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An international consensus on the appropriate evaluation and treatment for adults with spinal deformity

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  1. Classification of normal sagittal spine alignment: refounding the Roussouly classification

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  2. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy

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  3. Significant differences in morbidity when comparing adverse events for cervical and lumbar spine surgery - prospectively graded with SAVES

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  • AOSpine Knowledge Forum Deformity
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PURPOSE: Evaluation and surgical management for adult spinal deformity (ASD) patients varies between health care providers. The purpose of this study is to identify appropriateness of specific approaches and management strategies for the treatment of ASD.

METHODS: From January to July 2015, the AOSpine Knowledge Deformity Forum performed a modified Delphi survey where 53 experienced deformity surgeons from 24 countries, rated the appropriateness of management strategies for multiple ASD clinical scenarios. Four rounds were performed: three surveys and a face-to-face meeting. Consensus was achieved with ≥70% agreement.

RESULTS: Appropriate surgical goals are improvement of function, pain, and neural symptoms. Appropriate preoperative patient evaluation includes recording information on history and comorbidities, and radiographic workup, including long standing films and MRI for all patients. Preoperative pulmonary and cardiac testing and DEXA scan is appropriate for at-risk patients. Intraoperatively, appropriate surgical strategies include long fusions with deformity correction for patients with large deformity and sagittal imbalance, and pelvic fixation for multilevel fusions with large curves, sagittal imbalance, and osteoporosis. Decompression alone is inappropriate in patients with large curves, sagittal imbalance, and progressive deformity. It is inappropriate to fuse to L5 in patients with symptomatic disk degeneration at L5-S1.

CONCLUSIONS: These results provide guidance for informed decision-making in the evaluation and management of ASD. Appropriate care for ASD, a very diverse spectrum of disease, must be responsive to patient preference and values, and considerations of the care provider, and the healthcare system. A monolithic approach to care should be avoided.

Original languageEnglish
JournalEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Volume27
Issue number3
Pages (from-to)585-596
Number of pages12
ISSN0940-6719
DOIs
Publication statusPublished - Mar 2018

    Research areas

  • Adult, Aged, Delphi Technique, Diagnostic Imaging, Female, Humans, Male, Medical History Taking, Middle Aged, Orthopedic Procedures/standards, Physical Examination, Postoperative Care/standards, Postoperative Complications/prevention & control, Preoperative Care/standards, Spinal Curvatures/diagnostic imaging, Venous Thrombosis/prevention & control

ID: 56465110