Adulte Skoliosen

Zusammenfassung

Durch die global alternde Bevölkerung tritt die degenerative Lumbalskoliose (DLS) im Erwachsenenalter immer mehr in den Vordergrund und repräsentiert somit einen Großteil der spinalen Deformitäten. Durch die schleichende Progredienz der Erkrankung entsteht ein massiver Leidensdruck der Patienten. Die konservative Therapie der DLS zeigt ernüchternde Resultate, weshalb bei Versagen der nicht-chirurgischen Behandlungskonzepte häufig die operative Therapie indiziert wird. Neben relativ simplen Dekompressionen für milde Formen der DLS mit isolierten klaudikativen bzw. radikulären Beschwerden, können komplexe und komplikationsreiche Wirbelkörperosteotomien sowie kombinierte ventro-dorsale Eingriffe zur Anwendung kommen. Klassifikationssysteme und Einteilungen dienen zur Graduierung der Deformität und können bei der Wahl der adäquaten operativen Technik bzw. dem Ausmaß des operativen Eingriffs hilfreich sein. Neben der primären koronaren Korrektur sollte insbesondere eine sagittale Korrektur erfolgen, da das sagittale Profil einen engen Zusammenhang mit der Patientenzufriedenheit aufweist und zudem Einfluss auf die Progression der Deformität haben kann. Dieser Artikel soll einen Überblick zur degenerativen Lumbalskoliose als Hauptvertreter der adulten Skoliosen und ihren Behandlungsmöglichkeiten geben.

Abstract

Due to the globally aging population, degenerative lumbar scoliosis (DLS) represents the major deformity of older patients. The progression of the disease results in severe suffering of the affected patients, which ultimately leads to an increased financial burden on the health system. Conservative treatment of DLS patients is often of limited success. The surgical armamentarium ranges from simple decompression procedures in patients with predominantly claudicative or radicular pain to complex three-dimensional osteotomy maneuvers with combined ventro-dorsal interventions. Classification systems help to grade the deformity and consequently adjust the surgical technique and the extent of the procedure accordingly. In addition to a coronar realignment, the correction of the sagittal profile plays a major role and is consequently related to patient satisfaction and may influence deformity progression. This article should give the reader an overview of current treatment concepts and treatment options in DLS patients.

Schlüsselwörter

adulte Skoliosen - degenerative Lumbalskoliose - sagittale Deformitäten - koronare Deformitäten - Spinalkanalstenose

Key words

adult scoliosis - degenerative lumbar scoliosis - sagittal spinal deformity - coronal deformity - degenerative scoliosis - spinal stenosis

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