Halbwirbelresektion bei kongenitalen Skoliosen-Ein Vergleich zweier Operationsverfahren.

Abstract

Die Halbwirbelresektion ist aktuel Methode der Wahl für die operative Behandlung von progredienten, kongenitalen Skoliosen aufgrund isolierter Wirbelfehlbildungen. Das klassische Verfahren erfordert eine Darstellung des Wirbels von allen Seiten, bei der neuen operativen Technik kann eine Halbwirbelresektion über einen rein dorsalen Zugang durchgeführt werden. Die Arbeit vergleicht beide operative Techniken mit Fokus auf Korrektur, perioperative Komplikationen und Morbidität. Ergebnisse: Mit der rein dorsalen Technik kann eine vergleichbar gute Korrektur, bei deutlich niedriger Komplikationsrate und Morbidität erreicht werden.

Study Design: Retrospective review of patients records and radiographic assessment. Objective: To compare the results with emphasis on perioperative complications after hemivertebra resection performed through a single posterior approach and through a combined anterior and posterior approach. Summary of Background data: Good results have been reported with combined anterior and posterior approach and with single posterior approach. However, the perioperative aspects in terms of complications and morbidity have not been well studied. Methods: From 1998 to 2008 thirteen patients (n=13) underwent hemivertebra resection with short fusion via a single posterior approach (SPA) and twelwe patents (n=12) via a combined anterior and posterior approach (CAPA). Curve magnitude before and after surgery, the duration of the surgical procedure, mechanical ventilation, intensive care management and hospital stay, as well as the rate of perioperative complications and the need for blood transfusion in both groups were compared. Student‘s paired samples T-test was used for statistical significance. Results: Age at surgery, preoperative curve magnitude, curve correction and the need for blood transfusion were similar in both groups(p<0,05). The mean duration of surgery (272 vs. 310 min) and the mean duration of the mechanical ventilation (9h vs. 34h) after completion of the surgical procedure were shorter in the SPA group, but did not reach statistical significance (p>0,05). The duration of the intensive care (1 day vs. 3 days) and the hospital stay (12 days vs. 19 days) were significantly shorter in the SPA group (p<0,003). None of the patients operated through a single posterior approach (SPA) had general perioperative complications. Four out of 11 patients (36%) operated through combined anterior and posterior approach (CAPA) had general surgery related complications. Those resolved without sequelae, but needed intensive therapy. Transitory neurologic complications were seen in 2 out of 13 patients (15%) in the SPA group and in one out of 11 patients (9%) in the CAPA group. Conclusions: The rate of the perioperative general complications after hemivertebra resection can be minimized with the use of the single posterior approach. The obtained curve correction is similar to the combined anterior and posterior approach. Key words: congenital scoliosis, hemivertebra resection, single posterior approach.