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Principles of Management for Adult Spinal Deformity

Principles of Management for Adult Spinal Deformity. 成人脊椎畸形治療之原則. Po-Quang Chen, MD., PhD 台大骨科 陳博光 名譽教授 敏盛醫院 副總裁 www.taiwanspine.org.tw. 1. Adult versus Adolescent Scoliosis. Adult deformity skeletally mature with relatively fixed curves,

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Principles of Management for Adult Spinal Deformity

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  1. Principles of Management for Adult Spinal Deformity 成人脊椎畸形治療之原則 Po-Quang Chen, MD., PhD 台大骨科 陳博光 名譽教授 敏盛醫院 副總裁 www.taiwanspine.org.tw 3rd Guangtong Orthopedic Congress 1

  2. Adult versusAdolescent Scoliosis Adult deformity • skeletally mature with relatively fixed curves, • Typically present with back pain and neurological concerns, • degenerated and osteoporotic • sagittal balance is lost • co-morbidities Adolescent • skeletally immature with flexible curves • present with cosmetic complaints. • have normal bone stock, no degenerative changes • Consider normal coronal and sagittal profile Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 2

  3. Adult Spinal Deformity(成人脊椎畸形) • Adult scoliosis • Degenerative scoliosis • Flat back deformity • Salvage procedure Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 3

  4. 手術適應症indications for operation • relief of back pain, radiating pain to the legs, • motor weakness due to root compression, • curve progression or severe deformity and truncal decompensation resulting in pulmonary compromise. Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 4

  5. 手術路徑Surgical approaches • Anterior instrumentation and fusion • Combined A/P instrumentation – long instrumentation, • Posterior pedicle screw fixation • Fusion to sacrum • inter-vertebral fixation with cages Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 5

  6. Case Presentations 病例介紹 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 6

  7. 1.31Y/F. symptomatic scoliosis 術前 術後4+7 年 71 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 7

  8. 2. Chao CM 37 Y/F severe LBP 術前 術後 2Yrs 63 62 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 8

  9. 3. 36 Y/F Progressive symptomatic lumbar curve, 1999 2001 2002 2000 55 27 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 9

  10. PO PO 5Y PO 7Y PO 7Y PO 5Y OP: A/P with follow-up radiographs Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 10

  11. we use posterior fixation & correction by pedicle screws 經後路 使用椎弓根釘 矯正方式 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 11

  12. 4. 44 Y/F with severe LBP Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 12

  13. 5. 66Y/F, symptomatic L scoliosis 3rd Guangtong Orthopedic Congress

  14. Post-operative 4M, painless 3rd Guangtong Orthopedic Congress

  15. 7. Degenerative scoliosis蔣O賢 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 15

  16. 8. 先天性 Scoliosis T12 HemiV, 41歲 女 77 58 50 95 T12 Hemivertebra Excision, Cobb angle 95°  50º Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 16

  17. 9. 61 yo woman, DLS FBS PO10Y術後十年背疼痛嚴重 Op for LS No canal compromise 50 17 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 17

  18. Revision by extending screws upward to correct deformity PO 9M 18 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 18

  19. Surgical Approaches 2002 2007: • 360º↓ vs. posterior↑ only SRS report 2008 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 19

  20. 2. Bone graft substitutes, mainly BMP ↑ (29% →66%) SRS report 2008 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 第一屆首都高峰論壇 20

  21. 3. Distal Fusion Level for Long Fusion: L5↓ vs. S1↑ SRS report 2008 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 21

  22. 4. Posterior Thoracic Fixation Type: Screws ↑ vs. hooks vs. hybrid ↓ SRS report 2008 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 22

  23. The Conclusions: • A posterior only approach provided the same deformity as A/P fusion • OR time, EBL, and LOS were significantly less • Outcomes and complications were equivalent at • over 2 years follow-up • Pseudarthrosis was not seen in the Posterior • only group • 2008 SRS report Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 23

  24. 1. 手術目的為矯正畸形及緩和背部疼痛 2. 從後路利用all pedicle screwmethod 一次完成. 3. 有退化性之病人可考慮塞入椎籠 (Structural cages) 4. 矯正率: young adults 與 adolescent 相同 72.7 vs. 70.6% 5. 併發症: all age>22 Y, 210 cases (ADIS 89 cases) paresis one, paraplegia one, deep wound infection one. Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 24

  25. Reported operative complications文獻報告之合併症 • Neurologic injury – 1 to 5% • Infection – 1 to 8 % • Pseudarthrosis – 38% • Pulmonary embolism – 1 to 20% • Low lime thrombo-embolism • Spinal decompensation Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 25

  26. Neurological deficits: analysis of 1373 cases at 南京鼓樓醫院 • Total incidence 1.89%, serious 0.51%, mild ones was 1.38%, risk factors Congenital Scoliosis, Scoliosis with hyperkyphosis, Correction by combined procedures, Scoliosis with a Cobb's angle > 90°, Revision surgery. --- Qiu Y et al Spine. 2008 Mar 1;33(5):519-26 --- Qiu Y et al Spine. 2008 Mar 1;33(5):519-26 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 26

  27. complications in different scoliosis aetiologies --Weiss HR & Godall D. Scoliosis 2008 3:9 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 27

  28. Thank you,謝謝 APOA 16th Congress at Taipei 2010 Nov. 5-7th www.apoa-home.org 28 Oct. 24-25, 2008 3rd Guangtong Orthopedic Congress 28

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