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

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@article{332c756a334248e590cebc82142f6490,
title = "An international consensus on the appropriate evaluation and treatment for adults with spinal deformity",
abstract = "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.",
keywords = "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",
author = "Berven, {Sigurd H} and Kamper, {Steven J} and Germscheid, {Niccole M} and Benny Dahl and Shaffrey, {Christopher I} and Lenke, {Lawrence G} and Lewis, {Stephen J} and Cheung, {Kenneth M} and Ahmet Alanay and Manabu Ito and Polly, {David W} and Yong Qiu and {de Kleuver}, Marinus and {AOSpine Knowledge Forum Deformity}",
year = "2018",
month = "3",
doi = "10.1007/s00586-017-5241-1",
language = "English",
volume = "27",
pages = "585--596",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer",
number = "3",

}

RIS

TY - JOUR

T1 - An international consensus on the appropriate evaluation and treatment for adults with spinal deformity

AU - Berven, Sigurd H

AU - Kamper, Steven J

AU - Germscheid, Niccole M

AU - Dahl, Benny

AU - Shaffrey, Christopher I

AU - Lenke, Lawrence G

AU - Lewis, Stephen J

AU - Cheung, Kenneth M

AU - Alanay, Ahmet

AU - Ito, Manabu

AU - Polly, David W

AU - Qiu, Yong

AU - de Kleuver, Marinus

AU - AOSpine Knowledge Forum Deformity

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Delphi Technique

KW - Diagnostic Imaging

KW - Female

KW - Humans

KW - Male

KW - Medical History Taking

KW - Middle Aged

KW - Orthopedic Procedures/standards

KW - Physical Examination

KW - Postoperative Care/standards

KW - Postoperative Complications/prevention & control

KW - Preoperative Care/standards

KW - Spinal Curvatures/diagnostic imaging

KW - Venous Thrombosis/prevention & control

U2 - 10.1007/s00586-017-5241-1

DO - 10.1007/s00586-017-5241-1

M3 - Journal article

VL - 27

SP - 585

EP - 596

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 3

ER -

ID: 56465110