Sagittales Alignement und segmentale Beweglichkeit nach endoprothetischer Versorgung lumbaler Bewegungssegmente

Zusammenfassung

Studienziel: Um Veränderungen von statischen und dynamischen Messwerten nach Implantation von Bandscheibenprothesen (BSP) zu evaluieren, wurden die Röntgenbilder von Patienten mit endoprothetischem Ersatz der lumbalen Bewegungssegmente prä- und postoperativ miteinander verglichen. Methode: Bei 22 Patienten mit 24 implantierten BSP (ProDisc®, Spine Solutions), wurden die präoperativen und postoperativen seitlichen Röntgenbilder ausgewertet. Gemessen wurden die Bandscheibenhöhe, der Segmentwinkel, die Gesamtlendenlordose und dieÂ’Beweglichkeit im operierten Segment. Ergebnisse: Postoperativ konnten eine signifikante Erhöhung der vorderen (prä: 9,0 ± 3,4 mm; post: 16,7 ± 2,4 mm; p < 0,001) und hinteren (prä: 4,4 ± 1,3 mm; post: 8,8 ± 1,3 mm; p < 0,001) Bandscheibenhöhe und eine Verstärkung der segmentalen Lordose (prä: 20° ± 7,2°; post: 27,7° ± 7,4°; p < 0,001) festgestellt werden. Der Gesamtlordosewinkel (prä: 56,2° ± 10,7°; post: 58,6° ± 9,3°; p = 0,196) und die Beweglichkeit im operierten Segment (prä: 5,0° ± 4,0°; post: 5,9° ± 3,5°; p = 0,293) zeigten keine statistisch signifikanten Veränderungen. Schlussfolgerung: Der endoprothetische Ersatz des lumbalen Bewegungssegmentes mit dem untersuchten Prothesendesign führt zu einer signifikanten Erhöhung der Bandscheibenhöhe ohne Verbesserung der Beweglichkeit. Die signifikante Verstärkung der segmentalen Lordose bei unveränderter Gesamtlendenlordose bewirkt eine veränderte Einstellung der Anschlusssegmente.

Abstract

Aim: To evaluate changes in static and dynamic values, X-rays of patients who underwent total disc replacement for degenerative disc disease were analyzed. Method: An analysis of pre- and postoperative lateral X-rays in 22 patients with 24 total disc replacements (Prodics®, Spine Solutions) was performed. The total lumbar lordosis, the segmental lordosis angle, the disc height and the range of motion in the operated level were measured. Results: Postoperatively a significant increase was observed for the following parameters: the anterior (pre: 9.0 ± 3.4 mm; post: 16.7 ± 2.4 mm; p < 0.001) and posterior (pre: 4.4 ± 1.3 mm; post: 8.8 ± 1.3 mm; p < 0.001) disc height and the segmental lordosis angle (pre: 20° ± 7.2°; post: 27.7° ± 7.4°; p < 0.001). Statistically no significant changes could be observed postoperatively for the total lumbar lordosis (pre: 56.2° ± 10.7°; post: 58.6° ± 9.3°; p = 0.196) and the range of motion (pre: 5.0° ± 4.0°; post: 5.9° ± 3.5°; p = 0.293). Conclusion: Total disc replacement for degenerative disc disease of the lumbar spine with the current concept does not alter the range of motion but significantly increases the disc height. The significant increase in segmental lordosis without a change in the total lumbar lordosis accounts for a change in lordosis in adjacent segments.

Bandscheibendegeneration - Beweglichkeit - Bandscheibenendoprothese

Total disc replacement - range of motion - degenerative disc disease

Literatur

• 1 Akamura T, Kawahara N, Yoon T, Minamide A, Kim K S, Tomita K, Hutton W C. Adjacent segment motion after a simulated lumbar fusion in different sagittal alignments.  Spine. 2003;  28 1560-1566
• 2 Bertagnoli R, Kumar S. Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications.  Eur Spine J. 2002;  11 131-136
• 3 Dabbs V M, Dabbs L G. Correlation between disc height narrowing and low-back pain.  Spine. 1990;  15 1366-1369
• 4 de Kleuver M, Oner F C, Jacobs W C. Total disc replacement for chronic low back pain: background and a systematic review of the literature.  Eur Spine J. 2003;  12 108-116
• 5 Dvorak J, Panjabi M M, Chang D G, Theiler R, Grob D. Functional radiographic diagnosis of the lumbar spine. Flexion-extension and lateral bending.  Spine. 1991;  16 562-571
• 6 Dvorak J, Panjabi M M, Grob D, Novotny J E, Antinnes J A. Clinical Validation of Functional Flexion/Extension Radiographs of the Cervical Spine.  Spine. 1993;  18 943-950
• 7 Gelb D E, Lenke L G, Bridwell K H, Blanke K, McEnery K W. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers.  Spine. 1995;  20 1351-1358
• 8 Gilad I, Nissan M. A Study of Vertebra and Disc Geometric Relations of the Human Lumbar and Cervical Spine.  Spine. 1986;  11 154-157
• 9 Gödde S, Ekkehard F, Dienst M, Kohn D. Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion.  Spine. 2003;  28 1693-1699
• 10 Gregersen G G, Lucas D B. An in Vivo Study of the Axial Rotation of the Human Thoracolumbar Spine.  J Bone Joint Surg [Am]. 1967;  49 247-262
• 11 Haher T R, Bergman M, O'Brien M, Felmly W T, Choueka J, Welin D, Chow G, Vassiliou A. The effect of the three columns of the spine on the instantaneous axis of rotation in flexion and extension.  Spine. 1991;  16 312-318
• 12 Hayes M A, Howard T C, Cruel C R, Kopta J A. Roentgenographic Evaluation of Lumbar Spine Flexion-Extension in Asymptomatic Individuals.  Spine. 1986;  14 327-331
• 13 Hopf C, Heeckt H, Beske C. Der Bandscheibenersatz mit der SB Charité-Bandscheibenendoprothese - Erfahrungen, Frühergebnisse und Feststellungen nach 35 prospektiv durchgeführten Operationen.  Z Orthop. 2002;  140 485-491
• 14 Kimura S, Steinbach G C, Watenpaugh D E, Hargens A R. Lumbar spine disc height and curvature responses to an axial load generated by a compression device compatible with magnetic resonance imaging.  Spine. 2001;  26 2596-2600
• 15 Jackson R P, McManus A C. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study.  Spine. 1994;  19 1611-1618
• 16 Kostuik J P, Maurais G R, Richardson W J, Okajima Y. Combined single stage anterior and posterior osteotomy for correction of iatrogenic lumbar kyphosis.  Spine. 1988;  13 257-266
• 17 La Grone M O. Loss of lumbar lordosis. A complication of spinal fusion for scoliosis.  Orthop Clin North Am. 1988;  19 383-393
• 18 Lee C K. Accelerated Degeneration of the Segment Adjacent to a Lumbar Fusion.  Spine. 1988;  13 375-377
• 19 Luk K D, Lee F B, Leong J C, Hsu L C. The effect on the lumbosacral spine of long spinal fusion for idiopathic scoliosis. A minimum 10-year follow-up.  Spine. 1987;  12 996-1000
• 20 Magora A. Investigation of the relation between low back pain and occupation. IV physical requirements: bending, rotation, reching and sudden maximal effort.  Scand J Rehabil Med. 1973;  5 186-190
• 21 Mayer H M, Korge A. Non-fusion technology in degenerative lumbar spinal disorders: facts, questions, challenges.  Eur Spine J. 2002;  11 85-91
• 22 Mayer H M, Wiechert K, Korge A, Qose I. Minimally invasive total disc replacement: surgical technique and preliminary clinical results.  Eur Spine J. 2002;  11 124-130
• 23 Nissan M, Gilad I. The Cervical and Lumbar Vertebrae-an Anthropometric Model.  Eng Med. 1984;  13 111-114
• 24 Panjabi M M, Goel V K, Takata K. Physiologic strains in the lumbar spinal ligaments. An in vitro biomechanical study 1981 Volvo Award in Biomechanics.  Spine. 1982;  7 192-203
• 25 Pearcy M, Portek I, Shepherd J. Three-Dimensional X-ray Analysis of Normal Movement in the Lumbar Spine.  Spine. 1984;  9 294-297
• 26 Schlegel J D, Smith J A, Schleusener R L. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions.  Spine. 1996;  21 970-981
• 27 Shufflebarger H L, Clark C E. Thoracolumbar osteotomy for postsurgical sagittal imbalance.  Spine. 1992;  17 287-290
• 28 Splithoff C. Lumbosacral junction, roentgenographic comparison of patients with and without backaches.  JAMA. 1953;  152 1610-1613
• 29 Stagnara P, De Mauroy J C, Dran G, Gonon G P, Costanzo G, Dimnet J, Pasquet A. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis.  Spine. 1982;  7 335-342
• 30 Tibrewal S B, Pearcy M J. Lumbar intervertebral disc heights in normal subjects and patients with disc herniation.  Spine. 1985;  10 452-454
• 31 Tibrewal S B, Pearcy M J, Portek I, Spivey J, Chir B. A Prospective Study of Lumbar Spinal Movements Before and After Discectomy Using Biplanar Radiography - Correlation of Clinical and Radiographic Findings.  Spine. 1985;  10 455-460
• 32 Umehara S, Zindrick M R, Patwardhan A G, Havey R M, Vrbos L A, Knight G W, Miyano S, Kirincic M, Kaneda K, Lorenz M A. The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments.  Spine. 2000;  25 1617-1624
• 33 Von Lackum H. The lumbosacral region.  JAMA. 1924;  82 1109
• 34 Voutsinas S A, MacEwen G D. Sagittal profiles of the spine.  Clin Orthop. 1986;  210 235-242