tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 71

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 71. 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. | Spinal Deformities and Malformations Section 693 25 Congenital Scoliosis Francis H. Shen Vincent Arlet Core Messages Most cases of congenital scoliosis are sporadic and therefore are non-hereditary Up to 60 of patients with congenital scoliosis may have malformations of other organ systems particularly the genitourinary cardiovascular and nervous systems The classification system is based on either failure of formation failure of segmentation or mixed failure of both formation and segmentation Curve progression in congenital scoliosis is based on both the type and location of vertebral anomaly MRI searching for associated neurologic malformations is mandatory The treatment of congenital scoliosis is primarily surgical The goal of prophylactic surgery is to prevent curve progression or attempt a slow progressive correction over time through fusions in situ and or hemiepiphysiodeses The principle of corrective surgery focuses on attempting to correct the spinal deformity at the time of spinal fusion through either osteotomies or spinal resections Neurologic monitoring is essential during correction of congenital curves Epidemiology The presence of a coronal plane curvature secondary to an anomalous congenital vertebral defect that is present at birth is known as congenital scoliosis. This can be distinguished from infantile idiopathic scoliosis by the presence of a structural vertebral abnormality. If the vertebral anomaly results in a sagittal plane deformity it will result in congenital kyphosis or lordosis. Frequently the resulting deformity is a combination of both planes with congenital kyphoscoliosis being more common than congenital lordoscoliosis. The true incidence of congenital scoliosis is unknown. Among the large studies reported there do not appear to be any significant ethnic or geographic differences although there is a greater female to male ratio to 1 . Most cases of congenital scoliosis are non-hereditary and pose little risk to subsequent .