Operative Korrektur der idiopathischen Adoleszentenskoliose – Pro Bewegungserhalt

Zusammenfassung

Die kritische Literaturanalyse zeigt zum Einen, dass die fusionierende Behandlung von Adoleszentenskoliosen (IAS) eindeutig Konsequenzen bez. Funktion, Sport und Degeneration der Anschlußsegmente hat, sowie dass durchaus relevante Reoperationsraten resultieren. Zum Anderen ist klar erkennbar, dass bewegungserhaltende Ansätze, von denen bisher nur die flexible anteriore Skoliosekorrektur (FASK/VBT) gut untersucht ist, noch keine optimal definierten Indikationsgrenzen haben und dass diese Implantatsysteme noch früh in ihrer medizintechnischen Entwicklung stehen, was beides Gründe für die anfangs vergleichsweise hohen technischen Versagerraten waren. Definiert man die Versteifung einer adoleszenten Wirbelsäule jedoch als Schadensbegrenzung bei erfolgloser konservativer Therapie, liegt dann die Versagerquote nach Spondylodese nicht bei 100%? Diese Zahl zu reduzieren sollte unser Anspruch sein.

Abstract

A critical review of the literature demonstrates that treating adolescent idiopathic scoliosis (AIS) by means of an arthrodesis clearly carries consequences with regards to function, sports activities and adjacent segment degeneration. The reported reoperation rates also are of a relevant dimension. It is clear on the other hand, that motion-preserving strategies, of which only the vertebral body tethering (VBT) technique has been adequately studied, still lack precisely defined indications and that the implant systems currently in use are still early in their technical development. Both aspects have contributed to the comparatively high technical failure rates in early series. But when we understand the arthrodesis of an adolescent scoliotic spine as the failure of conservative treatment, the failure rate of fusion surgery stands at 100%. It should be our ambition to reduce this number.

Schlüsselwörter

Skoliose - idiopathische Adoleszentenskoliose - Bewegungserhaltung - Wachstumslenkung - wachstumslenkende Implantatsysteme - flexible anteriore Skoliosekorrektur - FASK - VBT

Keywords

scoliosis - adolescent idiopathic scoliosis - AIS - growth guidance - growth-guiding implants - motion preservation - vertebral body tethering

Publication History

Article published online:
04 March 2022

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