Thoracolumbar spinal deformity: Part II. Developments from 1990 to today

Abstract

<jats:p>In the first part of this 2-part historical review, the authors outlined the early diagnostic and therapeutic strategies used in the management of spinal deformity. In this second part, they expand upon those early innovations and further detail the advances from 1990 to the modern era.</jats:p>

Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management

“…The initial degenerative process is a loss of absorbable function of the intervertebral discs that is characterized by reduced disc height, loss of water and proteoglycan content, and increased enzyme degradation. Subsequently, the pathological changes of vertebral and facet joints increase the load on the anterior part of the vertebral joints and cause arthritic changes to posterior elements, which induce bone remodeling and instability [1,7,8].…”

“…Diminution of the lumbar lordosis (LL) can be caused by several factors, including degenerative changes, scoliosis, and iatrogenic changes. LL loss tilts the body forward, resulting in an increase in the pelvic incidence (PI)/LL mismatch and the sagittal vertical axis (SVA) [7][8][9]. In order to maintain an erect posture, patients with sagittal imbalance use the following series of compensatory mechanisms: the head and neck tilt back to level the gaze, and the thoracic spine straightens to reduce kyphosis, with concurrent pelvic retroversion and knee flexion [7,10].…”

“…In terms of the coronal plane, Cobb's angle and axial rotation of vertebrae in the apical region can be measured for the assessment of scoliotic curves and type as regional parameters. The global parameters for the assessment of coronal alignment are the distance between the C7 plumb line (C7PL; a vertical line from the center of the C7 vertebral body) and the central sacral vertical line (CSVL; a vertical line from the center of the sacrum) [7,8].…”

Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions

“…To date, there are no definitive guidelines for treatment decision-making for patients with ASD [3]. In the past years, conservative treatment of ASD was preferred [29] because surgical intervention warranted prolonged recovery time, involved difficult perioperative management, and was associated with a high complication rate and costs [36][37][38]. Conservative treatment includes physical therapy, consuming oral or parenteral analgesics, and brace, but this approach does not improve disability or the quality of life of patients with ASD [39].…”

Editorial

“…Kanter and associates 1,2 have written a comprehensive synopsis of the historical developments in the evaluation and management of thoracolumbar spinal deformity. Part I covers the period from antiquity to the development of spinal instrumentation.…”