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Was ist eigentlich eine adulte spinale Deformität?

Entwicklung, Klassifikation und Indikation zur operativen Therapie

What is actually adult spinal deformity?

Development, classification, and indications for surgical treatment

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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.

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.

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Abbreviations

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

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Authors and Affiliations

  1. Zentrum für Wirbelsäulenchirurgie, Klinik für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    D. Adler, H. Almansour &  M. Akbar

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  1. D. Adler
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Correspondence to D. Adler.

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Adler, D., Almansour, H. & Akbar, M. Was ist eigentlich eine adulte spinale Deformität?. Orthopäde 47, 276–287 (2018). https://doi.org/10.1007/s00132-018-3533-8

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