Traumatische und posttraumatische Deformität der thorakalen und lumbalen Wirbelsäule

Zusammenfassung

Die frische traumatische Deformität der thorakalen und lumbalen Wirbelsäule bedarf einer gründlichen Analyse des Verletzungsmusters. Die systematische Anwendung von Frakturklassifikationen liefert ausreichend Hinweise auf die Instabilität der Fraktur. Die Art der erforderlichen Versorgung ist vom Ausmaß der Wirbelkörper- und Bandscheibendestruktion sowie der Verletzung der dorsal zuggurtenden Elemente der Wirbelsäule abhängig. Die Entwicklung neuer Operationsmethoden, wie der endoskopisch-assistierten Chirurgie, sowie besserer Implantate haben neue Ansätze für das Management von schweren Wirbelkörperfrakturen ermöglicht.

Die posttraumatische Kyphose entsteht infolge einer in Fehlstellung verheilten Fraktur oder nach Bildung einer Pseudarthrose. Abhängig vom Grad der zu korrigierenden Deformität stehen die Möglichkeiten einer anatomischen Rekonstruktion des Wirbelsäulenprofils über die kombinierten dorso-ventralen Zugänge und die dorsal verkürzenden Osteotomien wie Smith Petersen Osteotomie, Ponte Osteotomie oder Pedikelsubtraktionsosteotomie mit unterschiedlichem Korrekturpotential zur Auswahl. Mit einer individuellen Risikoanalyse und adäquaten Operationsplanung können die Komplikationen reduziert und zufriedenstellende Ergebnisse erreicht werden.

Abstract

Injuries of the thoracic and lumbar spine require proper analysis of the underlying trauma mechanism. The instability of the fracture could be depicting using fracture classification systems. Therapeutic strategies depend on the amount of damaged vertebral body, the spread of fragments on the fracture site, the lesion of the intervertebral disc and the extent of destruction on the dorsal elements.

Development of new implants and operative techniques such as video assisted endoscopic surgery offer new approaches for management of severe injuries of the thoracic and lumbar spine.

Posttraumatic kyphosis is a final sequel of untreated or even inadequate treatment of spine injuries. Therapeutic options depend on the amount of corrected traumatic kyphosis, the degree of the kyphotic angulations and location of deformity. Closing wedge osteotomies as Smith Petersen osteotomy, Ponte osteotomy or pedical subtraction osteotomy allow restoring the alignment through a dorsal approach. The anatomical realignment of the spine could be achieved through dorso-ventral reconstruction. Individual risk assessment and preoperative planning is mandatory to reduce perioperative complications and to achieve satisfactory results.

Schlüsselwörter

posttraumatische Deformität - Kyphose - thorakolumbale Wirbelkörperfraktur - Korrekturosteotomie der Wirbelsäule

Keywords

posttraumatic spinal deformity - kyphosis - fracture of thoracolumbar spine - osteotomy of the spine

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