Skip to main content

Dreidimensionale Korrekturprinzipien einer dreidimensionalen Deformität

Möglichkeiten und Relevanz der operativen Optimierung der Thorakalkyphose in der Skoliosechirurgie

Multiplan correction of a 3D deformity

Options and relevance of optimizing the thoracic kyphosis in reconstructive scoliosis surgery

Der Orthopäde volume 40, Article number: 672 (2011) Cite this article

Zusammenfassung

Hintergrund

Bis heute besteht kein Konsens, wie eine adoleszente idiopathische Skoliose (AIS) und speziell der thorakale Flachrücken operativ zu behandeln sind. Lange Zeit wurde primär auf die koronare Korrektur der Deformität geachtet und die sagittale Komponente vernachlässigt. Die Arbeit gibt aus der aktuellen Literatur und eigenen Daten eine Übersicht über die optimale Einstellung der Wirbelsäule zur Vermeidung von Sekundärkomplikationen. Es werden verfahrensspezifisch die Auswirkungen der Standardverfahren der Skoliosekorrektur inkl. der immanenten Vor- und Nachteile und der auf die globalen und positionellen Parameter der sagittalen Balance (sagittales Lot, „lumbar lordosis“ [LL], „thoracic kyphosis“ [TK], „pelvic tilt“ [PT], „sagittal slope“ [SSL] und „pelvic incidence“ [PI]) und deren Anwendung für die operative Therapieplanung dargestellt.

Ergebnisse

Retrospektiv wurden 24 Patienten (2 Gruppen zu je 12 Patienten) mit AIS und dorsaler Korrekturspondylodese mit (A) bzw. ohne (B) additive Osteotomien in der Auswirkung auf die spinopelvine Balance und die Health-Related Quality of Life (HRQoL) erfasst. Gruppe A hatte eine signifikante Reduktion der TK, LL und des SSL sowie Zunahme des PT, Gruppe B umgekehrt. Eine Korrelationsanalyse ergab eine signifikante Abhängigkeit der HRQoL vom PT.

Diskussion

Sowohl die eigenen Daten als auch die der Literatur zeigen, dass operative Korrekturen unabhängig vom gewählten Verfahren einer sorgfältigen Planung unter Berücksichtigung der sagittalen spinopelvinen Parameter bedürfen. Rigide Flachrückenprofile erfordern additive Osteotomien.

Abstract

Background

There is presently still no consensus on how to operatively treat adolescent idiopathic scoliosis (AIS), i.e. a clearly reduced thoracic kyphosis. For a long time the primary focus was mostly on correcting the coronal plane while neglecting the sagittal profile. Based on the current literature and own retrospective data a comprehensive review will be given on the optimal correction of the spine and how to avoid secondary complications. Different operative standard procedures are demonstrated with special attention to the sagittal balance and the special parameters sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sagittal slope (SSL) and pelvic incidence (PI).

Results

A total of 24 patients (2 groups of 12 patients) with AIS and posterior fusion with (group A) and without (group B) additional osteotomy were analyzed with respect to the impact on spinopelvic balance and health-related quality of life (HRQoL) parameters. Patients in group A had a significant reduction of TK, LL and SSL and an increase in PT whereas patients in group B showed the opposite. Correlation analysis revealed a significant dependence of HRQoL on PT.

Discussion

Both the results from the literature and own data confirm that operative correction of AIS needs a careful planning including sagittal spinopelvic parameters. Rigid thoracic hypokyphosis require additional osteotomy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721

    PubMed  Article  CAS  Google Scholar 

  2. Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47

    PubMed  Article  Google Scholar 

  3. Boos N, Dolan LA, Weinstein SL (2007) Long-term clinical and radiographic results of Cotrel-Dubousset instrumentation of right thoracic adolescent idiopathic scoliosis. Iowa Orthop J 27:40–46

    PubMed  Google Scholar 

  4. Boulay C, Tardieu C, Hecquet J et al (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422

    PubMed  Article  CAS  Google Scholar 

  5. Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine 31:S171–S178

    PubMed  Article  Google Scholar 

  6. Bridwell KH, Betz R, Capelli AM et al (1990) Sagittal plane analysis in idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. Spine 15:921–926

    PubMed  Article  CAS  Google Scholar 

  7. Bullmann V, Halm HF, Niemeyer T et al (2003) Dual-rod correction and instrumentation of idiopathic scoliosis with the Halm-Zielke instrumentation. Spine 28:1306–1313

    PubMed  Google Scholar 

  8. Cho KJ, Bridwell KH, Lenke LG et al (2005) Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine 30:2030–2037; discussion 2038

    PubMed  Article  Google Scholar 

  9. Danielsson AJ, Nachemson AL (2003) Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II. Spine 28:E373–E383

    PubMed  Article  Google Scholar 

  10. Danielsson AJ, Romberg K, Nachemson AL (2006) Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for adolescent idiopathic scoliosis: a case-control study. Spine 31:275–283

    PubMed  Article  Google Scholar 

  11. Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831

    PubMed  Article  CAS  Google Scholar 

  12. Diab MG, Franzone JM, Vitale MG (2011) The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop 31:S88–S98

    PubMed  Article  Google Scholar 

  13. Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. In: Weinstein SL (ed) Pediatric spine: principles and practice. Raven Press, New York

  14. Gill JB, Levin A, Burd T, Longley M (2008) Corrective osteotomies in spine surgery. J Bone Joint Surg [Am] 90:2509–2520

    Google Scholar 

  15. Guo X, Chau WW, Chan YL, Cheng JC (2003) Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral-membranous bone growth. J Bone Joint Surg [Br] 85:1026–1031

    Google Scholar 

  16. Halm H, Niemeyer T, Halm B et al (2000) Halm-Zielke instrumentation as primary stable improvement of the Zielke-VDS in idiopathic scoliosis. 1 to 4 year outcome of a prospective study of 29 consecutive patients. Orthopade 29:563–570

    PubMed  Article  CAS  Google Scholar 

  17. Helenius I, Remes V, Yrjonen T et al (2003) Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis. Long-term functional and radiographic outcomes. J Bone Joint Surg [Am] 85-A:2303–2309

    Google Scholar 

  18. Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine 21:492–499

    PubMed  Article  CAS  Google Scholar 

  19. Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19:1611–1618

    PubMed  Article  CAS  Google Scholar 

  20. Kim HJ, Blanco JS, Widmann RF (2009) Update on the management of idiopathic scoliosis. Curr Opin Pediatr 21:55–64

    PubMed  Article  Google Scholar 

  21. Kim YJ, Lenke LG, Bridwell KH et al (2007) Prospective pulmonary function comparison following posterior segmental spinal instrumentation and fusion of adolescent idiopathic scoliosis: is there a relationship between major thoracic curve correction and pulmonary function test improvement? Spine 32:2685–2693

    PubMed  Article  Google Scholar 

  22. Kim YJ, Lenke LG, Cho SK et al (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 29:2040–2048

    PubMed  Article  Google Scholar 

  23. Koller H, Zenner J, Hitzl W et al (2010) The morbidity of open transthoracic approach for anterior scoliosis correction. Spine 35:E1586–E1592

    PubMed  Article  Google Scholar 

  24. Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606

    PubMed  Article  Google Scholar 

  25. Lagrone MO, Bradford DS, Moe JH et al (1988) Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg [Am] 70:569–580

    Google Scholar 

  26. Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103

    PubMed  Article  CAS  Google Scholar 

  27. Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg [Am] 83-A:1169–1181

    Google Scholar 

  28. Liljenqvist U, Hackenberg L, Link T, Halm H (2001) Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg 67:157–163

    PubMed  CAS  Google Scholar 

  29. Lonner BS, Auerbach JD, Boachie-Adjei O et al (2009) Treatment of thoracic scoliosis: are monoaxial thoracic pedicle screws the best form of fixation for correction? Spine 34:845–851

    PubMed  Article  Google Scholar 

  30. Lonner BS, Auerbach JD, Estreicher MB et al (2009) Pulmonary function changes after various anterior approaches in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 22:551–558

    PubMed  Article  Google Scholar 

  31. Lowenstein JE, Matsumoto H, Vitale MG et al (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452

    PubMed  Article  Google Scholar 

  32. Luk KD, Lee FB, Leong JC, Hsu LC (1987) The effect on the lumbosacral spine of long spinal fusion for idiopathic scoliosis. A minimum 10-year follow-up. Spine 12:996–1000

    PubMed  Article  CAS  Google Scholar 

  33. Luk KD, Vidyadhara S, Lu DS et al (2010) Coupling between sagittal and frontal plane deformity correction in idiopathic thoracic scoliosis and its relationship with postoperative sagittal alignment. Spine 35:1158–1164

    PubMed  Article  Google Scholar 

  34. Mac-Thiong JM, Berthonnaud E, Dimar JR 2nd et al (2004) Sagittal alignment of the spine and pelvis during growth. Spine 29:1642–1647

    PubMed  Article  Google Scholar 

  35. Mac-Thiong JM, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine caucasian asymptomatic adults. Spine 35:E1193–E1198

    PubMed  Article  Google Scholar 

  36. Muschik MT, Kimmich H, Demmel T (2006) Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients. Eur Spine J 15:1128–1138

    PubMed  Article  Google Scholar 

  37. Newton PO, Upasani VV, Lhamby J et al (2008) Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. A five-year follow-up study. J Bone Joint Surg [Am] 90:2077–2089

    Google Scholar 

  38. Newton PO, Yaszay B, Upasani VV et al (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine 35:1365–1370

    PubMed  Google Scholar 

  39. Oda I, Cunningham BW, Buckley RA et al (1999) Does spinal kyphotic deformity influence the biomechanical characteristics of the adjacent motion segments? An in vivo animal model. Spine 24:2139–2146

    PubMed  Article  CAS  Google Scholar 

  40. Parent S, Odell T, Oka R et al (2008) Does the direction of pedicle screw rotation affect the biomechanics of direct transverse plane vertebral derotation? Spine 33:1966–1969

    PubMed  Article  Google Scholar 

  41. Perez-Grueso FS, Fernandez-Baillo N, Arauz Robles S de, Garcia Fernandez A (2000) The low lumbar spine below Cotrel-Dubousset instrumentation: long-term findings. Spine 25:2333–2341

    PubMed  Article  CAS  Google Scholar 

  42. Ponte A (2003) Posterior column shortening for Scheuermann’s kyphosis – an innovative technique. In: Haher TMA (ed) Surgical techniques for the spine. Thieme, New York Stuttgart, pp 107–113

  43. Ritzman TF, Upasani VV, Pawelek JB et al (2008) Return of shoulder girdle function after anterior versus posterior adolescent idiopathic scoliosis surgery. Spine 33:2228–2235

    PubMed  Article  Google Scholar 

  44. Rose PS, Lenke LG, Bridwell KH et al (2009) Pedicle screw instrumentation for adult idiopathic scoliosis: an improvement over hook/hybrid fixation. Spine 34:852–857; discussion 858

    PubMed  Article  Google Scholar 

  45. Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine 34:1828–1833

    PubMed  Article  Google Scholar 

  46. Smith-Petersen MN LC, Aufranc OE (1945) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg [Am] 27:1–11

    Google Scholar 

  47. Soucacos PN, Zacharis K, Gelalis J et al (1998) Assessment of curve progression in idiopathic scoliosis. Eur Spine J 7:270–277

    PubMed  Article  CAS  Google Scholar 

  48. Tis JE, O’Brien MF, Newton PO et al (2010) Adolescent idiopathic scoliosis treated with open instrumented anterior spinal fusion: five-year follow-up. Spine 35:64–70

    PubMed  Article  Google Scholar 

  49. Wu X, Yang S, Xu W et al (2010) Comparative intermediate and long-term results of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. J Spinal Disord Tech 23:467–473

    PubMed  Article  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

  1. Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Sektion Wirbelsäulenchirurgie, Klinikum der Ruprecht-Karls-Universität Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    B. Wiedenhöfer, C.H. Fürstenberg, K. Schröder & M. Akbar

Authors
  1. B. Wiedenhöfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C.H. Fürstenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Schröder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Akbar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Wiedenhöfer.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wiedenhöfer, B., Fürstenberg, C., Schröder, K. et al. Dreidimensionale Korrekturprinzipien einer dreidimensionalen Deformität. Orthopäde 40, 672 (2011). https://doi.org/10.1007/s00132-011-1795-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s00132-011-1795-5

Schlüsselwörter

  • Adoleszente idiopathische Skoliose
  • Sagittales Profil
  • Spinopelvine Parameter
  • Ventrale/dorsale Derotationsspondylodese
  • Additive Osteotomien

Keywords

  • Adolescent idiopathic scoliosis
  • Sagittal profile
  • Spinopelvic parameters
  • Anterior/posterior correction
  • Additional osteotomy