Spinal fusion
Spondylodesis (interlocking of the vertebral bodies) is an operation to stiffen two or more vertebral bodies on the cervical , thoracic and / or lumbar spine in order to allow full load-bearing capacity of the spine if conservative treatments did not lead to improvement or could be excluded.
The stiffening of vertebral segments leads to an irreversible loss of movement in the affected section of the spine, with the loss of movement depending on the length of the stiffening.
The operation is used to remedy or prevent spinal instability, such as that caused by B. unstable fractures ( fracture ) , congenital scoliosis with progression or vertebral slipping (spondylolisthesis) due to a gap in the vertebral arch.
To guarantee strength, screws are inserted into the vertebral bodies, which are connected to one another by rods or metal plates. Bone chips are often introduced into the intervertebral disc space in order to bring about the bony connection between the vertebral bodies. Special implants may also be inserted into the intervertebral space, such as As titanium cages (Cage) , which maintain the spacing of the vertebral bodies to each other is carried out until the bony healing.
A special feature of X-ray imaging after spinal fusion is that many artifacts occur in computer tomography due to the metal implants, which can make it difficult to assess the images. If steel implants are used, magnetic resonance imaging (MRI) cannot be performed. However, titanium implants are also available that can be used for an MRI scan.
The figure shows a state after spondylodesis of the two lowest lumbar vertebrae (LWK4 and LWK5) with the first sacral vertebra (LWK1) two years after the operation. The intervertebral space between the fourth and fifth lumbar vertebrae is already bony bridged (ankylosed); At the transition from the fifth lumbar vertebra to the first sacral vertebra, this bony structure is missing. When all interlocked vertebral bodies are firmly connected to one another, the spondylodesis material can be removed.
Dorsoventral spinal fusion LWK5 - SWK1
The same patient in the MPR
The arrows indicate the bony build-up LWK4 / 5 and the lack of build-up LWK5 / SWK1.
Example of a long spinal fusion with anterior and posterior fusion in severe scoliosis
As an alternative to stiffening, movement-preserving methods are becoming increasingly important. In the flexible spine stabilization z. B. is a dynamic implant that is used in spinal stenoses . Compared to stiffening, this surgical method protects neighboring segments from wear. Due to the lack of load transfer to neighboring vertebral segments, back pain occurs less often. (See also: Intervertebral Disc Prosthesis .)
See also
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- Siegfried Hoc: Spine Surgery: Gentle interventions with high precision . In: Dtsch Arztebl. 101 (36), 2004, pp. A-2366 / B-1990 / C-1918. ( pdf )
