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Z Orthop Ihre Grenzgeb 2006; 144(1): 33-39
DOI: 10.1055/s-2005-918189
Wirbelsäule

© Georg Thieme Verlag Stuttgart · New York

Anatomische Reposition und monosegmentale Fusion bei hochgradiger dysplastischer Spondylolisthese L5/S1

Anatomic Reduction and Monosegmental Fusion for High-Grade Developmental Spondylolisthesis L5/S1M. Ruf1 , R. Melcher1 , H. Merk2 , J. Harms1
  • 1Orthopädie und Traumatologie, Wirbelsäulenchirurgie, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
  • 2Klinik für Orthopädische Chirurgie, Ernst-Moritz-Arndt-Universität, Greifswald, Germany
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Publication History

Publication Date:
23 February 2006 (online)

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Zusammenfassung

Einleitung: Die dysplastische Spondylolisthese führt zu einer segmentalen lumbosakralen Kyphosierung mit Retroversion des Sakrums, Hyperlordose der LWS und damit zu einer Beeinträchtigung des gesamten sagittalen Profils. Die Fehlstellung ist während des Wachstums progredient. Die vorliegende retrospektive Studie beschreibt eine operative Technik zur vollständigen Reposition und dokumentiert Ergebnisse. Patienten: 34 Patienten (Durchschnittsalter 16 J 3 M, 10 Männer, 24 Frauen) mit hochgradiger dysplastischer Spondylolisthese L5/S1 (Meyerding 3-5) wurden zwischen Februar 1997 und Juli 2002 operiert. Methode: Die Reposition wurde über eine temporäre transpedikuläre Instrumentation von L4 erzielt, die Schrauben bei L4 am Ende der Operation oder nach 12 Wochen entfernt. Ergebnisse: Der Gleitgrad wurde von durchschnittlich 76 % auf 10 % korrigiert, die segmentale Kyphose L5/S1 von + 21° auf - 7°. Die Sakruminklination betrug präoperativ 34°, postoperativ 43° und 47° bei der letzten Nachuntersuchung. 76 % der Patienten wurden vollständig beschwerdefrei. Bei 4 Patienten musste bei späterer Dekompensation eine Fusion L4/5 durchgeführt werden. Schlussfolgerung: Die beschriebene Operationstechnik ermöglicht eine nahezu anatomische Reposition mit Korrektur sowohl des Ventralgleitens als auch der segmentalen Kyphose. Die Korrektur der lokalen Fehlstellung mit nur monosegmentaler Fusion L5/S1 normalisiert die Gesamtstatik der Wirbelsäule. Das primär gesunde Segment L4/5 kann meist erhalten werden.

Abstract

Introduction: Developmental spondylolisthesis leads to lumbosacral kyphosis with retroversion of the sacrum and lumbar hyperlordosis. The overall sagittal profile of the spine is affected. The deformity is progressive during growth. This retrospective study describes a technique for complete reduction with clinical and radiological evaluation. Patients: Thirty-four patients (mean age 16 years 3 months, 10 males, 24 females) with severe developmental spondylolisthesis L5/S1 (Meyerding grades 3 to 5) were operated on between February 1997 and July 2002. Method: Reduction was achieved by temporary transpedicular instrumentation of L4. These screws were removed at the end of the operation or 12 weeks later. Results: Mean slippage was corrected from 76 % preoperatively to 10 % postoperatively. Segmental kyphosis L5/S1 improved from + 21° preoperatively to - 7° postoperatively. Sacral inclination was 34° preoperatively, 43° postoperatively, and 47° at latest follow-up. 76 % of the patients were pain free at the latest follow-up. In 4 patients a fusion at L4/5 was performed due to subsequent decompensation. Conclusion: The technique described allows for a nearly anatomic reduction with correction of slippage as well as segmental kyphosis. Correction of the local deformity with monosegmental fusion L5/S1 improves dramatically the overall sagittal profile of the spine. Fusion of the primarily healthy segment L4/5 can be avoided.

Schlüsselwörter

Spondylolisthese - Spondyloptose - dysplastische Spondylolisthese - kongenitale Spondylolisthesis - temporäre Instrumentation

Key words

spondylolisthesis - spondyloptosis - developmental spondylolisthesis - congenital spondylolisthesis - temporary instrumentation

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Michael Ruf

Klinikum Karlsbad-Langensteinbach

Guttmannstr. 1

76307 Karlsbad

Germany

Phone: (+49) 72 02-6 10

Fax: (+49) 72 02-61 61 66

Email: michael.ruf@kkl.srh.de