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Klassifikation des Wachstumspotenzials und resultierende therapeutische Konsequenzen bei Wirbelsäulendeformitäten

Wann ergibt was Sinn?

Classification of the growth potential and consecutive treatment consequences for spinal deformities

When does what make sense?

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Zusammenfassung

Hintergrund

Die adoleszente idiopathische Skoliose ist eine dreidimensionale Achsabweichung der Wirbelsäule mit einer Krümmung in der Frontalebene (Cobb-Winkel) von mehr als 10° ohne nachweisbare Ursache. Während den Phasen des schnellen Wachstums ist eine Verschlechterung der Skoliose im Sinne einer Zunahme des Cobb-Winkels sowie der rotatorischen Komponente wahrscheinlich. Entsprechend ist die Kenntnis der unterschiedlichen Phasen des menschlichen Wachstums für die Behandlung der adoleszenten idiopathischen Skoliose entscheidend.

Klassifikation

Es existieren eine Vielzahl an Klassifikationssystemen, die bei der Abschätzung des Wachstumspotenzials helfen. Im Folgenden sollen zum einen die gängigsten Klassifikationssysteme in Hinblick auf ihre flächendeckende Verfügbarkeit, Lernkurve sowie Genauigkeit in Bezug auf die Anwendung bei adoleszenten idiopathischen Skoliosen genauer betrachtet werden. Zum anderen soll, basierend auf den gemessenen Cobb-Winkeln sowie dem zu erwartenden Wachstumspotenzial, ein Therapiealgorithmus zur Behandlung der adoleszenten idiopathischen Skoliose vorgestellt werden.

Abstract

Background

Adolescent idiopathic scoliosis is a three-dimensional spinal deformity with a curvature in the frontal plane (Cobb angle) of more than 10° without known underlying causes. During the phase of rapid growth, scoliosis deterioration is likely with an increase in the Cobb angle as well as deterioration of the rotational component. Accordingly, knowledge of the different stages of human growth is crucial for the treatment of adolescent idiopathic scoliosis.

Classification

There are a variety of classification systems helping to estimate the growth potential. In the following, on the one hand, the most common classification systems with regard to their availability, learning curve as well as accuracy with respect to the application in adolescent idiopathic scoliosis will be considered in more detail. On the other hand, based on the measured Cobb angles and the expected growth potential, a treatment algorithm for the management of adolescent idiopathic scoliosis will be presented.

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Abbreviations

MRT:

Magnetresonanztomographie

VBS :

„Vertebral body staples“

VBT :

„Vertebral body tethering“

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Authors and Affiliations

  1. Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    M. Thielen &  M. Akbar

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  1. M. Thielen
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M. Thielen und M. Akbar geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Thielen, M., Akbar, M. Klassifikation des Wachstumspotenzials und resultierende therapeutische Konsequenzen bei Wirbelsäulendeformitäten. Orthopäde 48, 452–460 (2019). https://doi.org/10.1007/s00132-019-03738-1

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