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Der Trend zu vollendoskopischen Dekompressionen

Aktuelle Möglichkeiten und Grenzen bei Bandscheibenvorfall und Spinalkanalstenose
  • S. Ruetten
  • M. Komp
Leitthema

Zusammenfassung

Hintergrund

Die häufigsten Ursachen degenerativer Einengungen des Spinalkanals sind Bandscheibenvorfälle und Spinalkanalstenosen. Lenden- und Halswirbelsäule stehen im Vordergrund.

Chirurgische Verfahren

Nach Ausschöpfen konservativer Maßnahmen kann ein operatives Vorgehen notwendig werden. Als Standardverfahren gelten heutzutage im lumbalen Bereich die mikrochirurgische Dekompression, im zervikalen Bereich die mikrochirurgische ventrale Dekompression und Fusion. Vollendoskopische Techniken zur Dekompression finden zunehmend weltweit Verbreitung. Die Entwicklung verschiedener operativer Zugänge und Instrumentarien hat die vollendoskopische Operation von Bandscheibenvorfällen und Spinalkanalstenosen ermöglicht. Die Anwendung der jeweiligen Zugänge ist abhängig von anatomischen und pathologischen Ein- und Ausschlusskriterien.

Ergebnisse

Die klinischen Ergebnisse der Standardverfahren werden erreicht, was als Mindestkriterium bei der Einführung neuer Techniken gelten muss. Unter Berücksichtigung von Evidence-based-medicine-(EBM)-Kriterien kann festgestellt werden, dass mittels der entwickelten vollendoskopischen Techniken eine suffiziente Dekompression bei den genannten Indikationen erreicht wird, mit reduzierter Traumatisierung, verbesserten Sichtbedingungen und positiver Kostenrelation. Somit können vollendoskopische Operationen heute als Erweiterung und Alternative innerhalb des Gesamtkonzeptes der Wirbelsäulenchirurgie eingeordnet werden.

Schlüsselwörter

Radikulopathie Bandscheibenprolaps Endoskopie Lumbalregion Minimalinvasive Chirurgie 

The trend towards full-endoscopic decompression

Current possibilities and limitations in disc herniation and spinal stenosis

Abstract

Background

The most frequent causes of degenerative constrictions of the spinal canal are disk herniations and spinal stenoses. The lumbar and cervical spine is the most affected.

Surgical procedures

After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical decompression is regarded as the standard procedure in the lumbar region, while in the cervical spine, microsurgical anterior decompression and fusion are standard. Full-endoscopic techniques for decompression are becoming increasingly widespread worldwide. The development of various surgically created approaches and appropriate instrument sets have made the full-endoscopic operation of disk herniations and spinal stenosis possible. This development has also permitted resection of soft disk herniations in the cervical spine. The use of the approaches depends on anatomical and pathological inclusion and exclusion criteria.

Results

The clinical results of standard procedures have been achieved, which must be regarded as a minimum criterion for the introduction of new technologies. On the basis of EBM criteria, it can be established that using the full-endoscopic techniques developed, adequate decompression is achieved in the defined indications with reduced traumatization, improved visibility conditions, and positive cost benefits. Today, full-endoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery.

Keywords

Radiculopathy Disc prolapse Endoscopy Lumbar region Minimally invasive surgery 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Ruetten und M. Komp geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie der St. Elisabeth Gruppe – Katholische Kliniken Rhein-RuhrSt. Anna Hospital Herne/Universitätsklinikum, Marien Hospital Herne/Marien Hospital WittenHerneDeutschland

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