gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Lumbar fusion using a full-endoscopic transforaminal implanted intervertebral expandable spacer combined with translaminar fixation – a truly minimally-invasive alternative?

Lumbale Fusionsoperation mittels vollendoskopisch transforaminal implantierten intervertebralspacer und dorsaler translaminärer Fixierung – Eine echte minimalinvasive Alternative?

Meeting Abstract

  • corresponding author M. Komp - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • S. Ruetten - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • A. Lienert - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • G. Godolias - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.04.06

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc109.shtml

Published: May 8, 2006

© 2006 Komp et al.
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Outline

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Objective: Minimally invasive concepts in lumbar fusion are usually limited to dorsal fixation systems. The reconstruction of the intervertebral space may be problematic. Expandable spacers can be positioned in full-endoscopic transforaminal access. The problem of preparation of the intervertebral space was solved with development of new endoscopes. The objective of this prospective study was the comparison of two operation techniques on the basis of the first 12-month results. Group 1: intervertebral TLIF-Technique (PEEK cage) with transpedicular stabilization, Group 2: full-endoscopic transforaminal, expandable titanium intervertebral spacer combined with translaminar fixation.

Methods: 20 patients each with monosegmental discogenic pain syndrome, arthropathy of the zygoapophyseal joints and degenerative instability max. Meyerding I were operated in 2004. The PEEK cages and the intervertebral spaces were each filled with percutaneously harvested pelvic spongiosa. Follow-up lasted 12 months. 38 patients (18 Group 1, 20 Group 2) were followed. In addition to general parameters validated measuring instruments were used.

Results: No serious operative complications occurred. The mean operation time in Group 1 was 85 minutes, in Group 2 65 minutes. The mean blood loss in Group 1 was 460 ml, in Group 2 there was no measurable blood loss. The postoperative pain symptoms and rehabilitation were significantly reduced in Group 2. The mean stay in hospital was 10 days in Group 1 and 5 days in Group 2. Subsidence to max. 4 mm occurred 2x in Group 1 and 5x in Group 2. Radiological signs of intervertebral fusion were found 14 times in Group 1 and 17 times in Group 2. Overall, 30 patients subjectively attained a good result, 6 a moderate and 2 an unsatisfactory result, but without significant differences between the two groups. This corresponded to the results of the measuring instruments.

Conclusions: The full-endoscopic technique achieved the clinical results of the control group, which correspond to those in the literature, and can represent a minimally-invasive alternative according to preliminary results. Due to new endoscopes, this procedure is sufficiently technically feasible. Advantages can be seen in less traumatization with reduced operation pain, shorter hospitalisation and more rapid rehabilitation. Translaminar fixation provides adequate stability. Attention must be paid to the subsidence rate of the expandable spacers with small contact area.