退变性脊柱侧凸的分型与治疗

Classification and treatment progress of degenerative scoliosis

scoliosis，DS）是指既往无脊柱侧凸史，骨骼成熟后伴随椎间盘及关节突关节退变性改变而发生的原发性脊柱侧凸。o退变性脊柱侧凸好发于腰段和胸腰段，除引起患者体型不美观外，还可导致持续性腰痛、神经根性痛和间歇性跛行，部分患者需要手术治疗。目前，关于退变性脊柱侧凸的分型、手术策略的选择等尚无统一标准。

Degenerative scoliosis （ DS ）, known as de novo scoliosis developing after skeletal maturity without a previous history of spinal deformities, is associated with the asymmetric degenerative process of intervertebral discs and facet joints. It frequently involves the lumbar and thoracolumbar spine, and can give rise to symptoms of persistent low back pain, radicular pain and intermittent claudication as well as cosmetic concerns. In the presence of severe pain and progressive neurological deficits, and when nonoperative treatment is ineffective, surgical management should be considered. A perfect classification scheme will help guide the operation decision-making, and while a unified standard for the DS classification is lacking. Thus far, several classification schemes have emerged to describe DS in previous literatures, including the Scoliosis Research Society （ SRS ） system, the Schwab system, the Simmons system, the Aebi system and the Coronal Imbalance system. The classification schemes stated above are still not perfect now, but there is clinical significance in each of them. Regarding the surgical management of DS, the primary aims are to relieve pain, normalize both sagittal balance and coronal plane deformity, restore normal function and improve the quality of life （ QOL ）. However, due to the disparities in patients＇neurogenic symptoms, general conditions and demands for QOL, the choice of treatment strategy is the key point of contention, especially aboutfusion segments. Although Silva and Lenke proposed the Lenke-Silva Treatment Levels I-Vlto help guide the surgical planning, the question of fusion level selection still remains largely unsolved. All in all, comprehensive assessment before the surgery and selection of appropriate surgical approach play pivotal roles in improving the QOL of patients with DS.