Symptomatic adult spinal deformity: implications for treatment and research.
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ABSTRACT:
SUBMITTER: Zaina F
PROVIDER: S-EPMC7210213 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
Publications
Symptomatic adult spinal deformity: implications for treatment and research.
Zaina Fabio F Di Felice Francesca F Donzelli Sabrina S Negrini Stefano S
Annals of translational medicine 20200401 7
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Project description:Study designA post hoc analysis.ObjectiveAdvances in machine learning (ML) have led to tools offering individualized outcome predictions for adult spinal deformity (ASD). Our objective is to examine the properties of these ASD models in a cohort of adult symptomatic lumbar scoliosis (ASLS) patients.Summary of background dataML algorithms produce patient-specific probabilities of outcomes, including major complication (MC), reoperation (RO), and readmission (RA) in ASD. External validation of these models is needed.MethodsThirty-nine predictive factors (12 demographic, 9 radiographic, 4 health-related quality of life, 14 surgical) were retrieved and entered into web-based prediction models for MC, unplanned RO, and hospital RA. Calculated probabilities were compared with actual event rates. Discrimination and calibration were analyzed using receiver operative characteristic area under the curve (where 0.5=chance, 1=perfect) and calibration curves (Brier scores, where 0.25=chance, 0=perfect). Ninety-five percent confidence intervals are reported.ResultsA total of 169 of 187 (90%) surgical patients completed 2-year follow up. The observed rate of MCs was 41.4% with model predictions ranging from 13% to 68% (mean: 38.7%). RO was 20.7% with model predictions ranging from 9% to 54% (mean: 30.1%). Hospital RA was 17.2% with model predictions ranging from 13% to 50% (mean: 28.5%). Model classification for all three outcome measures was better than chance for all [area under the curve=MC 0.6 (0.5-0.7), RA 0.6 (0.5-0.7), RO 0.6 (0.5-0.7)]. Calibration was better than chance for all, though best for RA and RO (Brier Score=MC 0.22, RA 0.16, RO 0.17).ConclusionsASD prediction models for MC, RA, and RO performed better than chance in a cohort of adult lumbar scoliosis patients, though the homogeneity of ASLS affected calibration and accuracy. Optimization of models require samples with the breadth of outcomes (0%-100%), supporting the need for continued data collection as personalized prediction models may improve decision-making for the patient and surgeon alike.
| S-EPMC9771887 | biostudies-literature
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.
| S-EPMC8363534 | biostudies-literature
Project description:Operative management of adult spinal deformity (ASD) has been increasing in recent years secondary to an aging society. The advance of intraoperative image guidance, such as the development of navigation and robotics systems has contributed to the growth and safety of ASD surgery. Currently, intraoperative image guidance is mainly used for pedicle screw placement and the evaluation of alignment correction in ASD surgery. Though it is expected that the use of navigation and robotics would result in increasing pedicle screw accuracy as reported in other spine surgeries, there are no well-powered studies specifically focusing on ASD surgery. Currently, deformity correction relies heavily on preoperative planning, however, a few studies have shown the possibility that intraoperative image modalities may accurately predict postoperative spinopelvic parameters. Future developments of intraoperative image guidance are needed to overcome the remaining challenges in ASD surgery such as radiation exposure to patient and surgeon. More novel imaging modalities may result in evolution in ASD surgery. Overall there is a paucity of literature focusing on intraoperative image guidance in ASD surgery, therefore, further studies are warranted to assess the efficacy of intraoperative image guidance in ASD surgery. This narrative review sought to provide the current role and future perspectives of intraoperative image guidance focusing on ASD surgery.
| S-EPMC7859785 | biostudies-literature
Project description:Purpose To review the current literature for the nonoperative and operative treatment for adult spinal deformity. Recent Findings With more than 11 million baby boomers joining the population of over 60 years of age in the United States, the incidence of lumbar deformity is greatly increasing. Recent literature suggests that a lack of evidence exists to support the effectiveness of nonoperative treatment for adult scoliosis. In regards to operative treatment, current literature reports a varying range of improved clinical outcomes, curve correction, and complication rates. The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic among literature. Summary Most adult deformity patients never seek nonoperative or operative treatment. Of the few that seek treatment, many can benefit from nonoperative treatment. However, in selected patients who have failed nonoperative treatment and who are candidates for surgical intervention, the literature reflects positive outcomes related to surgical intervention as compared with nonoperative treatment despite varying associated ranges in morbidity and mortality rates. If nonoperative therapy fails in addressing a patient's complaints, then an appropriate surgical procedure that relieves neural compression, corrects excessive sagittal or coronal imbalance, and results in a solidly fused, pain-free spine is warranted.
| S-EPMC3856386 | biostudies-other
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.
| S-EPMC10825775 | biostudies-literature
Project description:Adult spinal deformity (ASD) is one of the most challenging spinal disorders associated with broad range of clinical and radiological presentation. Correct selection of fusion levels in surgical planning for the management of adult spinal deformity is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. In this study, we describe our new simple decision making algorithm and selection of fusion level for ASD surgery in terms of adult idiopathic idiopathic scoliosis vs. degenerative scoliosis.
| S-EPMC4954878 | biostudies-literature
Project description:Study designSystematic review.ObjectivesAdult spinal deformity (ASD) can be a debilitating condition with a profound impact on patients' health-related quality of life (HRQoL). Many reports have suggested that the frailty status of a patient can have a significant impact on the outcome of the surgery. The present review aims to identify all pre-operative patient-specific frailty markers that are associated with postoperative outcomes following corrective surgery for ASD of the lumbar and thoracic spine.MethodsA systematic review of the literature was performed to identify findings regarding pre-operative markers of frailty and their association with postoperative outcomes in patients undergoing ASD surgery of the lumbar and thoracic spine. The search was performed in the following databases: PubMed, Embase, Cochrane and CINAHL.ResultsAn association between poorer performance on frailty scales and worse postoperative outcomes. Comorbidity indices were even more frequently employed with similar patterns of association between increased comorbidity burden and postoperative outcomes. Regarding the assessment of HRQoL, worse pre-operative ODI, SF-36, SRS-22 and NRS were shown to be predictors of post-operative complications, while ODI, SF-36 and SRS-22 were found to improve post-operatively.ConclusionsThe findings of this review highlight the true breadth of the concept of "frailty" in ASD surgical correction. These parameters, which include frailty scales and various comorbidity and HRQoL indices, highlight the importance of identifying these factors preoperatively to ensure appropriate patient selection while helping to limit poor postoperative outcomes.
| S-EPMC9109568 | biostudies-literature
Project description:BackgroundAs the frequency of adult deformity surgery (ADS) continues to increase, our understanding of techniques that enhance fusion must continue to evolve because pseudarthrosis can be a serious and costly event.Purposes/questionsWe sought to conduct a review of the literature investigating techniques that can enhance outcomes of ADS.MethodsTwo databases were searched for keywords such as "advances in spinal fusion," "new technology in adult spinal deformity," "interbody devices for adult spinal deformity," "adult spinal deformity rods," and "screw design in adult spinal deformity" to examine recent literature and trends in ADS.ResultsWe identified 45 articles for our review. Topics studied include the use of multiple rods, interbody fusion, distal fixation techniques, and bone morphogenetic protein or iliac crest bone graft.ConclusionsMany recent innovations in treatments to enhance fusion in ADS have been studied, some more controversial than others. Further research into the efficacy of these techniques may increase fusion rates in ADS.
| S-EPMC7253541 | biostudies-literature
Project description:BackgroundOblique lumbar interbody fusion (OLIF) and percutaneous posterior approach for screw fixation (PPS) is the latest minimal invasive treatment for spinal deformity in adult patients (ASD). This study aims to design and highlight key points for ASD correction.Materials and methodsWe retrospectively analyzed 54 patients who had undergone OLIF with PPS for ASD from October 2019 to January 2022 (average 71.5 ± 6.2 years-old, male 4, female 50) with a mean follow-up period of 29.2 months. Clinical outcomes are expressed by values including the Oswestry disability index (ODI) and visual analogue scale (VAS) for back pain. The imagistic assessment was also performed preoperatively and at 12, and 24 months postoperatively. For OLIF51, CT- MRI fusion images were obtained before surgery.ResultsPostoperative ODI and VAS were 30.5 ± 18.9% and 31.2 ± 6.9 mm, respectively. The average operating time and blood loss during the surgical exposure was 490.9 ± 85.4 min and 1195.2 ± 653.8 ml. Preoperative SVA, PI-LL, and PT were 96.5 ± 55.9 mm, 39.3 ± 22.1°, 34.5 ± 11.0°, respectively. Postoperatively, SVA and PT became normal (24.1 ± 39.0 mm, 17.1 ± 10.3°) and PI-LL was ideal (2.4 ± 12.6°). Postoperative ODI and VAS were 30.5 ± 18.9% and 31.2 ± 6.9 mm. For OLIF51, the results revealed gain in L5-S1 lordosis and intervertebral disc height 9.4° and 4.2 mm respectively. The complications consisted of PJK in 21 cases (38.9%), rod breakage in 5 cases (9.3%), deep or superficial wound infection in 2 cases (3.7%).ConclusionClinical and imagistic results of OLIF and PPS for ASD were excellent. The radiographic measurements revealed that OLIF51 created good L5-S1 lordosis and significant L5-S1 disc height. CT-MRI fusion images were very useful for evaluating vascular anatomy for OLIF51.
| S-EPMC10562616 | biostudies-literature
Project description:Study Design Retrospective cross-sectional study. Clinical Question What is the prevalence of cervical spondylosis (CS) and thoracolumbar (TL) spinal deformity in an administrative database during a 4-year study period? Is the prevalence of CS or TL deformity higher in patients who have the other spine diagnosis compared with the overall study population? Are patients with both diagnoses more likely to have undergone spine surgery? Patients and Methods An administrative claims database containing 53 million patients with either Medicare (2005-2008) or private payer (2007-2010) insurance was used to identify patients with diagnoses of CS and/or TL deformity. Disease prevalence between groups was compared using a χ (2) test and reported using prevalence ratios (PR). Results The prevalence of CS was higher in patients with TL deformity than without TL deformity, for both Medicare (PR = 2.81) and private payer (PR = 1.79). Similarly, the prevalence of TL deformity was higher in patients with CS than without CS for both Medicare (PR = 3.19) and private payer (PR = 2.05). Patients with both diagnoses were more likely to have undergone both cervical (Medicare, PR = 1.44; private payer, PR = 2.03) and TL (Medicare, PR = 1.68; private payer, PR = 1.74) spine fusion. All comparisons were significant with p < 0.0001. Conclusions Patients with either CS or TL deformity had a higher prevalence of the other spinal diagnosis compared with the overall disease prevalence in the study population. Patients with both diagnoses had a higher prevalence of having spine surgery compared with patients with only one diagnosis. More studies to identify a causal mechanism for this relationship are warranted.
| S-EPMC3969428 | biostudies-literature