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Dekompression der lumbalen Rezessusstenose

Endoskopische, interlaminäre Technik

Decompression of lumbar lateral spinal stenosis

Full-endoscopic, interlaminar technique

  • Operative Techniken
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Dekompression der lumbalen Rezessusstenose in vollendoskopischer Technik mittels interlaminärem Zugang.

Indikationen

Lumbale Rezessusstenose aufgrund ligamentärer, ossärer, diskogener Kompression und/oder Zysten der Zygapophysealgelenke.

Kontraindikationen

Reine Rückenschmerzen, korrekturbedürftige Instabilität/Deformität, reine Foramenstenose.

Operationstechnik

Einbringen einer Operationshülse zum interlaminären Fenster. Unter endoskopischer Sicht Resektion komprimierender knöcherner/ligamentärer Strukturen sowie von Osteophyten und Anulusanteilen.

Weiterbehandlung

Sofortige Mobilisation, isometrische/koordinative Übungen, ab der 3. Woche funktionelle Übungen, ab der 6. Woche Kraftaufbau.

Ergebnisse

Insgesamt 192 Patienten wurden vollendoskopisch oder mikrochirurgisch operiert und mindestens über 2 Jahre nachuntersucht. Es zeigte sich eine signifikante Verbesserung. Schwerere Komplikationen traten bei 5% auf und waren in der endoskopischen Gruppe signifikant reduziert. Mittels Dekompression und/oder Fusion wurden 5 Patienten revidiert. 89% der Patienten würden den Eingriff wiederholen lassen.

Abstract

Objective

Decompression in lumbar recess stenosis in a full-endoscopic technique using an interlaminar approach.

Indications

Lumbar recess stenosis due to ligamentous, osseous, discogenic compression, and/or juxta-facet cysts.

Contraindications

Pure back pain, instability/deformity requiring correction, pure foraminal stenosis.

Surgical technique

Introduction of a surgical sleeve to the intralaminar window. Endoscopic resection of compressing bony/ligamentary structures and also of osteophytes or parts of annulus.

Postoperative management

Immediate mobilization, isometric/coordination exercises, functional exercises from week 3, building up strength from week 6.

Results

A total of 192 patients underwent full-endoscopic surgery or microsurgery and were followed up over a minimum of 2 years. A significant improvement was revealed. Serious complications occurred in 5% and were significantly reduced in the endoscopic group. Five patients were revised with decompression and/or fusion. Eighty-nine percent would undergo the operation again.

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Ruetten, S., Komp, M., Hahn, P. et al. Dekompression der lumbalen Rezessusstenose. Oper Orthop Traumatol 25, 31–46 (2013). https://doi.org/10.1007/s00064-012-0195-2

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  • DOI: https://doi.org/10.1007/s00064-012-0195-2

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