Minimal Invasive Teil-Korporektomie von direkt lateral – Erfahrungen an einer Serie von 45 Patienten

Zusammenfassung

Hintergrund Der direkt laterale Zugangsweg hat in den letzten Jahren zunehmend an Popularität gewonnen. Er könnte neben der Diskektomie aber auch für Teil-Korporektomien an der thorakolumbalen Wirbelsäule genutzt werden. Wir präsentieren hiermit nun unsere Erfahrung der letzten 5 Jahre (2012 – 2017).

Methoden Es wurde retrospektiv unsere Datenbank ausgewertet, die ab 2012 kurz nach Markteinführung alle Patienten erfasste. Es wurden prä- und postoperative CT- und Röntgenaufnahmen in unserem PACS-System gespeichert. Die Patienten wurden 3 Monate nach der Operation erneut in unserer Ambulanz gesehen und das klinische Outcome bestimmt. Eine Vergleichsgruppe konnte für die Schmerzanalyse bei Patienten mit Metastasen an der Wirbelsäule gebildet werden, da nicht alle Patienten über denselben Zugang in dem Zeitraum operiert wurden.

Ergebnisse Im Zeitraum zwischen März 2012 und März 2017 wurden 45 Patienten in den Höhen Th7 bis L4 operiert. Bei 30 Patienten waren spinale Metastasen die Indikation und bei 15 Patienten lag eine Berstungsfraktur zugrunde. Im gleichen Zeitraum wurde bei 8 Patienten eine Kostotransversektomie als operativer Zugang zur Resektion von osteolytischen Metastasen an der Wirbelsäule durchgeführt. Bei 88 % der Patienten konnte eine 90 %-Deckplattenabdeckung erreicht werden. In der Vergleichsanalyse zeigte sich, dass die Patienten, die sich einem minimalinvasiven lateralen Zugang unterzogen, einen signifikant geringeren kombinierten Blutverlust und weniger unmittelbar postoperative Schmerzen hatten. Neurologische Komplikationen erlitten 6 Patienten (13 %). Implantatassoziierte Komplikationen wurden in 7 Fällen (15 %) beobachtet, davon 5 revisionspflichtig.

Schlussfolgerung Unsere Serie untersucht anhand von 45 Patienten die mini-open direkt laterale Teil-Korporektomie. Diese Technik ist ein wertvolles minimalinvasives Zugangsverfahren für Tumoren und Frakturen der Wirbelsäule insbesondere bei Wirbelkörperdestruktionen mit der Möglichkeit einer exzellenten Deckplattenabdeckung durch das lateral eingebrachte Implantat. Weitere Nachuntersuchungen und Erfahrungen sind notwendig, um das Indikationsspektrum sowie die Langzeitergebnisse zu untersuchen.

Abstract

Objektive Contemporary techniques in spine surgery have emerged in recent years, enabling less traumatic access via the lateral approach. We used a novel mini open approach to treat thoracolumbar burst fractures and palliate metastases. We present our experience of 45 cases performed in the last 5 years.

Methods We analyzed our local single center prospectively acquired database and assessed pre- and post operative radiographs or CT scans. Follow-up length, OR time, estimated blood loss (EBL), endplate-surface bone-implant coverage, screw augmentation, new neurologic deficits and post-op complications (including dysesthesias and motor deficits) were recorded. Clinical outcome was assessed at the 3-month follow-up visit. A comparison group was assembled with our local spine database with patients who had a corpectomy done via a posterior approach in the same time period.

Results 45 patients were included. Mean follow up was 18,3 months (range 1 – 25). Mean OR time was 197 min (range 110 – 275 min). Over 90 % endplate surface bone-on-implant coverage was achieved in 88 %. 13 % of patients had neurologic complications. Seven cases (15 %) had implant failure and implant dislocation. The group of patients with metastasis who underwent the mini open approach had significantly less estimated blood loss than a group of patients with metastasis who underwent a costotransversectomy (p < 0.001).

Conclusion This is a large series of mini open direct lateral corpectomy. It may be a valuable minimally invasive access tool in spine surgery for neoplastic and traumatic indications with an excellent bone-on-implant coverage.

Schlüsselwörter

Korporektomie - Maxcess - XLIF

Keywords

corpectomy - XLIF - lateral access extreme lateral approach - minimally invasive spine surgery

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