Indikationen zur Korrekturspondylodese bei degenerativer Spondylolisthesis

Zusammenfassung

Es gibt keinen allgemeingültigen Konsens über die Indikationen zur chirurgischen Therapie der degenerativen Spondylolisthesis. Dies liegt zumindest teilweise an der geringen Evidenz der vorliegenden Literatur und den begrenzten Kenntnissen zum natürlichen Verlauf und zu den Langzeitergebnissen konservativer Therapie. Neurologische Defizite und konservativ-therapieresistente Instabilitätsbeschwerden stellen absolute Indikationen dar. Neben der Dekompression neuraler Strukturen ist die Stabilisation der 2. integrale Bestandteil der Operation. Die Dekompression und instrumentierte Fusion stellt den Standard dar. Die Wahl des Operationsverfahrens ist aber eine Herausforderung angesichts der zahlreichen Techniken und Implantate. Der Operateur sollte seine Entscheidung für jeden Patienten individuell treffen, um allen spezifischen Besonderheiten Rechnung zu tragen. Der Artikel gibt einen Überblick über die derzeitige Evidenz bei der operativen Versorgung sowie die OP-Verfahren und soll auf diesem Wege die Therapieentscheidungen erleichtern.

Abstract

There is no general consensus about indications for surgical treatment of degenerative spondylolisthesis. This is – in part – due to a paucity of knowledge of its natural history and outcomes of conservative treatment, as well as a relatively small number of sufficiently powered outcome studies for surgical treatment. We aim to provide an overview of current surgical techniques and deduce indications based on two simple principles: presence of neurological deficits and instability. Today, decompression and instrumented fusion is the standard of care. However, the complete armamentarium of possible treatment options should be carefully considered, and the adequate procedures and instruments used should be chosen individually, when a decision to operate is made.

Key words

degenerative Spondylolisthesis - Fusion - Stabilisation - Dekompression - Spondylodese

Key words

degenerative lumbar spondylolisthesis - fusion - stabilisation - decompression - spondylodesis

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