Klinik und Ambulanz, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach
  • Pavel Timofeev - Neurochirurgische Klinik und Ambulanz, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach
  • Elke Januschek - Neurochirurgische Klinik und Ambulanz, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach
  • Peter Ulrich - Neurochirurgische Klinik und Ambulanz, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.08.01

doi: 10.3205/13dgnc227, urn:nbn:de:0183-13dgnc2270

Veröffentlicht: 21. Mai 2013

© 2013 Archavlis 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however, little data to assess whether these procedures in combination with minimally invasive transforaminal interbody fusion (TLIF) and percutaneous pedicle screw insertion are effective in complex cases of stenotic degenerative spondylolisthesis (SDS) with severe facet joint osteoarthritis (FJO). The authors’ aim in this study was to evaluate clinical and radiographic outcome after the treatment of SDS with severe FJO who underwent MIS (24 patients) compared with a reference group who underwent open surgery (25 patients).

Method: This study retrospectively reviewed all patients who underwent lumbar instrumentation, fusion and decompression for degenerative spondylolisthesis with severe stenosis and facet joint osteoarthritis (FJO). Eighty five cases were assessed for eligibility. Forty nine subjects met study criteria and all were available for follow-up. Blood loss, operative time and intraoperative complications were assessed and clinical outcome was measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain. Satisfaction was assessed with VAS for satisfaction.

Results: The minimum follow-up was 24 months with a mean of 26 months in both groups. In the MIS and open surgery groups, the distribution on the postoperative ODI (p=0,841), VAS leg (p=0,943) and back pain (p=0,735) scores were similar. Twenty one out of 24 cases and 23 out of 25 cases experienced a clinical benefit according to VAS for satisfaction and ODI in the MIS group and the open group respectively. Moreover, the accuracy of pedicle screws was high in both groups and only one revision surgery was performed in the MIS group. The overall proportion of complications showed no significant difference between the groups (29% in the MIS group vs. 28% in the open group, p=0,999).

Conclusions: MIS for severe SDS leads to adequate and safe decompression of lumbar stenosis and results in a highly significant reduction of symptoms and disability. 2 year outcome and radiologic result after MIS-TLIF and percutaneous pedicle screw insertion was comparable with that after conventional techniques and thus constitutes a promising treatment alternative.