Artikel
First experience with the topping off technique using semi-rigid stabilisation of the lumbar spine
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Autoren
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Sandro M. Krieg
- Neurochirurgische Klinik, München, Deutschland
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Anna Rienmüller
- Neurochirurgie Klinikum rechts der Isar TU München, Orthopädie, München, Deutschland; Medizinische Universität Wien, Österreich
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Balser Nele
- Neurochirurgische Klinik Klinikum rechts der Isar, München, Deutschland
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Haiko Pape
- Neurochirurgische Klinik Klinikum rechts der Isar, München, Deutschland
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Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Semi-rigid stabilization was introduced due to the concept of load sharing. We propose a topping-off technique leaving the most upper motion segment without anterior cage in order to reduce adjacent segment disease (ASD) by creating a smooth transition from stabilized to free motion segments. The objective of this study was to evaluate the influence of these angles on reoperations to investigate potential impacts.
Methods: We report on the first 203 patients enrolled from 2009 to 2013. Reoperation rate, VAS, ODI, RMDI, and subjective patient rating were used as outcome measures. All patients underwent pedicle screw-based semi-rigid stabilization of the lumbar spine with the Medtronic Horizon PEEK Rod®-system. All patients underwent computed tomography or x-ray after surgery. Outcome measures were evaluated 3 and 12 months after surgery.
Results: For 46.9% of patients, implantation of the PEEK rod was the first lumbar surgery while 53.1% received a PEEK rod system as revision surgery after decompression or following ASD after dynamic or rigid stabilization. A mean of 2.8 ± 0.7 (median 3) motion segments were included while 1.3 ± 0.6 (median 1) motion segments were fused. 80.6% of patients underwent TLIF in the same surgery. 78.4% of patients also received decompression. General satisfaction with the surgical result 12 months after surgery was 91.8%. Mean pain score using VAS was 7.9 ± 1.0 before and 3.4 ± 1.1 at 3 months after surgery (p<0.05), while RMDI was 15.8 ± 2.7 before and 9.8 ± 2.2 at 3 months after surgery (p<0.05). ODI was 46.0 ± 6.8 before and 28.9 ± 6.2 at 3 months after surgery (p<0.05). Concerning screw loosening, we observed a rate of 3.6% loosened screw of all screws which caused revision surgery in 8.2% of all patients 1.5 ± 1.3 years after PEEK rod surgery. Screw loosening mainly occurred in L5 (12.2%) and S1 (14.3% of all patients).
Conclusion: The PEEK rod concept including the topping of principle seems safe with high satisfaction at least in short-term follow up. Concerning future steps, longer follow up examinations are mandatory.
