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Evolution and Advancement of Adult Spinal Deformity Research and Clinical Care: An Overview of the Scoli-RISK-1 Study.

ABSTRACT: Study Design:Narrative review. Objective:The prevalence of adult spinal deformity (ASD) has been cited anywhere between 2-32%, while the prevalence in the elderly population has been estimated at 68%. Neurologic complications following ASD surgery remains a concern. Previous literature reported incidence of neurologic complications varied between 1-10%, while non-neurologic complications reported were as high as 50%. To assess the incidence of neurologic deficits, complications, and outcomes following ASD surgery, an international group of spine deformity surgeons initiated a prospective, multicenter, international, observational study: Scoli-RISK-1. Methods:Two hundred seventy-two patients were enrolled from 15 centers with ASD having primary or revision surgery with a major Cobb?80°, revision including an osteotomy, and/or a complex 3-column osteotomy. Patients had lower extremity muscle strength (LEMS) exams performed preoperatively and at specific time points through 2-year follow-up. Results:Preoperatively, 203 patients (74.9%) had no LEMS impairment (normal) and 68 (25.1%) had a LEMS of <50 (abnormal). Compared with baseline, 23.0% of all patients experienced a LEMS decline at discharge, with this rate decreasing to 17.1% at 6-weeks and to 9.9% at 6-months and remaining stable at 10.0% at 2-years. Conclusion:This study revealed that a decline in LEMS after complex ASD surgery is common and more frequent than previously reported. We identified such a decline in 23.0% of patients at discharge, with neurologic function recovering over time to a decline of 10.0% at 2-years postoperatively. The Scoli-RISK-1 study revealed valuable information regarding the incidence, natural history, and prognosis of neurologic and non-neurologic complications following ASD surgery and provides useful information for patient counseling.

SUBMITTER: Cerpa M

PROVIDER: S-EPMC6512199 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Evolution and Advancement of Adult Spinal Deformity Research and Clinical Care: An Overview of the Scoli-RISK-1 Study.

Cerpa Meghan M Lenke Lawrence G LG Fehlings Michael G MG Shaffrey Christopher I CI Cheung Kenneth M C KMC Carreon Leah Yacat LY

Global spine journal 20190508 1 Suppl

<h4>Study design</h4>Narrative review.<h4>Objective</h4>The prevalence of adult spinal deformity (ASD) has been cited anywhere between 2-32%, while the prevalence in the elderly population has been estimated at 68%. Neurologic complications following ASD surgery remains a concern. Previous literature reported incidence of neurologic complications varied between 1-10%, while non-neurologic complications reported were as high as 50%. To assess the incidence of neurologic deficits, complications, a ...[more]

PMID: 31157151

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Project description:PurposeSymptomatic adult spinal deformity (ASD) with an extremely variable presentation with pain, with and without neurogenic leg pain, and/or disturbed sagittal and coronal balance, causes a significant societal burden of disease. It is an important consequence of the aging adult population, generating a plethora of spine-related interventions with variable treatment efficacy and consistently high costs. Recent years have witnessed more than a threefold increase in the prevalence and treatment of ASD, and further increases over the coming decades are expected with the growing elderly population worldwide. The ability to monitor and assess clinical outcomes has not kept pace with these developments. This paper addresses the pressing need to provide a set of common outcome metrics for this growing group of patients with back pain and other disabilities due to an adult spinal deformity.MethodsThe standard outcome set was created by a panel with global representation, using a thorough modified Delphi procedure. The three-tiered outcome hierarchy (Porter) was used as a framework to capture full cycle of care. The standardized language of the International Classification of Functioning, Disability and Health (WHO-ICF) was used.ResultsConsensus was reached on a core set of 25 WHO-ICF outcome domains ('What to measure'); on the accompanying globally available clinician and patient reported measurement instruments and definitions ('How to measure'), and on the timing of the measurements ('When to measure'). The current work has brought to light domains not routinely reported in the spinal literature (such as pulmonary function, return to work, social participation), and domains for which no adequate instruments have yet been identified (such as how to clinically quantify in routine practice lumbar spinal stenosis, neurogenic claudication, radicular pain, and loss of lower extremity motor function).ConclusionA standard outcome set was developed for patients undergoing treatment for adult spinal deformity using globally available outcome metrics. The current framework can be considered a reference for further work, and may provide a starting point for routine methodical and systematic monitoring of outcomes. Post-COVID e-health may accelerate the routine capture of these types of data.

Project description:Study designRetrospective observational study of a cohort of consecutive patients.ObjectivesPostoperative ileus (POI) is associated with a variety of adverse effects. Although the incidence of and risk factors for POI following spinal surgery have been reported, the frequency and pathology of POI after spinal corrective surgery for adult spinal deformity (ASD) are still largely unknown. The study objectives were to: (1) clarify the prevalence and clinical significance of POI, (2) elucidate the risk factors for POI, (3) determine radiographically which preoperative and/or postoperative spinal parameters predominantly influence the risk of POI after spinal corrective surgery for ASD.MethodsWe included data from 144 consecutive patients who underwent spinal corrective surgery. Perioperative medical complications and clinical information were extracted from patient electronic medical records. Preoperative radiographic parameters and changes in radiographic parameters after surgery were compared between patients with and without POI. Multivariate logistic regression analyses were performed to clarify potential risk factors for POI.ResultsPOI developed in 25/144 (17.4%) patients and was the most common complication in the present study. The frequencies of smoking, gastroesophageal reflux disease, and lateral lumbar interbody fusion (LLIF), as well as the duration of surgery were significantly greater in the group with POI versus the group without POI. Among radiographic parameters, only the change in thoracolumbar kyphosis (TLK) from before to after surgery was significantly larger in the group with POI. Multivariate logistic regression analysis showed that male sex, LLIF and large changes in TLK from before to after surgery were significantly associated with the development of POI.ConclusionsThese results suggested that LLIF and large corrections in TLK were independent risk factors for POI after ASD surgery. When patients with ASD have large TLK preoperatively, and it is determined that a large correction is needed, physicians must be aware of the potential for occurrence of POI.

Project description:BackgroundAdult spinal deformity patients (ASD) experience altered spinal alignment affecting spatiotemporal parameters and joint kinematics. Differences in spinal deformity between patients with symptomatic idiopathic scoliosis (ID-ASD) and patients with "de novo" scoliosis (DN-ASD) may affect gait characteristics differently. This study aims to compare gait characteristics between ID-ASD, DN-ASD, and asymptomatic healthy matched controls.MethodsIn this observational case-control study, ID-ASD (n = 24) and DN-ASD (n = 26) patients visiting the out-patient spine clinic and scheduled for long-segment spinal fusion were included. Patients were matched, based on age, gender, leg length and BMI, with asymptomatic healthy controls. Gait was measured at comfortable walking speed on an instrumented treadmill with 3D motion capture system. Trunk, pelvic and lower extremities range of motion (ROM) and spatiotemporal parameters (SPT) are presented as median (first and thirds quartile). Independent t-test or Mann-Whitney U test was used to compare ID-ASD, DN-ASD and controls. Statistical Parametric Mapping (independent t-test) was used to compare 3D joint kinematics.ResultsDN-ASD patients walk with increased anterior trunk tilt during the whole gait cycle compared with ID-ASD patients and controls. ID-ASD walk with decreased trunk lateroflexion compared with DN-ASD and controls. DN-ASD showed decreased pelvic obliquity and -rotation, increased knee flexion, and decreased ankle plantar flexion. ID-ASD and DN-ASD displayed decreased trunk, pelvic and lower extremity ROM compared with controls, but increased pelvic tilt ROM. ID-ASD patients walked with comparable SPT to controls, whereas DN-ASD patients walked significantly slower with corresponding changes in SPT and wider steps.ConclusionsDN-ASD patients exhibit distinct alterations in SPT and kinematic gait characteristics compared with ID-ASD and controls. These alterations seem to be predominantly influenced by sagittal spinal malalignment and kinematic findings in ASD patients should not be generalized as such, but always be interpreted with consideration for the nature of the ASD.

Project description:Adults with spinal deformity (ASD) are known to have spinal malalignment affecting their quality of life and daily life activities. While walking kinematics were shown to be altered in ASD, other functional activities are yet to be evaluated such as sitting and standing, which are essential for patients' autonomy and quality of life perception. In this cross-sectional study, 93 ASD subjects (50 ± 20 years; 71 F) age and sex matched to 31 controls (45 ± 15 years; 18 F) underwent biplanar radiographic imaging with subsequent calculation of standing radiographic spinopelvic parameters. All subjects filled HRQOL questionnaires such as SF36 and ODI. ASD were further divided into 34 ASD-sag (with PT > 25° and/or SVA >5 cm and/or PI-LL >10°), 32 ASD-hyperTK (with only TK >60°), and 27 ASD-front (with only frontal malalignment: Cobb >20°). All subjects underwent 3D motion analysis during the sit-to-stand and stand-to-sit movements. The range of motion (ROM) and mean values of pelvis, lower limbs, thorax, head, and spinal segments were calculated on the kinematic waveforms. Kinematics were compared between groups and correlations to radiographic and HRQOL scores were computed. During sit-to-stand and stand-to-sit movements, ASD-sag had decreased pelvic anteversion (12.2 vs 15.2°), hip flexion (53.0 vs 62.2°), sagittal mobility in knees (87.1 vs 93.9°), and lumbar mobility (L1L3-L3L5: -9.1 vs -6.8°, all p < 0.05) compared with controls. ASD-hyperTK showed increased dynamic lordosis (L1L3-L3L5: -9.1 vs -6.8°), segmental thoracic kyphosis (T2T10-T10L1: 32.0 vs 17.2°, C7T2-T2T10: 30.4 vs 17.7°), and thoracolumbar extension (T10L1-L1L3: -12.4 vs -5.5°, all p < 0.05) compared with controls. They also had increased mobility at the thoracolumbar and upper-thoracic spine. Both ASD-sag and ASD-hyperTK maintained a flexed trunk, an extended head along with an increased trunk and head sagittal ROM. Kinematic alterations were correlated to radiographic parameters and HRQOL scores. Even after controlling for demographic factors, dynamic trunk flexion was determined by TK and PI-LL mismatch (adj. R 2 = 0.44). Lumbar sagittal ROM was determined by PI-LL mismatch (adj. R 2 = 0.13). In conclusion, the type of spinal deformity in ASD seems to determine the strategy used for sitting and standing. Future studies should evaluate whether surgical correction of the deformity could restore sitting and standing kinematics and ultimately improve quality of life.

Dataset Information

Evolution and Advancement of Adult Spinal Deformity Research and Clinical Care: An Overview of the Scoli-RISK-1 Study.

Publications

Evolution and Advancement of Adult Spinal Deformity Research and Clinical Care: An Overview of the Scoli-RISK-1 Study.

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