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Erschienen in: Der Orthopäde 9/2016

11.08.2016 | Pädiatrische Orthopädie und Unfallchirurgie | Leitthema

Operative Therapie der degenerativen Lumbalskoliose

verfasst von: Prof. Dr. M. Putzier, M. Pumberger, H. Halm, R. K. Zahn, J. Franke

Erschienen in: Die Orthopädie | Ausgabe 9/2016

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Zusammenfassung

Hintergrund

Degenerative Lumbaskoliosen gehen nahezu ausnahmslos mit Rückenschmerzen und in bis zu 70 % der Fälle mit neurogenen Beinschmerzen einher. Das Auftreten einer segmentalen lateralen Olisthese ist dabei ein entscheidender Faktor für die frontale und sagittale Progression der Deformität. Operative Maßnahmen sind mit einer sehr hohen Komplikationsrate assoziiert, sodass eine umfassende konservative Behandlung immer Ausgangspunkt therapeutischer Überlegungen sein sollte. Erst bei gravierenden Beschwerden ist eine operative Intervention in Form von isolierten dekomprimierenden Eingriffen, kurzstreckigen Fusionen oder langstreckigen Korrekturspondylodesen indiziert. Neben der Beurteilung der klinischen Symptomatik ist eine gezielte bildgebende Diagnostik die Voraussetzung für die Wahl des geeigneten Verfahrens.

Operative Therapie

Die alleinige Dekompression ist nur bei stabilen Deformitäten und führender neurologischer Symptomatik eine sinnvolle Therapieoption. Die kurzstreckige, bis zu 3 Segmente umfassende Fusion kann wiederum bei einer fokalen Pathologie im Anfangsstadium der Deformität gerechtfertigt sein. Als weniger invasive Alternative bei fortgeschrittenen degenerativen Lumbalskoliosen eignet sich die limitierte Fusion nicht. Ausgeprägte Deformitäten mit Zeichen der Progression erfordern für eine anhaltende Beschwerdereduktion eine multisegmentale Korrektur und Spondylodese unter Berücksichtigung des frontalen und sagittalen Alignements. Voraussetzung für die Durchführung dieses komplexen Eingriffes ist ein standardisiertes perioperatives Management.

Schlussfolgerung

Die Erfolg versprechende operative Therapie einer degenerativen Lumbalskoliose setzt stets differenzierte und individuelle Entscheidungen voraus.
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Metadaten
Titel
Operative Therapie der degenerativen Lumbalskoliose
verfasst von
Prof. Dr. M. Putzier
M. Pumberger
H. Halm
R. K. Zahn
J. Franke
Publikationsdatum
11.08.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Orthopädie / Ausgabe 9/2016
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-016-3313-2

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