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Indications for Adult Spinal Deformity Surgery

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Minimally Invasive Spinal Deformity Surgery

Abstract

Shifting demographics and aging populations have resulted in a rise in adult spinal deformity (ASD). ASD refers to abnormal spinal curvature in the coronal, axial, or sagittal planes in patients over the age of 18. A recent publication found that the prevalence of ASD ranges from 2 % to 32 % in the general population but exceeds 60 % for adults greater than 60 years of age [1]. With a simultaneous shift in expectations for quality of life (QOL), the demand for treatment of ASD has dramatically increased. ASD is most commonly caused by untreated adolescent idiopathic scoliosis, adult-onset degenerative scoliosis, or primary sagittal imbalance [2]. While some cases of ASD can be managed with conservative care and nonoperative procedures, many ASD cases require surgical intervention. Unlike adolescent idiopathic scoliosis (AIS), there is no widely accepted classification system that provides guidelines for the surgical treatment of ASD [3]. Therefore, the decision to undergo surgical treatment of ASD must carefully consider clinical symptoms, radiographic parameters, coexisting medical comorbidities, and the patient’s physiologic status. The potential benefits and risks associated with the surgical treatment of ASD must also factor into the treatment decision. This chapter provides an overview of current indications for the surgical treatment of ASD and highlights the significance of using a combination of both clinical symptomatology and radiographic imaging to propose the optimal treatment plan for patients with ASD.

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References

  1. Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine. 2005;30:1082–5.

    Article  PubMed  Google Scholar 

  2. Schwab FJ, Hawkinson N, Lafage V, et al. Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients. Eur Spine J. 2012;21(12):2603–10.

    Google Scholar 

  3. Lafage V, Hawkinson N, Schwab F, et al. Major complications following adult spinal deformity surgery: is there a high risk patient profile? Chicago: SRS; 2012.

    Google Scholar 

  4. Bess S, Boachie-Adjei O, Burton D, et al. Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Spine (Phila Pa 1976). 2009;34:2186–90.

    Article  Google Scholar 

  5. Benzel EC, Hoh DJ, Ghogawala Z, Schlenk R. Indications for spine fusion for axial pain. In: Benzel EC editor. Spine surgery: techniques, complication avoidance, and management. 2nd ed. 2005. Philadelphia: Saunders Elsevier.

    Google Scholar 

  6. Benzel EC, Lavelle WF, Bianco AJ, Kitab SA. Anatomy of nerve root compression, nerve root tethering, and spinal instability spine surgery: techniques, complication avoidance, and management. In: Benzel EC editor. Spine surgery: techniques, complication avoidance, and management. 2nd ed. 2005. Philadelphia: Saunders Elsevier.

    Google Scholar 

  7. Traynelis VC. Spinal arthroplasty. Neurosurg Focus. 2002;13:1–7.

    Article  Google Scholar 

  8. Williams RW. Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine (Phila Pa 1976). 1983;8:708–16.

    Article  CAS  Google Scholar 

  9. de Loubresse CG, Bon T, Deburge A, Lassale B, Benoit M. Posterolateral fusion for radicular pain in isthmic spondylolisthesis. Clin Orthop Relat Res. 1996;323:194–201.

    Article  PubMed  Google Scholar 

  10. Benzel EC, Mazanec DJ, DeMicco RC. Management of a 45-year-old with mechanical low back pain with or without L4-5 spondylolisthesis and no neurologic findings. In: Benzel EC editor. Spine surgery: techniques, complication avoidance, and management. 2nd ed. 2005. Philadelphia: Saunders Elsevier.

    Google Scholar 

  11. Fairbank JCT, Pynsent PB. The Oswestry disability index. Spine. 2000;25:2940.

    Article  CAS  PubMed  Google Scholar 

  12. Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30:682–8.

    Article  Google Scholar 

  13. Schwab FJ, Lafage V, Farcy JP, Bridwell KH, Glassman S, Shainline MR. Predicting outcome and complications in the surgical treatment of adult scoliosis. Spine. 2008;33:2243.

    Article  PubMed  Google Scholar 

  14. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.

    Article  CAS  PubMed  Google Scholar 

  15. Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30:1082–5.

    Article  Google Scholar 

  16. Duval-Beaupere G, Marty C, Barthel F, et al. Sagittal profile of the spine prominent part of the pelvis. Stud Health Technol Inform. 2002;88:47–64.

    CAS  PubMed  Google Scholar 

  17. Legaye J, Duval-Beaupere G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7:99–103.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976). 2005;30:346–53.

    Article  Google Scholar 

  19. Schwab F, Lafage V, Boyce R, Skalli W, Farcy JP. Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976). 2006;31:E959–67.

    Article  Google Scholar 

  20. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005;87:260–7.

    Article  PubMed  Google Scholar 

  21. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine. 2009;34:E599.

    Article  PubMed  Google Scholar 

  22. Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine. 2008;33:1572–8.

    Article  PubMed  Google Scholar 

  23. Schwab F, Ungar B, Blondel B, et al. Scoliosis research society – Schwab adult spinal deformity classification: a validation study. Spine. 2012;37:1077.

    Article  PubMed  Google Scholar 

  24. Schwab FJ, Bess S, Blondel B, et al. Combined assessment of pelvic tilt, pelvic incidence/lumbar lordosis mismatch and sagittal vertical axis predicts disability in adult spinal deformity: a prospective analysis: PAPER# 20*. 2011, p. 65.

    Google Scholar 

  25. Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity – postoperative standing Imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine. 2010;35:2224.

    Article  PubMed  Google Scholar 

  26. Horton WC, Brown CW, Bridwell KH, Glassman SD, Suk SI, Cha CW. Is there an optimal patient stance for obtaining a lateral 36” radiograph? A critical comparison of three techniques. Spine. 2005;30:427–33.

    Article  PubMed  Google Scholar 

  27. Haughton VM, Rogers B, Meyerand ME, Resnick DK. Measuring the axial rotation of lumbar vertebrae in vivo with MR imaging. Am J Neuroradiol. 2002;23:1110–6.

    PubMed  Google Scholar 

  28. Blankenbaker DG, Haughton VM, Rogers BP, Meyerand ME, Fine JP. Axial rotation of the lumbar spinal motion segments correlated with concordant pain on discography: a preliminary study. Am J Roentgenol. 2006;186:795–9.

    Article  Google Scholar 

  29. Lu WW, Hu Y, Luk KDK, Cheung KMC, Leong JCY. Paraspinal muscle activities of patients with scoliosis after spine fusion: an electromyographic study. Spine. 2002;27:1180–5.

    Article  PubMed  Google Scholar 

  30. Cheung J, Halbertsma JPK, Veldhuizen AG, et al. A preliminary study on electromyographic analysis of the paraspinal musculature in idiopathic scoliosis. Eur Spine J. 2005;14:130–7.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Glassman SD, Schwab FJ, Bridwell KH, Ondra SL, Berven S, Lenke LG. The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine. 2007;32:93.

    Article  PubMed  Google Scholar 

  32. Bradford DS, Tay BKB, Hu SS. Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine. 1999;24:2617.

    Article  CAS  PubMed  Google Scholar 

  33. Figueiredo N, Martins JWG, Arruda AA, et al. TLIF: transforaminal lumbar interbody fusion. Arq Neuropsiquiatr. 2004;62:815–20.

    Article  PubMed  Google Scholar 

  34. Dickson JH, Mirkovic S, Noble PC, Nalty T, Erwin WD. Results of operative treatment of idiopathic scoliosis in adults. J Bone Joint Surg Am. 1995;77:513.

    CAS  PubMed  Google Scholar 

  35. Bridwell KH, Glassman S, Horton W, et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine. 2009;34:2171.

    Article  PubMed  Google Scholar 

  36. Smith JS, Shaffrey CI, Berven S, et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine. 2009;34:1693–8.

    Article  PubMed  Google Scholar 

  37. Li G, Passias P, Kozanek M, et al. Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine. 2009;34:2165.

    Article  PubMed  Google Scholar 

  38. Kluba T, Dikmenli G, Dietz K, Giehl JP, Niemeyer T. Comparison of surgical and conservative treatment for degenerative lumbar scoliosis. Arch Orthop Trauma Surg. 2009;129:1–5.

    Article  PubMed  Google Scholar 

  39. Smith JS, Shaffrey CI, Berven S, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery. 2009;65:86–94.

    Article  PubMed  Google Scholar 

  40. Berven S, Deviren V, Demir-Deviren S, Hu SS, Bradford DS. Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine (Phila Pa 1976). 2003;28:2164–9. discussion 2169.

    Article  Google Scholar 

  41. Smith JS, Shaffrey CI, Glassman SD, et al. Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine. 2011;36:817.

    Article  PubMed  Google Scholar 

  42. Glassman SD, Polly DW, Bono CM, Burkus K, Dimar JR. Outcome of lumbar arthrodesis in patients sixty-five years of age or older. J Bone Joint Surg. 2009;91:783–90.

    Article  PubMed  Google Scholar 

  43. Carreon LY, Puno RM, DimarII JR, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg. 2003;85:2089–92.

    PubMed  Google Scholar 

  44. Baron EM, Albert TJ. Medical complications of surgical treatment of adult spinal deformity and how to avoid them. Spine. 2006;31:S106–18.

    Article  PubMed  Google Scholar 

  45. Glassman SD, Berven S, Kostuik J, Dimar JR, Horton WC, Bridwell K. Nonsurgical resource utilization in adult spinal deformity. Spine. 2006;31:941–7.

    Article  PubMed  Google Scholar 

  46. Glassman SD, Alegre GM. Adult spinal deformity in the osteoporotic spine: options and pitfalls. Instr Course Lect. 2003;52:579–88.

    PubMed  Google Scholar 

  47. Kalanithi PS, Patil CG, Boakye M. National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine. 2009;34:1963.

    Article  PubMed  Google Scholar 

  48. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine. 2005;30:1460–5.

    Article  PubMed  Google Scholar 

  49. Sansur CA, Smith JS, Coe JD, et al. Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine. 2011;36:E593.

    Article  PubMed  Google Scholar 

  50. Baker SP, O’Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.

    Article  CAS  PubMed  Google Scholar 

  51. Knaus WA, Wagner D, Draper E, et al.: The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619–36.

    Google Scholar 

  52. Weidenbaum M. Considerations for focused surgical intervention in the presence of adult spinal deformity. Spine. 2006;31:S139–43.

    Article  PubMed  Google Scholar 

  53. Ha HI, Seo JB, Lee SH, et al. Imaging of marfan syndrome: Multisystemic Manifestations. Radiographics. 2007;27(4):989–1004.

    Google Scholar 

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Correspondence to Frank Schwab M.D. .

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Weinreb, J.H., Bianco, K.L., Lafage, V., Schwab, F. (2014). Indications for Adult Spinal Deformity Surgery. In: Wang, M., Lu, Y., Anderson, D., Mummaneni, P. (eds) Minimally Invasive Spinal Deformity Surgery. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1407-0_3

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  • DOI: https://doi.org/10.1007/978-3-7091-1407-0_3

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