Zusammenfassung
Konventionelle Operationstechniken zur Korrektur einer Skoliose führen zumeist zu einer Fusion der instrumentierten Wirbelsäulensegmente. Äußerst kritisch ist dieses bei Kindern mit signifikantem Restwachstum zu beurteilen, da es konsekutiv zu einem dysproportionierten Körperwachstum mit hypoplastischem Thorax und assoziierter Begleitmorbidität kommt. Inzwischen stehen sog. Nonfusionstechniken (u. a. Growing Rods, Vertical Expandable Prosthetic Titanium Rib® [VEPTR], Staples) zur Behandlung der kindlichen Skoliose zur Verfügung. Ihr jeweiliges Indikationsspektrum muss jedoch penibel eingehalten werden, um Komplikationen wie ein Therapie- und Materialversagen zu minimieren. Neu ist die Entwicklung einer extrakorporalen magnetischen Distraktion bei Growing Rods (MAGEC®), die operative Nachstellungen entbehrlich macht. Auch für das VEPTR-Verfahren wird eine ähnliche Technik der Wachstumsanpassung ohne Folgeoperationen demnächst zu Verfügung stehen. Dieses ist ein wesentlicher Fortschritt bei der Anwendung von Nonfusionstechniken und wird sicherlich zu einer zunehmenden Verbreitung solcher Operationsverfahren führen.
Abstract
The primary goal of treatment in children with early onset scoliosis (EOS) is to control the deformity and to allow spinal and chest wall growth to continue and improve pulmonary function. In skeletally immature children spondylodesis leads to fusion of the instrumented segments with associated nonsymmetrical growth and pulmonary insufficiency. Non-fusion, techniques such as growing rods, vertical expandable prosthetic titanium rib® (VEPTR) and staples have evolved over the past years. Each technique has its different spectrum of indications which the surgeon has to follow accurately to prevent the patient from developing complications. A new trend started by using magnetically controlled growing rods to avoid the need for anesthesia and open surgery during adaptive growth. The intention of this article is to give the reader a synopsis about the three most important non-fusion techniques based on own experience and the current literature.
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Literatur
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 33(9):984–990
Akbarnia BA, Cheung K, Noordeen H et al (2012) Next generation of growth-sparing technique: preliminary clinical results of a Magnetically Controlled Growing Rod (MCGR) in 14 patients with early onset scoliosis. Spine (Epub ahead of print)
Akbarnia BA, Marks DS, Boachie-Adjei O et al (2005) Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine 17(Suppl):S46–S57
Bess S, Akbarnia BA, Thompson GH et al (2010) Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg [Am] 92(15):2533–2543
Betz RR, Kim JD, Andrea LP (2003) An innovative technique of vertebral body stapling for the treatment of patients with adolescent idiopathic scoliosis: a feasibility, safety and utility study. Spine 28(20):255–265
Betz RR, Mulcahey MJ, Ramirez N (2008) Mortality and life-threatening events after vertical expandable prosthetic titanium rib surgery in children with hypoplastic chest wall deformity. J Pediatr Orthop 28:850–853
Betz RR, Ranade A, Samdani AF (2010) Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis. Spine 35(2):169–176
Campbell MR Jr, Adcox BM, Smith MD (2007) The effect of mid-thoracic VEPTR opening wedge thoracostomy on cervical tilt associated with congenital thoracic scoliosis in patients with thoracic insufficiency syndrome. Spine 32:2171–2177
Cheung KM, Cheung JP, Samartzis D et al (2012) Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series. Lancet 379(9830):1967–1974
Dannawi Z, Altaf F, Harshavardhana NS et al (2013) Early results of a remotely-operated magnetic growth rod in early-onset scoliosis. Bone Joint J 95-B(1):75–80
Dimeglio A (1993) Growth of the spine below age 5 years. J Pediatr Orthop-B 1:102–107
Emans JB, Caubet JF, Ordonez CL (2005) The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes. Spine 30(Suppl):58–68
Harrington PR (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg [Am] 44-A:591–610
Hell AK, Campbell RM, Hefti F (2005) The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children. J Pediatr Orthop-B 14(4):287–293
Hell AK, Hefti F, Campbell RM Jr (2004) Treatment of congenital scoliosis with the vertical expandable prosthetic titanium rib implant. Orthopäde 33:911–918
Lavelle WF, Samdani AF, Cahill PJ et al (2011) Clinical outcomes of nitinol staples for preventing curve progression in idiopathic scoliosis. J Pediatr Orthop 31(Suppl 1):107–113
Mayer OH, Redding G (2009) Early changes in pulmonary function after vertical expandable prosthetic titanium rib insertion in children with thoracic insuffiency syndrome. J Pediatr Orthop 29:35–38
Motoyama EK, Yang CI, Deeney VF (2009) Thoracic malformation with early-onset scoliosis: effect of serial VEPTR expansion thoracoplasty on lung growth and function in children. Paediatr Respir Rev 10:12–17
Nassr A, Larson AN, Crane B (2009) Iatrogenic thoracic outlet syndrome secondary to vertical expandable prosthetic titanium rib expansion thoracoplasty: pathogenesis and strategies for prevention/treatment. J Pediatr Orthop 29:31–34
Redding G, Song K, Inscore S (2008) Lung function asymmetry in children with congenital and infantile scoliosis. Spine J 8:639–644
Samdani AF, Hilaire TS, Emans JB (2010) The usefulness of VEPTR in the older child with complex spine and chest deformity. Clin Orthop Relat Res 468:700–704
Samdani AF, Ranade A, Dolch HJ (2009) Bilateral use of the VEPTR attached to the pelvis: a novel treatment for scoliosis in the growing spine. J Neurosurg Spine 10:287–292
Stücker R (2009) Ergebnisse der Behandlung von progredienten Skoliosen mit SMA-Klammern. Orthopäde 38:176–180
Trobisch PD, Samdani A, Cahill P et al (2011) Vertebral body stapling as an alternative in the treatment of idiopathic scoliosis. Oper Orthop Traumatol 23(3):227–231
Vitale MG, Matsumoto H, Roye DP Jr (2008) Health-related quality of life in children with thoracic insufficiency syndrome. J Pediatr Orthop 28:239–243
Wimmer C, Wallnöfer P, Pfandlsteiner T (2009) VEPTR 4 years follow up in the treatment of severe spinal deformities. Euro Spine J 18(Suppl 4):424
Winter RB (1981) Convex anterior and posterior hemiarthrodesis and hemiepiphyseodesis in young children with progressive congenital scoliosis. J Pediatr Orthop 1(4):361–366
Zazycki D, Tesiorowski M, Potaczek T (2008) Use of VEPTR device in the treatment of congenital spine and thorax deformities. Przegl Lek 65:329–323
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Interessenkonflikt. K. Ridderbusch, M. Rupprecht, P. Kunkel, R. Stücker geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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K. Ridderbusch und M. Rupprecht haben in gleichen Teilen zu dieser Arbeit beigetragen und teilen sich deshalb die Erstautorenschaft.
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Ridderbusch, K., Rupprecht, M., Kunkel, P. et al. Nonfusionstechniken zur Behandlung der kindlichen Skoliose. Orthopäde 42, 1030–1037 (2013). https://doi.org/10.1007/s00132-012-2049-x
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DOI: https://doi.org/10.1007/s00132-012-2049-x
Schlüsselwörter
- Indikationsspektrum
- Vertical Expandable Prosthetic Titanium Rib® (VEPTR)
- Growing Rod
- Staples
- Wachstumslenkung