j rad smt 3 astri dr. dy

8/18/2019 J Rad Smt 3 Astri Dr. DY

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Presented by:Setia Wati Astri Arifin

Resident of Medical Rehabilitation Department

Supervised by:

dr. N. Diana Yulisa SpRad!"#

$ournal Readin%

Ris& factors for ad'acent se%men

de%eneration after sur%ical correctiode%enerative lumbar scoliosis

"ee yon% (a $on% Min Son $in (yun% )m )n Soo *h‑ ‑ ‑ ‑


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Introduction


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Study

Subject• 98 patients

• Underwent scorrection alumbar/thor

bar fusions wpedicle screinstrumentaDLS

• Aug 2003 to

200•

Material &Methods


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$o assess the ris% factors ofoccurrence of radiographic ASD&

this stud# e"aluated thecorrelation between'


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• Age ( )8 #*o* at the time ofsurger#

• +ith at least one of the

de,ned radiographic ASDcriteria

Inclusion

Criterias•

$ranslation greatemm& angular chgreater than )0

• Se"ere collapse ointer"ertebral dis

• erniated nucleupulposus and ste

• 1ertebral comprefracture

• edicle screw looand nonunion

RadiograASD


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$ranslation ( .mm

Angular change ()0

Se"ere cointer"ertebra


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erniated nucleuspulposus

stenosis

1ertebralcompression

fracture

ediclooseni

pedic


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Material &


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Material &Methods


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Resul


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Results $he

statisticall#signi,cantparametersthat wererelated to ASDoccurrencewere'

•Age

•

Discdegenerationon 45!6cephaladand caudaldisc7


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rom the multi"ariate anal#sis& there were no statisignicant di!erences between age& cephalad dcaudal disc as prognostic factors for sur"i"al in patie

ASD after surger#


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"aplan#Meier sur$i$orshipanalysis


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%actors that ere related to ASD occurrence erThe 2ean 3DI i2pro$ed fro2 /4,. preoperati$elyThe 2ean 8AS i2pro$ed fro2 7,5 preoperati$elyThere ere

Results


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The Risk Factors of ASD)* Old age

2* Female gender3* High BMI

.* Osteoporosis

* Rigid fusion such as PLIF and pedicular screw

* Fusion length

:* Sagittal malalignment

8* Pre existing adacent le!el degeneration;

Ch h


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Cheh


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Limitations

"he limitations of this study are#)* "he relati!ely short duration of follow

2* $ot ta%ing into consideration the scor!e type and sagittal im&alance'

3* "he num&er of patients was limited.* Retrospecti!e nature

* $ot a randomi(ed controlled design


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)onclusion• "he presence of disc deg

eneration and age greater than *+ years seem to &e the most significant ris%factors for ,S- after surg

ical correction of -LS andshould &e primarily considered &efore recommending spinal fusions

•

Further in!estigth respect to deion of the impothe indi!idual riss. particularly riss that are modife re/uired to rede!elopment of

,d maiorem -ei gloriam in/ue hominum salutem


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C bb’ A l


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Cobb’s Angle

• "he )o&& ,ngle helps a doctor to determine what type of treaessary'

• A Cobb Angle of 10 degrees – Regarded as a minimum angulation to define Scoliosis

• Between 15 and 20 degrees# – $ot re/uire any specific treatment. regular chec%0ups. physical therapy cont

sions. home exercise program

•

Between 20 and 0 degrees – Brace to %eep the spine from de!eloping more of a cur!e. scoliosis intensi!erogram is necessary 120+x3wee%4

• 0 ! 50 degrees or "ore# – Surgery to correct the cur!e. a fre/uent recurring procedure is the 5spinal fu

e !erte&rae together so that the spine cannot longer continue to cur!e'

S itt l S i l P t


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Sagittal Spinal Paramete

• 7eometrical measurements relating tatures were o&tained from following

• Thoracic k#$hosis %T&4 – "he angle measured from the upper end

the lower endplate of "9:

• '("bar lordosis %'') – "he angle measured from the upper end

he upper endplate of S9

• Pre!ious studies ha!e shown good reldiographic e!aluation of spinal cur!at

$odd et al*


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Sagittal *ertical A+is %S*Sagittal *ertical A+is %S*A)

• -efined &y using the ); plum& line that intersects the superior corner of the upper sacral endplate

• Measured and recorded in centimeter

•

"he sagittal !ertical axis assesses if an indi!idual is in neutral. positi!e or negati!e alignment &y comparing the head position relati!eto the sacral promontory

$odd et al*


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Sagittal ,el-ic ,ara"ete• 7eometrical measurements relating to t

ers were measured and recorded in deg

• ,el-ic incidence %,.) – , morphological parameter and is t

d from a perpendicular line to the mcral plate and extended to the centhead

• ,el-ic tilt %,T) – , positional parameter and is the a

m a perpendicular line starting at thmoral head and extended to the mral plate

• Sacral slo$e %SS) – , positional parameter and is the a

m the superior endplate of S9 and

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@eometrical relationship)I * )T 9 SS

$odd et al*


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S$inal C(r-at(res• Four types of spinal cur!atures correlatin

g to the angle of the sacral slope were d

efined according to Roussouly et al'

• "ype I# – Low sacral slope ?#:? thorac

olum&ar cur!e'

• "ype II# – Low sacral slope


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Intercristal Line

• ,n imaginary line draw

n in the hori(ontal plane at the upper marginof the iliac crests

• Locates the le!el of theL8 !erte&ra

• , useful landmar% in spinal tap procedure

http'//www*med*umich*edu/lrc/coursepages/m)/anatom#20)0/html/anatom#tables/topograbdomen*html

http'//www*mif>ua*com/frmteBt/$r20)2/)8/)8*?pg

$he lines referred to inpalpated intercristal linimaged intercristal linepalpated posterior sup

spine line 6c7*

Oswestry -isa&


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Oswestry -isa&ex

1O-I4

=swestr# Dis


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=swestr# Dis!ndeB6=D!7

Pfirrman )lassification of -isc -egeneratio


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Pfirrman )lassification of -isc -egeneratio

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j rad smt 3 astri dr. dy

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