Implantatversagen bei Instrumentierungen am lumbosakralen Übergang und Becken – Ursachen und Behandlungskonzepte

Zusammenfassung

Die Instrumentierung des lumbosakralen Überganges mit oder ohne Fusion erfolgt bei einer Vielzahl von Pathologien. Häufig ist dies bei der operativen Therapie von degenerativen Erkrankungen, aber auch bei Frakturen, Infektionen oder tumorassozierten Osteolysen der unteren Lendenwirbelsäule und des Sakrums erforderlich. Die biomechanischen Anforderungen an die Instrumentierung sind in diesem Wirbelsäulenabschnitt besonders hoch. Insbesondere bei langstreckigen Instrumentierungen auf S1 ist eine hohe Pseudarthroserate im Segmet L5/S1 mit und ohne Implantatversagen beschrieben. Um das Risiko von Komplikationen, die zur Schraubenlockerung oder Implantatversagen im Segment L5/S1 führen, zu minimieren, bieten sich mehrere Verfahren an.

Revisionsstrategien zur Behandlung dieser Komplikationen erfordern neben der genauen Analyse der Situation, unter Umständen besondere Implantatsysteme und Operations-Techniken. Die Indikationsstellung zum dorsalen, ventralen oder kombinierten Zugang ist im Wesentlichen davon abhängig, ob das Ziel der Operation die Fusion L5/S1 darstellt und wie diese mit größt möglicher Wahrscheinlichkeit erreicht werden kann.

Abstract

L5/S1 fixation with or without fusion is required in a lot of pathologies, such as degenerative diseases, but also in fractures and tumor of the lumbosacral junction. Because the lumbosacral junction has a high biomechanical demand, a high rate of implant failure along with pseudarthrosis in the level L5/S1, espacially for long adult spinal fusion to the sacrum, has been described.

To avoid and to treat these complications leading to failure of lumbosacral fixation and fusion, several solutions have been proposed. Despite the detailed analysis of the situation, the use of special Implants and surgical techniques is essential. The indication for an anterior, posterior or combinded anterior-posterior approach is basically dependent of the necessity of a fusion in L5/S1 and how to achieve this with the greatest chance.

Schlüsselwörter

Implantatversagen - Pseudarthrose - lumbosakraler Übergang - spinopelvine Stabilisierung - S2-Ala-ilium Schraube

Keywords

Implantfailure - pseudarthrosis - lumbosacral junction - spinopelvine stabilisation - S2-Alar-Ilium screw

Publication History

Article published online:
17 May 2022

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