Degenerative_Scoliosis退变性脊柱侧凸解读.ppt

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1、DegenerativeScoliosisWangXuepengM.D.HangzhouFirstPeople'sHospitalEpidemiology?canbedifferentiatedintotwomajorgroups,i.e.,primarydegenerativescoliosisordenovoscoliosisandsecondarydegenerationofadultidiopathicscoliosis?theprevalenceofscoliosisinpatientsolderthan50yearsisabout6%,theaverageageofthosese

2、ekingmedicalcareisinthesixties.?thereisapotentialforcurveprogressionwithanaverageof3.3°oneyearPathogenesis?theasymmetricdegenerationofthediscandthefacetjointleadstoanasymmetricloadingofthespinalsegmentandconsequentlyanasymmetricdeformity,i.e.,scoliosisorkyphosis?theformationofosteophytesatthefacetj

3、oint(spondylarthritis)andatthevertebralendplates(spondylosis)contributestotheincreasingnarrowingofthespinalcanaltogetherwiththehypertrophyandcalcificationoftheligamentumflavumandjointcapsules,creatingcentralandrecessalspinalstenosisClassification?theclassificationofLenke'smaybeabletocovertheadultid

4、iopathicscoliosisgroupwithsecondarydegenerationbutisnotnecessarilyadequatefortheprimarydegenerativescoliosistypeClassification?SchwabdistinguishedthreegroupsbasedonmeasurementsoftheendplateobliquityofL3inthefrontalplane,andofthelumbarlordosismeasuredbetweentheL1andS1superiorendplatesinthesagittalpl

5、aneClassificationCardinalSymptomsBackPain?isthemostfrequentclinicalproblemofadultscoliosis?patientsoftencomplainofaxialbackpainduetosegmentalinstability?atthesiteofthecurvecanbelocalizedeitherattheapexorinitsconcavity?unbalanced,overloadedandstressedparavertebralbackmusclesmaybecomeverysoreandinret

6、urnwillnotcontributetobalance,consequentlybecomingpartofaviciouscircleSpinalClaudication?isthesecondmostimportantsymptomofadultdegenerativescoliosisandmayexpressitselfas:radicularclaudicationcentralclaudication?therootsarecompressednotnecessarilyontheconcavesideduetoanarrowforamen,butoftenontheconv

7、exsideNeurologicalCompromise?neurologicaldeficitsoccurlate?isthethirdmostimportantclinicalpresentationandmayincludeindividualroots,severalrootsorthewholecaudaequinawithapparentbladderandrectalsphincterprobl