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Dynamische Verfahren bei der juvenilen Skoliose

Dynamic instrumentation techniques in early-onset scoliosis

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Zusammenfassung

Ähnlich wie bei der idiopathischen Adoleszentenskoliose wird man die Indikation für eine operative oder konservative Behandlung von der Progressionswahrscheinlichkeit abhängig machen. Neben Alter und Krümmungswinkel spielen v. a. die Rippenwirbelwinkeldifferenz (RVAD) und die Rotation eine prognostische Rolle. Eine Operationsindikation wird allgemein gesehen, wenn es trotz konsequenter Korsetttherapie zu einer Krümmungszunahme von >10° kommt oder eine Cobb-Winkel von >45° besteht. An dorsalen dynamischen Systemen stehen im Wesentlichen zwei Verfahren zur Verfügung. Bei der „Growing-rod-Technik“ werden 1 oder 2 Stäbe kranial und kaudal fixiert und dazwischen sukzessive distrahiert. Hierfür sind mindestens alle 6 Monate Wiederholungseingriffe notwendig. Einen neuen Ansatz verfolgt das Orthobiom®-System, bei dem die Hauptkrümmung (Apex) rigide fixiert wird, und die Nebenkrümmungen durch flexible Konnektoren geführt werden. Innerhalb der dynamischen Stabilisation soll ein Längenwachstum möglich sein. Mit beiden Systemen existieren keine Langzeiterfahrungen in großen Kollektiven, so dass noch keine generelle Empfehlung ausgesprochen werden kann.

Abstract

Similar to the situation in idiopathic scoliosis, the decision for operative or conservative treatment is based on the progression of the curve. Apart from age and Cobb angle, the rib–vertebral angle difference and rotation of the vertebrae are decisive for the prognosis. Surgery is indicated if, despite consistent brace treatment, a progression of >10° or a Cobb angle of more than 45° is found. Two different dorsal dynamic systems are presently used. With the growing rod technique, one or two rods are fixed to the spine cranially and caudally and are repeatedly“lengthened.“ Surgery is mandatory at least every 6 months. The Orthobiom system follows a new approach in which a rigid fixation is done in the middle of the curve, while the ends of the rods are linked to flexible connectors that can slide while the child grows. No long-time results are presently available for either system, so no general recommendations can be given.

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  1. Abteilung für Wirbelsäulenorthopädie, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt a.M., Deutschland

    F. Geiger & M. Rauschmann

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  1. F. Geiger
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  2. M. Rauschmann
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Correspondence to F. Geiger.

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Geiger, F., Rauschmann, M. Dynamische Verfahren bei der juvenilen Skoliose. Orthopäde 38, 122–130 (2009). https://doi.org/10.1007/s00132-008-1368-4

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