Zur Entwicklung der fusionslosen operativen Therapie von frühkindlichen Skoliosen

C. C. Hasler; A. Schulze

doi:10.1055/s-0038-1629244

Kinder- und Jugendmedizin, Inhaltsverzeichnis

Kinder- und Jugendmedizin 2014; 14(06): 416-423
DOI: 10.1055/s-0038-1629244

Kinderorthopädie

Schattauer GmbH

Zur Entwicklung der fusionslosen operativen Therapie von frühkindlichen Skoliosen

The evolution of operative non-fusion treatment for early onset scoliosis

C. C. Hasler

¹Orthopädische Abteilung, Universitätskinderspital beider Basel/Schweiz

,

A. Schulze

¹Orthopädische Abteilung, Universitätskinderspital beider Basel/Schweiz

› Institutsangaben

Abstract

Zusammenfassung

Progressive frühkindliche Skoliosen werden bevorzugt möglichst lange konservativ mit seriellen Gipskorsetten und Redressionsorthesen behandelt. Bei Krümmungen über 60° kommen operative Maßnahmen in Betracht. Die langstreckige, frühzeitige Fusionsoperation ist heute obsolet. Funktionell und quo ad vitam ist sie schlechter als der natürliche Verlauf. Wachstumserhaltende Verfahren sind heute die Mittel der Wahl: VEPTR bei kongenitalen Skoliosen und begleitenden Thoraxfehlbildungen sowie beidseitige Wachstumsstäbe (growing rods) bei normal segmentierten und formierten Wirbelsäulen. Von extern steuerbare Antriebseinheiten ersetzen zuneh-mend die Notwendigkeit der repetitiv opera-tiven Verlängerung herkömmlicher Implantate mit weniger Komplikationen und besserem Komfort für Patient und Familie. Zukünftig gilt es, die Begrifflichkeit „non-fusion“ und den suggerierten Erhalt der Funktion der Wirbelsäule in die Praxis umzusetzen. Die lang-jährige überbrückende Immobilisierung mit Wachstumsstäben kontrolliert zwar die Deformität, schließt jedoch noch meist mit einer finalen, instrumentierten Wirbelsäulenfusion bei Wachstumsende ab.

Summary

The primary treatment of progressive early scoliosis is preferably conservative by means of serial plasters and spinal orthoses. Severe deformities of more than 60° Cobb angles warrant a surgical instrumented intervention to prevent further deterioration. Long fusions in early childhood are obsolete. They were shown to be worse than the natural history and often deleterious for the patient, both functionally and quo ad vitam. Growth-preserving operative non-fusion strategies represent the modern standard: VEPTR for congenital scoliosis with concomittant thoracic malformations and bilateral growing rods for normally segmented and formed spines. Implants with non-invasively expandable magnetic-driven are increasingly used and omit the need for half-yearly invasive expansion procedure which are a burden for both patients and their families. Future strategies must seek to convert the term „non-fusion“ into biologic reality. Hitherto, years-long immobilisation by growing implants may control the deformity but usually still ends up in a final fusion procedure at the end of growth.

Schlüsselwörter

Skoliose - fusionslos - frühkindlich - Wachstumsstäbe

Keywords

Scoliosis - non-fusion - early onset - growing rods

Volltext

Referenzen

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