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Pseudarthrose und Konstruktversagen nach lumbaler Pedikelsubtraktionsosteotomie

Einflüsse von Biomechanik, Operationstechnik, Biologie und Vermeidungsstrategien

Pseudarthrosis and construct failure after lumbar pedicle subtraction osteotomy

Influence of biomechanics, surgical technique, biology and avoidance strategies

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Zusammenfassung

Multiple Faktoren können die Ausbildung einer Pseudarthrose und ein Konstruktversagen nach lumbaler Pedikelsubtraktionsosteotomie (PSO) begünstigen und in den meisten Fällen sind mehrere Faktoren gemeinsam ausschlaggebend. Diese Arbeit versucht, die chirurgischen, biomechanischen und biologischen Aspekte zu erklären, die verstanden werden sollten, um das Risiko für Pseudarthrosen und Konstruktversagen zu minimieren. Es werden technische Varianten der PSO und chirurgisch-technische Aspekte dargestellt sowie die Wahl von Metalllegierungen und Multistabkonstrukte erklärt. Biologische Gründe für eine Pseudarthrose und Vermeidungsstrategien werden ebenso diskutiert wie der mögliche Einfluss von Low-grade-Infekten auf die Pseudarthroseentstehung. Zudem wird auf indikatorische Aspekte eingegangen und auf die mögliche Alternative, Lordosen über multiple ALIF zu rekonstruieren, um so unter Umständen eine PSO zu vermeiden.

Abstract

There are numerous factors that can lead to construct failure and pseudarthrosis after corrective pedicle subtraction osteotomy (PSO) in the lumbar spine. Frequently, several factors are of relevance in these problematic cases. This article attempts to explain the surgical, biomechanical and biological aspects that should be understood in order to minimize the risk of pseudarthrosis and construct failure. It addresses technical varieties of the PSO procedure as well as the surgical technique, the choice of rod material and the design of multirod constructs. Biological reasons for pseudarthrosis and preventive strategies are discussed, as well as the possible contribution of low-grade infections to pseudarthrosis. The option of substituting a multilevel ALIF procedure for a PSO is another topic, as is the question of surgical indication and strategy.

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Abbreviations

ALIF:

„Anterior lumbar interbody fusion“

ASD :

Adulte spinale Deformitäten

CAM:

Mitte der Verbindungslinie zwischen den Meati acustici

CoCr:

„Cobalt chrome“

CPTi :

„Commercially pure titanium“

LWS :

Lendenwirbelsäule

oPLIF :

„Open posterior lumbar intervertebral fusion“

PI :

„Pelvic incidence“

PLIF :

„Posterior lumbar intervertebral fusion“

PMMA :

Polymethylmethacrylat

PSO :

Pedikelsubtraktionsosteotomie

rhBMP :

Rekombinantes menschliches Knochenmorphogeneseprotein

SS :

„Stainless steel“

SVA :

Sagittale vertikale Achse

TiAlV :

Titanium-alumin(i)um-vanadium

TLIF :

„Transforaminal lumbar interbody fusion“

XLIF :

„Extreme lateral interbody fusion“

Z. n.:

Zustand nach

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  1. Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland

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Birkenmaier, C. Pseudarthrose und Konstruktversagen nach lumbaler Pedikelsubtraktionsosteotomie. Orthopäde 47, 310–319 (2018). https://doi.org/10.1007/s00132-018-3537-4

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