Einsatz der spinalen Navigation in der Wirbelsäulenchirurgie – Kontra

Widmung

Meinem verehrten früheren Chef und Doktorvater, Herrn Univ.- Prof. Dr. med. Winfried Winkelmann zum 75. Geburtstag

Zusammenfassung

Instrumentierte spinale Fusionen in der Wirbelsäulenchirurgie sind häufig durchgeführte operative Eingriffe bei verschiedensten Pathologien und werden in allen Bereichen der Wirbelsäule angewandt. Das freihändige Setzen von Pedikelschrauben nach Identifikation zuverlässiger, anatomischer Landmarken mit intraoperativer fluoroskopischer Kontrolle ist ein standardisiertes, anerkanntes und in der Literatur vielfach beschriebenes Vorgehen mit relativ geringen Komplikationsraten. Neuere Verfahren ersetzen die freihändige Technik mit Röntgen- oder CT-basierten Navigationssystemen. Diese werden insbesondere von der Industrie als bedeutend risikoärmere und exaktere Verfahren beworben, wobei sie diesen Nachweis bisher schuldig geblieben sind. Ein beispielhafter Vergleich unserer Daten bei Skoliosen, die mit Freihandtechnik instrumentiert wurden, mit Daten von CT-gestützt eingebrachten Pedikelschrauben aus einer anderen Studie belegt eine etwa 10-fach erhöhte Strahlenbelastung in der navigierten Studie, was gerade bei jugendlichen Patienten inakzeptabel ist, zumal in der Freihandtechnik in keinem einzigen Fall eine schraubenassoziierte Komplikation auftrat und auch in den letzten 8 Jahren bei insgesamt 472 Skoliosen nicht aufgetreten ist. Auch sind die Sachkosten und der Zeitaufwand bei Navigation unverhältnismäßig höher. Entscheidend für ein optimales Outcome bei der Freihandtechnik ist eine exzellente Ausbildung der Wirbelsäulenchirurgen mit exakter Kenntnis der Anatomie bzw. Pathoanatomie.

Abstract

Instrumented spinal fusion in spine surgery are routinely performed surgical procedures of various pathologies and are done in all areas of the spine. The freehand techniques of pedicle screw positioning after identification of valid anatomical landmarks with intraoperative fluoroscopic imaging is a standardised , recognised and often published technique with relatively low complication rates. New techniques substitute the freehand technique with x-ray or CT-based navigation systems. These are especially advertised by industry as being less risky and more accurate. This has yet to be proved. An exemplary comparison of our data of scoliosis patients, who were instrumented by freehand technique with scoliosis patients of another published series, whose pedicle screws were inserted with CT-guided imaging demonstrated a 10 times higher radiation exposure within the navigated series, which is especially for adolescent patients inacceptably high. No screw related complications occurred within the freehand study and also have not occurred in a consecutive series of 472 scoliosis patients over the past 8 years. In addition in navigated procedures material costs are much higher and the procedures are more time consuming. Concerning use of freehand technique excellent education of spine surgeons with exact knowledge of pathoanatomy are critical for an optimal outcome.

Schlüsselwörter

spinale Navigation - Wirbelsäulenchirurgie - Instrumentation

Keywords

spinal navigation - spine surgery - instrumentation

• Literatur

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