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
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Priv.-Doz. Dr. Ulrich QuintChefarzt Orthopädisch-Traumatologisches Zentrum
St. Marien-Hospital Hamm
Nassauerstraße 13-19
D-59069 Hamm
