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Z Orthop Ihre Grenzgeb 2004; 142(2): 166-173
DOI: 10.1055/s-2004-818781
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© Georg Thieme Verlag Stuttgart · New York

Die Anwendung eines dynamischen Pedikelschraubensystems (DYNESYS™) bei lumbalen Segmentdegenerationen - ein Vergleich klinischer und radiologischer Ergebnisse bei unterschiedlichen Indikationen

Application of a Dynamic Pedicle Screw System (DYNESYS™) for Lumbar Segmental Degenerations - Comparison of Clinical and Radiological Results for Different IndicationsM. Putzier1 , S. V. Schneider1 , J. Funk1 , C. Perka1
  • 1Orthopädische Universitätsklinik und Poliklinik, Medizinische Fakultät der Humboldt-Universität zu Berlin, Campus Charité Mitte
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Publication History

Publication Date:
28 April 2004 (online)

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Zusammenfassung

Studienziel: Bestimmung der Effizienz eines dynamisch stabilisierenden Systems bei unterschiedlichen Indikationen anhand mittelfristiger klinischer und radiologischer Parameter. Methode: Von insgesamt 70 Patienten lag bei 35 Patienten neben einer initialen Diskusdegeneration ein Bandscheibenprolaps vor, hier erfolgte zusätzlich eine Nukleotomie (Gruppe 1). 22 Patienten wiesen außer einer beginnenden Osteochondrose eine Spondylarthrose auf (Gruppe 2). Bei 13 Patienten war entweder eine höhergradige Segmentdegeneration oder eine degenerative Spondylolisthesis nachzuweisen (Gruppe 3). Die klinischen Untersuchungen erfolgten präoperativ, 3 Monate postoperativ sowie zum Follow-up (33 Monate). Erfasst wurden subjektive und objektive Daten unter Verwendung gängiger Scores (Oswestry, VAS). Ferner wurden jeweils Röntgen- und MRT-Untersuchungen veranlasst. Ergebnisse: Oswestry-Score und VAS zeigen in den Gruppen 1 und 2 eine signifikante und gleich bleibende Verbesserung (p < 0,05, ANOVA), in der 3. Gruppe wurde kein signifikanter Unterschied gefunden. In den Gruppen 1 und 2 wurden röntgenologisch und MR-tomographisch weder eine Progredienz der Degeneration in den instrumentierten Etagen noch degenerative Veränderungen in den benachbarten Segmenten nachgewiesen. In Gruppe 3 war neben 3 Anschlusslockerungen in 9 Fällen eine Zunahme der Segmentdegeneration in den operierten Etagen zu verzeichnen. Von 5 implantatspezifischen Komplikationen entfielen 4 auf die 3. Gruppe. Schlussfolgerung: Das Dynesys™ ist in der Lage, initiale morphologische Veränderungen zu kompensieren und das Fortschreiten einer Segmentdegeneration zu verhindern. Liegt bereits eine ausgeprägte Deformität vor oder ist eine knöcherne Dekompression geplant, so erscheint dieses System nicht indiziert.

Abstract

Aim: Evaluation of the efficacy of a dynamic stabilizing system for different indications using medium-term clinical and radiological parameters. Methods: Out of a total of 70 evaluated patients, 35 showed initial disc degeneration and disc herniation (group 1). In this group, additional nucleotomy was performed. Group 2 included 22 patients with initial osteochondrosis and facet joint osteoarthritis. 13 patients suffered from progressive segment degeneration or degenerative spondylolisthesis (group 3). Clinical evaluation was performed preoperatively, three months postoperatively and at follow-up (33 months). Examinations included subjective and objective measures using the Oswestry Index and VAS as well as radiographs and MRI. Results: Oswestry Index and VAS improved significantly in groups 1 and 2 and remained improved until follow-up. Group 3 showed no significant changes. The evaluation of radiographs and MRI of groups 1 and 2 revealed no progression of the degeneration either at the operated segments or at the adjacent segments. In group 3, 9 cases of progressive degeneration of the operated segments and 3 cases of adjacent segment degeneration were found. Out of 5 implant-associated complications 4 were observed in group 3. Conclusion: Dynesys™ is able to compensate initial morphological changes and to prevent progression of segment degeneration. The system seems not to be indicated for treating marked deformities or if osseous decompression needs to be performed.

Schlüsselwörter

Dynamische Stabilisation - Bandscheibendegeneration - Bandscheibenprolaps - Spondylarthrose - Spondylolisthesis

Key words

Dynamic stabilization - disc degeneration - disc herniation - facet joint osteoarthritis - spondylolisthesis - adjacent segment degeneration

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Dr. med. Michael Putzier

Medizinische Fakultät der Humboldt-Universität zu Berlin, Campus Charité Mitte

Orthopädische Universitätsklinik und Poliklinik

Schumannstraße 20/21

10117 Berlin

Phone: 0 30/4 50 51 50 55

Fax: 0 30/4 50 51 59 22

Email: michael.putzier@charite.de

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