Quante M, Richter A, Thomsen B, Köszegvary M, Halm H
Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Klinikum Neustadt, Lehrkrankenhaus der Universität Lübeck, Neustadt in Holstein, Deutschland.
Orthopade. 2009 Feb;38(2):159-69. doi: 10.1007/s00132-008-1391-5.
Adult scoliosis is defined as a spinal deformity with a Cobb angle of more than 10 degrees in the coronal plain in a skeletally mature patient. Patients predominantly suffer from back pain symptoms, often accompanied by signs of spinal stenosis (central as well as lateral). Asymmetric degeneration leads to asymmetric load and therefore to a progression of the degeneration and deformity as either scoliosis (0.5-1 degree per year), kyphosis, or both. The diagnostic evaluation includes static and dynamic imaging, magnetic resonance imaging, and myelo-computed tomography, as well as invasive diagnostic procedures such as discograms, facet blocks, and epidural and root blocks. The treatment, either conservative or surgical, is then tailored to the patient's specific symptomatology. Surgical management is usually complex and must take into account an array of specific problems, including the patient's age and general medical condition, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis, and any previous scoliosis surgery. The main goal of corrective surgery is a balancing of the coronal and sagittal planes.This review focuses on the special indications for vertebral body cement augmentation in patients with osteoporosis and the problem of adjacent level degeneration and its surgical management.
成人脊柱侧弯被定义为在骨骼成熟的患者中，冠状面Cobb角大于10度的脊柱畸形。患者主要表现为背痛症状，常伴有脊柱狭窄（中央型和侧方型）体征。不对称退变导致不对称负荷，进而导致退变和畸形进展，表现为脊柱侧弯（每年0.5 - 1度）、后凸畸形或两者皆有。诊断评估包括静态和动态影像学检查、磁共振成像、脊髓计算机断层扫描，以及诸如椎间盘造影、小关节阻滞、硬膜外阻滞和神经根阻滞等侵入性诊断程序。然后根据患者的具体症状制定保守或手术治疗方案。手术治疗通常较为复杂，必须考虑一系列具体问题，包括患者的年龄和一般健康状况、融合长度、相邻节段情况、腰骶关节状况、骨质疏松以及既往任何脊柱侧弯手术史。矫正手术的主要目标是平衡冠状面和矢状面。本综述重点关注骨质疏松患者椎体强化的特殊适应证以及相邻节段退变问题及其手术治疗。
