[Bone grafts endoscopically applied to the spine Ergebnisse der anterioren Fusion und therapeutische Konsequenzen].
The application of autogenous bone grafts represents the golden standard for reconstruction of the load-bearing anterior column in the thoracolumbar spine. However, the osseous integration of the implanted grafts is demanding and delayed union or pseudarthrosis may occur. There are no standardized data available yet indicating the further course in such cases. The aim of this study was to evaluate the incorporation of endoscopically applied grafts and to develop therapeutic strategies for delayed or non-fusions. Twenty patients suffering from unstable injuries of the thoracolumbar spine were studied in a prospective clinical trial. After primary dorsal stabilization, the anterior column was thoracoscopically reconstructed with an autogenous iliac crest graft and a fixed-angle implant (MACS). The osseous integration of the bone grafts was detected by MSCT 1 year postoperatively. Complete integration of the transplanted bone grafts was observed in only 65% of the cases. In 25% partial integration was detected and in two cases a fracture of the transplanted iliac crest graft occurred. Despite the incomplete integration of the bone grafts, the further course without surgical intervention revealed no clinical or radiological evidence of a concomitant implant loosening or a relevant secondary loss of correction. Similar to the open technique, endoscopic reconstruction of the anterior column with autogenous bone grafts may lead to disadvantageous results concerning the integration and healing of the applied bone grafts. Decision making in such cases depends on the individual clinical and radiological findings (i.e., evidence of implant loosening and concomitant loss of correction).
Klinik und Poliklinik für Unfall-, Hand und Wiederherstellungschirurgie, Zentrum für Operative Medizin, Universitätsklinikum, Hamburg-Eppendorf. briem@uke.uni-hamburg.de
D
D
Briem
J
J
Windolf
W
W
Lehmann
P G C
PG
Begemann
N M
NM
Meenen
J M
JM
Rueger
W
W
Linhart
D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013906:Thoracoscopy; D036542:Tomography, Spiral Computed