退变性腰椎侧凸的认知及矫形融合固定治疗
|
摘要
背景:退变性腰椎侧凸是引起下腰背痛及下肢根性症状和间歇性跛行的常见原因之一,是近年来脊柱退行性疾病中的研究热点。目的:主要对近几年国内外关于退变性腰椎侧凸的认知及治疗方法进行综述,旨在为退变性腰椎侧凸的治疗方案提供参考。方法:以"退变性腰椎侧凸,椎间融合,内固定治疗,手术治疗,椎弓根螺钉,degenerative scoliosis, interbody fusion,internal fixation,operative treatment,pediclescrew"为检索词,分别检索1987年12月至2018年12月发表的与退变性腰椎侧凸、腰椎滑脱症、脊柱不稳、脊柱侧凸、脊柱畸形等的相关文章。根据入选标准及排除标准摘选42篇文献进行综述。结果与结论:(1)成人退行性脊柱侧凸手术的主要适应证是椎间孔狭窄引起的腰背痛、下肢放射痛、麻木及跛行;(2)在选择手术方法时,应仔细评估主要症状和潜在的疾病,不仅要减轻症状,而且要尽量减少术后并发症;(3)由于手术后侧凸的进展,单纯减压术通常不能治愈;在Cobb角较小、旋转畸形最小、冠状位和矢状位不平衡较轻的情况下,可采用减压加短节段固定融合术;在较大的Cobb角和冠状矢状不平衡的情况下,可选择减压加长节段矫形融合固定术;(4)任何用于成人退行性脊柱侧凸的手术都有较高的并发症,因此在选择手术方法之前,应该仔细考虑患者手术的风险和获益。
BACKGROUND: Degenerative lumbar scoliosis is one of the common causes of lower back pain and intermittent claudication. It is one of the focus research of spinal degenerative diseases in recent years. OBJECTIVE: To review the cognition and treatment methods of degenerative lumbar scoliosis at home and abroad in recent years, and to provide reference for the treatment of degenerative lumbar scoliosis. METHODS: The articles related to the degenerative lumbar scoliosis, spondylolisthesis, spinal instability, scoliosis, and spinal deformity published between December 1987 and December 2018 were retrieved by computer. The keywords were "degenerative scoliosis, interbody fusion, internal fixation, operative treatment, pedicle screw" in Chinese and English, respectively. Totally 42 articles were enrolled based on the inclusion and exclusion criteria. RESULTS AND CONCLUSION:(1) The main indications for adult degenerative scoliosis surgery are low back pain, radiation pain in lower limbs, numbness and claudication caused by intervertebral foramen stenosis.(2) When choosing the surgical methods, the main symptoms and potential diseases should be carefully evaluated. Not only to reduce symptoms, but also to minimize postoperative complications.(3) Due to the progression of postoperative scoliosis, decompression alone is usually not curable. In the case of small Cobb angle, minimal rotational deformity, light coronal and sagittal imbalances, decompression plus segmentary fixation and fusion can be used. In the case of large Cobb angle and coronal sagittal imbalance, decompression and lengthening segmentary orthopaedic fusion fixation may be selected.(4) Any surgery for adult degenerative scoliosis has a higher incidence of complications, so the risks and benefits of surgery should be carefully considered before selecting a surgical approach.
BACKGROUND: Degenerative lumbar scoliosis is one of the common causes of lower back pain and intermittent claudication. It is one of the focus research of spinal degenerative diseases in recent years. OBJECTIVE: To review the cognition and treatment methods of degenerative lumbar scoliosis at home and abroad in recent years, and to provide reference for the treatment of degenerative lumbar scoliosis. METHODS: The articles related to the degenerative lumbar scoliosis, spondylolisthesis, spinal instability, scoliosis, and spinal deformity published between December 1987 and December 2018 were retrieved by computer. The keywords were "degenerative scoliosis, interbody fusion, internal fixation, operative treatment, pedicle screw" in Chinese and English, respectively. Totally 42 articles were enrolled based on the inclusion and exclusion criteria. RESULTS AND CONCLUSION:(1) The main indications for adult degenerative scoliosis surgery are low back pain, radiation pain in lower limbs, numbness and claudication caused by intervertebral foramen stenosis.(2) When choosing the surgical methods, the main symptoms and potential diseases should be carefully evaluated. Not only to reduce symptoms, but also to minimize postoperative complications.(3) Due to the progression of postoperative scoliosis, decompression alone is usually not curable. In the case of small Cobb angle, minimal rotational deformity, light coronal and sagittal imbalances, decompression plus segmentary fixation and fusion can be used. In the case of large Cobb angle and coronal sagittal imbalance, decompression and lengthening segmentary orthopaedic fusion fixation may be selected.(4) Any surgery for adult degenerative scoliosis has a higher incidence of complications, so the risks and benefits of surgery should be carefully considered before selecting a surgical approach.
引文
[1]Carter OD,Haynes SG.Prevalence rates for scoliosis in US adults:results from the first National Health and Nutrition Examination Survey.Int J Epidemiol.1987;16(4):537-544.
[2]Schwab F,Dubey A,Gamez L,et al.Adult scoliosis:prevalence,SF-36,and nutritional parameters in an elderly volunteer population.Spine(Phila Pa 1976).2005;30(9):1082-1085.
[3]Hong JY,Suh SW,Modi HN,et al.The prevalence and radiological findings in 1347 elderly patients with scoliosis.J Bone Joint Surg Br.2010;92(7):980-983.
[4]Graham RB,Sugrue PA,Koski TR.Adult Degenerative Scoliosis.Clin Spine Surg.2016;29(3):95-107.
[5]Garcia-Ramos CL,Obil-Chavarria CA,Zarate-Kalfopulos B,et al.Degenerative adult scoliosis.Acta Ortop Mex.2015;29(2):127-138.
[6]Dehnokhalaji M,Golbakhsh M R,Siavashi B,et al.Evaluation of the Degenerative Changes of the Distal Intervertebral Discs after Internal Fixation Surgery in Adolescent Idiopathic Scoliosis.Asian Spine J.2018;12(6):1060-1068.
[7]Akazawa T,Watanabe K,Matsumoto M,et al.Modic changes and disc degeneration in adolescent idiopathic scoliosis patients who reach middle age without surgery:Can residual deformity cause lumbar spine degeneration?J Orthop Sci.2018;23(6):884-888.
[8]Tome-Bermejo F,Pinera AR,Alvarez-Galovich L.Osteoporosis and the Management of Spinal Degenerative Disease(I).Arch Bone Jt Surg.2017;5(5):272-282.
[9]Lowe T,Berven SH,Schwab FJ,et al.The SRS classification for adult spinal deformity:building on the King/Moe and Lenke classification systems.Spine(Phila Pa 1976).2006;31(19 Suppl):S119-S125.
[10]Aebi M.The adult scoliosis.Eur Spine J.2005;14(10):925-948.
[11]Schwab F,Farcy JP,Bridwell K,et al.A clinical impact classification of scoliosis in the adult.Spine(Phila Pa 1976).2006;31(18):2109-2114.
[12]Schwab F,Lafage V,Farcy JP,et al.Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis:application of the new adult deformity classification.Spine(Phila Pa1976).2007;32(24):2723-2730.
[13]Sengupta DK.Re:Schwab F,Ungar B,Blondel B,et al.Scoliosis research society-Schwab adult spinal deformity classification--a validation study.Spine 2012;37:1077-82.Spine(Phila Pa 1976).2012;37(20):1790.
[14]York PJ,Kim HJ.Degenerative Scoliosis.Curr Rev Musculoskelet Med.2017;10(4):547-558.
[15]Daffner SD,Vaccaro AR.Adult degenerative lumbar scoliosis.Am JOrthop(Belle Mead NJ).2003;32(2):77-82,82.
[16]Grubb SA,Lipscomb HJ,Suh PB.Results of surgical treatment of painful adult scoliosis.Spine(Phila Pa 1976).1994;19(14):1619-1627.
[17]Cheng JC,Castelein RM,Chu WC,et al.Adolescent idiopathic scoliosis.Nat Rev Dis Primers.2015;1:15030.
[18]Glassman SD,Bridwell K,Dimar JR,et al.The impact of positive sagittal balance in adult spinal deformity.Spine(Phila Pa 1976).2005;30(18):2024-2029.
[19]Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.Clin Orthop Relat Res.2001;(384):45-53.
[20]Putzier M,Pumberger M,Halm H,et al.[Surgical treatment of de-novo scoliosis].Orthopade.2016;45(9):744-754.
[21]Schwab FJ,Blondel B,Bess S,et al.Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity:a prospective multicenter analysis.Spine(Phila Pa 1976).2013;38(13):E803-E812.
[22]Cho KJ,Suk SI,Park SR,et al.Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis.Spine(Phila Pa 1976).2010;35(17):1595-1601.
[23]Bradford DS,Tay BK,Hu SS.Adult scoliosis:surgical indications,operative management,complications,and outcomes.Spine(Phila Pa1976).1999;24(24):2617-2629.
[24]Marchesi DG,Aebi M.Pedicle fixation devices in the treatment of adult lumbar scoliosis.Spine(Phila Pa 1976).1992;17(8 Suppl):S304-S309.
[25]Akbarnia BA,Ogilvie JW,Hammerberg KW.Debate:degenerative scoliosis:to operate or not to operate.Spine(Phila Pa 1976).2006;31(19 Suppl):S195-S201.
[26]Vaccaro AR,Ball ST.Indications for instrumentation in degenerative lumbar spinal disorders.Orthopedics.2000;23(3):260-271,272-273.
[27]Cho KJ,Suk SI,Park SR,et al.Short fusion versus long fusion for degenerative lumbar scoliosis.Eur Spine J.2008;17(5):650-656.
[28]Bradford DS,Tribus CB.Vertebral column resection for the treatment of rigid coronal decompensation.Spine(Phila Pa 1976),1997;22(14):1590-1599.
[29]Shufflebarger H,Suk S I,Mardjetko S.Debate:determining the upper instrumented vertebra in the management of adult degenerative scoliosis:stopping at T10 versus L1.Spine(Phila Pa 1976).2006;31(19 Suppl):S185-S194.
[30]Cho KJ,Suk SI,Park SR,et al.Selection of proximal fusion level for adult degenerative lumbar scoliosis.Eur Spine J.2013;22(2):394-401.
[31]Bridwell KH,Edwards CN,Lenke LG.The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct.Spine(Phila Pa 1976).2003;28(20):S234-S242.
[32]Polly DJ,Hamill CL,Bridwell KH.Debate:to fuse or not to fuse to the sacrum,the fate of the L5-S1 disc.Spine(Phila Pa 1976).2006;31(19Suppl):S179-S184.
[33]Edwards CN,Bridwell KH,Patel A,et al.Thoracolumbar deformity arthrodesis to L5 in adults:the fate of the L5-S1 disc.Spine(Phila Pa1976).2003;28(18):2122-2131.
[34]Dakwar E,Cardona RF,Smith DA,et al.Early outcomes and safety of the minimally invasive,lateral retroperitoneal transpsoas approach for adult degenerative scoliosis.Neurosurg Focus.2010;28(3):E8.
[35]Isaacs RE,Hyde J,Goodrich JA,et al.A prospective,nonrandomized,multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis:perioperative outcomes and complications.Spine(Phila Pa 1976).2010;35(26 Suppl):S322-S330.
[36]Kim YJ,Bridwell KH,Lenke LG,et al.Sagittal thoracic decompensation following long adult lumbar spinal instrumentation and fusion to L5 or S1:causes,prevalence,and risk factor analysis.Spine(Phila Pa1976).2006;31(20):2359-2366.
[37]Kim YJ,Bridwell KH,Lenke LG,et al.Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis.JBone Joint Surg Am.2006;88(4):721-728.
[38]Emami A,Deviren V,Berven S,et al.Outcome and complications of long fusions to the sacrum in adult spine deformity:luque-galveston,combined iliac and sacral screws,and sacral fixation.Spine(Phila Pa1976).2002;27(7):776-786.
[39]Pateder DB,Kebaish KM,Cascio BM,et al.Posterior only versus combined anterior and posterior approaches to lumbar scoliosis in adults:a radiographic analysis.Spine(Phila Pa 1976).2007;32(14):1551-1554.
[40]Tsuchiya K,Bridwell KH,Kuklo TR,et al.Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation(bilateral S1 and iliac screws)for spinal deformity.Spine(Phila Pa 1976).2006;31(3):303-308.
[41]Cho KJ,Kim KT,Kim WJ,et al.Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance.Spine(Phila Pa1976).2013;38(24):E1561-E1566.
[42]Schwab FJ,Patel A,Shaffrey CI,et al.Sagittal realignment failures following pedicle subtraction osteotomy surgery:are we doing enough?:Clinical article.J Neurosurg Spine.2012;16(6):539-546.
[2]Schwab F,Dubey A,Gamez L,et al.Adult scoliosis:prevalence,SF-36,and nutritional parameters in an elderly volunteer population.Spine(Phila Pa 1976).2005;30(9):1082-1085.
[3]Hong JY,Suh SW,Modi HN,et al.The prevalence and radiological findings in 1347 elderly patients with scoliosis.J Bone Joint Surg Br.2010;92(7):980-983.
[4]Graham RB,Sugrue PA,Koski TR.Adult Degenerative Scoliosis.Clin Spine Surg.2016;29(3):95-107.
[5]Garcia-Ramos CL,Obil-Chavarria CA,Zarate-Kalfopulos B,et al.Degenerative adult scoliosis.Acta Ortop Mex.2015;29(2):127-138.
[6]Dehnokhalaji M,Golbakhsh M R,Siavashi B,et al.Evaluation of the Degenerative Changes of the Distal Intervertebral Discs after Internal Fixation Surgery in Adolescent Idiopathic Scoliosis.Asian Spine J.2018;12(6):1060-1068.
[7]Akazawa T,Watanabe K,Matsumoto M,et al.Modic changes and disc degeneration in adolescent idiopathic scoliosis patients who reach middle age without surgery:Can residual deformity cause lumbar spine degeneration?J Orthop Sci.2018;23(6):884-888.
[8]Tome-Bermejo F,Pinera AR,Alvarez-Galovich L.Osteoporosis and the Management of Spinal Degenerative Disease(I).Arch Bone Jt Surg.2017;5(5):272-282.
[9]Lowe T,Berven SH,Schwab FJ,et al.The SRS classification for adult spinal deformity:building on the King/Moe and Lenke classification systems.Spine(Phila Pa 1976).2006;31(19 Suppl):S119-S125.
[10]Aebi M.The adult scoliosis.Eur Spine J.2005;14(10):925-948.
[11]Schwab F,Farcy JP,Bridwell K,et al.A clinical impact classification of scoliosis in the adult.Spine(Phila Pa 1976).2006;31(18):2109-2114.
[12]Schwab F,Lafage V,Farcy JP,et al.Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis:application of the new adult deformity classification.Spine(Phila Pa1976).2007;32(24):2723-2730.
[13]Sengupta DK.Re:Schwab F,Ungar B,Blondel B,et al.Scoliosis research society-Schwab adult spinal deformity classification--a validation study.Spine 2012;37:1077-82.Spine(Phila Pa 1976).2012;37(20):1790.
[14]York PJ,Kim HJ.Degenerative Scoliosis.Curr Rev Musculoskelet Med.2017;10(4):547-558.
[15]Daffner SD,Vaccaro AR.Adult degenerative lumbar scoliosis.Am JOrthop(Belle Mead NJ).2003;32(2):77-82,82.
[16]Grubb SA,Lipscomb HJ,Suh PB.Results of surgical treatment of painful adult scoliosis.Spine(Phila Pa 1976).1994;19(14):1619-1627.
[17]Cheng JC,Castelein RM,Chu WC,et al.Adolescent idiopathic scoliosis.Nat Rev Dis Primers.2015;1:15030.
[18]Glassman SD,Bridwell K,Dimar JR,et al.The impact of positive sagittal balance in adult spinal deformity.Spine(Phila Pa 1976).2005;30(18):2024-2029.
[19]Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.Clin Orthop Relat Res.2001;(384):45-53.
[20]Putzier M,Pumberger M,Halm H,et al.[Surgical treatment of de-novo scoliosis].Orthopade.2016;45(9):744-754.
[21]Schwab FJ,Blondel B,Bess S,et al.Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity:a prospective multicenter analysis.Spine(Phila Pa 1976).2013;38(13):E803-E812.
[22]Cho KJ,Suk SI,Park SR,et al.Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis.Spine(Phila Pa 1976).2010;35(17):1595-1601.
[23]Bradford DS,Tay BK,Hu SS.Adult scoliosis:surgical indications,operative management,complications,and outcomes.Spine(Phila Pa1976).1999;24(24):2617-2629.
[24]Marchesi DG,Aebi M.Pedicle fixation devices in the treatment of adult lumbar scoliosis.Spine(Phila Pa 1976).1992;17(8 Suppl):S304-S309.
[25]Akbarnia BA,Ogilvie JW,Hammerberg KW.Debate:degenerative scoliosis:to operate or not to operate.Spine(Phila Pa 1976).2006;31(19 Suppl):S195-S201.
[26]Vaccaro AR,Ball ST.Indications for instrumentation in degenerative lumbar spinal disorders.Orthopedics.2000;23(3):260-271,272-273.
[27]Cho KJ,Suk SI,Park SR,et al.Short fusion versus long fusion for degenerative lumbar scoliosis.Eur Spine J.2008;17(5):650-656.
[28]Bradford DS,Tribus CB.Vertebral column resection for the treatment of rigid coronal decompensation.Spine(Phila Pa 1976),1997;22(14):1590-1599.
[29]Shufflebarger H,Suk S I,Mardjetko S.Debate:determining the upper instrumented vertebra in the management of adult degenerative scoliosis:stopping at T10 versus L1.Spine(Phila Pa 1976).2006;31(19 Suppl):S185-S194.
[30]Cho KJ,Suk SI,Park SR,et al.Selection of proximal fusion level for adult degenerative lumbar scoliosis.Eur Spine J.2013;22(2):394-401.
[31]Bridwell KH,Edwards CN,Lenke LG.The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct.Spine(Phila Pa 1976).2003;28(20):S234-S242.
[32]Polly DJ,Hamill CL,Bridwell KH.Debate:to fuse or not to fuse to the sacrum,the fate of the L5-S1 disc.Spine(Phila Pa 1976).2006;31(19Suppl):S179-S184.
[33]Edwards CN,Bridwell KH,Patel A,et al.Thoracolumbar deformity arthrodesis to L5 in adults:the fate of the L5-S1 disc.Spine(Phila Pa1976).2003;28(18):2122-2131.
[34]Dakwar E,Cardona RF,Smith DA,et al.Early outcomes and safety of the minimally invasive,lateral retroperitoneal transpsoas approach for adult degenerative scoliosis.Neurosurg Focus.2010;28(3):E8.
[35]Isaacs RE,Hyde J,Goodrich JA,et al.A prospective,nonrandomized,multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis:perioperative outcomes and complications.Spine(Phila Pa 1976).2010;35(26 Suppl):S322-S330.
[36]Kim YJ,Bridwell KH,Lenke LG,et al.Sagittal thoracic decompensation following long adult lumbar spinal instrumentation and fusion to L5 or S1:causes,prevalence,and risk factor analysis.Spine(Phila Pa1976).2006;31(20):2359-2366.
[37]Kim YJ,Bridwell KH,Lenke LG,et al.Pseudarthrosis in adult spinal deformity following multisegmental instrumentation and arthrodesis.JBone Joint Surg Am.2006;88(4):721-728.
[38]Emami A,Deviren V,Berven S,et al.Outcome and complications of long fusions to the sacrum in adult spine deformity:luque-galveston,combined iliac and sacral screws,and sacral fixation.Spine(Phila Pa1976).2002;27(7):776-786.
[39]Pateder DB,Kebaish KM,Cascio BM,et al.Posterior only versus combined anterior and posterior approaches to lumbar scoliosis in adults:a radiographic analysis.Spine(Phila Pa 1976).2007;32(14):1551-1554.
[40]Tsuchiya K,Bridwell KH,Kuklo TR,et al.Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation(bilateral S1 and iliac screws)for spinal deformity.Spine(Phila Pa 1976).2006;31(3):303-308.
[41]Cho KJ,Kim KT,Kim WJ,et al.Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance.Spine(Phila Pa1976).2013;38(24):E1561-E1566.
[42]Schwab FJ,Patel A,Shaffrey CI,et al.Sagittal realignment failures following pedicle subtraction osteotomy surgery:are we doing enough?:Clinical article.J Neurosurg Spine.2012;16(6):539-546.