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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

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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.

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Authors and 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

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  1. B. Wiedenhöfer
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  2. C.H. Fürstenberg
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  4. M. Akbar
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Wiedenhöfer, B., Fürstenberg, C., Schröder, K. et al. Dreidimensionale Korrekturprinzipien einer dreidimensionalen Deformität. Orthopäde 40, 672–681 (2011). https://doi.org/10.1007/s00132-011-1795-5

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