Der Orthopäde
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Review Comparative Study Controlled Clinical Trial
[Multiplan correction of a 3D deformity. Options and relevance of optimizing the thoracic kyphosis in reconstructive scoliosis surgery].
There is presently still no consensus on how to operatively treat adolescent idiopathic scoliosis (AIS), i.e. a clearly reduced thoracic kyphosis. For a long time the primary focus was mostly on correcting the coronal plane while neglecting the sagittal profile. Based on the current literature and own retrospective data a comprehensive review will be given on the optimal correction of the spine and how to avoid secondary complications. Different operative standard procedures are demonstrated with special attention to the sagittal balance and the special parameters sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sagittal slope (SSL) and pelvic incidence (PI). ⋯ Both the results from the literature and own data confirm that operative correction of AIS needs a careful planning including sagittal spinopelvic parameters. Rigid thoracic hypokyphosis require additional osteotomy.
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Ignoring the sagittal profile in primary spinal fusion surgery is a common reason for revision surgery. Therefore, it is important that in cases of spinal revision surgery the sagittal alignment is realized. ⋯ Sagittal imbalance after revision surgery is a risk factor for recurrent pseudarthrosis. In cases of pseudarthrosis a combined approach may be more effective in realizing sagittal balance und enhancing rates of fusion.