„Iatrogenes Wirbelgleiten – Inzidenz, Risikofaktoren, Management“

Zusammenfassung

Iatrogenes Wirbelgleiten ist eine Subform der Olisthese nach erfolgter Wirbelsäulenoperation und wurde 1989 in die Klassifikation nach Wiltse, Newman und McNab hinzugefügt. Als Ursache werden in erster Linie die Entfernung der dorsalen ossären sowie ligamentären Strukturen nach Dekompressionsoperationen sowie die iatrogene Spondylolyse nach Fusionsoperationen beschrieben. Die Inzidenz wird in der Literatur mit einer Spannweite von 3,7 bis 20 % nach erfolgter Wirbelsäulenoperation angegeben. Folgende Risikofaktoren sind unter anderem für die iatrogene Olisthese in der Literatur erwähnt: präoperativ bestehende Olisthese, Beweglichkeit über 1.25 mm in dem betroffenen Segment bei Flexion-Extension, die Geometrie sowie Höhe des Bandscheibenfaches über 6.5 mm und Facettenwinkel über 50°. Die Therapie der symptomatischen iatrogenen Olisthese beinhaltet die Fusion der betroffenen Wirbelsegmente. In der Literatur sind verschieden Fusionsverfahren beschrieben, i. e. posterolaterale Fusion, TLIF, OLIF, XLIF und ALIF. Eine Evidenz bezüglich der Managements der Wahl existiert aufgrund mangelnder Studienlage aktuell nicht.

Abstract

Iatrogenic spondylolisthesis is a subtyp of spondylisthesis that occurs after spine surgeries. This subtyp was included in year 1989 to the previous classification from Wiltse, Newman und McNab. Common causes are mainly extensive resection of posterior structures during a decompression operation and iatrogenic spondolyse during or after fusion operations. The incidence has been reported between 3,7 – 20 % after spine surgeries. Some of the major risk factors for iatrogenic spondlolisthesis are: preexisiting spondylolisthesis, motion at the level of spondylolisthesis above 1,25 mm during flexion-extension, disc geometry and height above 6,5 mm und facet angle above 50 degrees. The treatment of iatrogenic symptomatic spondylolisthesis includes fusion operations of the affected segment. Different fusion operations have been described in the literature such as posterolateral fusion, TLIF, OLIF, XLIF and ALIF. However, there is still no evidence for the treatment of choice due to the deficiency of studies.

Schlüsselwörter

iatrogene Olisthesis - Instabilität - iatrogene Spondylolyse

Keywords

iatrogenic spondylolisthesis - instability - iatrogenic spondylolyse

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