Abstract：
Adult degenerative scoliosis (ADS) is a coronal plane deformity often accompanied by sagittal plane malalignment. Surgical correction may involve the major and/or distally-located fractional curves (FCs). Correction of the FC has been increasingly recognized as key to ameliorating radicular pain localized to the FC levels. The present study aims to summarize the literature on the rationale for FC correction in ADS. Three databases were systematically reviewed to identify all primary studies reporting the rationale for correcting the FC in ADS. Articles were included if they were English full-text studies with primary data from ADS ( ≥ 18 years old) patients. Seventy-four articles were identified, of which 12 were included after full-text review. Findings suggest FC correction with long-segment fusion terminating at L5 increases the risk of distal junctional degeneration as compared to constructs instrumenting the sacrum. Additionally, circumferential fusion offers greater FC correction, lower reoperation risk, and shorter construct length. Minimally invasive surgery (MIS) techniques may offer effective radiographic correction and improve leg pain associated with foraminal stenosis on the FC concavity, though experiences are limited. Open surgery may be necessary to achieve adequate correction of severe, highly rigid deformities. Current data support major curve correction in ASD where the FC concavity and truncal shift are concordant, suggesting that the FC contributes to the patient\'s overall deformity. Circumferential fusion and the use of kickstand rods can improve correction and enhance the stability and durability of long constructs. Last, MIS techniques show promise for milder deformities but require further investigation.
摘要：
成人退行性脊柱侧凸（ADS）是一种冠状面畸形，常伴有矢状面错位。手术矫正可能涉及主要和/或远端位置的分数曲线（FC）。FC的校正越来越被认为是改善局限于FC水平的神经根性疼痛的关键。本研究旨在总结有关ADS中FC校正原理的文献。系统审查了三个数据库，以确定所有报告纠正ADS中FC的理由的主要研究。如果文章是来自ADS（≥18岁）患者的主要数据的英文全文研究，则将其纳入。确定了74篇文章，其中12个是在全文审查后纳入的。研究结果表明，与植入the骨的构造相比，在L5处终止长段融合的FC矫正会增加远端交界变性的风险。此外,周向融合提供更大的FC校正，降低再操作风险，和较短的构造长度。微创手术（MIS）技术可以提供有效的影像学矫正，并改善与FC凹陷椎间孔狭窄相关的腿部疼痛。虽然经验有限。开放手术可能是必要的，以实现充分的矫正严重，高度僵硬的畸形。当前数据支持ASD中的主要曲线校正，其中FC凹度和截断偏移一致，这表明FC有助于患者的整体畸形。周向融合和支架杆的使用可以改善矫正并增强长结构的稳定性和耐久性。最后,MIS技术显示出轻度畸形的希望，但需要进一步研究。
