Vergleich dorsaler Dekompression nicht stabilisiert und dynamisch stabilisiert mit LimiFlex™

 

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Zusammenfassung

Hintergrund: Lumbale Spinalkanalstenosen werden häufig mittels dorsaler Dekompression behandelt. Die Abtragung posteriorer Strukturen führt jedoch zu einer Erhöhung der biomechanischen Instabilität und kann weitere Komplikationen hervorrufen. Durch eine Fusion kann dies reduziert werden. Jedoch können weitere Komplikationen, wie z. B. eine stark reduzierte Flexibilität oder Anschlussdegeneration, auftreten. Um diese Problematik zu umgehen, wurden dynamische Stabilisierungssysteme wie das paraspinale Spannband LimiFlex (PSB) entwickelt. Diese prospektive Studie vergleicht das klinische Ergebnis von Patienten mit implantiertem PSB und Patienten ohne PSB. Patienten und Methoden: Es wurden 63 Patienten mit 1- oder 2-etagiger lumbaler Spinalkanalstenose dorsal dekomprimiert. 40 Patienten erhielten nach der Dekompression das PSB. Es wurden Rücken-, Hüft- und Knieschmerzen sowie die funktionelle Einschränkung der Patienten prä- und postoperativ nach 3, 6 und 12 Monaten aufgenommen. Die Schmerzen wurden mittels der visuellen Analogskala (VAS) und die funktionale Beeinträchtigung mittels des Oswestry Disability Index (ODI) erhoben. Alle auftretenden Adverse Events wurden dokumentiert. Ergebnisse: Patienten, die das PSB erhielten, zeigten eine bessere Schmerzreduktion und eine deutlichere Verbesserung der funktionalen Beeinträchtigung als Patienten ohne PSB. Der VAS- und ODI-Verlauf der beiden Behandlungsgruppen unterschied sich signifikant bei 2 betroffenen Etagen. Schlussfolgerung: Die dynamische Stabilisierung mit dem PSB nach dorsaler Dekompression führte zu besseren Ergebnissen hinsichtlich der VAS- und ODI-Verbesserung als alleinige dorsale Dekompression. Der größte Nutzen des PBS zeigte sich bei 2 betroffenen Etagen.

Abstract

Background: Lumbar spinal canal stenosis is commonly treated by dorsal decompression. However, resection of posterior elements increases the biomechanical instability and may lead to further complications. In order to prevent this, fusion of the involved segments is often performed. But further complications may be associated with this, for example, highly reduced flexibility. In order to overcome fusion-related problems, dynamic stabilisation devices, like the new LimiFlex™ Paraspinous Tension Band (PSB), have been developed. This prospective study compares dorsal decompression without stabilisation and dorsal decompression with stabilisation using the PSB in patients with lumbar canal stenosis. Methods: Sixty-three patients with stenosis involving one or two lumbar vertebral levels were treated with dorsal decompression. Forty received the PSB following decompression surgery. Back, hip and leg pain as well as patientʼs degree of disability were assessed preoperatively and at 3, 6 and 12 months postoperatively for all patients. Evaluations were conducted using the visual analogue scale (VAS) and the Oswestry disability index (ODI). Adverse events during the study period were evaluated. Results: Patients who received the PSB experienced a better pain relief and improvement in disability compared to patients who received treatment through decompression only. A significant difference of VAS and ODI development was found between both groups when treating two vertebral levels. Furthermore, the total number of adverse events was lower in the PSB group compared to the decompression group. Conclusion: Dynamic stabilisation using the PSB delivers better results in terms of VAS and ODI values when compared to only dorsal decompression. In addition, it is also associated with a lower number of complications. The PSB is most favourable when 2 levels are treated.

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