退变性脊柱侧凸的外科诊治进展

Current surgical researches of degenerative scoliosis

退变性脊柱侧凸是老年人群中常见的脊柱冠状位的弯曲畸形。尽管病因尚未明确,但是它与引起神经受压的椎间盘、关节突关节和其他脊柱结构的退变有密切的关系。临床表现呈多样化,主要包括轴向腰背痛、根性症状、神经性跛行、畸形和马尾综合征。应该在多方面、多学科对风险和收益进行评估后制定手术治疗的方案。手术治疗的最主要目标是通过减压促进神经恢复和通过矫形恢复脊柱平衡。手术方式包括单纯减压术、前后路融合内固定术、矫形手术以及这些手术的联合使用并且要制定个体化方案。融合范围是一个热点问题,仍需要更多的研究来制定手术策略的选择标准。微创、动态稳定等较新技术已经被应用来降低围手术期并发症的发生率。

Degenerative scoliosis is a lateral curvature that is prevalent in the elderly population. Although the pathogenesis is unclear, it is associated with degenerative processes in the disc, facet joints, and other structural spinal elements typically leading to neural element compression. Clinical presentation varies and mainly includes axial back pain, radicular symptoms, neurogenic claudication, deformity and cauda equina syndrome. Operative treatment should be contemplated after muhifactorial and muhidisciplinary evaluation of the risks and the benefits. The primary goal of surgical treatment is to promote the recovery of nerves with decompression and to restore stability of the spine with orthopedics. Options include decompression, instrumented stabilization with posterior or anterior fusion, correction of deformity, or a combination of these that are tailored to each pa- tient. Numbers of fusion segments is a hot button issue and more research is needed to determine how to design surgical plan. Newer techniques have been introduced in an effort to reduce the perioperative morbidity by adopting minimally invasive methods or dynamic stabilization.