tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 67

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 67. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Idiopathic Scoliosis Chapter 23 653 Treatment. Treatment of infantile and juvenile scoliosis remains a therapeutic challenge because of the adverse effects of multisegmental fusion in a growing spine. If conservative treatment cast braces has failed to control the curve spinal instrumentation without fusion becomes necessary. Surgery for these curve types is very demanding and prone to complications often requiring revision surgery. The natural history of adolescent idiopathic scoliosis is benign without significant differences to an asymptomatic control group regarding physical functioning and quality of life in adulthood. The treatment depends on the severity of the curve and the risk of progression. Conservative treatment is intended to control progression of smaller curves. It consists of observation and physiotherapy in curves less than 10 -25 in skeletally immature patients. Curves of 25 -40 are usually treated by bracing. Braces are only effective before skeletal maturity is reached. Surgery is indicated in curves larger than 40 -50 or rapidly progressing curves despite conservative treatment. The objective of scoliosis surgery is to stop the progression and to correct the deformity. Posterior instrumentation and fusion remains the gold standard and allows for a correction of the coronal deformity with restoration of the coronal and sagittal balance and pro file. Today pedicle screws are frequently used as they allow a better correction and shorter fusion length than systems only using hooks and wires. In skeletally immature patients an anterior release and fusion is necessary to avoid further anterior growth after posterior fusion with a deterioration of the deformity crankshaft phenomenon . The more demanding anterior scoliosis surgery often allows motion segments to be spared and vertebral rotation to be better addressed. In contrast to adolescent scoliosis adult idiopathic scoliosis patients often present with symptoms pain neurological deficits due to .

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