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Die operative Behandlung der adulten Skoliose

Osteoporose und Versagen des Anschlusssegments als besondere Herausforderung bei der operativen Versorgung

Surgical management of adult scoliosis

The challenge of osteoporosis and adjacent level degeneration

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Zusammenfassung

Die adulte Skoliose ist als frontale strukturelle Seitausbiegung der Wirbelsäule von >10° bei Patienten nach Abschluss des Knochenwachstums definiert. Führende Symptome der Patienten sind der Rückenschmerz, oftmals wird dieser von einer Claudicatio spinalis als Folge einer zentralen, foraminalen oder rezessalen Stenose begleitet. Die pathophysiologisch maßgebliche asymmetrische Degeneration führt zu einer asymmetrischen Lastverteilung, was wiederum die weitere Degeneration und Deformität antreibt (Merkmale: frontale Dekompensation, segmentale Kyphose). Dabei entwickelt sich eine Progression der Skoliose (0,5–1,0°/Jahr) sowie der Kyphose.

Zur Diagnostik gehören Röntgenbilder inklusive Funktionsaufnahmen, MRT, Myelo-CT und invasiv-diagnostische Maßnahmen wie Diskographien, Facettenblockaden, Wurzelblockaden und epidurale Injektionen. Die Therapie (konservativ oder operativ) zielt auf die individuelle Symptomatologie des Patienten. Insbesondere ist die chirurgische Therapie anspruchsvoll und mitunter wegen des Alters und der Komorbiditäten der Patienten, der Ausdehnung der Fusionsstrecke, des Zustands des Anschlusssegments und des Iliosakralgelenks, der Osteoporose oder Osteopenie und eventueller Voroperationen problematisch. Im Falle einer Korrektur ist das Hauptziel die Wiederherstellung der sagittalen und frontalen Balance.

Diese Übersicht befasst sich mit den besonderen Indikationen für die Zementaugmentation bei Osteoporose und der Problematik der Anschlussdegeneration und deren chirurgischem Management.

Abstract

Adult scoliosis is defined as a spinal deformity with a Cobb angle of more than 10° in the coronal plain in a skeletally mature patient. Patients predominantly suffer from back pain symptoms, often accompanied by signs of spinal stenosis (central as well as lateral). Asymmetric degeneration leads to asymmetric load and therefore to a progression of the degeneration and deformity as either scoliosis (0.5–1° per year), kyphosis, or both.

The diagnostic evaluation includes static and dynamic imaging, magnetic resonance imaging, and myelo-computed tomography, as well as invasive diagnostic procedures such as discograms, facet blocks, and epidural and root blocks. The treatment, either conservative or surgical, is then tailored to the patient’s specific symptomatology. Surgical management is usually complex and must take into account an array of specific problems, including the patient’s age and general medical condition, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis, and any previous scoliosis surgery. The main goal of corrective surgery is a balancing of the coronal and sagittal planes.

This review focuses on the special indications for vertebral body cement augmentation in patients with osteoporosis and the problem of adjacent level degeneration and its surgical management.

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Literatur

  1. Aebi M (2005) The adult scoliosis. Eur Spine J 14(10): 925–948

    Article  PubMed  Google Scholar 

  2. Ascani E, Bartolozzi P, Logroscino CA et al (1986) Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 11(8): 784–789

    Article  PubMed  CAS  Google Scholar 

  3. Baroud G, Vant C, Wilcox R (2006) Long-term effects of vertebroplasty: adjacent vertebral fractures. J Long Term Eff Med Implants 16(4): 265–280

    PubMed  Google Scholar 

  4. Becker S, Chavanne A, Spitaler R et al (2008) Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J 17(11):1462–1469

    Article  PubMed  CAS  Google Scholar 

  5. Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 84(5): 748–752

    Article  PubMed  CAS  Google Scholar 

  6. Bertagnoli R, Tropiano P, Zigler J et al (2005) Hybrid constructs. Orthop Clin North Am 36(3): 379–388

    Article  PubMed  Google Scholar 

  7. Bertagnoli R, Yue JJ, Fenk-Mayer A et al (2006) Treatment of symptomatic adjacent-segment degeneration after lumbar fusion with total disc arthroplasty by using the prodisc prosthesis: a prospective study with 2-year minimum follow up. J Neurosurg Spine 4(2): 91–97

    Article  PubMed  Google Scholar 

  8. Berven SH, Lowe T (2007) The scoliosis research society classification for adult spinal deformity. Neurosurg Clin North Am 18(2): 207–213

    Article  Google Scholar 

  9. Bostrom MP, Lane JM (1997) Future directions. Augmentation of osteoporotic vertebral bodies. Spine 22(Suppl 24): 38–42

    Article  Google Scholar 

  10. Bradford DS, Tay BK, Hu SS (1999) Adult scoliosis: surgical indications, operative management, complications and outcomes. Spine 24(24): 2617–2629

    Article  PubMed  CAS  Google Scholar 

  11. Bridwell KH, Edwards CC, Lenke LG (2003) The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct. Spine 28(20): 234–242

    Article  Google Scholar 

  12. Burval DJ, McLain RF, Milks R, Inceoglu S (2007) Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine 32(10): 1077–1083

    Article  PubMed  Google Scholar 

  13. Cohen SP, Hurley RW (2007) The ability of diagnostic spinal injections to predict surgical outcomes. Anesth Analg 105(6): 1756–1775

    Article  PubMed  Google Scholar 

  14. Cook SD, Salkeld SL, Stanley T et al (2004) Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J 4(4): 402–408

    Article  PubMed  Google Scholar 

  15. Edwards CC, Bridwell KH, Patel A et al (2004) Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis. Spine 29(18): 1996–2005

    Article  PubMed  Google Scholar 

  16. Edwards CC, Bridwell KH, Patel A et al (2003) Thoracolumbar deformity arthrodesis to L5 in adults: the fate of the L5-S1 disc. Spine 28(18): 2122–2131

    Article  PubMed  Google Scholar 

  17. Etebar S, Cahill DW (1999) Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90(Suppl 2): 163–169

    PubMed  CAS  Google Scholar 

  18. Fribourg D, Tang C, Sra P et al (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29(20): 2270–2276

    Article  PubMed  Google Scholar 

  19. Glassman SD, Alegre GM (2003) Adult spinal deformity in the osteoporotic spine: options and pitfalls. Instr Course Lect 52: 579–588

    PubMed  Google Scholar 

  20. Grubb SA, Lipscomb HJ (1992) Diagnostic findings in painful adult scoliosis. Spine 17(5): 518–527

    Article  PubMed  CAS  Google Scholar 

  21. Gupta MC (2003) Degenerative scoliosis. Options for surgical management. Orthop Clin North Am 34(2): 269–279

    Article  PubMed  Google Scholar 

  22. Halvorson TL, Kelley LA, Thomas KA et al (1994) Effects of bone mineral density on pedicle screw fixation. Spine 19(21): 2415–2420

    Article  PubMed  CAS  Google Scholar 

  23. Harrop JS, Youssef JA, Maltenfort M et al (2008) Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine 33(15): 1701–1707

    Article  PubMed  Google Scholar 

  24. Hasegawa T, Inufusa A, Imai Y et al (2005) Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J 5(3): 239–243

    Article  PubMed  Google Scholar 

  25. Heary RF (2004) Evaluation and treatment of adult spinal deformity. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves. J Neurosurg Spine1(1): 9–18

    Google Scholar 

  26. Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(Suppl 6): 190–1904

    Article  Google Scholar 

  27. Horton WC, Holt RT, Muldowny DS (1996) Controversy. Fusion of L5-S1 in adult scoliosis. Spine 21(21): 2520–2522

    PubMed  CAS  Google Scholar 

  28. Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine 31(17): 1983–2001

    Article  PubMed  Google Scholar 

  29. Khoueir P, Kim KA, Wang MY (2007) Classification of posterior dynamic stabilization devices. Neurosurg Focus 22(1): 3

    Article  Google Scholar 

  30. Kostuik JP (1988) Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum. Orthop Clin North Am 19(2): 371–381

    PubMed  CAS  Google Scholar 

  31. Linhardt O, Luring C, Matussek J et al (2006) Stability of anterior vertebral body screws after kyphoplasty augmentation. An experimental study to compare anterior vertebral body screw fixation in soft and cured kyphoplasty cement. Int Orthop 30(5): 366–370

    Article  PubMed  CAS  Google Scholar 

  32. Lowe T, Berven SH, Schwab FJ, Bridwell KH (2006) The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems. Spine 31(Suppl 19): 119–125

    Article  Google Scholar 

  33. Marty-Poumarat C, Scattin L, Marpeau M et al (2007) Natural history of progressive adult scoliosis. Spine 32(11): 1227–1234

    Article  PubMed  Google Scholar 

  34. Ngu BB, Belkoff SM, Gelb DE, Ludwig SC (2006) A biomechanical comparison of sacral pedicle screw salvage techniques. Spine 31(6): 166–168

    Article  Google Scholar 

  35. Nunley PD, Jawahar A, Mukherjee DP et al (2008) Comparison of pressure effects on adjacent disk levels after 2-level lumbar constructs: fusion, hybrid and total disk replacement. Surg Neurol 70(3): 247–251

    Article  PubMed  Google Scholar 

  36. Oskouian RJ Jr, Shaffrey CI (2006) Degenerative lumbar scoliosis. Neurosurg Clin North Am 17(3): 299–315

    Article  Google Scholar 

  37. Park P, Garton HJ, Gala VC et al (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29(17): 1938–1944

    Article  PubMed  Google Scholar 

  38. Ploumis A, Transfledt EE, Denis F (2007) Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 7(4): 428–436

    Article  PubMed  Google Scholar 

  39. Renner SM, Lim TH, Kim WJ et al (2004) Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine 29(11): 212–216

    Article  Google Scholar 

  40. Schwab F, Farcy JP, Bridwell K et al (2006) A clinical impact classification of scoliosis in the adult. Spine 31(18): 2109–2114

    Article  PubMed  Google Scholar 

  41. Schwarzenbach O, Berlemann U, Stoll TM, Dubois G (2005) Posterior dynamic stabilization systems: DYNESYS. Orthop Clin North Am 36(3): 363–372

    Article  PubMed  Google Scholar 

  42. Smith JS, Shaffrey CI, Kuntz C, Mummaneni PV (2008) Classification systems for adolescent and adult scoliosis. Neurosurgery 63(Suppl 3): 16–24

    Article  PubMed  Google Scholar 

  43. Soshi S, Shiba R, Kondo H, Murota K (1991) An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine 16(11): 1335–1341

    Article  PubMed  CAS  Google Scholar 

  44. Tosun B, Snmazcelik T, Buluc L et al (2008) Effect of insertional temperature on the pullout strength of pedicle screws inserted into thoracic vertebrae: an in vitro calf study. Spine 33(19): 667–672

    Article  Google Scholar 

  45. Tribus CB (2003) Degenerative lumbar scoliosis: evaluation and management. J Am Acad Orthop Surg 11(3): 174–183

    PubMed  Google Scholar 

  46. Trout AT, Kallmes DF (2006) Does vertebroplasty cause incident vertebral fractures? A review of available data. Am J Neuroradiol 27(7): 1397–1403

    PubMed  CAS  Google Scholar 

  47. Trout AT, Kallmes DF, Layton KF et al (2006) Vertebral endplate fractures: an indicator of the abnormal forces generated in the spine after vertebroplasty. J Bone Miner Res 21(11): 1797–1802

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Klinikum Neustadt, Lehrkrankenhaus der Universität Lübeck, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland

    M. Quante, A. Richter, B. Thomsen, M. Köszegvary & H. Halm

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  1. M. Quante
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  2. A. Richter
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Quante, M., Richter, A., Thomsen, B. et al. Die operative Behandlung der adulten Skoliose. Orthopäde 38, 159–169 (2009). https://doi.org/10.1007/s00132-008-1391-5

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