Bandscheibenprothesen und Non-Fusion – ein Update

Zusammenfassung

In der operativen Behandlung degenerativer zervikaler und lumbaler Bandscheibenerkrankungen und Spondylosen spielen neben der klassischen Fusion „dynamische“ Implantate eine Rolle. In dieser Arbeit wird die gesammelte Evidenz zur Anwendung zervikaler und lumbaler Bandscheibenprothesen sowie von Non-Fusion-Implantaten dargestellt.

Kernaussagen

• Zervikale Bandscheibenprothesen liefern im 5-Jahres-Verlauf ein annähernd gleichwertiges klinisches Ergebnis wie die klassische ACDF. Erwartungen hinsichtlich der Anschlussdegeneration konnten bislang allerdings nicht erfüllt werden.

• Lumbale Bandscheibenprothesen zeigen bislang keine Vorteile gegenüber der Spondylodese.

• Interspinöse Spreizer zeigen eine hohe Komplikationsrate und können aufgrund fehlender prospektiver Langzeitdaten derzeit nicht zur standardisierten Anwendung empfohlen werden.

• Die Evidenz zur Anwendung pedikelschraubengestützter dynamischer Stabilisierungssysteme muss bei derzeit fehlenden prospektiv-randomisierten Studien allgemein als niedrig bewertet werden. Darüber hinaus zeigt sich in den verfügbaren Daten eine vergleichsweise hohe Revisionsrate.

• Literatur

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