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Selektive, mikrochirurgische „Cross-over“-Dekompression mehrsegmentaler lumbaler Spinalstenosen

Die „Slalom“-Technik

Selective, microsurgical cross-over decompression of multisegmental degenerative lumbar spinal stenoses

The “Slalom” technique

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

Zusammenfassung

Operationsziel

Selektive, beidseitige mikrochirurgische Dekompression mehrerer lumbaler Bewegungssegmente über separate wechselseitige, unilaterale „Cross-over“-Zugänge.

Indikationen

Bi- und multisegmentale degenerative zentrale und laterale, lumbale Spinalkanalstenosen.

Kontraindikationen

Keine (aber: bei klinisch und radiologisch notwendiger Stabilisierung ist die Slalom-Technik nicht durchführbar).

Operationstechnik

Minimal-invasive, muskelschonende und wirbelgelenkerhaltende beidseitige Dekompression des lumbalen Spinalkanals in 2 oder mehreren Etagen durch getrennte mikrochirurgische, unilaterale Zugänge.

Weiterbehandlung

Frühmobilisation nach 4–6 h postoperativ. Weiches lumbales Mieder für 4 Wochen (optional).

Ergebnisse

Zwischen Dezember 2010 und Mai 2011 wurden 35 Patienten (10 w; 25 m; Alter 71,8 Jahre) mit dieser Technik operiert. Die durchschnittliche Operationsdauer betrug 42 min/Segment, der durchschnittliche Blutverlust 20,3 ml/Segment. Bei 15/35 Patienten war keine Redondrainage notwendig. Die Mobilisierung erfolgte nach 4–6 h, der stationäre Aufenthalt betrug durchschnittlich 5,2 Tage. Insgesamt traten 3 Komplikationen auf, davon 2 Duraläsionen (5,7%) und eine temporäre L5-Radikulopathie durch Wurzelschwellung (2,8%). Postoperativ kam es zu einer signifikanten Verbesserung der Lebensqualität gemessen mit dem EQ 5D und dem „Oswestry Disability Index“ sowie zu einer subjektiv signifikanten Verbesserung der Gehstrecke und Stehzeit.

Abstract

Objective

Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches.

Indications

Two- and multisegmental degenerative central and lateral lumbar spinal stenoses.

Contraindications

None (however, if stabilization is necessary, the Slalom technique is not possible).

Surgical technique

Minimally invasive, muscle-sparing and facet-joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side.

Postoperative management

Early mobilization 4–6 h postoperatively. Soft lumbar brace for 4 weeks (optional).

Results

Between December 2010 and May 2011, the operation was performed in 35 patients (10 women; 25 men; age 71.8 years). The average time of surgery was 42 min/segment, the average blood loss was 20.3 ml/segment. Of the 35 patients, 15 did not required wound drainage. All patients were mobilized without restriction after 4–6 h, hospitalization was 5.2 days. There were 3 intraoperative complications (2 Dura lesions [5.7%] and 1 temporary L5 radiculopathy probably due to swelling of the L5 nerve root [2.8%]). Postoperatively there was a significant improvement in quality of life as measured with EQ 5D and Oswestry Disability Index as well as a significant improvement of walking distance and standing time.

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Authors and Affiliations

  1. Wirbelsäulenzentrum, Schön Klinik München – Harlaching, Harlachinger Str. 51, 81547, München, Deutschland

    H.M. Mayer & F. Heider

Authors
  1. H.M. Mayer
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  2. F. Heider
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Corresponding author

Correspondence to H.M. Mayer.

Zusatzmaterial online

64_2012_196_MO1_ESM.mov

Video zu Abb. 10: Fräsbeginn sublaminär (Die ‚Slalom-Technik’ zur selektiven, mikrochirurgischen cross-over Dekompression mehrsegmentaler lumbaler Spinalstenosen) (QuickTime mov 14MB)

64_2012_196_MO2_ESM.mov

Video zu Abb. 11: Dekompression ipsilateral gegen den Uhrzeigersinn (Die ‚Slalom-Technik’ zur selektiven, mikrochirurgischen cross-over Dekompression mehrsegmentaler lumbaler Spinalstenosen) (QuickTime mov 8,5MB)

64_2012_196_MO3_ESM.mov

Video 1 zu Abb. 14: Dekompression Spinalnerv kontralateral (Die ‚Slalom-Technik’ zur selektiven, mikrochirurgischen cross-over Dekompression mehrsegmentaler lumbaler Spinalstenosen) (QuickTime mov 10MB)

64_2012_196_MO4_ESM.mov

Video 2 zu Abb. 14: Dekompression Spinalnerv kontralateral (Die ‚Slalom-Technik’ zur selektiven, mikrochirurgischen cross-over Dekompression mehrsegmentaler lumbaler Spinalstenosen) (QuickTime mov 13MB)

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Mayer, H., Heider, F. Selektive, mikrochirurgische „Cross-over“-Dekompression mehrsegmentaler lumbaler Spinalstenosen. Oper Orthop Traumatol 25, 47–62 (2013). https://doi.org/10.1007/s00064-012-0196-1

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  • DOI: https://doi.org/10.1007/s00064-012-0196-1

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