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1、Degenerative Scoliosis,Wang Xuepeng M.D.,Hangzhou First Peoples Hospital,Epidemiology,?,can,be,differentiated,into,two,major,groups,i.e.,primary degenerative scoliosis or de novo scoliosis,and,secondary,degeneration,of,adult,idiopathic,scoliosis,?,the prevalence of scoliosis in patients older than 5
2、0,years is 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 year,Pathogenesis,?,the,asymmetric,degeneration,of,the,disc,and,the,facet,joint,leads,to,an,asymmetric,loading,of,the,spinal,segment,and,conseq
3、uently,an,asymmetric,deformity,i.e.,scoliosis or kyphosis,?,the,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,fl
4、avumand,joint,capsules,creating,central,and,recessal spinal stenosis,Classification,?,the 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 type,Classification,?,Schwab
5、,distinguished,three,groups,based,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 plane,Classification,Cardinal Symptoms,Back Pain,?,is the most frequent clinical problem of adult,scolio
6、sis,?,patients often complain of axial 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,consequen
7、tly becoming part of a vicious circle,Spinal Claudication,?,is,the,second,most,important,symptom,of,adult,degenerative scoliosis and may express itself as:,radicular claudication,central claudication,?,the,roots,are,compressed,not,necessarily,on,the,concave side due to a narrow foramen,but often on,
8、the convex side,Neurological Compromise,?,neurological 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 problems,Increasing Deformity,?,osteoporosis accelerates
9、curve progression,?,larger curves tend to progress faster than small,curves for biomechanical reasons,Physical Findings,Standard Radiographs,?,full body standing radiographs are indispensable,?,radiographs sometimes exhibit clues to the,etiology of the curve(primary vs.secondary),?,important to look
10、 at earlier radiographs to,understand the natural history and therefore the,etiology of the curve,Magnetic Resonance Imaging,?,is the imaging modality of choice to explore neural,compromise and disc degeneration,Computed Tomography,?,computed,tomography,with,or,without,a,myelogram is the diagnostic
11、imaging,?,method,of,choice,in,the,case,of,diagnostic,uncertainties related to the three dimensional,Interventional Radiological Procedure,?,in the context of the evaluation of the pain source,spinal injection studies are especially helpful since,their findings may change the therapeutic approach,Add
12、itional Diagnostic Tools,?,temporary,immobilization,cast,in,the,form,of,a,thoracolumbar,orthosis,(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,t
13、he,responsible level,?,osteodensitometry(DEXA)is indicated whenever there is a,suspicion,of,osteoporosis,because,of,the,implications,with,regard to curve progression and potential spinal fixation,Non-operative Treatment,?,The non-surgical treatment options basically,consist of:,non-steroid anti-infl
14、ammatory drugs(NSAIDs),muscular relaxation,pain medication,muscle exercises,gentle traction(in selected cases),spinal injection studies,orthosis,Non-operative Treatment,?,manipulations,and,physical,activation,should,be,avoided because they may increase the pain,?,therapeutic,epidural,and,selective,n
15、erve,root,blocks,as,well,as,facet,joint,blocksmay,help,to,control the pain temporarily.,?,a,well-fitted,brace,to,support,the,painful,spine,area may be necessary,Operative Treatment,Correction Procedures,?,whether,or,not,a,degenerative,scoliosis,should,be,corrected remains a crucial and complex quest
16、ion.,?,the,treatment,of,a,degenerative,scoliosis,has,different,goals,than,the,treatment,of,adolescent,scoliosis.It depends on several factors:,Correction Procedures,?,Sagittal balance is most important,Surgical Techniques,?,debate,continues,on,the,indications,for,a,lumbosacral fusion,?,in,young,pati
17、ents,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 possible,?,However,a,fusion,to,the,L5,vertebra,is,necessary,when the condition of the L4/5 facet joint is poor,Surgical Techniques,Take Home Messages,Thank You,！,
