成人脊柱畸形：需要注意什么?

成人脊柱畸形：需要注意什么?

AS THE POPULATION AGES, the incidence of adult spinal deformity – and in particular, degenerative scoliosis – is going to dramatically increase. For the first time in U.S. history, older adults (65 and up) are projected to outnumber children (18 and under) by the year 2035. It's estimated that 40 to 60% of adults will develop degenerative scoliosis by age 65.

隨著人口年齡的增長(zhǎng)，成人脊柱畸形的發(fā)生率——尤其是退行性脊柱側(cè)彎的發(fā)生率——將顯著增加。到2035年，預(yù)計(jì)65歲及以上老年人的數(shù)量將首次超過(guò)18歲及以下兒童的數(shù)量。據(jù)估計(jì)，40%到60%的成年人將在65歲時(shí)發(fā)生退行性脊柱側(cè)彎。

The majority of patients with scoliosis have little to no clinical symptoms and lead normal, healthy and active lives. Unfortunately a subset of these patients will develop significant pain and disability associated with their deformity, and will therefore seek treatment from a spine care professional.

大多數(shù)脊柱側(cè)彎患者幾乎沒(méi)有臨床癥狀，生活正常、健康、積極。不幸的是，這些患者中有一部分會(huì)出現(xiàn)與他們的畸形相關(guān)的嚴(yán)重疼痛和殘疾，因此將尋求脊柱護(hù)理專(zhuān)業(yè)人士的治療。

Patients with degenerative scoliosis typically complain of back pain, leg pain (sciatica or neurogenic claudication) and/or poor posture. The initial evaluation includes a thorough physical examination and appropriate imaging studies (such as scoliosis x-rays, MRI and CT scan).

退行性脊柱側(cè)彎患者通常抱怨背痛、腿痛(坐骨神經(jīng)痛或神經(jīng)源性跛行)和/或姿勢(shì)不佳。初步評(píng)估包括全面的身體檢查和適當(dāng)?shù)挠跋駥W(xué)研究(如脊柱側(cè)彎x線(xiàn)、MRI和CT掃描)。

The first line of treatment is always with non-operative care, which usually includes physical therapy, core-strengthening exercises, a weight loss program (when necessary), smoking cessation and targeted spinal injections (such as epidural steroid injections, nerve root blocks and facet injections).

治療的第一道防線(xiàn)總是非手術(shù)治療，通常包括物理治療、核心強(qiáng)化訓(xùn)練、減肥計(jì)劃(必要時(shí))、戒煙和有針對(duì)性的脊髓注射(如硬膜外類(lèi)固醇注射、神經(jīng)根阻滯和關(guān)節(jié)突注射)。

Patients who continue to have severe pain and limited function despite a comprehensive non-operative treatment program are often good candidates for surgery. The goals of adult spinal deformity surgery are to decompress the neural elements and improve posture (restore coronal and sagittal plane balance).

盡管實(shí)施了全面的非手術(shù)治療方案，但仍有嚴(yán)重疼痛和功能不全的患者往往需要進(jìn)行手術(shù)。成人脊柱畸形手術(shù)的目的是減壓神經(jīng)元件，改善姿勢(shì)(恢復(fù)冠狀面和矢狀面平衡)。

Surgery to correct adult spinal deformity has been shown to improve pain and health-related quality of life outcome measures but is often associated with significant risk and morbidity. Appropriate preoperative evaluation and optimization, as well as management, are crucial in minimizing complications and optimizing outcomes in this complex patient population.

矯正成人脊柱畸形的手術(shù)已被證明可以改善疼痛和與健康相關(guān)的生活質(zhì)量，但往往與顯著的風(fēng)險(xiǎn)和發(fā)病率相關(guān)。在這個(gè)復(fù)雜的患者群體中，適當(dāng)?shù)男g(shù)前評(píng)估和優(yōu)化以及管理對(duì)于最大限度地減少并發(fā)癥和優(yōu)化結(jié)果是至關(guān)重要的。

Patients undergoing surgical treatment of adult spinal deformity can expect a pain management consult after surgery and the utilization of multi-modal analgesia (pre-op, intra-op and post-op medications) to optimize pain control.

接受成人脊柱畸形手術(shù)治療的患者可以在手術(shù)后尋求疼痛管理咨詢(xún)，并使用多模式鎮(zhèn)痛(術(shù)前、術(shù)中和術(shù)后藥物)來(lái)優(yōu)化疼痛控制。