Operative Ergebnisse der monosegmentalen ventralen Fusion mit Plattenosteosynthese bei der therapieresistenten chronischen Zervikobrachialgie

Zusammenfassung.

Einleitung: Bei der ventralen zervikalen Spondylodese ohne Plattenosteosynthese sind Komplikationen in Form von Spanresorptionen mit daraus resultierender Kyphosierung und Spandislokationen bekannt. Neben den radiologischen und klinischen Ergebnissen sollte diese Studie den Effekt der zusätzlichen Plattenosteosynthese auf das zervikale Alignment erfassen. Material und Methode: Es wurden die operativen Ergebnisse eines Kollektives von 44 Patienten mit therapieresistenten chronischen Zervikobrachialgien und radiologisch nachweisbaren degenerativen Veränderungen ermittelt, bei denen eine monosegmentale ventrale Spondylodese mit Plattenosteosynthese durchgeführt wurde. Neben den klinischen Ergebnissen wurden die radiologische Entwicklung der HWS-Lordose und die segmentale Kyphosierung evaluiert. Ergebnisse: Die Gesamtlordose verbesserte sich radiologisch von 15,4° auf 18,5° sowie der segmentale Winkel von 2,6° auf 7,7°. Ein segmentaler postoperativer Korrekturverlust ließ sich nicht nachweisen. Nach 12 Monaten waren 95 % und nach 36 Monaten 100 % sicher knöchern durchbaut. Klinisch besserten sich die Brachialgien deutlicher (80 %) als die lokalen Nackenschmerzen (66 %). Diskussion: Die Plattenosteosynthese verhindert erfolgreich die postoperative Kyphosierung und Spandislokation. Die klinischen Ergebnisse und Durchbauungsraten entsprechen dem Vorgehen ohne ergänzende Osteosynthese. Langzeitstudien sind zur Beurteilung des klinischen Verlaufs in Abhängigkeit von der segmentalen Kyphosierung erforderlich.

Introduction: In anterior cervical stabilization, collapsise of the grafted bone with resulting localized kyphosis and graft dislocation has been reported. It was the aim of this clinical trial to evaluate the benefit of additional plating while taking specific implant-related complications into account. Methods: The results of single level anterior cervical spinal fusion were evaluated. In 44 patients suffering from chronic cervical radicular pain with degenerative changes, arthrodesis with iliac-crest bone and plate fixation was performed. Apart from elinical parameters, the pre- and postoperative segmental kyphosis and cervical lordosis were evalualed. Results: The total cervical alignment increased from 15.4° to 18.5° while the alignment of the fused segment increased from 2.6° to 7.7°. Postoperative decrease of correction did not occur. Bony fusion was confirmed in 95 % after 12 months and 100 % aller 36 months. Our results show that patients had more relief from radicular pain (80 %) ihan from unspecific neck pain (66 %). Discussion: In single level anterior cervical fusion, additional plating successfully prevents dislocation of the bone graft and postoperative kyphosis. The clinical results and pseudarthrosis rate do not differ from studies without plating. Long. term follow-up studies are necessary to show the benefit of the reduced postoperative kyphosis.

Plattenosteosynthese - Halswirbelsäule - ventrale Spondylodese

Anterior plating - cervical spine - anterior spondylodesis

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