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.

Schlüsselwörter

Bandscheibendegeneration - Beweglichkeit - Bandscheibenendoprothese

Key words

Total disc replacement - range of motion - degenerative disc disease

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