Künstliche Bandscheibe in der Lendenwirbelsäule – Hype oder Hope?

Der künstliche Ersatz einer lumbalen Bandscheibe hat für anhaltende Kontroversen gesorgt, dabei gibt es in der Wirbelsäulenchirurgie praktisch keine andere operative Technik mit einem Implantat, über die mehr und bessere Studien durchgeführt wurden. Trotzdem wird die Diskussion häufig immer noch emotional geführt. Während im Bereich der großen Gelenke der Extremitäten heute kein Zweifel mehr an der Effektivität des künstlichen Gelenkersatzes besteht, ist die Situation an der lumbalen Wirbelsäule noch nicht abschließend geklärt.

Kernaussagen

• Die lumbale Bandscheibenprothetik ist ein sicheres und wirksames Verfahren.

• Die sinnvollste Indikation stellt der axiale, lumbale Rückenschmerz bei monosegmentaler Bandscheibendegeneration dar.

• Im Vergleich zur Fusion ergeben sich in den ersten 2 Jahren Vorteile im Hinblick auf VAS (Visuelle Analogskala zur Schmerzmessung), ODI (Oswestry Disability Index) und Hospitalisationszeit.

• Bei Beachtung der Indikationen und Kontraindikationen werden klinisch gute Ergebnisse auch nach bis zu 10 Jahren beobachtet.

• Im Vergleich zur Fusion lassen sich die Raten an Anschlussdegenerationen und Facettenarthrosen nach aktuellem Wissensstand mit einer Prothese nicht senken.

• Die Komplikations- und Revisionsraten entsprechen denen der Fusionsoperationen.

• Bisegmentale Versorgungen führen zu schlechteren Ergebnissen als monosegmentale.

• Aufgrund der zahlreichen Kontraindikationen kommt nur ein geringer Anteil von Patienten für die Prothese in Frage.

Schlüsselwörter

Bandscheibenersatz - Wirbelsäulenchirurgie - Lumbalgie - LWS

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