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Mohammed ZJ, Worley J, Hiatt L, Rajaram Manoharan SR, Theiss S. Limited Intervention in Adult Scoliosis-A Systematic Review. J Clin Med 2024; 13:1030. [PMID: 38398343 PMCID: PMC10888624 DOI: 10.3390/jcm13041030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND/OBJECTIVES Adult scoliosis is traditionally treated with long-segment fusion, which provides strong radiographic correction and significant improvements in health-related quality of life but comes at a high morbidity cost. This systematic review seeks to examine the literature behind limited interventions in adult scoliosis patients and examine the best approaches to treatment. METHODS This is a MEDLINE- and PubMed-based literature search that ultimately included 49 articles with a total of 21,836 subjects. RESULTS Our search found that long-segment interventions had strong radiographic corrections but also resulted in high perioperative morbidity. Limited interventions were best suited to patients with compensated deformity, with decompression best for neurologic symptoms and fusion needed to treat neurological symptoms secondary to up-down stenosis and to provide stability across unstable segments. Decompression can consist of discectomy, laminotomy, and/or foraminotomy, all of which are shown to provide symptomatic relief of neurologic pain. Short-segment fusion has been shown to provide improvements in patient outcomes, albeit with higher rates of adjacent segment disease and concerns for correctional loss. Interbody devices can provide decompression without posterior element manipulation. Future directions include short-segment fusion in uncompensated deformity and dynamic stabilization constructs. CONCLUSIONS Limited interventions can provide symptomatic relief to adult spine deformity patients, with indications mostly in patients with balanced deformities and neurological pain.
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Affiliation(s)
| | | | | | | | - Steven Theiss
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (Z.J.M.); (J.W.); (L.H.); (S.R.R.M.)
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Echt M, De la Garza Ramos R, Geng E, Isleem U, Schwarz J, Girdler S, Platt A, Bakare AA, Fessler RG, Cho SK. Decompression Alone in the Setting of Adult Degenerative Lumbar Scoliosis and Stenosis: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:861-872. [PMID: 36127159 DOI: 10.1177/21925682221127955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis.OBJECTIVESSurgical decompression alone for patients with neurogenic leg pain in the setting of degenerative lumbar scoliosis (DLS) and stenosis is commonly performed, however, there is no summary of evidence for outcomes. METHODS A systematic search of English language medical literature databases was performed for studies describing outcomes of decompression alone in DLS, defined as Cobb angle >10˚, and 2-year minimum follow-up. Three outcomes were examined: 1) Cobb angle progression, 2) reoperation rate, and 3) ODI and overall satisfaction. Data were pooled and weighted averages were calculated to summarize available evidence. RESULTS Across 15 studies included in the final analysis, 586 patients were examined. Average preoperative and postoperative Cobb angles were 17.6˚ (Range: 12.7 - 25˚) and 18.0 (range 14.1 - 25˚), respectively. Average change in Cobb angle was an increase of 1.8˚. Overall rate of reoperation ranged from 3 to 33% with an average of 9.7%. Average ODI before surgery, after surgery, and change in scores were 56.4%, 27.2%, and an improvement of 29% respectively. Average from 8 studies that reported patient satisfaction was 71.2%. CONCLUSIONS Current literature on decompression alone in the setting of DLS is sparse and is not high quality, limited to patients with small magnitude of lumbar coronal Cobb angle, and heterogenous in the type of procedure performed. Based on available evidence, select patients with DLS who undergo decompression alone had minimal progression of Cobb angle, relatively low reoperation rate, and favorable patient-reported outcomes.
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Affiliation(s)
- Murray Echt
- Department of Neurological Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery, 2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Geng
- Department of Orthopedics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ula Isleem
- Department of Orthopedics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julia Schwarz
- Department of Orthopedics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Girdler
- Department of Orthopedics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew Platt
- Department of Neurological Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Adewale A Bakare
- Department of Neurological Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurological Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Samuel K Cho
- Department of Orthopedics, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zileli M, Akıntürk N, Yaman O. Complications of adult spinal deformity surgery: A literature review. J Craniovertebr Junction Spine 2022; 13:17-26. [PMID: 35386240 PMCID: PMC8978850 DOI: 10.4103/jcvjs.jcvjs_159_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: Adult spinal deformity incidence increases accordingly as the population ages. Even though surgery is the best option for the treatment, the complications due to surgery are pretty challenging. This study aims to review the complication rates of adult spinal deformity surgery. Methods: A literature review of the last decade was performed searching for the query “Adult spine deformity and complication.” This search yielded 2781 results, where 79 articles were chosen to investigate the complications of adult spinal deformity surgery. In addition, the demographic data, surgical interventions, and complications were extracted from the publications. Results: A total of 26,207 patients were analyzed, and 9138 complications were found (34.5%). Implant failure, including screw loosening, breakage, distal and proximal junctional kyphosis, were the most common complications. The neurologic complications were about 10.8%, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%. Discussion: Age, body mass index, smoking, osteoporosis, and other comorbidities are the significant risk factors affecting adult spinal deformity surgery. Presurgical planning and preoperative risk factor assessment must be done to avoid complications. Furthermore, intra and postoperative complications affect the patients’ quality of life and length of stay, and hospital readmissions. Revision surgery also increases the risk of complications. Conclusion: Good patient evaluation before surgery and careful planning of the surgery are essential in avoiding complications of adult spinal deformity.
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Li Z, Liu P, Zhang C, Xu G, Zhang Y, Chang Y, Liu M, Hou S. Incidence, Prevalence, and Analysis of Risk Factors for Surgical Site Infection After Lumbar Fusion Surgery: ≥2-Year Follow-Up Retrospective Study. World Neurosurg 2019; 131:e460-e467. [DOI: 10.1016/j.wneu.2019.07.207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 11/24/2022]
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Hori Y, Matsumura A, Namikawa T, Kato M, Takahashi S, Ohyama S, Ozaki T, Yabu A, Nakamura H. Does sagittal imbalance impact the surgical outcomes of short-segment fusion for lumbar spinal stenosis associated with degenerative lumbar scoliosis? J Orthop Sci 2019; 24:224-229. [PMID: 30391135 DOI: 10.1016/j.jos.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The degenerative lumbar scoliosis (DLS) patients who mainly complained about neurogenic claudication due to spinal canal stenosis are well-indicated for short segment fusion (SSF) at the affecting levels. However, it is unclear whether we should consider global sagittal balance or not. The aim of this study was to evaluate the impact of sagittal balance on the surgical outcomes of degenerative lumbar scoliosis (DLS) patients who underwent SSF. METHODS We retrospectively reviewed 70 DLS patients who underwent SSF (less than 3 levels) and could be followed for at least 2 years. The PI-LL, PT, SVA, and T1 pelvic angle (TPA) were measured using standing whole spine X-rays preoperatively (PreO) and at final follow-up (FFU). Surgical outcomes were assessed with the improvement in Japanese Orthopaedic Association score (JOAs) for low back pain (LBP), and the level of LBP was measured using the visual analogue scale (LBP-VAS). We analysed the relationships between the radiographic parameters and the surgical outcomes. RESULTS We divided the patients into the three groups (poor/fair/good) based on the JOAs. The analysis with the Jonckheere-Terpstra trend test indicated that the following radiographic parameters had a significant trend with surgical outcomes in each group: (poor/fair/good; p value); PreO PI-LL (26/20/17°; P = 0.04), SVA (46/75/35.5 mm; P = 0.02), TPA (28/27/23°; p = 0.04), FFU PI-LL (33/25/8.5°; P = 0.004), SVA (93/90.5/32.5 mm; P = 0.001), and TPA (33/29/25°; P = 0.007). Additionally, LBP-VAS had a significant correlation between the three groups at final follow-up (P = 0.004). There were significant correlations between improvement in JOAs and PI-LL, SVA, and TPA both PreO and at FFU (P < 0.05). CONCLUSIONS Sagittal spinal imbalance and spinopelvic malalignment significantly impact the surgical outcomes of SSF for DLS. Preoperative evaluation of spinopelvic alignment and sagittal balance is of critical importance when SSF are performed for DLS patients.
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Affiliation(s)
- Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shoichiro Ohyama
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Tomonori Ozaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Falahatian M, Masaeli MF. Effect of posterior fusion surgery on idiopathic scoliosis in Iran. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:24-27. [PMID: 31000976 PMCID: PMC6469314 DOI: 10.4103/jcvjs.jcvjs_121_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Scoliosis is a sideways curve in the spine. Considering that postoperative complications are common among these patients, the aim of this study is to examine the postoperative complications of posterior fusion surgery with instrumentation among adult patients with idiopathic scoliosis. Methods: In this cross-sectional descriptive study, the postoperative complications were examined among 93 patients with idiopathic scoliosis who underwent posterior fusion surgery with instrumentation. The convenience sampling was used by referring to the files of these patients. The patients were classified into four groups according to the type of scoliosis deformity (long C-shaped, thoracic, thoracolumbar/lumbar, and double-curve) and the complications were compared together. Results: Postoperative respiratory problems were significantly different between the four groups of scoliosis deformity (P = 0.009); 35 cases of postoperative complications occurred and 20 of them were related to postoperative pulmonary complications. Conclusion: Postoperative complications are common among patients with idiopathic scoliosis who underwent posterior fusion surgery with instrumentation; in addition, pulmonary complications are the most common postoperative complication among these patients.
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Affiliation(s)
- Masih Falahatian
- Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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What are the risk factors for surgical site infection after spinal fusion? A meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2469-2480. [DOI: 10.1007/s00586-018-5733-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/19/2018] [Accepted: 08/13/2018] [Indexed: 01/05/2023]
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Kurra S, Lavelle WF, Silverstein MP, Savage JW, Orr RD. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. Spine J 2018; 18:1014-1021. [PMID: 29174460 DOI: 10.1016/j.spinee.2017.10.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with spinal deformity may present with complaints related to either the deformity itself or the manifestations of the coexisting spinal stenosis. There are reports of successful management of lumbar pathology in the absence of global sagittal or coronal imbalance, with limited decompression and fusion, addressing only the symptomatic segment. PURPOSE Our study examined the long-term outcomes of transforaminal lumbar interbody fusion (TLIF), a less extensive procedure, based on the experience of the senior author over the past 10 years. STUDY DESIGN/SETTING This was a retrospective study of symptomatic lumbar spinal stenosis and spinal deformity managed by one surgeon at The Cleveland Clinic since 2003. PATIENT SAMPLE Forty-one patients were included in the study. OUTCOME MEASURES The present study measures the long-term clinical functional outcomes of these patients through EQ-5D (EuroQol five dimensions questionnaire), PHQ-9 (Patient Health Questionnaire), and PDQ (Pain Disability Questionnaire) forms, along with documented radiographic parameters and Charlson Comorbidity Index (CCI). METHODS There were no funding or potential conflicts of interest associated biases in the present study. Patients with symptomatic lumbar spinal stenosis with neutral global alignment in the sagittal and coronal planes and symptomatic stenosis at the deformity level were treated by limited fusion and TLIF, and had a follow-up period of at least 5 years. Excluded were patients under 18 years of age, had more than three levels of fusion, and had an active spinal malignancy or recent spinal trauma. The grouping variables were curve magnitude, revision surgeries, and TLIF levels. Clinical outcomes were compared in all the grouping variables. Analysis of variance (ANOVA) and chi-square tests were utilized; p<.05 was considered statistically significant. RESULTS The average age and follow-up period were 66±10 and 7.5 years, respectively. There was no statistical difference between patients with curves measuring between 10° and 20° and greater than 20° for EQ-5D, PHQ-9, and PDQ. Patients had worse PDQ data with larger curves compared with smaller curves at both 5 years and final follow-up. Although there was no statistical significance between preoperative coronal curve magnitude and revision surgeries, patients with curves greater than 20° had higher rates of revision surgeries (75%; p=.343) in the global lumbar curve deformity group. Although there was no statistical significance for patients who underwent revision surgeries,those patients had low PHQ-9 values at the final follow-up (p=.09). The revision surgery rate was 48% in one-level TLIF and 18% in two-level TLIF. Moderate pain disability scores were noticed for one-level TLIF patients (mean=75) compared with two-level TLIF patients (mean=27) at the final follow-up, and approached statistical significance in this comparison (p=.06). CONCLUSION Although this topic has a limited audience to spinal deformity surgeons, the prevalence of patients who present with adult spinal deformities has been increasing. Short segment fusion, in the setting of modest spinal deformity, is a reasonable and safe option. Further study on the concept of short segment fusions in the growing patient population is required as more comprehensive fusions do have noted complication rates, and a compromise must be reached between the extent of surgery that is enough to provide pain relief and disability and the degree of surgery that is too much to be tolerated in terms of complication rates.
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Affiliation(s)
- Swamy Kurra
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA
| | - William F Lavelle
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA.
| | - Michael P Silverstein
- Department of Orthopaedic Surgery, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Jason W Savage
- Center for Spine Health, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - R Douglas Orr
- Department of Orthopaedic Surgery, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
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Ailon T, Smith JS, Shaffrey CI, Soroceanu A, Lafage V, Schwab F, Burton D, Hart R, Kim HJ, Gum J, Hostin R, Kelly MP, Glassman S, Scheer JK, Bess S, Ames CP. Patients with Adult Spinal Deformity with Previous Fusions Have an Equal Chance of Reaching Substantial Clinical Benefit Thresholds in Health-Related Quality of Life Measures but Do Not Reach the Same Absolute Level of Improvement. World Neurosurg 2018; 116:e354-e361. [PMID: 29751181 DOI: 10.1016/j.wneu.2018.04.204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction. OBJECTIVE To investigate the impact of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery. METHODS We conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for patients with ASD undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes included absolute and change scores in ODI, PCS, and back and leg pain. RESULTS In total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures. CONCLUSIONS Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.
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Affiliation(s)
- Tamir Ailon
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia.
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Alex Soroceanu
- Department of Orthopedics, University of Calgary, Calgary, Alberta
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Frank Schwab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Douglas Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert Hart
- Department of Orthopedics, Swedish Medical Center, Seattle, Washington
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jeffrey Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - Richard Hostin
- Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | | | - Justin K Scheer
- Department of Neurosurgery, University of Illinois, Chicago, Illinois
| | - Shay Bess
- Presbytarian/St. Luke's Medical Center, Denver, Colorado
| | - Christopher P Ames
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California
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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2272-2284. [DOI: 10.1007/s00586-018-5535-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
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Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block Combined with Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery in the Treatment of Adult Degenerative Scoliosis: A Clinical Observation Including 96 Patients. World Neurosurg 2017; 108:791-797. [PMID: 28986228 DOI: 10.1016/j.wneu.2017.09.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Application of nerve root block is mainly for diagnosis with less application in intraoperative treatment. The aim of this study was to observe clinical and imaging outcomes of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in to treat adult degenerative lumbar scoliosis. METHODS From January 2012 to November 2014, 108 patients with adult degenerative lumbar scoliosis were treated with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery combined with intraoperative gelatin sponge impregnated with a mixture of 3 drugs. Visual analog scale and Oswestry Disability Index scores were used to evaluate postoperative improvement of back and leg pain, and clinical effects were assessed according to the 36-Item Short-Form Health Survey. Imaging was obtained preoperatively, 1 week and 3 months postoperatively, and at the last follow-up. Fusion status, complications, and other outcomes were assessed. RESULTS Follow-up was complete for 96 patients. Visual analog scale scores of leg and back pain on postoperative days 1-7 were decreased compared with preoperatively. At 1 week postoperatively, 3 months postoperatively, and last follow-up, visual analog scale score, Oswestry Disability Index score, coronal Cobb angle, and coronal and sagittal deviated distance decreased significantly (P = 0.000) and lumbar lordosis angle increased (P = 0.000) compared with preoperatively. Improvement rate of Oswestry Disability Index was 81.8% ± 7.4. Fusion rate between vertebral bodies was 92.7%. CONCLUSIONS Application of gelatin sponge impregnated with 3 drugs combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion for treatment of adult degenerative lumbar scoliosis is safe and feasible with advantages of good short-term analgesia effect, minimal invasiveness, short length of stay, and good long-term clinical outcomes.
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Radcliff K, Jalai C, Vira S, Yang S, Boniello AJ, Bianco K, Oh C, Gerling M, Poorman G, Horn SR, Buza JA, Isaacs RE, Vaccaro AR, Passias PG. Two-Year Results of the Prospective Spine Treatment Outcomes Study: Analysis of Postoperative Clinical Outcomes Between Patients with and without a History of Previous Cervical Spine Surgery. World Neurosurg 2017; 109:e144-e149. [PMID: 28962949 DOI: 10.1016/j.wneu.2017.09.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE History of previous cervical spine surgery is a frequently cited cause of worse outcomes after cervical spine surgery. The purpose of this study was to determine any differences in clinical outcomes after cervical spine surgery between patients with and without a history of previous cervical spine surgery. METHODS A multicenter prospective database was reviewed retrospectively to identify patients with cervical spondylosis undergoing surgery with a minimum 2-year follow-up. Patients were divided into 2 groups: patients with (W) or without (WO) previous history of cervical spine surgery. Statistical analyses of Health-Related Quality of Life scores were analyzed with statistical software to fit linear mixed models for continuous longitudinal outcome. RESULTS A total of 1286 patients (377 W, 909 WO) met criteria for inclusion. Overall, patients in both groups experienced an improvement in their Health-Related Quality of Life scores. However, patients in the W group had significantly decreased improvement compared with WO patients in the Neck Disability Index score and the following SF-36 domain scores: Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Health Transition, and Physical Component Summary at all time points (P < 0.05). There was no statistically significant difference between the W and WO groups in operative time, estimated blood loss, length of stay, or complications (P > 0.05). CONCLUSIONS Patients with a history of previous cervical spine surgery had inferior improvement in quality of life outcome scores. Patients with a history of previous surgical intervention who elect to undergo subsequent surgeries should be appropriately counseled about expected results.
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Affiliation(s)
- Kris Radcliff
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Cyrus Jalai
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Sun Yang
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Anthony J Boniello
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Kristina Bianco
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Cheongeun Oh
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Michael Gerling
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Gregory Poorman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - John A Buza
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA
| | - Robert E Isaacs
- Division of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, USA.
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Acaroglu E, Guler UO, Cetinyurek-Yavuz A, Yuksel S, Yavuz Y, Ayhan S, Domingo-Sabat M, Pellise F, Alanay A, Perez Grueso FS, Kleinstück F, Obeid I. Decision analysis to identify the ideal treatment for adult spinal deformity: What is the impact of complications on treatment outcomes? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:181-190. [PMID: 28454778 PMCID: PMC6197456 DOI: 10.1016/j.aott.2017.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/19/2017] [Accepted: 03/05/2017] [Indexed: 11/08/2022]
Abstract
Objective The aim of this study was to analyze the impact of treatment complications on outcomes in adult spinal deformity (ASD) using a decision analysis (DA) model. Methods The study included 535 ASD patients (371 with non-surgical (NS) and 164 with surgical (S) treatment) from an international multicentre database of ASD patients. DA was structured in two main steps; 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference -utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as life threatening (LT) and nonlife threatening (NLT) and their probabilities were calculated from the database as well as a thorough literature review. Outcomes were analyzed as improvement, no change and deterioration. Death/complete paralysis was considered as a separate category. Results All 535 patients were analyzed in regard to complications. Overall, there were 78 NLT and 12 LT complications and 3 death/paralysis. Surgical treatment offered significantly higher chances of clinical improvement but also was significantly more prone to complications (31.7% vs. 11.1%, p < 0.001). Conclusion Surgical treatment of ASD is more likely to cause complications compared to NS treatment. On the other hand, surgery has been shown to provide a higher likelihood of improvement in HRQoL scores. So, the decision on the type of treatment in ASD needs to take both chances of improvement and burden associated with S or NS treatments and better be arrived by the active participation of patients and physicians equipped with the present information. Level of evidence Level II, Decision analysis.
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Lumbar Radiculopathy in the Setting of Degenerative Scoliosis: MIS Decompression and Limited Correction are Better Options. Neurosurg Clin N Am 2017; 28:335-339. [PMID: 28600008 DOI: 10.1016/j.nec.2017.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Surgery for adult spinal deformity (ASD) has emerged as an efficient treatment alternative, but it is fraught with potential perioperative morbidity, incompletely mitigated by emerging minimally invasive surgical techniques. In mild-to-moderate ASD balanced in the sagittal plane, there are situations in which the counterintuitive simple decompression through a foraminotomy or laminectomy, or even a short-segment fusion may be an attractive treatment. This article presents a case example and the authors' treatment rationale and reviews the limited available literature supporting it.
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Teles AR, Mattei TA, Righesso O, Falavigna A. Effectiveness of Operative and Nonoperative Care for Adult Spinal Deformity: Systematic Review of the Literature. Global Spine J 2017; 7:170-178. [PMID: 28507887 PMCID: PMC5415160 DOI: 10.1177/2192568217699182] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE There is a need for synthesizing data on effectiveness of treatments for patients with adult spinal deformity (ASD) due to its increasing prevalence and health care costs for these patients. The objective of this review was to estimate the effectiveness of surgery versus nonoperative care in patients with ASD. METHODS A systematic review of articles in published in English using PubMed between 2005 and 2015. Surgical and nonsurgical series that reported baseline and follow-up health-related quality of life measures of patients with ASD with a minimum 2 years of follow-up were selected. Independent extraction of articles by 2 authors using predefined data fields, including risk of bias assessment. RESULTS Surgery significantly reduces disability, pain, and improves patients' quality of life. The average postoperative improvement in Oswestry Disability Index was -19.1 (±9.0), Numerical Rating Scale back pain -4.14 (±1.38), Numerical Rating Scale leg pain -3.36 (±1.33), Short-Form Health Survey 36-SF36-Physical Component score 11.2 (±5.07), and Short-Form Health Survey 36-Mental Component score 9.93 (±4.96). The complication rate ranged from 9.52% to 81.52% (mean = 39.62%), and the need for revision surgery ranged from 1.72% to 40.0% (mean = 15.71%). The best existing evidence about nonoperative care of ASD is provided from observational studies with very high risk of bias. Quantitative analyses of nonsurgical cohorts did not demonstrate significant changes in quality of life of patients after 2 years of observation. CONCLUSIONS This data may assist clinicians to counsel patients, as well as to inform health care providers and policymakers about what to expect from the treatment for ASD.
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Affiliation(s)
- Alisson R. Teles
- Department of Clinical Neurosciences – Neurosurgery, University of Calgary, Calgary, Alberta, Canada,Alisson R. Teles, Foothills Medical Centre, 12Fl, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Tobias A. Mattei
- Neurosurgery & Spine Specialists, Eastern Maine Medical Center, Bangor, Maine, USA
| | - Orlando Righesso
- Department of Orthopedics, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Asdrubal Falavigna
- Department of Neurosurgery, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
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Smith JS, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, O'Brien M, Boachie-Adjei O, Akbarnia BA, Mundis GM, Errico T, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Sciubba D, Ailon T, Fu KMG, Kelly MP, Zebala L, Line B, Klineberg E, Gupta M, Deviren V, Hart R, Burton D, Bess S, Ames CP. Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity. Neurosurgery 2016; 78:851-61. [DOI: 10.1227/neu.0000000000001116] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed.
OBJECTIVE:
To compare outcomes of operative and nonoperative treatment for ASD.
METHODS:
This is a multicenter, prospective analysis of consecutive ASD patients opting for operative or nonoperative care. Inclusion criteria were age >18 years and ASD. Operative and nonoperative patients were propensity matched with the baseline Oswestry Disability Index, Scoliosis Research Society-22r, thoracolumbar/lumbar Cobb angle, pelvic incidence–to–lumbar lordosis mismatch (PI-LL), and leg pain score. Analyses were confined to patients with a minimum of 2 years of follow-up.
RESULTS:
Two hundred eighty-six operative and 403 nonoperative patients met the criteria, with mean ages of 53 and 55 years, 2-year follow-up rates of 86% and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At baseline, operative patients had significantly worse health-related quality of life (HRQOL) based on all measures assessed (P < .001) and had worse deformity based on pelvic tilt, pelvic incidence–to–lumbar lordosis mismatch, and sagittal vertical axis (P ⩽ .002). At the minimum 2-year follow-up, all HRQOL measures assessed significantly improved for operative patients (P < .001), but none improved significantly for nonoperative patients except for modest improvements in the Scoliosis Research Society-22r pain (P = .04) and satisfaction (P < .001) domains. On the basis of matched operative-nonoperative cohorts (97 in each group), operative patients had significantly better HRQOL at follow-up for all measures assessed (P < .001), except Short Form-36 mental component score (P = .06). At the minimum 2-year follow-up, 71.5% of operative patients had ≥1 complications.
CONCLUSION:
Operative treatment for ASD can provide significant improvement of HRQOL at a minimum 2-year follow-up. In contrast, nonoperative treatment on average maintains presenting levels of pain and disability.
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Affiliation(s)
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Virginie Lafage
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Christopher I. Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Frank Schwab
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Renaud Lafage
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Richard Hostin
- Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Michael O'Brien
- Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | | | | | | | - Thomas Errico
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - D. Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Justin K. Scheer
- Department of Neurosurgery, Northwestern University Medical Center, Chicago, Illinois
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tamir Ailon
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Kai-Ming G. Fu
- Department of Neurosurgery, Weill Cornell Medical College, New York City, New York
| | - Michael P. Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | - Lukas Zebala
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | - Breton Line
- Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Eric Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Munish Gupta
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California
| | - Robert Hart
- Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, Oregon
| | - Doug Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Shay Bess
- Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Christopher P. Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine whether an association exists between high body mass index (BMI>25 kg/m) and surgical outcomes in revision adult scoliosis patients. SUMMARY OF BACKGROUND DATA Obesity is thought to be associated with increased surgical complications and inferior clinical outcomes in adults. There are no studies analyzing the effect of obesity on surgical outcomes in revision patients for adult scoliosis. METHODS Forty-five consecutive revision adult scoliosis patients (35 women and 10 men; mean age, 62.7±9.3 y) with a minimum follow-up of 2 years were included in this study. Patients were divided into 2 groups according to BMI: overweight (BMI≥25 kg/m, n=27) and nonoverweight (<25 kg/m, n=18). Radiographic measures, Oswestry Disability Index (ODI), Visual Analog Scale (VAS), as well as comorbidities and complications were reviewed and compared at preoperative and 2-year follow-up. RESULTS No significant differences in surgical methods, complication rates, or radiographic measures were found between the 2 groups except for the greater preoperative and final follow-up thoracic kyphosis in the overweight group (P<0.05). A higher comorbidity rate of circulatory disorders (33.3% vs. 0%, P=0.018) and diabetes (25.9% vs. 0%, P=0.053) was observed in the overweight group, as well as a higher preoperative VAS score (7.1±1.7 vs. 5.2±2.9, P=0.031). At 2-year follow-up, VAS and ODI improvements for both groups showed significant and similar improvement from preoperative (P<0.01). CONCLUSIONS Overweight revision adult scoliosis patients had higher thoracic kyphosis and more significant preoperative pain compared with normal-weight individuals. Overweight patients also had significantly higher rates of medical comorbidities. However, BMI did not affect the functional outcome of surgical correction or perioperative complication rates. Overweight patients benefited from surgery just as much as nonoverweight patients at 2-year follow-up.
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Putzier M, Pumberger M, Halm H, Zahn RK, Franke J. [Surgical treatment of de-novo scoliosis]. DER ORTHOPADE 2016; 45:744-54. [PMID: 27514825 DOI: 10.1007/s00132-016-3313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient's symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient's symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy. TREATMENT Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success. CONCLUSION All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.
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Affiliation(s)
- M Putzier
- Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - M Pumberger
- Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - H Halm
- Schön Klinik Neustadt, Fachzentrum Wirbelsäulenchirurgie & Skoliosezentrum, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland
| | - R K Zahn
- Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - J Franke
- Klinik für Wirbelsäulenchirurgie, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Deutschland
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Abstract
Adult spinal deformity (ASD) is a very diverse condition that affects the quality of life of the involved individuals deeply. There is an ongoing discussion as to whether treatment should be surgical (which is potentially dangerous) or non-surgical.In addition to a systematic review of literature on the surgical treatment of ASD with special emphasis on complications, a decision-analysis was performed using the patient information within a European multi-centric database of ASD.The probabilities of improvement and complications as well as associated disease burden (utility) were calculated at the baseline and at first-year follow-up.Decision-analysis suggests that the chances of clinical improvement are significantly higher with surgical treatment. Though surgical treatment is significantly more prone to complications, the likelihood of improvement remains higher than that offered by non-surgical treatment.Surgical treatment of ASD appears to be associated with a higher likelihood of clinical improvement. Future work needs to focus on refining the criteria for appropriate patient selection and decreasing the incidence of complications. Cite this article: Acaroglu E, European Spine Study Group. Decision-making in the treatment of adult spinal deformity. EFORT Open Rev 2016;1:167-176. DOI: 10.1302/2058-5241.1.000013.
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Affiliation(s)
- Emre Acaroglu
- Ankara ARTES Spine and Spinal Cord Center, Ankara, Turkey
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20
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Jiang CJ, Yang YJ, Zhou JP, Yao SQ, Yang K, Wu R, Tan YC. Applications of the scoliosis width-to-length ratio for guiding selection of the surgical approaches of degenerative lumbar scoliosis. BMC Musculoskelet Disord 2016; 17:48. [PMID: 26832925 PMCID: PMC4736623 DOI: 10.1186/s12891-016-0904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/26/2016] [Indexed: 11/24/2022] Open
Abstract
Background There does not exist a comprehensive parameter for guiding selection of short or long segment fusion for degenerative lumbar scoliosis (DLS). The aim of our study was to investigate the applications of the width-to-length ratio in guiding selection of the surgical approaches for DLS. Methods A retrospective analysis was performed of 142 patients with DLS who underwent operative treatments from July 2000 to January 2012. The scoliosis width-to-length ratios were measured and used as a grouping criterion of surgical approaches. The Oswestry disability index (ODI) was used to evaluate the clinical outcomes. Radiological parameters such as Cobb’s angle of main curve, Cobb’s angle of compensatory curve were all measured. Results For patients with width-to-length ratio less than 0.36, the short segment group had better short-term postoperative outcomes with regard to Cobb’s angle of main curve, Cobb’s angle of compensatory curve and ODI scores compared to the long segment group. However, for patients with width-to-length ratio greater than 0.36, the postoperative outcomes for the long segment group were better compared to the short segment group. Conclusions The scoliosis width-to-length ratio can provide a comprehensive preoperative assessment of the severity of the DLS and guiding selection of a therapeutic treatment regimen. Further studies with a larger number of samples and longer term of follow up are warranted.
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Affiliation(s)
- Chuan-jie Jiang
- Department of Orthopaedics, Shandong Wendeng Orthopedic and Traumatic Hospital, No.1 Fengshan Road, Wendeng, Shandong, 26400, China
| | - Yong-jun Yang
- Department of Orthopaedics, Shandong Wendeng Orthopedic and Traumatic Hospital, No.1 Fengshan Road, Wendeng, Shandong, 26400, China.
| | - Ji-ping Zhou
- Department of Orthopaedics, Shandong Wendeng Orthopedic and Traumatic Hospital, No.1 Fengshan Road, Wendeng, Shandong, 26400, China
| | - Shu-qiang Yao
- Department of Orthopaedics, Shandong Wendeng Orthopedic and Traumatic Hospital, No.1 Fengshan Road, Wendeng, Shandong, 26400, China
| | - Kai Yang
- Department of Orthopaedics, Shandong Wendeng Orthopedic and Traumatic Hospital, No.1 Fengshan Road, Wendeng, Shandong, 26400, China
| | - Rui Wu
- Department of Orthopaedics, Shandong Wendeng Orthopedic and Traumatic Hospital, No.1 Fengshan Road, Wendeng, Shandong, 26400, China
| | - Yuan-chao Tan
- Department of Orthopaedics, Shandong Wendeng Orthopedic and Traumatic Hospital, No.1 Fengshan Road, Wendeng, Shandong, 26400, China
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21
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Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S, Kebaish K, Schwab F, Shaffrey CI, Ames CP. A Comprehensive Review of Complication Rates After Surgery for Adult Deformity: A Reference for Informed Consent. Spine Deform 2015; 3:575-594. [PMID: 27927561 DOI: 10.1016/j.jspd.2015.04.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE An up-to-date review of recent literatures and a comprehensive reference for informed consent specific to ASD complications is lacking. The goal of the present study was to determine current complication rates after ASD surgery, in order to provide a reference for informed consent as well as to determine differences between three-column and non-three-column osteotomy procedures to aid in shared decision making. METHODS A review of the literature was conducted using the PubMed database. Randomized controlled trials, nonrandomized trials, cohort studies, case-control studies, and case series providing postoperative complications published in 2000 or later were included. Complication rates were recorded and calculated for perioperative (both major and minor) and long-term complication rates. Postoperative outcomes were all stratified by surgical procedure (ie, three-column osteotomy and non-three-column osteotomy). RESULTS Ninety-three articles were ultimately eligible for analysis. The data of 11,692 patients were extracted; there were 3,646 complications, mean age at surgery was 53.3 years (range: 25-77 years), mean follow-up was 3.49 years (range: 6 weeks-9.7 years), estimated blood loss was 2,161 mL (range: 717-7,034 mL), and the overall mean complication rate was 55%. Specifically, major perioperative complications occurred at a mean rate of 18.5%, minor perioperative complications occurred at a mean rate of 15.7%, and long-term complications occurred at a mean rate of 20.5%. Furthermore, three-column osteotomy resulted in a higher overall complication rate and estimated blood loss than non-three-column osteotomy. CONCLUSIONS A review of recent literatures providing complication rates for ASD surgery was performed, providing the most up-to-date incidence of early and late complications. Providers may use such data in helping to counsel patients of the literature-supported complication rates of such procedures despite the planned benefits, thus obtaining a more thorough informed consent.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA.
| | - Alp Yurter
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, 4921 Parkview Place, A 12, St. Louis, MO 63110, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, 3182 SW Sam Jackson Park Rd; Ortho Dept MC: OP31, Portland, OR 97239, USA
| | - Shay Bess
- Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA
| | - Khaled Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University, 610 North Caroline Street, Suite 5243, Baltimore, MD 21287, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M779 - Department of Neurosurgery, San Francisco, CA 94143, USA
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van Hooff ML, Jacobs WCH, Willems PC, Wouters MWJM, de Kleuver M, Peul WC, Ostelo RWJG, Fritzell P. Evidence and practice in spine registries. Acta Orthop 2015; 86:534-44. [PMID: 25909475 PMCID: PMC4564774 DOI: 10.3109/17453674.2015.1043174] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE We performed a systematic review and a survey in order to (1) evaluate the evidence for the impact of spine registries on the quality of spine care, and with that, on patient-related outcomes, and (2) evaluate the methodology used to organize, analyze, and report the "quality of spine care" from spine registries. METHODS To study the impact, the literature on all spinal disorders was searched. To study methodology, the search was restricted to degenerative spinal disorders. The risk of bias in the studies included was assessed with the Newcastle-Ottawa scale. Additionally, a survey among registry representatives was performed to acquire information about the methodology and practice of existing registries. RESULTS 4,273 unique references up to May 2014 were identified, and 1,210 were eligible for screening and assessment. No studies on impact were identified, but 34 studies were identified to study the methodology. Half of these studies (17 of the 34) were judged to have a high risk of bias. The survey identified 25 spine registries, representing 14 countries. The organization of these registries, methods used, analytical approaches, and dissemination of results are presented. INTERPRETATION We found a lack of evidence that registries have had an impact on the quality of spine care, regardless of whether intervention was non-surgical and/or surgical. To improve the quality of evidence published with registry data, we present several recommendations. Application of these recommendations could lead to registries showing trends, monitoring the quality of spine care given, and ultimately improving the value of the care given to patients with degenerative spinal disorders.
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Affiliation(s)
- Miranda L van Hooff
- Sint Maartenskliniek, Nijmegen,Dutch Institute for Clinical Auditing (DICA), Leiden
| | | | | | | | | | | | - Raymond W J G Ostelo
- Department of Health Sciences and Department of Epidemiology and Biostatistics, VU University, Amsterdam, the Netherlands
| | - Peter Fritzell
- Ryhov Hospital Neuro-Orthopedic Department, Futurum Academy, Jönköping, Sweden
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Theis J, Gerdhem P, Abbott A. Quality of life outcomes in surgically treated adult scoliosis patients: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1343-55. [DOI: 10.1007/s00586-014-3593-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/20/2014] [Accepted: 09/21/2014] [Indexed: 01/22/2023]
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Anand N, Baron EM, Khandehroo B. Is circumferential minimally invasive surgery effective in the treatment of moderate adult idiopathic scoliosis? Clin Orthop Relat Res 2014; 472:1762-8. [PMID: 24658900 PMCID: PMC4016423 DOI: 10.1007/s11999-014-3565-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes for minimally invasive scoliosis correction surgery have been reported for mild adult scoliosis. Larger curves historically have been treated with open surgical procedures including facet resections or posterior column osteotomies, which have been associated with high-volume blood loss. Further, minimally invasive techniques have been largely reported in the setting of degenerative scoliosis. QUESTIONS/PURPOSES We describe the effects of circumferential minimally invasive surgery (cMIS) for moderate to severe scoliosis in terms of (1) operative time and blood loss, (2) overall health and disease-specific patient-reported outcomes, (3) deformity correction and fusion rate, and (4) frequency and types of complications. METHODS Between January 2007 and January 2012, we performed 50 cMIS adult idiopathic scoliosis corrections in patients with a Cobb angle of greater than 30° but less than 75° who did not have prior thoracolumbar fusion surgery; this series represented all patients we treated surgically during that time meeting those indications. Our general indications for this approach during that period were increasing back pain unresponsive to nonoperative therapy with cosmetic and radiographic worsening of curves. Surgical times and estimated blood loss were recorded. Functional clinical outcomes including VAS pain score, Oswestry Disability Index (ODI), and SF-36 were recorded preoperatively and postoperatively. Patients' deformity correction was assessed on pre- and postoperative 36-inch (91-cm) standing films and fusion was assessed on CT scan. Minimum followup was 24 months (mean, 48 months; range, 24-77 months). RESULTS Mean blood loss was 613 mL for one-stage surgery and 763 mL for two-stage surgery. Mean operative time was 351 minutes for one-stage surgery and 482 minutes for two-stage surgery. At last followup, mean VAS and ODI scores decreased from 5.7 and 44 preoperatively to 2.9 and 22 (p < 0.001 and 0.03, respectively) and mean SF-36 score increased from 48 preoperatively to 74 (p = 0.026). Mean Cobb angle and sagittal vertical axis decreased from 42° and 51 mm preoperatively to 16° and 27 mm postoperatively (both p < 0.001). An 88% fusion rate was confirmed on CT scan. Perioperative complications occurred in 11 of the 50 patients (22%), with delayed complications needing further surgery in 10 more patients at last followup. CONCLUSIONS cMIS provides for good clinical and radiographic outcomes for moderate (30°-75°) adult idiopathic scoliosis. Patients undergoing cMIS should be carefully selected to avoid fixed, rigid deformities and a preoperative sagittal vertical axis of greater than 10 cm; surgeons should consider alternative techniques in those patients. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Neel Anand
- Spine Center, Cedars-Sinai Medical Center, 444 S San Vicente Blvd, Suite 800, Los Angeles, CA 90048 USA
| | - Eli M. Baron
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA USA
| | - Babak Khandehroo
- Spine Center, Cedars-Sinai Medical Center, 444 S San Vicente Blvd, Suite 800, Los Angeles, CA 90048 USA
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Smith JS, Shaffrey CI, Fu KMG, Scheer JK, Bess S, Lafage V, Schwab F, Ames CP. Clinical and radiographic evaluation of the adult spinal deformity patient. Neurosurg Clin N Am 2013; 24:143-56. [PMID: 23561553 DOI: 10.1016/j.nec.2012.12.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Among the prevalent forms of adult spinal deformity are residual adolescent idiopathic and degenerative scoliosis, kyphotic deformity, and spondylolisthesis. Clinical evaluation should include a thorough history, discussion of concerns, and a review of comorbidities. Physical examination should include assessment of the deformity and a neurologic examination. Imaging studies should include full-length standing posteroanterior and lateral spine radiographs, and measurement of pelvic parameters. Advanced imaging studies are frequently indicated to assess for neurologic compromise and for surgical planning. This article focuses on clinical and radiographic evaluation of spinal deformity in the adult population, particularly scoliosis and kyphotic deformities.
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Affiliation(s)
- Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA.
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