Adult Spinal Deformity: National Trends in the Presentation, Treatment and Perioperative Outcomes from 2003-2010

Passias, Peter G.; Jalai, Cyrus M.; Worley, Nancy; Marascalchi, Bryan J.; Lafage, Virginie; Errico, Thomas J.

doi:10.1016/j.spinee.2015.07.368

Cited by 15 publications

(25 citation statements)

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“…Traditional open techniques for surgical management of adult deformity have been associated with high rates of complications [2][3][4][5][6]. Major perioperative complications lead to increased patient disability as long as 1 year after surgery [4].…”

Section: Comparing Complication Rates In Mis and Open Surgerymentioning

confidence: 99%

“…Major perioperative complications lead to increased patient disability as long as 1 year after surgery [4]. Even more concerning, an epidemiological analysis of adult deformity surgery reported an increase in inpatient complications from 2003 to 2010 [3]. The surgical trauma induced by extensive open posterior dissection also leads to a difficult recovery, with many patients staying in the hospital for a week or more [36,37].…”

Section: Comparing Complication Rates In Mis and Open Surgerymentioning

confidence: 99%

“…With regard to surgical management of adult spinal deformity (ASD), surgical goals include restoration of sagittal and coronal balance, construction of a solid fusion foundation, and decompression of the neural elements. When considering the morbidity of longsegment open fusions traditionally utilized in this patient population [2][3][4][5][6], the potential of a minimally invasive approach can appeal to both patients and surgeons alike. However, given that extensive tissue dissection and release has been traditionally indispensable to achieve ASD goals especially with regard to restoration of alignment, a minimally invasive approach inherently seems problematic.…”

Section: Introductionmentioning

confidence: 99%

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The Current State of Minimally Invasive Approaches to Adult Spinal Deformity

Lovecchio

Qureshi

2019

Curr Rev Musculoskelet Med

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Purpose of Review Minimally invasive approaches to adult spinal deformity (ASD) surgery have seen a large increase in popularity over the last decade, largely because these techniques are viewed as a potential improvement to the lengthy recovery and high complication rates observed after traditional open surgery for this pathology. The purpose of this review is to present a summary of the latest minimally invasive techniques used in adult spinal deformity surgery, examine whether MIS surgery can accomplish the goals of ASD surgery, and investigate whether MIS surgery is safer than traditional approaches. Recent Findings While minimally invasive approaches have been able to achieve similar patient-reported outcomes as open approaches, they are associated with their own unique complications. Furthermore, they are limited in their ability to correct severe sagittal imbalance. Emerging techniques, such as anterior column realignment and mini-open posterior column osteotomy, have been developed to address these limitations. The minimally invasive spinal deformity surgery algorithm (MISDEF) can help guide surgeons on which approaches may be appropriate for a particular case. Summary To maximize the benefits of a minimally invasive approach without compromising the goals of ASD surgery, surgeons must be selective in choosing which cases are amenable to an MIS approach. Leading experts continue to develop algorithms to guide surgical decision-making. As we learn to better define our indications, understand treatment goals, and refine our techniques, MIS approaches will likely play an even larger role in a comprehensive ASD treatment strategy.

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Section: Comparing Complication Rates In Mis and Open Surgerymentioning

confidence: 99%

Section: Comparing Complication Rates In Mis and Open Surgerymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Current State of Minimally Invasive Approaches to Adult Spinal Deformity

Lovecchio

Qureshi

2019

Curr Rev Musculoskelet Med

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“…With the changes seen in North American demographics, MIS options for deformity may be needed in an ever-aging and debilitated ASD population. 8,9 This may also account for the relative stability in operative blood loss and hospital length of stay. We suspect the reduction in complications has been the result of three major factors.…”

Section: Effects Of Surgical Experiencementioning

confidence: 99%

“…he morbidity of adult spinal deformity (ASD) surgery has been well proven through several large multiinstitutional studies. 6,9,14 Although these operations carry inherent risk, the benefits of such interventions have been shown as well, provided that the tenets of the surgical goals have been met. 2,10,11 Given these conditions, substantial enthusiasm has been demonstrated for minimally invasive surgery (MIS) options.…”

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confidence: 99%

Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers

Wang

Tran

Brusko

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEThe past decade has seen major advances in techniques for treating more complex spinal disorders using minimally invasive surgery (MIS). While appealing from the standpoint of patient perioperative outcomes, a major impediment to adoption has been the significant learning curve in utilizing MIS techniques.METHODSData were retrospectively analyzed from a multicenter series of adult spinal deformity surgeries treated at eight tertiary spine care centers in the period from 2008 to 2015. All patients had undergone a less invasive or hybrid approach for a deformity correction satisfying the following inclusion criteria at baseline: coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, or pelvic tilt > 20°. Analyzed data included baseline demographic details, severity of deformity, surgical metrics, clinical outcomes (numeric rating scale [NRS] score and Oswestry Disability Index [ODI]), radiographic outcomes, and complications. A minimum follow-up of 2 years was required for study inclusion.RESULTSAcross the 8-year study period, among 222 patients, there was a trend toward treating increasingly morbid patients, with the mean age increasing from 50.7 to 62.4 years (p = 0.013) and the BMI increasing from 25.5 to 31.4 kg/m2 (p = 0.12). There was no statistical difference in the severity of coronal and sagittal deformity treated over the study period. With regard to radiographic changes following surgery, there was an increasing emphasis on sagittal correction and, conversely, less coronal correction. There was no statistically significant difference in clinical outcomes over the 8-year period, and meaningful improvements were seen in all years (ODI range of improvement: 15.0–26.9). Neither were there statistically significant differences in major complications; however, minor complications were seen less often as the surgeons gained experience (p = 0.064). Operative time was decreased on average by 47% over the 8-year period.Trends in surgical practice were seen as well. Total fusion construct length was unchanged until the last year when there was a marked decrease in conjunction with a decrease in interbody levels treated (p = 0.004) while obtaining a higher degree of sagittal correction, suggesting more selective but powerful interbody reduction methods as reflected by an increase in the lateral and anterior column resection techniques being utilized.CONCLUSIONSThe use of minimally invasive methods for adult spinal deformity surgery has evolved over the past decade. Experienced surgeons are treating older and more morbid patients with similar outcomes. A reliance on selective, more powerful interbody approaches is increasing as well.

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The relationship of global sagittal malalignment to fatty infiltration in the aging spine

et al. 2021

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Purpose To investigate associations between muscle size, fat infiltration (FI), and global sagittal alignment in patients with adult spinal deformity (ASD). Methods Retrospective cohort study was conducted on a single-institution database of ASD patients with preoperative radiographs and CTs. Following multiplanar reconstructions of CTs, images in the plane of each vertebra were generated. The posterior vertebral musculature (PVM) was contoured on axial images at three vertebral levels (T2, T10, L3). FI was calculated by comparing Hounsfield units within muscles to the normative values of fat. Correlation analyses were conducted between demographics, alignment, and muscle characteristics. Results 107 patients underwent preoperative spine CT (58yo, 79%F, BMI 27 kg/m2). Muscle data were available for 49 pts at T2, 39 pts at T10, and 81 pts at L3. Mean FI was T2 = 33% ± 18, T10 = 28% ± 19, L3_Erector = 39% ± 19, and L3_Psoas = 19% ± 9. FI correlated across levels (T2 vs. T10 r = 0.698; T10 vs L3_Erector r = 0.506; L3_Erector vs Psoas r = 0.419) and with demographics; older pts had greater fat percentages (r = 0.31–0.45) and BMIs (r = 0.24–0.51). Increased FI at T2, T10, and L3 was associated with increased pelvic retroversion (PT: r = 0.25–0.43), global deformity (TPA: r = 0.27–0.45), and anterior malalignment (SVA: r = 0.23–0.41). The degree of FI in the PVM increased with the severity of SRS-Schwab PT and SVA modifiers. Conclusion In ASD patients, global sagittal malalignment is related to FI of the PVM throughout the lumbar and thoracic spine, as identified through CT. Future research should investigate how FI relates to ASD pathogenesis.

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Adult Spinal Deformity: National Trends in the Presentation, Treatment and Perioperative Outcomes from 2003-2010

Cited by 15 publications

References 0 publications

The Current State of Minimally Invasive Approaches to Adult Spinal Deformity

The Current State of Minimally Invasive Approaches to Adult Spinal Deformity

Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers

The relationship of global sagittal malalignment to fatty infiltration in the aging spine

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