Spine Division, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York University, 301 East 17th St, New York, NY 10003, USA.
Spine J. 2013 Apr;13(4):464-74. doi: 10.1016/j.spinee.2012.11.046. Epub 2013 Jan 11.
Adult spinal deformity (ASD) is commonly associated with disability and represents a challenging condition for physicians. Although surgical management has been reported as superior to conservative care, the choice of patient-specific optimal strategy has been poorly defined. A key question remains selection of fusion levels as this implies careful balance of risks and benefits.
The aim of this review is to propose an update on current knowledge related to optimal fusion levels in the surgical treatment of ASD.
Literature review.
Based on a comprehensive literature search, recent studies focusing on the management of ASD were reviewed to establish current concepts on fusion levels in the management of symptomatic ASD.
Despite numerous published studies, the management of ASD and specifically optimal fusion levels is incompletely defined. Described approaches carry benefits and risks. However, the need for detailed analysis and preoperative planning is confirmed as a prerequisite to obtaining realignment objectives and good outcomes.
The treatment of ASD is emerging as an important health-care issue of the 21st century because of prevalence and cost. Despite technical advances related to ASD surgery, complication rates remain elevated, particularly in the older population. Recent research, mostly driven by outcome measures, has improved our understanding of optimal treatment approaches to ASD. The development of a widely accepted classification system will help to share knowledge and improve our ability to treat these complex patients.
成人脊柱畸形（ASD）通常与残疾有关，对医生来说是一种具有挑战性的疾病。虽然手术治疗被报道优于保守治疗，但患者特异性最佳治疗策略的选择仍未得到明确界定。一个关键问题仍然是融合节段的选择，因为这需要仔细平衡风险和获益。
本综述旨在对 ASD 手术治疗中有关最佳融合节段的现有知识进行更新。
文献回顾。
基于全面的文献检索，对近期关注 ASD 管理的研究进行了综述，以确立目前在 ASD 管理中有关融合节段的概念。
尽管有大量的已发表研究，但 ASD 的管理，特别是最佳融合节段的选择仍未完全明确。所描述的方法各有优缺点。然而，需要详细的分析和术前规划，以作为获得矫正目标和良好结果的前提。
由于 ASD 的发病率和治疗费用较高，因此，它是 21 世纪一个重要的医疗保健问题。尽管 ASD 手术的技术进步，但并发症发生率仍然居高不下，特别是在老年人群中。最近的研究主要受到治疗结果的驱动，这提高了我们对 ASD 最佳治疗方法的理解。广泛接受的分类系统的发展将有助于分享知识并提高我们治疗这些复杂患者的能力。
