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Erhöhtes Risiko der thorakalen Hypokyphose nach dorsaler Korrekturspondylodese bei adoleszenten idiopathischen Skoliosen mit thorakaler Doppelkrümmung

Increased risk of thoracic hypokyphosis after posterior spinal correction and fusion in adolescent idiopathic scoliosis with thoracic double curve

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Zusammenfassung

Hintergrund

Die adoleszente idiopathische Skoliose (AIS) geht häufig mit einer thorakalen Hypokyphose oder sogar Lordose einher.

Fragestellung

Ziel war es, den Einfluss der dorsalen Korrekturspondylodese bei thorakalen, strukturell doppelbogigen AIS zu analysieren.

Material und Methoden

Von insgesamt 127 prospektiv erfassten thorakalen AIS (Lenke-Typ 1 und 2) wurden die doppelbogigen thorakalen AIS retrospektiv analysiert. Operation 2010–2019 mit Pedikelschrauben-Doppelstab-Systemen in einem Skoliosezentrum. Nachuntersuchung (FU) mind. 2 Jahre. Frontale und sagittale Winkel (Ganzwirbelsäulen-Röntgenbilder, 2E): thorakale Krümmung (MK), proximal-thorakale Krümmung (PK) und lumbale Nebenkrümmung (LK), thorakale Kyphose (TK), Lendenlordose (LL). Statistische Analyse: Werte als MW ± SD, Students t‑Test (Signifikanz a = 0,05), Pearson’s Korrelation, Subanalyse mit sagittalen Modifiern (−, N, +).

Ergebnisse

Insgesamt wurden 47 doppelbogige thorakale AIS identifiziert, mittlere FU 29,3 ± 12,2 Monate, mittleres Alter 14 ± 1,5 Jahre. Mittlere Korrektur (FU-präop) der MK betrug 67 %, PK 53 %, LK 73 %, jeweils signifikant, (p < 0,05). Im Durchschnitt verringerte sich die TK (FU-präop) um −6,5 ± 11,6° (p < 0,05), keine signifikante Veränderung zum FU (p = 0,6). Die TK (FU-präop) nahm bei hypokyphotischen Fällen um 8,6 ± 5,0° (p < 0,05) zu, bei normokyphotischen AIS um −4,8 ± 9,6° und bei hyperkyphotischen um −25,3 ± 11,1° jeweils signifikant ab (p < 0,05). Bei Hypokyphosen: Mäßig starke Korrelation zwischen der Korrektur PK (r = −0,5) und Spontankorrektur LK (r = 0,8) (Frontalebene) und der Veränderung von prä- zu postoperativen TK (Sagittalebene) (p < 0,05). Moderate Korrelation bei Hyperkyphosen: Korrektur PK (r = −0,5) und postoperativer TK (p < 0,05). Keine relevanten Korrelationen für Normokyphosen. 17 % hatten eine postoperative Hypokyphose, davon 0 präoperative Hypokyphosen. Der Stabdurchmesser (5,5 mm vs. 6 mm) hatte keinen signifikanten Einfluss auf die TK.

Schlussfolgerung

Mit der dorsalen Korrekturspondylodese (Pedikelschrauben-Doppelstab-Systeme) kann bei doppelbogig thorakalen Skoliosen eine signifikante Korrektur der Seitausbiegungen beider Krümmungen erreicht werden, wenngleich diese insbesondere bei präoperativ normokyphotischen Patienten mit einem erhöhten Risiko für eine postoperative thorakale Hypokyphose einhergeht.

Abstract

Background

Adolescent idiopathic scoliosis (AIS) is often associated with thoracic hypokyphosis or even lordosis.

Objectives

To analyze the influence of posterior correction and fusion in thoracic, structurally double-curved AIS.

Material and methods

Out of 127 thoracic AIS (Lenke types 1 and 2) recorded prospectively, idiopathic double thoracic curve AIS were analyzed retrospectively. Surgery 2010–2019 with pedicle screw double rod systems in a scoliosis center. Follow-up (FU) at least 2 years. Frontal and sagittal angles (whole-spine radiographs, 2 planes): thoracic curve (MK), proximal-thoracic curve (PK) and lumbar curve (LK), thoracic kyphosis (TK), lumbar lordosis (LL). Statistical analysis: values as MW ± SD, students t‑test (significance a = 0.05), Pearson’s correlation, sub-analysis with sagittal modifiers (−, N, +).

Results

A total of 47 AIS-double thoracic curve were identified, mean FU 29.3 ± 12.2 months, mean age 14 ± 1.5 years. The mean correction (FU-preop) of MK was 67%, PK 53%, LK 73%, each significant, (p < 0.05). On average, TK (FU-preop) decreased by −6.5 ± 11.6° (p < 0.05), no significant change from FU (p = 0.6). TK (FU-preop) increased by 8.6 ± 5.0° (p < 0.05) in hypokyphotic cases, significantly decreased by −4.8 ± 9.6° in normokyphotic AIS and −25.3 ± 11.1° in hyperkyphotic cases, respectively (p < 0.05). In hypokyphosis: moderately strong correlation between correction PK (r = −0.5) and spontaneous correction LK (r = 0.8) (frontal plane) and change from pre- to postop TK (sagittal plane) (p < 0.05). Moderate correlation for hyperkyphosis: correction PK (r = −0.5) and postop TK (p < 0.05). No relevant correlations for normokyphosis. 17% had postop hypokyphosis, of which 0% had preop hypokyphosis. Rod diameter (5.5 mm vs. 6 mm) had no significant effect on TC.

Conclusions

Posterior instrumented correction and fusion (pedicle screw dual rod systems) can significantly correct both lateral curves in idiopathic double thoracic curves, although it is associated with an increased risk of postop thoracic hypokyphosis, especially in preoperatively normokyphotic patients.

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Abbreviations

AIS:

Adoleszente idiopathische Skoliose

BWS:

Brustwirbelsäule

FU:

Follow-up

LK:

Lumbale Krümmung

LL:

Lumbale Lordose

MK:

Thorakale Hauptkrümmung

PK:

Proximal thorakale Hauptkrümmung

PRÄ:

Präoperativ

POST:

Postoperativ

TK:

Thorakale Kyphose

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Authors and Affiliations

  1. Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland

    Clara Berlin,  Markus Quante &  Henry Halm

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  1. Clara Berlin
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Correspondence to Clara Berlin.

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Interessenkonflikt

C. Berlin gibt an, dass kein Interessenkonflikt besteht., M. Quante hat einen Beratervertrag und erhält Honorare der Firmen Silony Nuvasive Inc. (USA) und Surgalign. M. Quante hat Beteiligungen der Firmen Active Ortho und Surgalign und erhält Lizenzgebühren (royalties) der Firma Surgalign. H. Halm hat einen Beratervertrag mit Lizenzgebühr mit der Firma Nuvasive Inc. (USA).

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

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Genderhinweis: Aus Gründen der leichteren Lesbarkeit wird im folgenden Text die männliche Sprachform (z. B. „der Patient“ oder der „Operateur“) verwendet. Dies soll im Sinne der sprachlichen Vereinfachung als geschlechtsneutral zu verstehen sein.

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Berlin, C., Quante, M. & Halm, H. Erhöhtes Risiko der thorakalen Hypokyphose nach dorsaler Korrekturspondylodese bei adoleszenten idiopathischen Skoliosen mit thorakaler Doppelkrümmung. Orthopädie 52, 233–242 (2023). https://doi.org/10.1007/s00132-022-04339-1

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