Operative Korrektur der idiopathischen Adoleszentenskoliose – Pro Bewegungserhalt

Zusammenfassung

Die kritische Literaturanalyse zeigt zum Einen, dass die fusionierende Behandlung von Adoleszentenskoliosen (IAS) eindeutig Konsequenzen bez. Funktion, Sport und Degeneration der Anschlußsegmente hat, sowie dass durchaus relevante Reoperationsraten resultieren. Zum Anderen ist klar erkennbar, dass bewegungserhaltende Ansätze, von denen bisher nur die flexible anteriore Skoliosekorrektur (FASK/VBT) gut untersucht ist, noch keine optimal definierten Indikationsgrenzen haben und dass diese Implantatsysteme noch früh in ihrer medizintechnischen Entwicklung stehen, was beides Gründe für die anfangs vergleichsweise hohen technischen Versagerraten waren. Definiert man die Versteifung einer adoleszenten Wirbelsäule jedoch als Schadensbegrenzung bei erfolgloser konservativer Therapie, liegt dann die Versagerquote nach Spondylodese nicht bei 100%? Diese Zahl zu reduzieren sollte unser Anspruch sein.

Abstract

A critical review of the literature demonstrates that treating adolescent idiopathic scoliosis (AIS) by means of an arthrodesis clearly carries consequences with regards to function, sports activities and adjacent segment degeneration. The reported reoperation rates also are of a relevant dimension. It is clear on the other hand, that motion-preserving strategies, of which only the vertebral body tethering (VBT) technique has been adequately studied, still lack precisely defined indications and that the implant systems currently in use are still early in their technical development. Both aspects have contributed to the comparatively high technical failure rates in early series. But when we understand the arthrodesis of an adolescent scoliotic spine as the failure of conservative treatment, the failure rate of fusion surgery stands at 100%. It should be our ambition to reduce this number.

Schlüsselwörter

Skoliose - idiopathische Adoleszentenskoliose - Bewegungserhaltung - Wachstumslenkung - wachstumslenkende Implantatsysteme - flexible anteriore Skoliosekorrektur - FASK - VBT

Keywords

scoliosis - adolescent idiopathic scoliosis - AIS - growth guidance - growth-guiding implants - motion preservation - vertebral body tethering

Publication History

Article published online:
04 March 2022

• Referenzen

• 1 Hoernschemeyer DG, Boeyer ME, Robertson ME. et al. Anterior Vertebral Body Tethering for Adolescent Scoliosis with Growth Remaining: A Retrospective Review of 2 to 5-Year Postoperative Results. J Bone Joint Surg Am 2020; 102: 1169-1176
• 2 Ferrero E, Bocahut N, Lefevre Y. et al. Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort. Eur Spine J 2018; 27: 2241-2250
• 3 Kim YJ, Lenke LG, Bridwell KH. et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine 2007; 32: 2731-2738
• 4 Sponseller PD, Betz R, Newton PO. et al. Differences in curve behavior after fusion in adolescent idiopathic scoliosis patients with open triradiate cartilages. Spine 2009; 34: 827-831
• 5 Campos M, Dolan L, Weinstein S. Unanticipated revision surgery in adolescent idiopathic scoliosis. Spine 2012; 37: 1048-1053
• 6 Richards BS, Hasley BP, Casey VF. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis. Spine 2006; 31: 3018-3026
• 7 Samdani AF, Pahys JM, Ames RJ. et al. Prospective Follow-up Report on Anterior Vertebral Body Tethering for Idiopathic Scoliosis: Interim Results from an FDA IDE Study. J Bone Joint Surg Am 2021;
• 8 Uehara M, Takahashi J, Ikegami S. et al. Correlation of Lower Instrumented Vertebra With Spinal Mobility and Health-related Quality of Life After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Clin Spine Surg 2019; 32: E326-e329
• 9 Sanchez-Raya J, Bago J, Pellise F. et al. Does the lower instrumented vertebra have an effect on lumbar mobility, subjective perception of trunk flexibility, and quality of life in patients with idiopathic scoliosis treated by spinal fusion?. J Spinal Disord Tech 2012; 25: 437-442
• 10 Udoekwere UI, Krzak JJ, Graf A. et al. Effect of Lowest Instrumented Vertebra on Trunk Mobility in Patients With Adolescent Idiopathic Scoliosis Undergoing a Posterior Spinal Fusion. Spine deformity 2014; 2: 291-300
• 11 von Strempel A, Scholz M, Daentzer M. Sports capacity of patients with scoliosis. Sportverletz Sportschaden 1993; 7: 58-62
• 12 Lehman RA, Kang DG, Lenke LG. et al. Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group. The spine journal : official journal of the North American Spine Society 2015; 15: 951-958
• 13 Barile F, Ruffilli A, Manzetti M. et al. Resumption of sport after spinal fusion for adolescent idiopathic scoliosis: a review of the current literature. Spine deformity 2021; 9: 1247-1251
• 14 Marks MC, Bastrom TP, Petcharaporn M. et al. The Effect of Time and Fusion Length on Motion of the Unfused Lumbar Segments in Adolescent Idiopathic Scoliosis. Spine deformity 2015; 3: 549-553
• 15 Sarwahi V, Wendolowski S, Gecelter R. et al. When Do Patients Return to Physical Activities and Athletics After Scoliosis Surgery?: A Validated Patient Questionnaire Based Study. Spine 2018; 43: 167-171
• 16 Baroncini A, Trobisch PD, Berrer A. et al. Return to sport and daily life activities after vertebral body tethering for AIS: analysis of the sport activity questionnaire. Eur Spine J 2021;
• 17 Green DW, Lawhorne TW, Widmann RF. et al. Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis. Spine 2011; 36: 1948-1954
• 18 Nohara A, Kawakami N, Seki K. et al. The Effects of Spinal Fusion on Lumbar Disc Degeneration in Patients with Adolescent Idiopathic Scoliosis: A Minimum 10-Year Follow-Up. Spine deformity 2015; 3: 462-468
• 19 Lonner BS, Ren Y, Upasani VV. et al. Disc Degeneration in Unfused Caudal Motion Segments Ten Years Following Surgery for Adolescent Idiopathic Scoliosis. Spine deformity 2018; 6: 684-690
• 20 Newton PO, Kluck DG, Saito W. et al. Anterior Spinal Growth Tethering for Skeletally Immature Patients with Scoliosis: A Retrospective Look Two to Four Years Postoperatively. J Bone Joint Surg Am 2018; 100: 1691-1697
• 21 Alanay A, Yucekul A, Abul K. et al. Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: Follow-up Curve Behavior According to Sanders Skeletal Maturity Staging. Spine 2020; 45: E1483-E1492
• 22 Miyanji F, Pawelek J, Nasto LA. et al. Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis. Bone Joint J 2020; 102-B: 1703-1708
• 23 Buyuk AF, Milbrandt TA, Mathew SE. et al. Measurable Thoracic Motion Remains at 1 Year Following Anterior Vertebral Body Tethering, with Sagittal Motion Greater Than Coronal Motion. J Bone Joint Surg Am 2021;
• 24 Baroncini A, Rodriguez L, Verma K. et al. Feasibility of Single-Staged Bilateral Anterior Scoliosis Correction in Growing Patients. Global Spine J 2021; 11: 76-80
• 25 Floman Y, Burnei G, Gavriliu S. et al. Surgical management of moderate adolescent idiopathic scoliosis with ApiFix: a short peri- apical fixation followed by post-operative curve reduction with exercises. Scoliosis 2015; 10: 4
• 26 Floman Y, El-Hawary R, Lonner BS. et al. Vertebral growth modulation by posterior dynamic deformity correction device in skeletally immature patients with moderate adolescent idiopathic scoliosis. Spine deformity 2021; 9: 149-153
• 27 Holewijn RM, de Kleuver M, van der Veen AJ. et al. A Novel Spinal Implant for Fusionless Scoliosis Correction: A Biomechanical Analysis of the Motion Preserving Properties of a Posterior Periapical Concave Distraction Device. Global Spine J 2017; 7: 400-409
• 28 Stadhouder A, Holewijn RM, Haanstra TM. et al. High Failure Rates of a Unilateral Posterior Peri-Apical Distraction Device (ApiFix) for Fusionless Treatment of Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am 2021;