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Skoliose im Wachstumsalter

Von der Deformität zur Therapie

Adolescent scoliosis

From deformity to treatment

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Zusammenfassung

Hintergrund

Bis zu 6 % der Bevölkerung haben eine Skoliose. Steigendes Rückenschmerzrisiko, kosmetische Aspekte sowie restriktive Lungenfunktionsstörungen bei einem Cobb-Winkel > 80° und eine Progredienz nach Wachstumsabschluss bei Krümmungen > 50° indizieren konservative oder operative Therapiemaßnahmen. Diese leiten sich aus den Klassifikationen der Skoliose ab, die die Deformität, die Topographie derselben sowie das Lebensalter bei Erstdiagnose berücksichtigen.

Ziel

Überblick über die praxisrelevanten und gebräuchlichsten Klassifikationen und deren abgeleitete Therapie der Skoliose im Wachstumsalter

Ergebnisse

Während die radiographische Messung des Cobb-Winkels in der Frontalebene die Deformität unterscheidet, berücksichtigen die topographischen Einteilungen die Höhenlokalisation und die Form der Krümmung sowie das sagittale Wirbelsäulenprofil und dienen insbesondere der präoperativen Festlegung der Instrumentationshöhe. Die das Lebensalter berücksichtigenden Klassifikationen unterscheiden zwischen den sog. Early-onset-Skoliosen, die bis zum 10. Lebensjahr diagnostiziert werden, den Adoleszentenskoliosen, die bis zum Wachstumsabschluss entstehen, sowie adulten Skoliosen. Die Early-onset-Skoliosen werden dabei nochmals anhand ihres Alters, sowie ihrer Ätiologie subklassifiziert.

Schlussfolgerung

Die Einordnung der erhobenen klinisch-radiologischen Befunde in die vorgenannten Klassifikationen erleichtert die begründete Ableitung von Therapiemaßnahmen. In der heutigen Zeit sind die Klassifikationen, die klinisch-radiographische Parameter berücksichtigen, unverzichtbarer Bestandteil der modernen Skoliosetherapie.

Abstract

Scoliosis affects up to 6 % of the population. The resulting spine deformity, the increasing risk of back pain, cosmetic aspects, pulmonary disorders if the Cobb angle is > 80°, and the progress of the deformity to > 50° after the end of growth indicate non-operative or operative therapy. In daily clinical practice, the classifications of scoliosis allow the therapy to be adapted. Classifications consider deformity, topography of the scoliosis, and the age at diagnosis. This publication gives an overview of the relevant and most common classifications in the treatment of adolescent scoliosis. For evaluation, the deformity measurement on the coronary radiographic projection of the total spine (Cobb angle) is relevant to therapy. The classification of topography, form, and the sagittal profile of the deformity of the spine are useful for preoperative planning of the fusion level. Classifications that take into account the age at the time of the diagnosis of scoliosis differentiate among early onset scoliosis (younger than 10 years of age), adolescent scoliosis (up to the end of growth), and adult scoliosis. Early onset scoliosis is subdivided by age and etiology. Therapy is derived from the classification of clinical and radiological findings. Classifications that take into account clinical and radiological parameters are essential components of modern scoliosis therapy.

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Authors and Affiliations

  1. Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    A. Schulze, M. Betsch, V. Quack & M. Tingart

  2. Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    S. Schrading

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Correspondence to A. Schulze.

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A. Schulze, S. Schrading, M. Betsch, V. Quack und M. Tingart geben an, dass kein Interessenkonflikt besteht.

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Schulze, A., Schrading, S., Betsch, M. et al. Skoliose im Wachstumsalter. Orthopäde 44, 836–844 (2015). https://doi.org/10.1007/s00132-015-3165-1

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