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DOI: 10.1055/s-2004-836250
© Georg Thieme Verlag Stuttgart · New York
Follow-up-Studie nach dynamischer und statischer Stabilisierung der lumbalen Wirbelsäule
Follow-up Study after Dynamic and Static Stabilisation of the Lumbar SpinePublikationsverlauf
Publikationsdatum:
08. März 2005 (online)
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Zusammenfassung
Einleitung: Als Behandlungsoption für die lumbale Instabilität und ihre pathologischen Folgeerkrankungen ist als operative Therapieoption die dorsoventrale Fusion mit Fixateur interne etabliert. Eine neuere Therapieoption stellt die dynamische Stabilisierung der lumbalen Wirbelsäule durch die Ligamentoplastie nach Graf dar. Studienziel: Wir untersuchten beide Stabilisierungsmethoden im Follow-up-Vergleich. Methodik: 52 Patienten wurden präoperativ und durchschnittlich 79 Monate postoperativ, klinisch und radiologisch nach erfolgter Segmentfusion oder Ligamentoplastie nach Graf (jeweils 26 Fälle), untersucht. Es kamen der Oswestry-Score, der Low-Back-Outcome-Score (LBOS), die Visual Analogue Scale, der Mimura- und Pathria-Score zur Anwendung. Ergebnisse: Im klinischen Vergleich ergaben sich keine statistisch signifikanten Unterschiede. Die Differenz der Wertpaare hinsichtlich der Schmerzreduktion innerhalb beider Gruppen war statistisch signifikant (p < 0,001). Kein präoperativer Parameter für eine Entscheidung zugunsten eines der Therapieverfahren war nachweisbar. Schlussfolgerung: Beide Stabilisierungsmethoden der lumbalen Wirbelsäule zeigten vergleichbare klinische Resultate.
Abstract
Introduction: The clinical indication for graf's ligamentoplasty and dorsoventral fusion may be described as the “lumbar instability syndrome”. A follow-up comparison between Graf's ligamentoplasty and instrumental dorsoventral fusion in a consecutive series of 52 patients was performed. Methods: 52 patients operated on for low back pain were recalled for a clinical and radiological review (at mean 79 months postoperatively). 26 patients underwent Graf' ligamentoplasty and 26 patients underwent dorsoventral fusion. We evaluated the surgical results and measured an objective outcome using the Oswestry Score, Low Back Outcome Score (LBOS) and Visual Analogue Scale (VAS). For radiological evaluation the Mimura and the Pathria Scores were used. Results: There was no statistically significant difference between the two groups, when measured by the Oswestry Score, LBOS and VAS at the latest follow-up. The difference between the preoperative and actual VAS in each group was statistically significant (p < 0.001). Furthermore, there was no provable preoperative parameter in favour of either one of these therapies. Conclusion: Both methods for stabilisation methods of the lumbar spine had a comparable clinical outcome.
Schlüsselwörter
Graf-Ligamentoplastie - lumbale Segmentfusion - Bandscheibendegeneration - Nachuntersuchung
Key words
Graf ligamentoplasty - lumbar spine fusion - disc degeneration - low back pain - follow-up
Literatur
- 1 Bernhardt M, Swartz D E, Clothiaux P L, Crowell R P, White A A. Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clin Orthop. 1992; 284 109-115
- 2 Dawson E G, Lotysch M, Urist M R. Intertransverse process lumbar athrodesis with autogenous bone graft. Clin Orthop. 1981; 154 90-96
- 3 Fairbank J C, Cooper J, Davies J B, O'Brien J P. The Oswestry Low Back Pain Disability Questionaire. Physiotherap. 1980; 66 271-273
- 4 Frymoyer J W. Segmental instability. Overview and Classification. In: Frymoyer JW (Hrsg.). The adult spine: Principles and Practice. Raven Press, New York 1991; 1873-1891
- 5 Frymoyer J W. The role of spine fusion. Spine. 1981; 6 284-290
- 6 Gardner A, Declerk G M, Hardcastle P, Markwalder T M, Moon M S, Salanova C, Shim Y S. Re: The Graf ligamentoplasty procedure: Comparison with posterolateral fusion in the management of low back pain (letter). Spine. 2000; 25 273-276
- 7 Gardner A, Pande K C. Graf ligamentoplasty: a 7-year follow-up. Eur Spine J. 2002; 11 157-163
- 8 Graf H. Lumbar instability. Surgical treatment without fusion: soft system stabilisation. Rachis. 1992; 412 123-137
- 9 Greenough C G, Fraser R D. Assessment of outcome in patients with low back pain. Spine. 1992; 17 36-41
- 10 Grevitt M P, Gardner A DH, Spilsbury J, Shackleford I M, Baskerville R, Pursell L M, Hassaan A, Mulholland R C. The Graf stabilisation system: early results in 50 patients. Eur Spine J. 1995; 4 169-175
- 11 Hadlow S V, Fagan A B, Hillier T M, Fraser R D. The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low back pain. Spine. 1998; 23 1172-1179
- 12 Hanley E N, Phillips E D, Kostuik J P. Who should be fused?. In: Frymoyer JW (Hrsg.). The adult spine: Principles and Practice. Raven Press, New York 1991; 1873-1917
- 13 Hashimoto T, Oha F, Shigenobu K, Kanayama M, Harada M, Ohkoshi Y, Tada H, Yamamoto K, Yamane S. Mid-term clinical results of Graf stabilization for lumbar degenerative patholgies. A minimum 2-year-follow-up. Spine. 2001; 1 283-289
- 14 Herkowitz H N. Lumbar spine stenosis: indication for athrodesis and spinal instrumentation. In: Schäfer M (Hrsg.). Instructional course lectures. American Academy of Orthopaedic surgeons, Chicago 1994; 424-433
- 15 Hibbs R A. An operation for progressive spinal deformities: a preliminary report of three cases from the service of the orthopaedic hospital. Clin Orthop 1964; 35: 4-8. (Der Originalartikel wurde publiziert im New York Medical Journal 93: 1013, 1911. I.)
- 16 Kähler W M. Einführung in die Datenanalyse für die aktuelle Version. Version 8.0. 4., überarbeitete und erweiterte Auflage. Vieweg-Verlag, Braunschweig, Wiesbaden 1998
- 17 Kanayama M, Hashimoto T, Shigenobu K, Harada M, Oha F, Ohkoshi Y, Tada H, Yamamoto K, Yamane S. Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion. J Neurosurg. 2002; 95 5-10
- 18 Krag M H. Spinal Fusion. Overview of options and posterior internal fixation devices. In: Frymoyer JW (Hrsg.). The adult spine: Principles and Practice. Raven Press, New York 1991; 1919-1945
- 19 Legaye J, de Cloedt P H, Emery R. La stabilisation intervertébrale souple selon Graf. Bilan d'utilisation et apports de la technique. Acta Orthop Belg. 1994; 60 393-401
- 20 Markwalder T M, Dubach R, Braun M. Soft system stabilisation of the lumbar spine as an alternative surgical modality to lumbar athrodesis in the facet syndrome. Acta Neurochir. 1995; 134 1-4
- 21 Markwalder T M, Wenger M. Dynamic stabilization of lumbar motion segments by use of Graf's ligaments. results with an average follow up of 7.4 years in 39 highly selected, consecutive patients. Acta Neurochir. 2003; 145 209-214
- 22 Mimura M, Panjabi M M, Oxland T R, Crisco J J, Yamamoto I, Vasavada A A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine. 1994; 19 1371-1380
- 23 Pathria M, Sartoris D J, Resnik D. Osteoathritis of facet joints: Accuracy of oblique radiographic assessment. Radiology. 1987; 164 227-230
- 24 Quint U, Wilke H J, Löer F, Claes L E. Laminectomy and functional impairment of the lumbar spine: the importance of muscle forces in flexible and rigid instrumented stabilisation - a biomechanical study in vitro. Eur Spine J. 1998; 7 229-238
- 25 Schlegel J, Yuan H A, Fredericksen B. Interior interbody fixation devices. In: Frymoyer JW (Hrsg.). The adult spine: Principles and Practice. Raven Press, New York 1991; 1947-1959
- 26 Sidhu K S, Herkowitz H N. Spinal instrumentation in the management of degenerative disorders of the lumbar spine. Clin Orthop. 1997; 335 39-53
- 27 Sonntag V KH, Marciano F F. Is fusion indicated for lumbar spinal disorders. Spine. 1995; 20 138-142
- 28 Strauss P J, Novotny J E, Wilder D G, Grobler L J, Pope M H. Multidirectional stability of the Graf system. Spine. 1994; 19 965-972
- 29 Thomsen K, Christensen F B, Eiskjaer S P, Hansen E S, Fruensgaard S, Bünger C E. The effect of pedicle screw instrumentation on functional outcome and fusion rates in postero-lateral lumbar spine fusion: a prospective, randomized clinical study. Spine. 1997; 22 2813-2822
- 30 Yuan H A, Garfin S R, Dickman C A, Mardjetko S M. A historical cohort study of pedicle screw fixation in thoracic, lumbar and sacral spinal fusion. Spine. 1994; 20 2279-2296
Priv.-Doz. Dr. Ulrich QuintChefarzt Orthopädisch-Traumatologisches Zentrum
St. Marien-Hospital Hamm
Nassauerstraße 13-19
D-59069 Hamm