Zusammenfassung
Die Beurteilung der Revisionsfähigkeit nach endoprothetischem Bandscheibenersatz zeigt, dass das operative Vorgehen abhängig ist von Revisionszeitpunkt und -ursache. Die Erfahrungen beziehen sich auf 9 Revisionsoperationen bei 152 in den Jahren 2003–2007 eingesetzten Halswirbelsäulenendoprothesen der Typen Bryan und Prodisc C sowie von 312 in den Jahren 1999–2007 eingesetzten Endoprothesen der Typen Charité und Prodisc. Die eigenen Ergebnisse zeigen differierende Vorgehensweisen bei peri- oder spätpostoperativen Revisionseingriffen. Implantatwechseloperationen waren nicht möglich, der operative Verfahrenswechsel ist dagegen die Regel. Während im Bereich der Halswirbelsäule im Regelfall der gleiche Zugang gewählt werden kann, ist dies an der Lendenwirbelsäule nur perioperativ möglich, danach muss ein alternativer Zugang angewandt werden. Nur eine stringente Indikationsstellung bei der Primärimplantation verhindert postoperative Revisionseingriffe, die einer fehlerhaften Primärbeurteilung und nicht der Bandscheibenendoprothese angelastet werden können (z. B. Postdiskotomiesyndrom, Facettgelenkarthropathie, Rotationsinstabilität, Wirbelgleiten). Bandscheibenendoprothesen der nächsten Generation müssen die Punkte der Minderbelastung der Wirbelbogengelenke und der verbesserten Revisionsfähigkeit beinhalten.
Abstract
Assessment of the revisability of surgery after the endoprosthetic replacement of vertebral discs shows that the surgical approach depends on the time of revision surgery and the reason why it is carried out. Our experience is based on nine revision operations out of 152 cervical vertebra prostheses of the Bryan and Prodisc C types implanted from 2003 to 2007 and 312 endoprostheses of the Charité and Prodisc types implanted from 1999 to 2007. Our own results show differing approaches in perioperative or late postoperative revision operations. Operations to exchange implants were not possible, whereas a change of surgical procedure is the rule. The same access route can usually be selected in the cervical spine, but in the lumbar spine this can only be done perioperatively; if revision surgery is carried out at a later date, an alternative access route must be used. Using strict indications for the primary implant is the only way to prevent postoperative revision surgery that is due to an inaccurate primary assessment and not to the vertebral endoprosthesis (e.g. post-discotomy syndrome, facet joint arthropathy, rotation instability, vertebral slip). The next generation of vertebral disc endoprostheses must incorporate reduced load of the zygapophyseal joints and improved revisability.
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Hopf, C. Revisionschirurgie nach Bandscheibenprothesenimplantation. Orthopäde 37, 339–346 (2008). https://doi.org/10.1007/s00132-008-1229-1
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DOI: https://doi.org/10.1007/s00132-008-1229-1