Skip to main content

Advertisement

SpringerLink
Log in

Operative Strategien bei der Versorgung neuromuskulärer Skoliosen

Surgical strategies in the treatment of neuromuscular scoliosis

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Neuromuskuläre Skoliosen treten im Rahmen der Grunderkrankung bereits im frühen Kindesalter auf und zeigen im Vergleich zu idiopathischen Skoliosen eine rasche Progredienz, die auch mit Wachstumsabschluss nicht sistiert. Ein Aufhalten des Krümmungszuwachses und damit einhergehender Komplikationen lässt sich dauerhaft nur über eine operative Versorgung erreichen. Hierfür haben sich, abhängig von Patientenalter und Ausmaß der Deformität, verschiedene operative Strategien etabliert: Im frühen Kindesalter werden „mitwachsende Implantate“ eingesetzt, während ab dem 10.–12. Lebensjahr eine definitive Versorgung mittels Korrektur und Fusion der Skoliose die Therapie der Wahl ist. Diese unterschiedlichen Operationsstrategien stellen wir neben den Indikationen zur operativen Versorgung vor und diskutieren Herausforderungen bei der Behandlung dieser komplexen Deformitäten.

Abstract

As part of the underlying condition, neuromuscular scoliosis occurs in early childhood. Compared to idiopathic scoliosis, neuromuscular scoliosis shows a more rapid progress of deformity, which continues even after the end of growth. This progress and the associated complications can only be prevented by surgical treatment. Depending on the patient’s age and the extent of the deformity, different strategies have been established: in early childhood, so-called “growing implants” are used, while between the ages of 10 to 12, definitive treatment by reposition and fusion of the deformity is the treatment of choice. In this review, we present different surgical strategies as well as indications for surgery and discuss challenges in the treatment of these complex deformities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Abbreviations

BWK:

Brustwirbelkörper

BWS :

Brustwirbelsäule

LWS :

Lendenwirbelsäule

SWK :

Sakralwirbelkörper

Literatur

  1. Akbarnia BA, Breakwell LM, Marks DS et al (2008) Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine (Phila Pa 1976) 33:984–990

    Article  Google Scholar 

  2. Akbarnia BA, Cheung K, Noordeen H et al (2013) Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis. Spine (Phila Pa 1976) 38:665–670

    Article  Google Scholar 

  3. Andras LM, Joiner ER, Mccarthy RE et al (2015) Growing rods versus Shilla growth guidance: better Cobb angle correction and T1-S1 length increase but more surgeries. Spine Deform 3:246–252

    Article  Google Scholar 

  4. Berven S, Bradford DS (2002) Neuromuscular scoliosis: causes of deformity and principles for evaluation and management. Semin Neurol 22:167–178

    Article  Google Scholar 

  5. Dede O, Demirkiran G, Yazici M (2014) 2014 Update on the „growing spine surgery“ for young children with scoliosis. Curr Opin Pediatr 26:57–63

    Article  Google Scholar 

  6. Dimeglio A, Canavese F (2012) The growing spine: how spinal deformities influence normal spine and thoracic cage growth. Eur Spine J 21:64–70

    Article  Google Scholar 

  7. Fujak A, Raab W, Schuh A et al (2013) Natural course of scoliosis in proximal spinal muscular atrophy type II and IIIa: descriptive clinical study with retrospective data collection of 126 patients. BMC Musculoskelet Disord 14:283

    Article  Google Scholar 

  8. Gu Y, Shelton JE, Ketchum JM et al (2011) Natural history of scoliosis in nonambulatory spastic tetraplegic cerebral palsy. PM R 3:27–32

    Article  Google Scholar 

  9. Hardesty CK, Huang RP, El-Hawary R et al (2018) Early-onset scoliosis: updated treatment techniques and results. Spine Deform 6:467–472

    Article  Google Scholar 

  10. Helenius IJ, Viehweger E, Castelein RM (2020) Cerebral palsy with dislocated hip and scoliosis: what to deal with first? J Child Orthop 14:24–29

    Article  Google Scholar 

  11. 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 (Phila Pa 1976) 29:2040–2048

    Article  Google Scholar 

  12. Luhmann SJ, Mccarthy RE (2017) A comparison of Shilla growth guidance system and growing rods in the treatment of spinal deformity in children less than 10 years of age. J Pediatr Orthop 37:e567–e574

    Article  Google Scholar 

  13. Luhmann SJ, Smith JC, Mcclung A et al (2017) Radiographic outcomes of Shilla growth guidance system and traditional growing rods through definitive treatment. Spine Deform 5:277–282

    Article  Google Scholar 

  14. Mccall RE, Hayes B (2005) Long-term outcome in neuromuscular scoliosis fused only to lumbar 5. Spine (Phila Pa 1976) 30:2056–2060

    Article  Google Scholar 

  15. McCarthy RE (1999) Management of neuromuscular scoliosis. Orthop Clin North Am 30:435–449

    Article  CAS  Google Scholar 

  16. Murphy RF, Mooney JF 3rd (2019) Current concepts in neuromuscular scoliosis. Curr Rev Musculoskelet Med 12:220–227

    Article  Google Scholar 

  17. Olgun ZD, Ahmadiadli H, Alanay A et al (2012) Vertebral body growth during growing rod instrumentation: growth preservation or stimulation? J Pediatr Orthop 32:184–189

    Article  Google Scholar 

  18. Passias PG, Poorman GW, Jalai CM et al (2019) Incidence of congenital spinal abnormalities among pediatric patients and their association with scoliosis and systemic anomalies. J Pediatr Orthop 39:e608–e613

    Article  Google Scholar 

  19. Patel J, Walker JL, Talwalkar VR et al (2011) Correlation of spine deformity, lung function, and seat pressure in spina bifida. Clin Orthop Relat Res 469:1302–1307

    Article  Google Scholar 

  20. Prottengeier J, Amann B, Münster T (2020) Anesthesia for patients suffering from neuromuscular diseases. Anaesthesist 69:373–387

    Article  CAS  Google Scholar 

  21. Putzier M, Groß C, Zahn RK et al (2016) Characteristics of neuromuscular scoliosis. Orthopade 45:500–508

    Article  CAS  Google Scholar 

  22. Racca F, Mongini T, Wolfler A et al (2013) Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders. Minerva Anestesiol 79:419–433

    CAS  PubMed  Google Scholar 

  23. Shapiro F, Zurakowski D, Bui T et al (2014) Progression of spinal deformity in wheelchair-dependent patients with Duchenne muscular dystrophy who are not treated with steroids: coronal plane (scoliosis) and sagittal plane (kyphosis, lordosis) deformity. Bone Joint J 96:100–105

    Article  Google Scholar 

  24. Skaggs DL, Akbarnia BA, Flynn JM et al (2014) A classification of growth friendly spine implants. J Pediatr Orthop 34:260–274

    Article  Google Scholar 

  25. Tøndevold N, Lastikka M, Andersen T et al (2020) Should instrumented spinal fusion in nonambulatory children with neuromuscular scoliosis be extended to L5 or the pelvis? Bone Joint J 102:261–267

    Article  Google Scholar 

  26. Vitale MG, Gomez JA, Matsumoto H et al (2011) Variability of expert opinion in treatment of early-onset scoliosis. Clin Orthop Relat Res 469:1317–1322

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Unfallchirurgie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Friederike Schömig, Jasmin Fussi, Matthias Pumberger & Michael Putzier

Authors
  1. Friederike Schömig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jasmin Fussi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Pumberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Putzier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Friederike Schömig.

Ethics declarations

Interessenkonflikt

F. Schömig, J. Fussi, M. Pumberger und M. Putzier geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schömig, F., Fussi, J., Pumberger, M. et al. Operative Strategien bei der Versorgung neuromuskulärer Skoliosen. Orthopäde 50, 633–637 (2021). https://doi.org/10.1007/s00132-021-04128-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-021-04128-2

Schlüsselwörter

Keywords

Search

Navigation