DegenerativeScoliosis退变性脊柱侧凸解读课件.ppt

1、Degenerative ScoliosisWang Xuepeng M.D.Hangzhou First Peoples HospitalEpidemiologycan be differentiated into two major groups,i.e.,primary degenerative scoliosis or de novo scoliosis and secondary degeneration of adult idiopathic scoliosisthe prevalence of scoliosis in patients older than 50 years i

2、s about 6%,the average age of those seeking medical care is in the sixties.there is a potential for curve progression with an average of 3.3 one yearPathogenesisthe asymmetric degeneration of the disc and the facet joint leads to an asymmetric loading of the spinal segment and consequently an asymme

3、tric deformity,i.e.,scoliosis or kyphosisthe formation of osteophytes at the facet joint(spondylarthritis)and at the vertebral endplates(spondylosis)contributes to the increasing narrowing of the spinal canal together with the hypertrophy and calcification of the ligamentum flavumand joint capsules,

4、creating central and recessal spinal stenosisClassificationthe classification of Lenkes may be able to cover the adult idiopathic scoliosis group with secondary degeneration but is not necessarily adequate for the primary degenerative scoliosis typeClassificationSchwab distinguished three groups bas

5、ed on measurements of the endplate obliquity of L3 in the frontal plane,and of the lumbar lordosis measured between the L1 and S1 superior endplates in the sagittal planeClassificationCardinal SymptomsBack Pain is the most frequent clinical problem of adult scoliosis patients often complain of axial

6、 back pain due to segmental instability at the site of the curve can be localized either at the apex or in its concavity unbalanced,overloaded and stressed paravertebral back muscles may become very sore and in return will not contribute to balance,consequently becoming part of a vicious circleSpina

7、l Claudicationis the second most important symptom of adult degenerative scoliosis and may express itself as:radicular claudication central claudicationthe roots are compressed not necessarily on the concave side due to a narrow foramen,but often on the convex sideNeurological Compromise neurologica

8、l deficits occur late is the third most important clinical presentation and may include individual roots,several roots or the whole cauda equina with apparent bladder and rectal sphincter problemsIncreasing Deformity osteoporosis accelerates curve progression larger curves tend to progress faster th

9、an small curves for biomechanical reasonsPhysical FindingsStandard Radiographsfull body standing radiographs are indispensableradiographs sometimes exhibit clues to the etiology of the curve(primary vs.secondary)important to look at earlier radiographs to understand the natural history and therefore

10、 the etiology of the curveMagnetic Resonance Imagingis the imaging modality of choice to explore neural compromise and disc degenerationComputed Tomographycomputed tomography with or without a myelogram is the diagnostic imagingmethod of choice in the case of diagnostic uncertainties related to the

11、three dimensionalInterventional Radiological Procedurein the context of the evaluation of the pain source,spinal injection studies are especially helpful since their findings may change the therapeutic approachAdditional Diagnostic Tools temporary immobilization cast in the form of a thoracolumbar o

12、rthosis(TLO)or thoracolumbosacral orthosis(TLSO)to see whether an overall stabilization and fusion of the whole scoliotic spinal area could be beneficial neurophysiologic studies may be helpful to identify the responsible level osteodensitometry(DEXA)is indicated whenever there is a suspicion of ost

13、eoporosis because of the implications with regard to curve progression and potential spinal fixationNon-operative TreatmentThe non-surgical treatment options basically consist of:non-steroid anti-inflammatory drugs(NSAIDs)muscular relaxation pain medication muscle exercises gentle traction(in select

14、ed cases)spinal injection studies orthosisNon-operative Treatmentmanipulations and physical activation should be avoided because they may increase the paintherapeutic epidural and selective nerve root blocks as well as facet joint blocksmay help to control the pain temporarily.a well-fitted brace to

15、 support the painful spine area may be necessaryOperative TreatmentCorrection Procedureswhether or not a degenerative scoliosis should be corrected remains a crucial and complex question.the treatment of a degenerative scoliosis has different goals than the treatment of adolescent scoliosis.It depen

16、ds on several factors:Correction ProceduresSagittal balance is most importantSurgical Techniquesdebate continues on the indications for a lumbosacral fusion in young patients with secondary degenerative scoliosis,it is better to omit L5/S1 from fusion whenever possible in order to prevent iliosacral joint degeneration or an early hip problem.It is also usually preferable to stop at L4 in a lumbar curve whenever possibleHowever,a fusion to the L5 vertebra is necessary when the condition of the L4/5 facet joint is poorSurgical TechniquesTake Home MessagesThank You！