Vermeidung von Anschlussdegenerationen nach operativer Therapie lumbaler, degenerativer Wirbelsäulenpathologien

Abstract

Adjacent segment degeneration (ASD) is a common complication after spine surgery and often requires surgical revision. Given its importance and the multifactorial development, numerous articles on etiology, treatment options and prevention have been published. Prior to surgery, patient-related risk factors such as BMI, age, spinal anatomy and alignment need to be part of the decision-making process. The type and extent of surgery contribute to the development of ASD as well as the damage of dorsal anatomical structures such as facet joints and the paraspinal musculature. Current literature does not justify the use of motion-preserving procedures to diminish ASD occurrence. Importantly, it is recommended to act with regard to the individual spinopelvic alignment and limit the invasiveness of the given surgical procedure in order to prevent ASD. Nevertheless, despite significant research efforts, ASD remains a complication that has not yet been adequately addressed.

Kernaussagen

• Die Entstehung einer Anschlussdegeneration ist multifaktoriell mit einer Prävalenz von 2–3% pro Jahr im Bereich der Lendenwirbelsäule.

• Anschlussdegenerationen können vor allem im Falle von klinischen Beschwerden eine Revisionsoperation erforderlich machen.

• Das Fortschreiten degenerativer Wirbelsäulenveränderungen im Anschlusssegment ist auf Basis der aktuellen Literatur als fusionsunabhängig zu verstehen.

• Zur Vermeidung von Anschlussdegenerationen sollten Operateure die Risikofaktoren berücksichtigen und Eingriffe bevorzugen, die dorsale Strukturen schonen und das spinopelvine Alignment respektieren.

• Der Einfluss des Chirurgen auf die Entstehung und Progredienz der Anschlussdegeneration ist limitiert.

• Hinsichtlich einer möglichen Risikoreduktion für das Auftreten einer Anschlussdegeneration zeigen Hybridinstrumentierungen und lumbale Bandscheibenprothesen gegenüber der Fusion keinen Vorteil.

• Eine fehlende evidenzbasierte Leitlinie zum Umgang mit Anschlussdegenerationen erschwert die Behandlung ebenso wie das Fehlen einer einheitlichen Terminologie.

Schlüsselwörter

Anschlussdegeneration - Lendenwirbelsäule - Fusion - Dekompression - Spinopelvines Alignment - Prävention

Keywords

adjacent segment degeneration - lumbar spine - fusion - decompression - spinopelvic alignment - prevention

Publication History

Article published online:
26 August 2022

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