Die operative Behandlung infantiler und juveniler Skoliosen - eine retrospektive Analyse von 21 Patienten

Zusammenfassung.

Fragestellung: Wir führten eine retrospektive Untersuchung von 21 Patienten (9 Jungen und 12 Mädchen) mit infantiler bzw. juveniler Skoliose aus, die zwischen 1985 und 1997 operiert wurden. 13 Patienten wurden primär mit einer dorsalen Instrumentation ohne Spondylodese versorgt (growing-rod-Gruppe). Dagegen wurde bei 8 weiteren Patienten bereits in diesem jungen Alter eine instrumentierte Spondylodese ausgeführt (Spondylodese-Gruppe). Patienten und Methoden: Die Erstuntersuchung erfolgte im Alter von 6 Jahren (Median, Spannweite 29 Jahre), die erste Operation im Alter von 8 Jahren (Median, Spannweite 310 Jahre). Die Patienten wurden klinisch und radiologisch im Alter von 16 Jahren nachuntersucht (Median, Spannweite 1021 Jahre). Ergebnisse: Die präoperativen Messungen zeigten keine signifikanten Unterschiede zwischen beiden Gruppen (thorakaler Cobb-Winkel 77° versus 66° [Median], lumbaler Cobb-Winkel 40° versus 51° [Median]). Zur Nachuntersuchung haben wir signifikant bessere Ergebnisse in der Spondylodese-Gruppe als in der growing-rod-Gruppe gemessen (thorakaler Cobb-Winkel 24° versus 60° [Median; p < 0,01]), lumbaler Cobb-Winkel 21° versus 34° [Median; p < 0,05]). Die Spondylodese-Gruppe zeigte ebenfalls signifikant bessere Resultate hinsichtlich der Parameter (Median angegeben): stationärer Aufenthalt (14 versus 150 Tage), Gesamtanzahl der Operationen je Patient (2 versus 3) und Anzahl der Komplikationen (0 versus 26). Schlussfolgerung: Basierend auf den Ergebnissen dieser kleinen Patientengruppe stellen wir keine lndikation mehr, infantile oder juvenile Skoliosen mit einer dorsalen Instrumentation ohne Spondylodese zu behandeln. Dagegen sehen wir in dem Prinzip kurzer instrumentierter ventraler Spondylodesen einen erfolgversprechenden Ansatz.

Problem: We carried out a retrospective analysis of 21 patients with infantile or juvenile scoliosis (9 boys, 12 girls) who underwent surgical treatment between 1985 and 1997. 13 patients underwent primary dorsal instrumentation without fusion (growing-rod group). In contrast, 8 patients received already in this young age an instrumented spondylodesis (fusion-group). Patients and Methods: The initial examination was performed at an age of 6 years (median; range 29 years), and first surgery was performed at an age of 8 years (median, range 310 years). The patients have been followed-up clinically and radiologically at an age of 16 years (median; range 1021 years). Results: The preoperative measurement showed no significant differences between both groups (thoracic Cobb angle 77° versus 66° [median], lumbar Cobb angle 40° versus 51° [median]). At follow-up we measured significantly better results in the fusion-group than in the growing-rod group (thoracic Cobb angle 24° versus 60° [median; p < 0.01]), lumbar Cobb angle 21° versus 34° [median, p < 0.05]). The fusion-group also showed significantly better results with respect to the parameters (median values given): duration of hospital stay (14 versus 150 days), number of operations per patient (2 versus 3) and number of complications (0 versus 26). Conclusion: Based on the results of this small patient group we no longer see an indication to treat infantile and juvenile scoliosis by dorsal instrumentation without fusion. In contrast, we find the principle of short instrumented anterior fusion to be more promising.

Schlüsselwörter:

Infantile Skoliose - juvenile Skoliose - Spondylodese

Key words:

Infantile scoliosis - juvenile scoliosis - spondylodesis

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