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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Hybrid stabilization with rigid levels and “Topping-Off” for multi-level degenerative lumbar instabilities – Preliminary results of a series of 173 consecutive patients

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  • Haiko Pape - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • Florian Ringel - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • Thomas Obermüller - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • Maria Wostrack - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • Dominique Kuhlen - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • Bernhard Meyer - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München

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. DocMO.20.04

doi: 10.3205/13dgnc176, urn:nbn:de:0183-13dgnc1763

Published: May 21, 2013

© 2013 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: Numerous patients need reoperation after initial lumbar stabilization due to progressive degeneration, e.g. adjacent level disease. A treatment strategy for patients with thoracolumbar instabilities was established at our department aiming to reduce the reoperation rate: Dorsal stabilization using peek rods with at least one rigid level (XLIF/ALIF/TLIF) and at least one dynamic level (PEEK rod only) in a topping-off technique only including symptomatic levels.

Method: Between September 2009 and May 2012, we treated 173 consecutive patients with the hybrid system for painful degenerative instabilities. This included bisegmental stabilization in 71 patients, three-level stabilization in 85 patients and a four-level stabilization in 17 patients. The topping-off is meant to work as a transition zone between symptomatic and asymptomatic levels, only symptomatic levels were included in the instrumentation, The preoperative workup included radiological (MRI and myelography/CT) and clinical parameters (general/neurological examination, VAS, ODI, RMDI). Follow-Up intervals are 3, 12 and 24 months postoperatively (3FU, 12FU, 24FU). Data are being collected in a prospective observational design.

Results: Both back pain (mean VAS pre-op 7,8, post-op 3,8, 3FU 3,3, 12FU 3,7, 24FU 3,6) as well as pain-associated impairment/disability were reduced (mean ODI pre-op50%, post-op 32%, 3FU 28%, 12FU 28%, 24FU 30%; mean RMDI pre-op 19,8, post-op 15,2, 3FU 12,4, 12FU 11,5, 24FU 11,9). So far, 16 patients have needed revision surgery due to CSF fistula (n=7), symptomatic screw misplacement (n=5), epidural hematoma (n=2) or inflammation (n=2). Symptomatic thrombembolic events were seen, in 9 patients, new temporary motor deficits in 7 patients. Due to adjacent level disease (n=4) or symptomatic hardware failure (n=7) after 4 to 16 months, a rigid internal fixator had to be implanted.

Conclusions: The implantation of the hybrid-system consisting of spondylodesis and dynamic stabilization with a topping-off for the treatment of multi-level thoracolumbar instabilities is effective and feasible in regard to the clinical results. The complication rate is acceptable, long-term follow-up will show if a reduction of adjacent level disease can be achieved with this technique.