Degenerative Scoliosis退变性脊柱侧凸解读

Cardinal Symptoms
Back Pain
? is the most frequent clinical problem of adult scoliosis
? patients often complain of axial back pain due to segmental instability
Spinal Claudication
?is the second most important symptom of adult degenerative scoliosis and may express itself as:
radicular claudication
central claudication ?the roots are compressed not necessarily on the
concave side due to a narrow foramen, but often on the convex side
Neurological Compromise
? neurological deficits occur late
? is the third most important clinical presentation and may include individual roots, several roots or the whole cauda equina with apparent bladder and rectal sphincter problems
with an
Pathogenesis
?the asymmetric degeneration of the disc and the facet joint leads to an asymmetric loading of the spinal segment and consequently an asymmetric deformity, i.e., scoliosis or kyphosis
DegeneratBiblioteka Baiduve Scoliosis
Wang Xuepeng M.D. Hangzhou First People's Hospital
Epidemiology
?can be differentiated into two major groups, i.e., primary degenerative scoliosis or de novo scoliosis and secondary degeneration of adult idiopathic scoliosis
Classification
?Schwab distinguished three groups based on measurements of the endplate obliquity of L3 in the frontal plane, and of the lumbar lordosis measured between the L1 and S1 superior endplates in the sagittal plane
?the formation of osteophytes at the facet joint (spondylarthritis) and at the vertebral endplates (spondylosis) contributes to the increasing narrowing of the spinal canal together with the hypertrophy and calcification of the ligamentum flavumand joint capsules, creating central and recessal spinal stenosis
? at the site of the curve can be localized either at the apex or in its concavity
? unbalanced, overloaded and stressed paravertebral back muscles may become very sore and in return will not contribute to balance, consequently becoming part of a vicious circle
Classification
Classification
?the classification of Lenke's may be able to cover the adult idiopathic scoliosis group with secondary degeneration but is not necessarily adequate for the primary degenerative scoliosis type
?the prevalence of scoliosis in patients older than 50 years is about 6%,the average age of those seeking medical care is in the sixties.
?there is a potential for curve progression average of 3.3 ° one year
Increasing Deformity
? osteoporosis accelerates curve progression ? larger curves tend to progress faster than small
curves for biomechanical reasons
Physical Findings