Minimalinvasive Chirurgie bei Wirbelsäulentrauma – Unterschiede der Versorgungstechniken zwischen jungen und alten Patienten

Zusammenfassung

Perkutane Versorgungen von Frakturen an der BWS und LWS sind weit verbreitet und haben die offenen Verfahren in vielen Fällen als Standard verdrängt. Hierbei kommen beim Knochengesunden der minimalinvasive Fixateur interne mittels monoaxialen Schrauben sowie der thorakoskopische ventrale (partielle) Wirbelkörperersatz bzw. mittels Mini-Lumbotomie unterhalb von LWK 2 zum Einsatz. Beim osteoporotischen Knochen kommen v.a. Zementaugmentationen der Wirbelkörper und/oder dorsale Stabilisierungen mittels perkutanem Fixateur interne mit polyaxialen Schrauben mit oder ohne Zementaugmentation der Pedikelschrauben zum Einsatz. Die Vorteile der minimalinvasiven Versorgungen sind der geringere Blutverlust, die niedrigere Komplikationsrate sowie der geringere postoperative Schmerz.

Abstract

Surgical treatment of spinal injuries has seen a strong shift toward minimally invasive surgical procedures over the past 10 years. It is evident from the literature that there are advantages to the minimally invasive procedures in terms of postoperative pain, blood loss, and cut suture time. Feared disadvantages such as insufficient reduction and retention can be avoided by correct indication and surgical technique. With this in mind, this narrative review presents standard procedures for minimally invasive stabilization of spine fractures. These are posterior fixation and anterior fusion procedures, which can also be applied in combination. Specific techniques such as short level posterior and long-segmental posterior instrumentation, hybrid-fixation, and throracoscopic anterior fusion are described. Another focus is on differentiating the presentation of surgical techniques depending on bone quality, for example, in osteoporosis and ankylozing changes. Here, too, it can be shown that minimally invasive stabilization can be performed safely. In particular, injuries in ankylozed spine can be stabilized minimally invasively without significant disadvantages.

Schlüsselwörter

Wirbelsäule - Fraktur - Operationstechniken - geriatrisch

Keywords

Spine - fracture - surgical technique - geriatric

Publication History

Article published online:
24 August 2023

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