微创手术治疗成人退变性脊柱侧弯-- 是否可以改善脊柱平衡成人退变性脊柱侧弯De novo- DJD- Iatrogenic- Fractures- Lumbar curve apex L2-3 + compensatory fractional curve- Usually <40°- Usually thoracic curve is not structural- Rotation mainly lumbarAIS Progression- Curve progression- DJD- Usually an equal thoracic curve-usually >40°- Rotation all spine疼痛 ：腰痛，根性疼痛功能障碍 后凸畸形 ≠AIS ！ 成人退变性脊柱侧弯缓解神经根性疼痛◦压迫部位◦直接/ 间接减压缓解腰痛◦局部不稳定 ( 腰椎滑脱, 侧向滑移)◦脊柱整体不稳定改善畸形◦矢状面失平衡◦冠状面失平衡改善外观成人退变性脊柱侧弯的治疗目的Adding fusion to decompression gives better results than decompression aloneCorrecting coronal deformity is not as important as correcting sagittal deformity and may not impact quality of life我们需要矫正多少?LL=PI+TK-45°<20°<5cm<0°<4-5cm, within SI jointsSagittal ImbalanceCoronal Imbalance1st most important2nd most important3rd most importantSignificant• Sagittal alignment• Thoracolumbar alignment• Lumbar lordosis• Spondylolisthesis• Coronal imbalance >4-5cm• Lateral listhesis >7mmNot significant• Coronal cobb• Age• Adolescent vs. de-novo scoliosisSagittalCoronal那些是最需要纠正的问题?开放手术的治疗路线图SymptomLevel ILevel IILevel IIILevel IVLevel VLevel VIRadicular++++++Back Painminimal±++++Ant Osteophytes, <2mm sublux+-----Olisthesis ≥6mm--++++Coronal Cobb >30°--++++Lumbar Kyphosis---+++Global Imbalance----+ (flexible)+ (stiff) (<30% correction)Surgical TreatmentNo fusionFuse Levels decompFuse all lumbar curveAnt/Post fusionFuse to upper thoracicOsteotomy成人退变性脊柱侧弯：临床结果成人退变性脊柱侧弯：问题与挑战• 骨骼僵硬• 骨质疏松• 内科合并症• 体质虚弱• 其他关节疾病29%39%42%An MIS procedure is one that by virtue of the extent and means of surgical technique results in less collateral tissu...
