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J Rad SMT 3 Astri Dr. DY
J Rad SMT 3 Astri Dr. DY
Introduction
Study
Subjects
Material &
Methods
98 patients
Underwent surgical
correction and
lumbar/thoracolum
bar fusions with
pedicle screw
instrumentation for
DLS
Aug 2003 to Dec
2005
Inclusion
Criterias
Age > 18 y.o. at the time of
surgery
With at least one of the
defined radiographic ASD
criteria
Exclusion
Criterias
Diagnosis of scoliosis with
other etiology
Idiopathic,
paralytic/neuromuscular, or
congenital etiology
Inclusion
Criterias
Age > 18 y.o. at the time of
surgery
With at least one of the
defined radiographic ASD
criteria
Radiographic
ASD
Translation > 4
mm
Severe collapse of
intervertebral disc space
Herniated nucleus
pulposus &
stenosis
Vertebral
compression
fracture
Pedicle screw
loosening & broken
pedicle screws
Material &
Methods
The pe
Resul
The ts
statistically
significant
parameters
that were
related to ASD
occurrence
were:
Age
Disc
degeneration
on MRI
(cephalad
and caudal
disc)
KaplanMeier survivorship
analysis
Factors
The
There
mean
were
that
ODI
VAS
were
improved
improved
relatedfrom
from
to ASD
65.3
7.8 occurrence
preoperatively
preoperatively
wereto
to
preoperative
4.6
48.6
at at
the
the
la
Resul
ts
Discussion
ASD is a debatable late complication of spinal fusion
Old age
Female gender
High BMI
Osteoporosis
Rigid fusion such as PLIF and pedicular screw system
Fusion length
Sagittal malalignment
Preexisting adjacent level degeneration
Cheh
Limitations
The limitations of this study are:
1. The relatively short duration of followup
2. Not taking into consideration the scoliotic cu
rve type and sagittal imbalance.
3. The number of patients was limited
4. Retrospective nature
5. Not a randomized controlled design
Conclusion
The presence of disc deg
eneration and age greate
r than 65 years seem to b
e the most significant risk
factors for ASD after surg
ical correction of DLS and
should be primarily consi
dered before recommend
ing spinal fusions
Further investigations wi
th respect to determinat
ion of the importance of
the individual risk factor
s, particularly risk factor
s that are modifiable, ar
e required to reduce the
development of ASD
Cobbs Angle
The Cobb Angle helps a doctor to determine what type of treatment is nec
essary.
A Cobb Angle of 10 degrees
Not require any specific treatment, regular check-ups, physical therapy contains exercise ses
sions, home exercise program
Brace to keep the spine from developing more of a curve, scoliosis intensive rehabilitation p
rogram is necessary (3-5x/week)
40 50 degrees or more:
Surgery to correct the curve, a frequent recurring procedure is the spinal fusion, to link th
e vertebrae together so that the spine cannot longer continue to curve.
http://www.scielo.br/img/revistas/aob/v22n4//1413-7852aob-22-04-00179-gf01.jpg
Geometrical relationship
PI = PT + SS
Spinal Curvatures
Four types of spinal curvatures correlatin
g to the angle of the sacral slope were d
efined according to Roussouly et al.
Type I:
Low sacral slope <35 with an 80:20 thorac
olumbar curve.
Type II:
Low sacral slope <35 with a 60:40 thoracol
umbar flat back.
Type III:
Sacral slope >35 <45 with a 50:50 thorac
olumbar curve.
Type IV:
High sacral slope >45 with a 20:80 reverse
d thoracolumbar curve
Todd et al. Journal of Orthopaedic Surgery and Research (2015) 10:162
Intercristal Line
An imaginary line draw
n in the horizontal plan
e at the upper margin
of the iliac crests
Locates the level of the
L4 vertebra
A useful landmark in sp
inal tap procedure
http://www.mif-ua.com/frmtext/Trauma/2012/2-132012/158/158.jpg
Oswestry Disability
Index
(ODI)
http://synapse.koreamed.org/ArticleImage/0168ASJ/asj-8-813-i001-l.jpg