Zusammenfassung
Zur Operation von lumbalen Bandscheibenvorfällen stellte die Laminektomie viele Jahre den Standardzugang dar. Da dabei für die Statik der Wirbelsäule wichtige Strukturen wie Wirbelbogen, Dornfortsatz und interspinöse Ligamente und somit die hintere Zuggurtung der Wirbelsäule entfernt wurden, kam es bei 2–10 % der Fälle zu iatrogenen Instabilitäten. Die Einführung der Teilhemilaminektomie an Stelle der Laminektomie führte zu einer deutlichen Reduktion des Zugangstraumas. Durch diese Zugangstechnik und den systematischen Erhalt der wesentlichen Anteile der Facettengelenke wurden keine iatrogenen Instabilitäten nach lumbalen Diskektomien mehr beobachtet. Die Einführung der Mikrochirurgie in die Wirbelsäulenchirurgie ging mit einer Verkleinerung des paraspinösen OP-Zugangs einher und führte neben kleineren Hautschnitten zu einer Reduktion des Muskeltraumas der paravertebralen Muskulatur und damit des Zugangstraumas. In den letzten Jahren sind zunehmend minimalinvasive Zugangsverfahren für Wirbelsäulenoperationen eingeführt worden, die zu einer weiteren Reduktion des Zugangstraumas führten. Für die minimalinvasive tubuläre Mikrodiskektomie werden tubuläre Retraktoren, deren Durchmesser typischerweise bei 14–18 mm liegt und die in Längen zwischen 3 und 9 cm in Stufen von 1 cm verfügbar sind, verwendet. Die Besonderheit des minimalinvasiven tubulären Zugangs besteht in der Präparationstechnik.
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Hubbe, U. (2019). Minimalinvasive mikrochirurgische Bandscheibenoperation lumbal mit tubulären Retraktoren. In: Jerosch, J. (eds) Minimalinvasive Wirbelsäulenintervention. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58094-3_21
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