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Der Orthopäde

, Volume 47, Issue 4, pp 276–287 | Cite as

Was ist eigentlich eine adulte spinale Deformität?

Entwicklung, Klassifikation und Indikation zur operativen Therapie
  • D. Adler
  • H. Almansour
  • M. Akbar
Leitthema

Zusammenfassung

Hintergrund

Die adulte spinale Deformität (ASD) ist ein komplexes Krankheitsbild, welches im letzten Jahrzehnt zusehends in den Fokus des Wirbelsäulenchirurgen rückte. Sagittale und/oder koronare Deformitäten der Wirbelsäule gehen unter Umständen mit erheblichen Auswirkungen auf die Lebensqualität (Behinderung, Schmerz) der Patienten einher. Im Rahmen der radiologischen Diagnostik der gesamten Wirbelsäule werden die bekannten spinopelvinen Parameter ermittelt, wodurch erst eine Klassifikation der ASD möglich wird.

Therapie

Konservative Therapiekonzepte können für milde Formen der ASD ausreichend sein und sollten stets ausgeschöpft werden. Operativ erfordert die ASD aufgrund der Komplexität der Deformität nicht selten das gesamte Spektrum. Dieser Artikel gibt einen Überblick über die Entwicklung der ASD, die korrekte Klassifikation sowie die Indikation zur operativen Therapie.

Schlüsselwörter

Sagittales Profil Skoliose Wirbelsäule Kyphose Spinopelvines Alignment 

Abkürzungen

ASD

adulte spinale Deformität

BMI

Body-Mass-Index

BWS

Brustwirbelsäule

CCI

Charlson Comorbidity Index

EQ5D

EuroQol Five Dimension Questionnaire

HRQOL

Health Related Quality of Life

HWS

Halswirbelsäule

LL

lumbale Lordose

LWS

Lendenwirbelsäule

NAS

Numerische Analogskala

NSAR

nichtsteroidale Antirheumatika

ODI

Oswestry Disability Index

PI

Pelvic Incidence

PI-LL

spinopelvine Harmonie oder Mismatch zwischen PI und LL

PSO

Pedikelsubtraktionsosteotomie

PT

Pelvic Tilt

SF

Short-Form

SRS

Scoliosis Research Society

SVA

Sagittal Vertical Axis

TK

thorakale Kyphose

VAS

Visuelle Analogskala

WK

Wirbelkörper

What is actually adult spinal deformity?

Development, classification, and indications for surgical treatment

Abstract

Background

Adult spinal deformity (ASD) is a complex entity that has had emerging significance for spine surgeons in the last decade. Sagittal and/or coronary deformities can have a high impact (disability, pain) on the quality of patients’ life. Radiologic diagnostics determine the common spinopelvic parameters as the basis for classification of ASD.

Treatment

Conservative treatment options may be sufficient in mild cases. The deformity’s complexity frequently demands the entire spectrum of methods and techniques in spinal surgery. This article gives an overview on the development of the ASD, the correct classification as well as the indication for surgical therapy.

Keywords

Sagittal profile Scoliosis Spine Kyphosis Spino-pelvic alignment 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Adler, H. Almansour und M. Akbar geben an, dass kein Interessenkonflikt besteht. Sie versichern, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt oder abgebildet ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Acaroglu (2016) Decision-making in the treatment of adult spinal deformity. EFFORT Open Rev 1:167–176CrossRefGoogle Scholar
  2. 2.
    Acosta FL Jr, McClendon J Jr, O’Shaughnessy BA et al (2011) Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine 15:667–674CrossRefPubMedGoogle Scholar
  3. 3.
    Aebi M (2005) The adult scoliosis. Eur Spine J 14:925–948CrossRefPubMedGoogle Scholar
  4. 4.
    Ailon T, Scheer JK, Lafage V et al (2016) Adult spinal deformity surgeons are unable to accurately predict postoperative spinal alignment using clinical judgment alone. Spine Deform 4:323–329CrossRefPubMedGoogle Scholar
  5. 5.
    Ames CP, Scheer JK, Lafage V et al (2016) Adult spinal deformity: epidemiology, health impact, evaluation and management. Spine Deform 4:310–322CrossRefPubMedGoogle Scholar
  6. 6.
    Asher MA, Lai SM, Burton DC (2000) Further development and validation of the Scoliosis Research Society (SRS) outcomes instrument. Spine 25(18):2381–2386CrossRefPubMedGoogle Scholar
  7. 7.
    Bess S, Boachie-Adjei O, Burton D et al (2009) Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Spine 34:2186–2190CrossRefPubMedGoogle Scholar
  8. 8.
    Bess S, Line B, Fu KM et al (2016) The health impact of symptomatic adult spine deformity: comparison of deformity types to united states population norms and chronic diseases. Spine 41:224–233CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Blondel B, Schwab F, Chay E et al (2012) The comprehensive anatomical spinal osteotomy classification. Eur Spine J 21:297–297Google Scholar
  10. 10.
    Blondel B, Schwab F, Ungar B et al (2012) Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2‑years follow-up. Neurosurgery 71:341–348CrossRefPubMedGoogle Scholar
  11. 11.
    Bridwell KH, Glassman S, Horton W et al (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence based medicine study. Spine 34:2171–2178CrossRefPubMedGoogle Scholar
  12. 12.
    Carlsson AM (1983) Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16(1):87–101CrossRefPubMedGoogle Scholar
  13. 13.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMedGoogle Scholar
  14. 14.
    Dall TM, Gallo PD, Chakrabarti R et al (2013) An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Aff 32:2013–2020CrossRefGoogle Scholar
  15. 15.
    Daubs MD, Lenke LG, Cheh G et al (2007) Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine 32:2238–2244CrossRefPubMedGoogle Scholar
  16. 16.
    Duval-Beaupere G, Schmidt C, Cosson PA (1992) Barycentre-metric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20:451–462CrossRefPubMedGoogle Scholar
  17. 17.
    Everett CR, Patel RK (2007) A systematic literature review of nonsurgical treatment in adult scoliosis. Spine 32:130–134CrossRefGoogle Scholar
  18. 18.
    Fairbank JC, Couper J, Davies JB (1980) The oswestry low back pain questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  19. 19.
    Faldini C (2009) Le scoliosi degenerative. Timeo Editore, BolognaGoogle Scholar
  20. 20.
    Faldini C, Pagkrati S, Grandi G et al (2006) Degenerative lumbar scoliosis: features and surgical treatment. J Orthop Traumatol 7:67–71CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Glassman SD, Bridwell K, al Dimar JRet (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029CrossRefPubMedGoogle Scholar
  22. 22.
    Glassmann SD, Berven S, Bridwell K et al (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688CrossRefGoogle Scholar
  23. 23.
    Glassmann SD, Berven S, Kostuik J et al (2006) Nonsurgical resource utilisation in adult spine deformity. Spine 31:941–947CrossRefGoogle Scholar
  24. 24.
    Glassmann SD, Carreon LY, Shaffrey CI et al (2010) The costs and benefits of nonoperative management for adult scoliosis. Spine 35:578–582CrossRefGoogle Scholar
  25. 25.
    Grayson VK, Velkoff VA (2010) The next four decades, the older population in the United States: 2010 to 2050. In: Current population reports. United States Census Bureau, Washington, DC, S 25–1138Google Scholar
  26. 26.
    Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34(17):599–606CrossRefGoogle Scholar
  27. 27.
    Le Huec JC, Roussouly P (2011) Sagittal spino-pelvic balance is a crucial analysis for normal and degenerative spine. Eur Spine 20:556–557CrossRefGoogle Scholar
  28. 28.
    Le Huec JC, Saddiki R, Franke J et al (2011) Equilibrium of the human body and the gravity line: the basics. Eur Spine 20:558–563CrossRefGoogle Scholar
  29. 29.
    Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83-A:1169–1181CrossRefPubMedGoogle Scholar
  30. 30.
    Lowe T, Berven SH, Schwab FJ et al (2006) The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems. Spine 31:119–125CrossRefGoogle Scholar
  31. 31.
    Lu DC, Chou D (2007) Flatback syndrome. Neurosurg Clin N Am 18:289–294CrossRefPubMedGoogle Scholar
  32. 32.
    McCormick JD, Werner BC, Shimer AL (2013) Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 21:99–107CrossRefPubMedGoogle Scholar
  33. 33.
    McHorney CA, Ware JE, Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31(3):247–263CrossRefPubMedGoogle Scholar
  34. 34.
    Pellisé F, Vila-Casadement A, Ferrer M et al (2015) Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3–11CrossRefPubMedGoogle Scholar
  35. 35.
    Perennou D, Marcelli C, Herisson C et al (1994) Adult lumbar scoliosis. Epidemiologic aspects in a low-back pain population. Spine 19:123–128CrossRefPubMedGoogle Scholar
  36. 36.
    Potter BK, Lenke LG, Kuklo TR (2004) Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am 86-A:1793–1808CrossRefPubMedGoogle Scholar
  37. 37.
    Savage JW, Patel AA (2014) Fixed sagittal plane imbalance. Global Spine J 4:287–296CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Schwab F, Dubey A, Gamez L et al (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30(9):1082–1085CrossRefPubMedGoogle Scholar
  39. 39.
    Schwab F, Farcy JP, Bridwell K et al (2006) A clinical impact classification of scoliosis in the adult. Spine 31:2109–2114CrossRefPubMedGoogle Scholar
  40. 40.
    Schwab F, Patel A, Ungar B et al (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224–2231CrossRefPubMedGoogle Scholar
  41. 41.
    Schwab F, Ungar B, Blondel B et al (2012) Scoliosis research society-Schwab adult spinal deformity classification. A validation study. Spine 37:1077–1082CrossRefPubMedGoogle Scholar
  42. 42.
    Schwab FJ, Blondel B, Bess S et al (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 38(13):803–812CrossRefGoogle Scholar
  43. 43.
    Simmons ED (2001) Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis. Clin Orthop Relat Res 384:45–53CrossRefGoogle Scholar
  44. 44.
    Smith JS, Lafage V, Shaffrey CI et al (2014) Outcomes of operative and non-operative treatment for adult spinal deformity: a prospective, multicenter matched and unmatched cohort assessment with minimum two-year follow up. Paper presented at: North American Spine Society 29th Annual Meeting, San FranciscoGoogle Scholar
  45. 45.
    Smith JS, Shaffrey CI, Berven S et al (2009) Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65(1):86–93CrossRefPubMedGoogle Scholar
  46. 46.
    Smith JS, Shaffrey CI, Berven S et al (2009) Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine 34:1693–1698CrossRefPubMedGoogle Scholar
  47. 47.
    Smith JS, Shaffrey CI, Glassman SD et al (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine 36:817–824CrossRefPubMedGoogle Scholar
  48. 48.
    Smith JS, Shaffrey CI, Kuntz C et al (2008) Classification systems for adolescent and adult scoliosis. Neurosurgery 63:16–24CrossRefPubMedGoogle Scholar
  49. 49.
    Taneichi H (2015) Update on pathology and surgical treatment for adult spinal deformity. J Orthop Sci 21:116–123CrossRefGoogle Scholar
  50. 50.
    Terran J, Schwab F, Shaffrey CI et al (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73(4):559–568CrossRefPubMedGoogle Scholar
  51. 51.
    The EuroQol Group (1990) EuroQol – a new facility for the measurement of health-related quality of life. Health Policy (New York) 16:199–208CrossRefGoogle Scholar
  52. 52.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Fracture risk associated with the use of morphines and opiates. J Intern Med 260:76–87CrossRefPubMedGoogle Scholar
  53. 53.
    Weiss HR, Goodall D (2008) Rate of complications in scoliosis surgery: a systematic review of the Pub Med literature. Scoliosis 3:9CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Youssef AJ, Orndorf DO, Patty CA (2013) Current status of adult spinal deformity. Global Spine J 3:51–62CrossRefPubMedGoogle Scholar
  55. 55.
    Zimmerman RM, Mohamed AS, Skolasky RL et al (2010) Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older: a prospective study with minimum two-year follow-up. Spine 35(6):1861–1866CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Zentrum für Wirbelsäulenchirurgie, Klinik für Orthopädie, Unfallchirurgie und ParaplegiologieUniversitätsklinikum HeidelbergHeidelbergDeutschland

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