Expertenkommentar: Zukunft der operativen Therapie degenerativer Wirbelsäulenerkrankungen – Verantwortung übernehmen

Zusammenfassung

Eine alternde Gesellschaft und eine steigende Inzidenz an degenerativen Wirbelsäulenerkrankungen muss ein Umdenken in unseren Köpfen bewirken. Massiv steigende OP-Zahlen, v. a. instrumentierter spinaler Fusions-Operationen an vorwiegend geriatrischen Patienten zeigen dies. Geriatrische Patienten benötigen eine besonders intensive medizinische Betreuung, idealerweise durch ein multidisziplinäres Team. Nicht nur die OP und die Nachsorge sind wichtige Bausteine für eine Reduktion der Komplikationsraten und ein gutes Outcome, sondern auch die präoperative Vorbereitung und Risikoabschätzung. Technische Innovationen (wie spinale Navigation, augmented/virtual reality und Robotik) können helfen, Ausmaß und Invasivität eines operativen Eingriffs so gering wie möglich zu halten. Register oder Big Data Analysen sowie flächendeckende Fortbildungsmöglichkeiten sind weitere Maßnahmen die Qualität der Versorgung von degenerativen Wirbelsäulenpatienten zu verbessern. Die Verantwortung hierfür liegt in unserer, aber auch in der Hand des Patienten.

Abstract

An aging society and a increasing incidence of degenerative spine diseases need to make us rethink. Massive increases in surgical procedures, esp. instrumented spinal fusions in predominantly geriatric patients indicate this. Geratric patients require intensive medical care ideally by a multidsciplinary team. Surgery and postoperative care are important corner stones to reduce complication rates and improve postoperative outcome. But, preoperative preparation and risk assessment are just as important. Technical innovations (such as spinal navigation, augmented/virtual reality and robotics) can help to reduce extent and invasiveness of surgical procedures to a minimum. Registries or big data as well as nationwide available training opportunities are additional measures to improve the quality of spinal care of degenerative spine disease patients. The responsibility to succeed rests in our´s as well as in the patientʼs hand.

Schlüsselwörter

geriatrisches Komanagement - Prehabilitation - Wirbelsäulenregister - neue Technologien - MIS (minimalinvasive Wirbelsäulenchirurgie)

Keywords

geriatric comanagement - prehabilitation - spine registry - emerging technologies - MIS (minimally-invasive spine surgery)

• Literatur

• 1 Klauber J, Geraedts M, Friedrich J. et al. (Hrsg.) Krankenhaus-Report 2013: Mengendynamik: mehr Menge, mehr Nutzen?. Schattauer GmbH; 2013. ISBN: 978-3-7945-2884-4
• 2 Deyo RA, Mirza SK, Martin BI. et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010; 303: 1259-1265
• 3 Salzmann SN, Derman PB, Lampe LP. et al. Cervical Spinal Fusion: 16-Year Trends in Epidemiology, Indications, and In-Hospital Outcomes by Surgical Approach. World Neurosurg 2018; 113: e280-e295
• 4 Kobayashi K, Ando K, Nishida Y. et al. Epidemiological trends in spine surgery over 10 years in a multicenter database. Eur Spine J 2018; 27: 1698-1703
• 5 Nanavati AJ, Prabhakar S. Fast-track surgery: Toward comprehensive peri-operative care. Anesth Essays Res 2014; 8: 127-133
• 6 Shamji MF, Goldstein CL, Wang M. et al. Minimally invasive spinal surgery in the elderly: does it make sense?. Neurosurgery 2015; 77 (Suppl. 04) S108-S115
• 7 Kim HJ, Lee KY, Wang L. Complications and outcomes of surgery for degenerative lumbar deformity in elderly patients. Orthopedic Research and Reviews 2014; 6: 11-15
• 8 Transfeldt EE, Topp R, Mehbod AA. et al. Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. Spine 2010; 35: 1872-1875
• 9 Epstein NE. Spine surgery in geriatric patients: Sometimes unnecessary, too much, or too little. Surg Neurol Int 2011; 2: 188
• 10 Fu KM, Smith JS, Poly DW. et al. Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery. J Neurosurg Spine 2011; 14: 470-474
• 11 Yadla S, Malone J, Campbell PG. et al. Obesity and spine surgery: Reassessment based on a prospective evaluation of perioperative complications in electivedegenerative thoracolumbar procedures. Spine J 2010; 10: 581-587
• 12 Campbell PG, Yadia S, Malone J. et al. Early complications related to approach in cervical spine surgery: Single-center prospective study. World Neurosurg 2010; 74: 363-368
• 13 Campbell PG, Malone J, Yadla S. et al. Early complications related to approach in thoracic and lumbar spine surgery: A single center prospective study. World Neurosurg 2010; 73: 395-401
• 14 Hartin NL, Mehbod AA, Joglekar SB. et al. Fusion risk score. Evaluating fusion risk for thoracic and lumbar fusion surgery. Spine (Phila Pa 1976) 2013; 38: E1616-E1623
• 15 Mok JM, Cloyd JM, Bradford DS. et al. Reoperation after primary fusion for adult spinal deformity: rate, reason, and timing. Spine (Phila Pa 1976) 2009; 15: 832-839
• 16 Gussous Y, Than K, Mummanemi P. et al. Appropriate use of limited interventions vs extensive surgery in the elderly patient with spinal disorders. Neurosurgery 2015; 77 (Suppl. 04) S142-S163
• 17 Theusinger OM, Spahn DR. Perioperative blood conservation strategies for major spine surgery. Best Pract Res Clin Anaesthesiol 2016; 30: 41-52
• 18 Salvetti DJ, Tempel ZJ, Goldschnidt E. et al. Low preoperative serum prealbumin levels and the postoeprative surgical site infection risk in elective spine surgery: a consecutive series. J Neurosurg Spine 2018; 29: 549-552
• 19 Hornor MA, Ma M, Zhou L. et al. Enhancing the American College of Surgeons NSQIP Surgical Risk Calculator to predict geriatric outcomes. J Am Coll Surg 2019; S1072-7515 (19): 32120-32129
• 20 Yanamadala V, Kim Y, Buchlak QD. et al. Multidisciplinary evaluation leads to the decreased utilizatio of lumbar spine fusion: A observational cohort pilot study. Spine (Phila Pa 1976) 2017; 42: E1016-E1023
• 21 Adogwa O, Elsamadicy AA, Vuong VD. et al. Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience. J Neurosurg Spine 2017; 27: 670-675
• 22 Lindbäck Y, Tropp H, Enthoven P. et al. PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial. Spine J 2018; 18: 1347-1355
• 23 Nielsen PR, Andreasen J, Asmussen M. et al. Costs and quality of lif for prehabilitation and early rehabilitation after surgery of the lumbar spine. BMC Health Serv Res 2008; 8: 209
• 24 Barzilai O, Fisher CG, Bilsky MH. State of the Art Treatment of Spinal Metastatic Disease. Neurosurgery 2018; 82: 757-769
• 25 Kumar H, Ha D-H, Lee E-J. et al. Safety and tolerability of intradiscal implantation of combined autologous adipose-derived mesenchymal stem cells and hyaluronic acid in patients with chronic discogenic low back pain: 1-year follow-up of a phase I study. Stem Cell Res Ther 2017; 8: 262
• 26 Comella K, Silbert R, Parlo M. Effects of the intradiscal implantation of stromal vascular fraction plus platelet rich plasma in patients with degenerative disc disease. J Transl Med 2017; 15: 12
• 27 Pettine KA, Murphy MB, Suzuki RK. et al. Percutaneous Injection of autologous bone marrow concentrate cells significantly reduces lumbar discogenic pain through 12 months: autologous bmc injection reduces discogenic pain. Stem Cells 2015; 33: 146-156
• 28 Elabd C, Centeno CJ, Schultz JR. et al. Intra-discal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: a long-term safety and feasibility study. J Transl Med 2016; 14: 253
• 29 Noriega DC, Ardura F, Hernández-Ramajo R. et al. Intervertebral disc repair by allogeneic mesenchymal bone marrow cells: a randomized controlled trial. Transplantation 2017; 101: 1945-1951
• 30 Orozco L, Soler R, Morera C. et al. Intervertebral disc repair by autologous mesenchymal bone marrow cells: a pilot study. Transplantation 2011; 92: 822-828
• 31 Loibl M, Wuertz-Kozak K, Vadala G. et al. Controversies in regenerative medicine: Should intervertebral disc degeneration be treated with mesenchymal stem cells?. JOR Spine 2019; 2: e1043
• 32 Overley SC, Cho SK, Mehta AI. et al. Navigation and Robotics in Spinal Surgery: Where Are We Now?. Neurosurgery 2017; 80: S86-S99
• 33 Madhavan K, Kolcun JPG, Chieng LO. et al. Augmented-reality integrated robotics in neurosurgery: are we there yet?. Neurosurg Focus 2017; 42 : E3