Degenerative Scoliosis

York, Philip J.; Kim, Hee Jin

doi:10.1007/s12178-017-9445-0

Cited by 42 publications

(59 citation statements)

References 59 publications

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“…45 Patients with degenerative lumbar scoliosis present at a relatively high age, often with several comorbidities and poor bone quality. 1,25,45,52 This increases the risk of intra-and postoperative complications, 15,21 which is shown by a study of Transfeldt et al, who reported a complication rate of 40%-56% after spinal fusion, compared to only 10% in decompression alone. 47 FIG.…”

Section: Discussionmentioning

confidence: 98%

The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study

Rustenburg

Faraj

Holewijn

et al. 2019

Neurosurgical Focus

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OBJECTIVEDegenerative lumbar scoliosis, or de novo degenerative lumbar scoliosis, can result in spinal canal stenosis, which is often accompanied by disabling symptoms. When surgically treated, a single-level laminectomy is performed and short-segment posterior instrumentation is placed to restore stability. However, the effects of laminectomy on spinal stability and the necessity of placing posterior instrumentation are unknown. Therefore, the aim of this study was to assess the stability of lumbar spines with degenerative scoliosis, characterized by the range of motion (ROM) and neutral zone (NZ) stiffness, after laminectomy and placement of posterior instrumentation.METHODSTen lumbar cadaveric spines (T12–L5) with a Cobb angle ≥ 10° and an apex on L3 were included. Three loading cycles were applied per direction, from −4 Nm to 4 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR). Biomechanical evaluation was performed on the native spines and after subsequent L3 laminectomy and the placement of posterior L2–4 titanium rods and pedicle screws. Nonparametric and parametric tests were used to analyze the effects of laminectomy and posterior instrumentation on NZ stiffness and ROM, respectively, both on an individual segment’s motion and on the entire spine section. Spearman’s rank correlation coefficient was used to study the correlation between disc degeneration and spinal stability.RESULTSThe laminectomy increased ROM by 9.5% in FE (p = 0.04) and 4.6% in LB (p = 0.01). For NZ stiffness, the laminectomy produced no significant effects. Posterior instrumentation resulted in a decrease in ROM in all loading directions (−22.2%, −24.4%, and −17.6% for FE, LB, and AR, respectively; all p < 0.05) and an increase in NZ stiffness (+44.7%, +51.7%, and +35.2% for FE, LB, and AR, respectively; all p < 0.05). The same changes were seen in the individual segments around the apex, while the adjacent, untreated segments were mostly unaffected. Intervertebral disc degeneration was found to be positively correlated to decreased ROM and increased NZ stiffness.CONCLUSIONSLaminectomy in lumbar spines with degenerative scoliosis did not result in severe spinal instability, whereas posterior instrumentation resulted in a rigid construct. Also, prior to surgery, the spines already had lower ROM and higher NZ stiffness in comparison to values shown in earlier studies on nonscoliotic spines of the same age. Hence, the authors question the clinical need for posterior instrumentation to avoid instability.

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Section: Discussionmentioning

confidence: 98%

The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study

Rustenburg

Faraj

Holewijn

et al. 2019

Neurosurgical Focus

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“…The patient suffers from breathing difficulty; digestive disorders are common and promote abdominal hypertension and sphincter disorders. The loss of lumbar lordosis has multiple causes: a decrease in the anterior height of the disc, hypertrophy of the facet joints and spinous process increasing the posterior height, and loss of extensors muscle strength [29].…”

Section: Discussionmentioning

confidence: 99%

Bracing Adult Scoliosis: From Immobilization to Correction of Adult Scoliosis

Mauroy¹,

Gagliano²,

Gagliano³

et al. 2021

Spinal Deformities in Adolescents, Adults and Older Adults

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Unlike adolescent idiopathic scoliosis, bracing was used in adults less and was used more as a way of reducing pain. There is little publication of adult scoliosis series in the literature. The use of very high-rigidity and high-precision CAD/ CAM technologies currently makes it possible to create corrective braces for the adult. The digital CAD/CAM cast in three blocks allows for precise correction at the pelvic, lumbar, and thoracic levels. This chapter presents the results of a series of 62 consecutive adult scoliotic patients treated with a corrective asymmetric detorsion brace of very high rigidity made in 2014-2016. Tolerance and angular correction results will be compared to those of 158 patients treated with the former bivalve polyethylene overlapping immobilization brace mainly used for lumbar scoliosis. The new Lyon adult ARTbrace is a detorsion brace adapted to all the curvatures which controls the sagittal plane. Despite a resistance four times greater than that of polyethylene of the same thickness, the tolerance of the Europlex'O is excellent as it is a "shock absorber," and the anterior opening facilitates the use for very old people. Consequently, the aim of this chapter is to consider if it is possible to envisage for some patients an alternative to surgery, thanks to the new technologies of bracing.

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“…A associação com laterolistese é frequente, sendo ocasional a presença de curvas torácicas compensatórias. 10 Quando comparada com a EIA, a escoliose de novo apresenta curvas com menor angulação, entretanto com maior progressão (1,64°/ano versus 0,82°/ano). 17 A EIA ocorre em indivíduos com escoliose preexistente, principalmente do sexo feminino, em dois padrões principais.…”

Section: Apresentação Clínicaunclassified

“…Os parâmetros espinopélvicos, a lordose lombar e cifose torácica também devem ser avaliados. 10 À análise radiográfica, o aumento da rotação da vértebra apical (3 de Nash-Moe), ângulos de Cobb > 30°, assimetria dos discos intervertebrais acima e abaixo da vértebra apical, laterolistese > 6 milímetros, linha interilíaca (linha entre os aspectos superiores de ambas as cristas ilíacas) seccionando L5 ao invés de L4 são preditivos de progressão da curva. Já a presença de osteófitos anteriores confere maior estabilidade à coluna vertebral.…”

Section: Avaliação Radiográficaunclassified

“…9 O emprego de técnicas de acesso anterior e lateral, além de proporcionarem descompressão direta e indireta pela distração foraminal, permitem o uso de espaçadores discais com maior área, menor risco de fratura dos platôs (subsidência) e com potencial de correção angular nos planos sagital e coronal. 10,29 Na presença de desequilíbrio global importante associado a aumento da cifose torácica, a extensão da artrodese à coluna torácica pode ser necessária e reduz a chance de cifose juncional proximal. Prefere-se a fusão ao nível de T10 ou cefálicos em razão da estabilidade conferida pela articulação das respectivas costelas ao esterno nestes níveis (costelas verdadeiras), o que não ocorre com as costelas flutuantes (T11 e T12).…”

Section: Tratamento Cirúrgicounclassified

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Escoliose degenerativa do adulto

Cristante

Silva

Costa

et al. 2020

Rev Bras Ortop (Sao Paulo)

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ResumoO envelhecimento da população aumenta a incidência dos processos degenerativos osteomusculares, como a escoliose do adulto (EA). A EA é definida como uma deformidade da coluna no plano coronal com ângulo de Cobb > 10° e pode ocorrer devido a um processo degenerativo (escoliose de novo), evolução de uma escoliose pré-existente ou de forma iatrogênica.A EA é uma doença potencialmente limitante que acomete um grupo heterogêneo de pacientes. O tratamento clínico se mostrou pouco efetivo e a indicação cirúrgica é frequente. No presente artigo, é apresentada uma revisão sobre a fisiopatologia, a manifestação clínica e o diagnóstico da EA. Também são apresentadas as indicações cirúrgicas e as principais técnicas utilizadas atualmente.

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Degenerative Scoliosis

Cited by 42 publications

References 59 publications

The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study

The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study

Bracing Adult Scoliosis: From Immobilization to Correction of Adult Scoliosis

Escoliose degenerativa do adulto

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