title: [Surgical treatment of de-novo scoliosis].
abstract: BACKGROUND
  De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient's symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient's symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy.
  
  
  METHODS
  Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success.
  
  
  CONCLUSIONS
  All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.
authors: Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. michael.putzier@charite.de.
authors: M
authors: M
authors: Putzier
authors: Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
authors: M
authors: M
authors: Pumberger
authors: Schön Klinik Neustadt, Fachzentrum Wirbelsäulenchirurgie & Skoliosezentrum, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland.
authors: H
authors: H
authors: Halm
authors: Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
authors: R K
authors: RK
authors: Zahn
authors: Klinik für Wirbelsäulenchirurgie, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Deutschland.
authors: J
authors: J
authors: Franke
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008159:Lumbar Vertebrae / Q000601:surgery*; D012600:Scoliosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Back ache; Deformities; Pseudarthrosis; Sagittal Balance; Spondylodesis