Goel Atul, Jadhav Neha, Shah Abhidha, Rai Survendra, Vutha Ravikiran, Dandpat Saswat, Dhar Arjun, Prasad Apurva
Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India.
Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
J Craniovertebr Junction Spine. 2020 Apr-Jun;11(2):124-130. doi: 10.4103/jcvjs.JCVJS_61_20. Epub 2020 Jun 5.
The authors report their experience with 14 cases having adult idiopathic lumbar scoliosis (AIDLS) and presenting with the predominant symptoms of claudication pain in the low back and legs. The patients were treated by only multisegmental stabilization, and the surgical procedure aimed for arthrodesis without any form of bone or soft-tissue decompression. The clinical outcome of this novel form of surgical treatment is presented.
During the period of June 2014 to June 2019, 14 patients having AIDLS (degenerative scoliosis) were surgically treated. Apart from clinical and radiological guides, instability was diagnosed on the basis of direct physical observation of the status of articulation and by manual manipulation of bones of the region. The Camille transarticular facet screw fixation technique provided a quick, safe, and strong segmental spinal fixation. An additional inter-screw metal link plate provided intersegmental stability at selected levels. The Oswestry Disability index and visual analog scale were used to assess the patients before and after surgery and at follow-up. In addition, a personalized Patient Satisfaction Score was used to assess the outcome of surgery.
Clinical symptomatic recovery was observed in all patients in the immediate postoperative period. During the average follow-up period, 100% patients had varying degrees of symptomatic relief.
Spinal instability is the nodal point of pathogenesis of spinal degeneration-related AIDLS. Only fixation of the involved spinal segments is necessary, and decompression by bone or soft-tissue resection is not necessary.
作者报告了14例成人特发性腰椎侧弯（AIDLS）患者的治疗经验，这些患者以腰腿痛为主要症状。患者仅接受多节段稳定手术治疗，手术目的是实现关节融合，不进行任何形式的骨或软组织减压。本文介绍了这种新型手术治疗的临床结果。
2014年6月至2019年6月期间，对14例AIDLS（退行性脊柱侧弯）患者进行了手术治疗。除了临床和影像学指导外，根据对关节状态的直接体格观察以及对该区域骨骼的手动操作来诊断不稳定情况。卡米尔经关节小关节螺钉固定技术提供了快速、安全且强大的节段性脊柱固定。额外的螺钉间金属连接板在选定节段提供节段间稳定性。采用Oswestry功能障碍指数和视觉模拟量表在手术前后及随访时对患者进行评估。此外，使用个性化的患者满意度评分来评估手术结果。
所有患者术后即刻均观察到临床症状缓解。在平均随访期内，100%的患者有不同程度的症状缓解。
脊柱不稳定是脊柱退变相关AIDLS发病机制的关键点。仅需固定受累脊柱节段，无需进行骨或软组织切除减压。
