Operative Behandlungsstrategien der pyogenen Spondylodiszitis der thorakolumbalen Wirbelsäule

Zusammenfassung

Hintergrund Die Morbidität und Mortalität im Zusammenhang mit einer Spondylodiszitis sind trotz aller Fortschritte weiterhin hoch bei einer weltweit steigenden Inzidenz. Trotz der Fortschritte der konservativen Therapie bedarf es in nicht wenigen Fälle einer operativen Intervention. Kontroversen bestehen dabei in der Indikation und der operativen Strategie.

Methodik In einem gemeinsamen Konsensusprozess erstellten die Mitglieder der Arbeitsgemeinschaft „Spondylodiszitis“ der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) unter Berücksichtigung der aktuellen Literatur, insbesondere der neu erschienen S2k-Leitlinie der AWMF, Empfehlungen zur operativen Indikation und Behandlungsstrategien der thorakolumbalen Spondylodiszitis.

Ergebnisse Die operative Behandlung bei Spondylodiszitis ist nur bei einem kleinen Prozentsatz erforderlich. In vergleichenden Untersuchungen zwischen konservativer und operativer Therapie fanden sich im überwiegenden Anteil Vorteile in der invasiven Gruppe unabhängig von der gewählten Operationstechnik. Als Standardverfahren gilt heutzutage ein kombiniertes dorsoventrales Vorgehen, wobei immer versucht werden sollte, dies einzeitig durchzuführen. Die Wahl des verwendeten Materials (PEEK, Titan) zur ventralen Abstützung hat keinen Einfluss auf das klinische Ergebnis.

Schlüsselwörter

Spondylodiszitis - Spondylitis - Infektion - konservative Therapie - operative Therapie

Publication History

Article published online:
30 August 2021

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