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
Schlüsselwörter
- Spinalkanalstenose
- Rezessusstenose
- Operative Dekompression
- Endoskopische Operationsmethoden
- Mikrochirurgie