退变性侧弯的微创治疗.pdf

退变性侧弯的微创治疗 MIS in Correction of Degenerative Scoliosis 吴浩 AO SPINE Course 宣武医院 神经脊柱外科 主任医师 Adult Degenerative scoliosis (ADS) • Patients 65 years • Result of gradual disc degeneration • Lateral deviation • Rotated vertebral bodies • Kyphosis and scoliosis Indications and Contraindications Indications • Degenerative scoliosis 20° with a significant progression of the scoliosis • Persistent back pain and or leg pain that interferes with activities of daily living • Failed conservative therapy, neurological deficits Contraindications • “Severe osteoporosis”, osteopenia, or osteomyelitis • Poor psychological or “medical situation” Planning - Correction of scoliosis - Correction of kyphosis (sagittal balance) - Number of segments - Transition zones - Clinical symptoms Many questions must be answered before... • How much correction? • How many and which osteotomies? • Global or local correction? • How many fixation points? • Flexibility of the spine? • Relationship to the neuro axis? • Bone quality? Degenerative significantly but Cobb increases slowly L-stenosis associated with Rx-degenerative scoliosis! Cobb increases significantly but Degenerative slowly. Degenerative scoliosis associated stenosis! Symptoms of Degenerative Scoliosis Neuro-compression Related -Lower limb numbness -Sciatica -Claudication Scoliosis Related -low back pain -Progressive deformity -Trunk imbalance