修復成人脊柱側凸長期有效


  Feb. 28, 2003 - 根據刊載於二月份的Spine的研究報告指出,修復成人脊柱側凸可長期減輕痛苦、恢復功能並讓患者滿意。自從現代弧形器械出現後,這是第一份長期隨訪評估報告。
  
  紐約特殊外科醫院Gary S. Shapiro, MD博士和同僚表示,對於成人原發性脊柱側凸治療的重視已逐漸增加,未加治療的成人脊柱側凸可導致痛苦的脊柱骨關節炎、進行性變型、脊柱狹窄、神經根病、冠狀和矢狀面不平衡造成的肌肉疲勞,以及畸形所帶來的心理影響。
  
  此研究的受試者包括16位成人,他們皆因為胸腰部脊柱側凸和或腰部脊柱側凸、脊柱狹窄和下背部疼痛,接受了前部和後部外科重建治療。最少的隨訪時間為兩年。
  
  94%的受訪者對手術感到滿意,冠狀和矢狀面不平衡復位,在經過放射學檢查和臨床結果都有顯著的改善,長期的結果資料來自Modified Scoliosis Research Society的結果評估工具和Oswestry Disability Back Pain問卷。
  
  其中十位病人出現併發症,其中的八位需要再接受額外的手術,兩位也有輕微的併發症。研究的侷限性包括研究對象人數太少,進入標準太嚴苛,以及缺少CT資料。
  
  作者表示,胸腰部脊柱側凸和或腰部脊柱側凸的成人,如果同時患有脊柱狹窄和背部疼痛就需要進行複雜的重建外科手術,手術後通常可獲得疼痛減輕、功能恢復的長期顯著效果。
  

Repair of Adult Scoliosis Effe

By Laurie Barclay, MD
Medscape Medical News

Feb. 28, 2003 — Repair of adult scoliosis is effective in providing pain relief, functional restoration, and patient satisfaction over the long term, according to a case series published in the February issue of Spine. This is the first report of long-term follow-up evaluation in adults since the advent of modern segmental instrumentation.

"Increasing attention has been directed to the problem of treating the adult with idiopathic scoliosis," write Gary S. Shapiro, MD, from the Hospital for Special Surgery in New York City, and colleagues. "Untreated scoliosis in the adult can lead to painful spinal osteoarthritis, progressive deformity, spinal stenosis with radiculopathy, muscle fatigue from coronal and sagittal plane imbalance, and the psychological effects of living with a visible deformity."

This case series included 16 adults who underwent elective anterior and posterior surgical reconstruction for idiopathic thoracolumbar and/or lumbar scoliosis, spinal stenosis, and low-back pain. Minimum follow-up was two years.

Overall, 94% of the study subjects were satisfied with the surgery. All patients with balance problems had restoration or improvement of coronal and sagittal balance. There was significant improvement in radiographic and clinical findings, and in long-term outcome data from the Modified Scoliosis Research Society outcome instrument and the Oswestry Disability Back Pain Questionnaire.

Ten patients had major complications, and eight of them required additional surgery. Two had minor complications. Limitations of this study include the small number of subjects, strict inclusion criteria applying to only a small fraction of the adult population with scoliosis, and lack of computed tomography data.

"Combined symptoms of back pain and spinal stenosis require complex reconstructive surgery in adults with idiopathic thoracolumbar and/or lumbar scoliosis," the authors write. "Significant pain relief, functional restoration, and satisfaction can be achieved and maintained over the long term in the properly selected patient."

Spine. 2003;28:358-363

Reviewed by Gary D. Vogin, MD

    
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