Die idiopathische Adoleszentenskoliose

Die operative Formkorrektur der Adoleszentenskoliose, deren Ursachen nach wie vor ungeklärt sind, ist heute ein Standardeingriff mit hoher Zufriedenheitsrate und langfristigen Reoperationsraten von unter 10%. Jedoch sollten instrumentierte Korrekturspondylodesen ausschließlich in spezialisierten Zentren durchgeführt werden. Der Beitrag stellt das operative Vorgehen anhand von Patientenbeispielen dar.

Abstract

Indications for surgical correction of idiopathic adolescent scoliosis are curves of 40–50° Cobb angle or more. Furthermore, Patient’s age, location of the curve, degree of malrotation and sagittal plane abnormalities need to be taken into consideration. Standard of care is the pedicle screw based instrumented correction with a high implant density and the use of titanium and cobalt chrome rods. Bone substitutes and allogenic bone material have replaced the autologous bone harvesting from the iliac crest. Use of neuromonitoring and cellsaver, controlled hypotension and intraoperative placement of a thoracic epidural catheter for postoperative pain control have become standard of care. While the amount of derotation with posterior techniques is controversely discussed and mainly dependent on the flexibility, the sagittal plane can well be controlled using cobalt chrome rods. Frontal curve correction averages between 60 and 80%. However, the absolute curve correction is of less importance while restoring a well balanced spine and trunk with leveled shoulders are paramount. To enable a selective fusion of only the structural curves thorough knowledge of the clinical and radiological parameters to differentiate structural from non-structural curves is mandatory. Complications are rare, however, if they occur, they can be severe and with long-term sequelae. Therefore, instrumented curve correction procedures in idiopathic adolescent scoliosis should exclusively be performed in specialized centers.

Schlüsselwörter

Wirbelsäulenverkrümmung - Cobb-Winkel - Wirbelsäulenchirurgie - Malrotation - Korrekturspondylodese

Keywords

spine surgery - spine deviation - Cobb angle - malrotation - spinal fusion

Publikationsverlauf

Eingereicht: 20. Januar 2021

Artikel online veröffentlicht:
17. Mai 2022

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