Study Design: Retrospective review of a multicenter database of consecutive patients undergoing 3-column osteotomy for treatment of adult spinal deformity (ASD).
Objective: To rigorously develop a T1 pelvic angle (TPA) categorization paradigm and use it to assess the surgical management of patients with ASD.
Summary Of Background Data: TPA, the angle between the hips-T1 line and hips-S1 endplate line, is a novel spinopelvic parameter that assesses the combined effect of a loss of lordosis on trunk inclination and pelvic retroversion.
Background Context: Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system. Patients with PD often present with abnormal posturing.
Purpose: To investigate coronal plane deformities in patients with PD, and to evaluate the correlation between clinical features, coronal parameters related to spine alignment, and disease severity.
Study Design: Multicenter, prospective, consecutive case series.
Objective: To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities.
Summary Of Background Data: Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity.
Object: The goal of this study was to determine the outcome and risk factors in patients with adult spinal deformity (ASD) who elected to receive nonoperative care.
Methods: In this retrospective study the authors reviewed a nonoperative branch of the International Spine Study Group database, derived from 10 sites across the US. Specific inclusion criteria included nonoperative treatment for ASD and the availability of Scoliosis Research Society (SRS)-22 scores and radiographic data at baseline (BL) and at 1-year (1Y) follow-up.
Object: Increased sagittal vertical axis (SVA) correlates strongly with pain and disability for adults with spinal deformity. A subset of patients with sagittal spinopelvic malalignment (SSM) have flatback deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10°) but remain sagittally compensated with normal SVA. Few data exist for SSM patients with flatback deformity and normal SVA.
View Article and Find Full Text PDFBackground Context: Whereas the costs of primary surgery, revisions, and selected complications for adult spinal deformity (ASD) have been individually reported in the literature, the total costs over several years after surgery have not been assessed. The determinants of such costs are also not well understood in the literature.
Purpose: This study analyzes the total hospital costs and operating room (OR) costs of ASD surgery through extended follow-up.
Study Type Retrospective review of a prospectively collected multicenter database. Introduction Three-column resection osteotomies (3CO), including pedicle subtraction osteotomies and vertebral column resections are performed for correction of sagittal deformity; however, they have high rates of reported complications. This study examined the incidence and intercenter variability of major intraoperative complications (IOC), postoperative complications (POC), and overall complications (IOC + POC) up to 6 weeks postoperation.
View Article and Find Full Text PDFStudy Design: Narrative review.
Objective: To provide a comprehensive narrative review of cervical alignment parameters, the methods for quantifying cervical alignment, normal cervical alignment values, and how alignment is associated with cervical deformity and myelopathy with discussions of health-related quality of life.
Summary Of Background Data: Indications for surgery to correct cervical alignment are not well-defined and there is no set standard to address the amount of correction to be achieved.
Study Design: Post hoc analysis of prospectively collected data.
Objective: Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM).
Summary Of Background Data: CSM is the leading cause of spinal cord dysfunction.
Object: Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies.
View Article and Find Full Text PDFStudy Design: Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD).
Objective: Evaluate correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with ASD.
Summary Of Background Data: Sagittal spinal deformity is commonly defined by an increased sagittal vertical axis (SVA); however, SVA alone may underestimate the severity of the deformity.
Background Context: Adult spinal deformity (ASD) is commonly associated with disability and represents a challenging condition for physicians. Although surgical management has been reported as superior to conservative care, the choice of patient-specific optimal strategy has been poorly defined. A key question remains selection of fusion levels as this implies careful balance of risks and benefits.
View Article and Find Full Text PDFPatient-based outcome measures are important tools quantifying the disease-specific and/or global quality of life (QOL) effects of spinal deformity treatment. In patients with neuromuscular disorders such as cerebral palsy, muscular dystrophy, and myelomeningocele, treatment effects must be differentiated from underlying disease functional impairments. In general, the goals of spinal surgery in these patients are to improve QOL by enhancing sitting balance and posture, improving lung and gastrointestinal function, and reducing pain and deformity.
View Article and Find Full Text PDFPurpose: Predictors of marked improvement versus failure to improve following surgery for adult scoliosis have not been identified. Our objective was to identify factors that distinguish between patients with the best and worst outcomes following surgery for adult scoliosis.
Methods: This is a secondary analysis of a prospective, multicenter spinal deformity database.
Background: Improved understanding of rod fracture (RF) in adult spinal deformity could be valuable for implant design, surgical planning, and patient counseling.
Objective: To evaluate symptomatic RF after posterior instrumented fusion for adult spinal deformity.
Methods: A multicenter, retrospective review of RF in adult spinal deformity was performed.
Background: Patients with previous multilevel spinal fusion may require extension of the fusion to the sacro-pelvis. Our objective was to evaluate the outcomes and complications of these patients, stratified based on whether the revision was performed using a posterior-only spinal fusion (PSF) or combined anterior-posterior spinal fusion (APSF).
Methods: A retrospective, multicenter evaluation of adults (>18 years old) with a history of prior spinal fusion for scoliosis (≥4 levels) terminating in the distal lumbar spine requiring extension of fusion to the sacro-pelvis (including iliac fixation in all cases), with minimum 2-year follow-up, was performed.
Purpose: Major peri-operative complications for adult spinal deformity (ASD) surgery remain common. However, risk factors have not been clearly defined. Our objective was to identify patient and surgical parameters that correlate with the development of major peri-operative complications with ASD surgery.
View Article and Find Full Text PDFObject: Pedicle subtraction osteotomy (PSO) is a surgical procedure that is frequently performed on patients with sagittal spinopelvic malalignment. Although it allows for substantial spinopelvic realignment, suboptimal realignment outcomes have been reported in up to 33% of patients. The authors' objective in the present study was to identify differences in radiographic profiles and surgical procedures between patients achieving successful versus failed spinopelvic realignment following PSO.
View Article and Find Full Text PDFThe clinical evaluation of adults with spinal deformity can be challenging for both general orthopaedic surgeons and spinal specialists. To properly treat these patients, the physician must be aware of the various types of adult spinal deformity and the basic principles of spinal misalignment. A complete patient assessment must include a thorough history and physical examination.
View Article and Find Full Text PDFPurpose: Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD).
Methods: Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO.
Study Design: Retrospective review of a prospective, multicenter database.
Objective: The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients.
Summary Of Background Data: Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown.
Stud Health Technol Inform
September 2010
Introduction: Decompensation of un-fused vertebrae is a potential complication of spinal instrumentation performed for adolescent idiopathic scoliosis (AIS). This can result in problems requiring revision surgery. The purpose of this study was to compare patients who decompensated in the sagittal/coronal plane and those who do not and to identify risk factors.
View Article and Find Full Text PDFSpine (Phila Pa 1976)
September 2008
Study Design: prospective, multicenter.
Objective: To determine if models for predicting outcome and complications in the setting of adult deformity surgery can be constructed.
Summary Of Background Data: A classification of adult spinal deformity has been established.
Study Design: Retrospective case-control series.
Objective: The purpose of this study is to determine whether perioperative complications alter subsequent clinical outcome measures in adult spinal deformity surgery.
Summary Of Background Data: Increasingly, the benefit of surgical intervention is being evaluated based on patient reported outcomes and standardized health related quality of life (HRQOL) measures.