Implantatspezifische Komplikationen aufgrund von Implantatfehllage – Ursachen, Vermeidungs- und Behandlungskonzepte

Zusammenfassung

Die häufigste implantatspezifische Komplikation ist die Pedikelschraubenfehllage thorakolumbal. Fehllagen als auch andere Komplikationen scheinen nach aktueller Datenlage jedoch eher selten geworden zu sein. Insbesondere schwere neurovaskuläre Komplikationen als auch die Notwendigkeit einer Schrauben-bedingten Revisions-Operation sind insgesamt gering. Es zeigt sich, dass der Einsatz moderner Techniken, insbesondere der spinalen Navigation zu einer Verbesserung der Genauigkeit, Sicherheit, Effektivität und Revisionsnotwendigkeit beiträgt. Die besten Ergebnisse scheint dabei die CT-Navigation zu erzielen. Neben der spinalen Navigation sind weitere nützliche technische Innovationen hinzugekommen, wie elektronische Konduktivitäts-Devices und patienten-spezifische 3D-gedruckte Führungsschablonen, die die Genauigkeit und Sicherheit bei spinaler Instrumentation ebenfalls verbessern können. Diese Arbeit gibt einen Überblick über die aktuelle Datenlage und neue innovative Techniken, die zu einer Verbesserung Implantat-spezifischer Komplikationen, insbesondere Schraubenfehllagen beitragen können und gibt praktische Tipps zur Verbesserung navigierter Eingriffe.

Abstract

The most frequent implant-specific complication is the pedicle screw misplacement in the thoracolumbar spine. According to the recent literature misplaced implants as well as other complications seem to have become rare. Especially severe neurovascular complications and the need for revision surgeries due to misplaced pedicle screws are rare. The use of modern technical devices, especially spinal navigation have led to an improvement of accuracy, safety, efficacy and revision rates. The CT navigation techniques seem to yield the best results. Besides spinal navigation other technical innovations such as electronical conductivity devices and patient-specific 3D-printed guides can further improve the accuracy and safety of spinal instrumentation.

This manuscript gives an overview of the recent data on implant-specific complications after spinal instrumentation and introduces new innovative techniques, that might improve implant-related complications, especially due to misplaced screws. Furthermore this work gives tips and tricks on how to improve navigated procedures.

Schlüsselwörter

Implantat-spezifische Komplikationen - Implantatfehllage - Implantatdislokation - neurovaskuläre Läsion - viszerale Läsion - Wirbelsäulenchirurgie - Wirbelsäuleninstrumentation - spinale Instrumentation - spinale Implantate - spinale Navigation - 3D-gedruckte Führungshülsen - Elektronisches Konduktivitäts Device

Keywords

Implant-specific complications - implant misplacement - implant dislocation - neurovascular injury - visceral injury - spine surgery - spinal instrumentation - spinal implants - spinal navigation - 3D-printed guides - electronic conductivity device

Publication History

Article published online:
17 May 2022

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