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Korrektur der Adoleszentenkyphose

Was ist State of the Art?

Correction of adolescent kyphosis

What is the state of the art?

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Zusammenfassung

Die thorakale und thorakolumbale Kyphose ist eine häufige Deformität der pädiatrischen und adoleszenten Population. Die kyphotische Deformität der Wirbelsäule ist definiert als eine Kurve, die eine Zunahme der dorsal konvexen Angulation aufzeigt. Die häufigsten Ursachen einer Kyphose in der pädiatrischen und adoleszenten Population sind die Scheuermann-Erkrankung, die haltungsbedingte und die kongenitale Kyphose.

Fundamentale Prinzipien der Behandlung sind die Analyse der kyphotischen Deformität und die Wiederherstellung oder Erhaltung der sagittalen Balance. Klinisch signifikante sagittale Deformitäten können zu starken Schmerzen, erheblichen kosmetischen Veränderungen, Rückenmarkdysfunktion, Schluckbeschwerden, gastrointestinalen und kardiopulmonalen Beeinträchtigungen führen.

Wenn die kyphotische Deformität einen bestimmten Punkt überschritten hat und die konservativen Therapieoptionen nicht mehr zur Auswahl stehen, ist die chirurgische Intervention indiziert. Die zur Verfügung stehenden operativen Optionen zur Behandlung der unterschiedlichen Typen der pädiatrischen und adoleszenten thorakolumbalen Kyphosen beinhalten die dorsale Instrumentation und Fusion kombiniert mit ventraler Fusion und eine rein ventrale Instrumentation und Fusion.

Abstract

Thoracic and thoracolumbar kyphosis is a common deformity in pediatric and adolescent populations. Kyphotic deformation of the spine is defined as a curve which shows an increase in the dorsal convex angulation. The most common causes of kyphosis in pediatric and adolescent populations are Scheuermann’s disease, postural and congenital kyphosis.

The fundamental principles of treatment are analysis of the kyphotic deformity and restoration or maintenance of sagittal balance. Clinically significant sagittal deformities can lead to severe pain, substantial cosmetic alterations, spinal cord dysfunction, problems with swallowing, gastrointestinal and cardiopulmonary complications.

When the kyphotic deformity exceeds a certain point and conservative therapy options are no longer sufficient surgical intervention is indicated. The available operative options for treatment of the various types of pediatric and adolescent thoracolumbar kyphosis include dorsal instrumentation and fusion combined with ventral fusion and purely ventral instrumentation and fusion.

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

    M. Akbar & B. Wiedenhöfer

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  1. M. Akbar
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  2. B. Wiedenhöfer
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Correspondence to M. Akbar.

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Akbar, M., Wiedenhöfer, B. Korrektur der Adoleszentenkyphose. Orthopäde 40, 682–689 (2011). https://doi.org/10.1007/s00132-011-1799-1

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