重视症状与影像的综合评估阶梯化治疗退变性脊柱侧凸

姜建元

doi:10.3969/j.issn.2095-252X.2015.03.002

摘要：Degenerative scoliosis refers to the scoliosis deformity associated with lumbar degenerative changes, which appears after the age of 40, with coronal Cobb’s angle >10° and more concentrated in the lumbar segment. Its incidence falls in 6%-68%among the people over the age of 50 and increases with age. Traditionally, degenerative scoliosis is only a concept of imageology, while not all the symptoms are from scoliosis deformity. Severity of relative symptoms such as low back pain, radicular pain and intermittent claudication is not always positively correlated with the Cobb’s angle. Therefore, a comprehensive evaluation which combines clinical symptoms with imaging examination is necessary, and the strategy of individualized treatment has been recognized by an increasing number of scholars. For asymptomatic patients, they do not need special treatment, but still need regular follow-up. For those with operation indications such as severe back pain or progressive scoliosis accompanied by sagittal instability, the patients can receive operation to improve the living quality by relieving lumbar pain and nerve compression. The operation scheme must be individualized, and the patients’ complaints must be fully considered, which are mainly caused by spinal stenosis or spinal deformity. And meanwhile, the responsibility segments and fusion segments must be figured out. Therefore, in the process of clinical practice, the comprehensive assessment which combines clinical symptoms and imaging examination is quite signiifcant. Doctors should formulate reasonable stepwise treatment according to the patients’ general health, osteoporosis condition, type and location of scoliosis and spinal stability or balance situation in order to effectively relieve nerve compression and reconstruct spinal balance with minimal injury.