成人脊柱畸形：需要注意什么?

成人脊柱畸形：需要注意什么?

AS THE POPULATION AGES, the incidence of adult spinal deformity – and in particular, degenerative scoliosis – is going to dramatically increase. For the first time in U.S. history, older adults (65 and up) are projected to outnumber children (18 and under) by the year 2035. It's estimated that 40 to 60% of adults will develop degenerative scoliosis by age 65.

随着人口年龄的增长，成人脊柱畸形的发生率——尤其是退行性脊柱侧弯的发生率——将显著增加。到2035年，预计65岁及以上老年人的数量将首次超过18岁及以下儿童的数量。据估计，40%到60%的成年人将在65岁时发生退行性脊柱侧弯。

The majority of patients with scoliosis have little to no clinical symptoms and lead normal, healthy and active lives. Unfortunately a subset of these patients will develop significant pain and disability associated with their deformity, and will therefore seek treatment from a spine care professional.

大多数脊柱侧弯患者几乎没有临床症状，生活正常、健康、积极。不幸的是，这些患者中有一部分会出现与他们的畸形相关的严重疼痛和残疾，因此将寻求脊柱护理专业人士的治疗。

Patients with degenerative scoliosis typically complain of back pain, leg pain (sciatica or neurogenic claudication) and/or poor posture. The initial evaluation includes a thorough physical examination and appropriate imaging studies (such as scoliosis x-rays, MRI and CT scan).

退行性脊柱侧弯患者通常抱怨背痛、腿痛(坐骨神经痛或神经源性跛行)和/或姿势不佳。初步评估包括全面的身体检查和适当的影像学研究(如脊柱侧弯x线、MRI和CT扫描)。

The first line of treatment is always with non-operative care, which usually includes physical therapy, core-strengthening exercises, a weight loss program (when necessary), smoking cessation and targeted spinal injections (such as epidural steroid injections, nerve root blocks and facet injections).

治疗的第一道防线总是非手术治疗，通常包括物理治疗、核心强化训练、减肥计划(必要时)、戒烟和有针对性的脊髓注射(如硬膜外类固醇注射、神经根阻滞和关节突注射)。

Patients who continue to have severe pain and limited function despite a comprehensive non-operative treatment program are often good candidates for surgery. The goals of adult spinal deformity surgery are to decompress the neural elements and improve posture (restore coronal and sagittal plane balance).

尽管实施了全面的非手术治疗方案，但仍有严重疼痛和功能不全的患者往往需要进行手术。成人脊柱畸形手术的目的是减压神经元件，改善姿势(恢复冠状面和矢状面平衡)。

Surgery to correct adult spinal deformity has been shown to improve pain and health-related quality of life outcome measures but is often associated with significant risk and morbidity. Appropriate preoperative evaluation and optimization, as well as management, are crucial in minimizing complications and optimizing outcomes in this complex patient population.

矫正成人脊柱畸形的手术已被证明可以改善疼痛和与健康相关的生活质量，但往往与显著的风险和发病率相关。在这个复杂的患者群体中，适当的术前评估和优化以及管理对于最大限度地减少并发症和优化结果是至关重要的。

Patients undergoing surgical treatment of adult spinal deformity can expect a pain management consult after surgery and the utilization of multi-modal analgesia (pre-op, intra-op and post-op medications) to optimize pain control.

接受成人脊柱畸形手术治疗的患者可以在手术后寻求疼痛管理咨询，并使用多模式镇痛(术前、术中和术后药物)来优化疼痛控制。