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Dorsale operative Korrektur der idiopathischen Skoliose

Stellenwert von Pedikelschrauben vs. Haken

Posterior operative correction of idiopathic scoliosis

Value of pedicle screws versus hooks

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Zusammenfassung

Die dorsale Korrektur der Skoliose über multisegmental verankerte Implantatsysteme wurde von Cotrel-Dubousset Mitte der 1980er Jahre etabliert. Ursprünglich erfolgte die Korrektur über ausschließlich hakengetragene Instrumentationen. Im weiteren Verlauf wurden zunächst für den lumbalen Bereich und später für den thorakalen Bereich Pedikelschrauben verwendet. Heutzutage ist eine rein pedikelschraubengetragene Instrumentation in der Skoliosechirurgie etabliert. Biomechanische Studien konnten eine deutlich höhere Ausrissfestigkeit von schraubengetragenen vs. hakengetragenen Systemen nachweisen.

In klinischen Studien konnten von verschiedenen Autoren nachgewiesen werden, dass bei schrauben- im Vergleich zu hakengetragenen Instrumentationen sowohl die Cobb-Winkel-Korrektur der primären und sekundären Krümmung besser als auch der Korrekturverlust geringer war. Durch die bessere Korrektur mit überwiegend schraubengetragenen Instrumentationen konnte nachgewiesen werden, dass im kaudalen Bereich Fusionssegmente im Vergleich zu rein hakengetragenen Instrumentationen eingespart wurden. In den meisten Studien konnte kein Unterschied in der Operationszeit, dem Blutverlust und der Komplikationsrate gezeigt werden. Zusammenfassend ist somit bei besseren Korrekturmöglichkeiten ohne erhöhtes Risiko ein Trend zur Pedikelschraubeninstrumentation in der modernen dorsalen Skoliosechirurgie zu beobachten.

Abstract

Posterior correction and fusion of scoliosis with multisegmental instrumentation systems was developed by Cotrel-Dubousset in the 1980s. Initially correction and instrumentation was performed using hooks only. Later pedicle screws were implemented first for the lumbar and then for the thoracic spine. Nowadays instrumentation based on pedicle screws only is well established for posterior scoliosis surgery. Biomechanical studies demonstrated higher pull-out forces for pedicle than for hook constructs.

In clinical studies several authors reported better Cobb angle correction of the primary and the secondary curves and less loss of correction in pedicle screw versus hook instrumentations. Furthermore, pedicle screw instrumentation allows fewer segments to be fused, especially caudally, and thus saving mobile segments. In most of these publications there were no differences in operation time, blood loss and complication rates. In summary, there is better curve correction without an increased risk using multisegmental pedicle screw instrumentation in modern posterior scoliosis surgery.

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Authors and Affiliations

  1. Sektion Wirbelsäulenorthopädie, Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum, Albert Schweitzer-Straße 33, 48149, Münster, Deutschland

    V. Bullmann, C. Schmidt & T.L. Schulte

  2. Orthopädische Klinik II – Wirbelsäulenchirurgie, St. Franziskus-Hospital, Münster, Deutschland

    U.R. Liljenqvist

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  1. V. Bullmann
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  2. U.R. Liljenqvist
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  3. C. Schmidt
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  4. T.L. Schulte
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Correspondence to V. Bullmann.

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Bullmann, V., Liljenqvist, U., Schmidt, C. et al. Dorsale operative Korrektur der idiopathischen Skoliose. Orthopäde 38, 198–204 (2009). https://doi.org/10.1007/s00132-008-1370-x

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