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Minimal-invasive dorsale Stabilisierung der thorakolumbalen Wirbelsäule

Minimally invasive dorsal stabilization of the thoracolumbar spine

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Zusammenfassung

Die dorsale Instrumentierung instabiler Wirbelsäulenverletzungen stellt in der Akutsituation nach wie vor das Verfahren der ersten Wahl dar. Während rein ventrale Stabilisierungen weiterhin die Ausnahme darstellen, erfolgt die Entscheidung über weitere operative Strategien im Sinne zusätzlicher ventraler Stabilisierungen in Abhängigkeit von der Frakturmorphologie und der sich hieraus ergebenden Stabilität. Verletzungen des thorakolumbalen Übergangs stellen zahlenmäßig die häufigste Instabilität dar. Nicht zuletzt wegen des Scheitelpunkts der Wirbelsäule stellt die Wiederherstellung des Grunddeckplattenwinkels und des bisegmentalen Skoliosewinkels bei dieser Verletzung die höchste Prämisse dar. Das offene Vorgehen wird ähnlich wie auch bei den ventralen Versorgungen zunehmend von minimal-invasiven Techniken und Systemen ersetzt. Bei den dorsalen Systemen werden mittlerweile unterschiedliche Systeme zur perkutanen Instrumentierung angeboten. Der vorliegende Beitrag beschreibt das Prinzip, die möglichen Indikationen und Limitationen der minimal-invasiven dorsalen Stabilisierung.

Abstract

Thoracolumbar spine injuries represent the vast majority of unstable spine fractures. In common, patients are instrumented from a dorsal position while primary stabilization of those fractures using a ventral approach remains exceptional. Fracture morphology and concomitant injuries of the discoligamentous complex help to determine whether combined positions or second staged ventral positioned stabilization is indicated. While segmental stabilization and proper fracture reduction are the primary goals, the latter is of specific importance due to the angular point of the vertebral column in fractures of the thoracolumbar spine. The invasive surgical approach in open reduction and stabilization from a dorsal position seems to be replaced increasingly by less invasive angular stable internal spine fixator systems. This article describes the principle, suited indications and the limitations of one of the internal spine fixators available to achieve angular stable percutaneous dorsal stabilization.

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  1. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    S. Lendemans, B. Hussmann, M.D. Kauther, D. Nast-Kolb & G. Taeger

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  1. S. Lendemans
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  2. B. Hussmann
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  3. M.D. Kauther
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  4. D. Nast-Kolb
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  5. G. Taeger
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Correspondence to S. Lendemans.

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Lendemans, S., Hussmann, B., Kauther, M. et al. Minimal-invasive dorsale Stabilisierung der thorakolumbalen Wirbelsäule. Unfallchirurg 114, 149–160 (2011). https://doi.org/10.1007/s00113-010-1935-0

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