DegenerativeScoliosis退变性脊柱侧凸—培训课件.pptVIP

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 50 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 consequently 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 flavumand 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 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 scoliosis 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, consequently 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 claudicat