Treatment of adult thoracolumbar spinal deformity: past, present, and future.
Abstract
Care of the patient with adult spinal deformity (ASD) has evolved from being primarily
supportive to now having the ability to directly treat and correct the spinal pathology.
The focus of this narrative literature review is to briefly summarize the history
of ASD treatment, discuss the current state of the art of ASD care with focus on surgical
treatment and current challenges, and conclude with a discussion of potential developments
related to ASD surgery.In the past, care for ASD was primarily based on supportive
measures, including braces and assistive devices, with few options for surgical treatments
that were often deemed high risk and reserved for rare situations. Advances in anesthetic
and critical care, surgical techniques, and instrumentation now enable almost routine
surgery for many patients with ASD. Despite the advances, there are many remaining
challenges currently impacting the care of ASD patients, including increasing numbers
of elderly patients with greater comorbidities, high complication and reoperation
rates, and high procedure cost without clearly demonstrated cost-effectiveness based
on standard criteria. In addition, there remains considerable variability across multiple
aspects of ASD surgery. For example, there is currently very limited ability to provide
preoperative individualized counseling regarding optimal treatment approaches (e.g.,
operative vs nonoperative), complication risks with surgery, durability of surgery,
and likelihood of achieving individualized patient goals and satisfaction. Despite
the challenges associated with the current state-of-the-art ASD treatment, surgery
continues to be a primary option, as multiple reports have demonstrated the potential
for surgery to significantly improve pain and disability. The future of ASD care will
likely include techniques and technologies to markedly reduce complication rates,
including greater use of navigation and robotics, and a shift toward individualized
medicine that enables improved counseling, preoperative planning, procedure safety,
and patient satisfaction.Advances in the care of ASD patients have been remarkable
over the past few decades. The current state of the art enables almost routine surgical
treatment for many types of ASD that have the potential to significantly improve pain
and disability. However, significant challenges remain, including high complication
rates, lack of demonstrated cost-effectiveness, and limited ability to meaningfully
counsel patients preoperatively on an individual basis. The future of ASD surgery
will require continued improvement of predictability, safety, and sustainability.
Type
Journal articleSubject
ASD = adult spinal deformityCAT = computer adaptive testing
GSA = global sagittal alignment
ISSG = International Spine Study Group
LL = lumbar lordosis
MIS = minimally invasive surgery
PI = pelvic incidence
PJK = proximal junctional kyphosis
PROM = patient-reported outcomes measure
PROMIS = Patient-Reported Outcomes Measurement Information System
PSO = pedicle subtraction osteotomy
PT = pelvic tilt
RF = rod fracture
SVA = sagittal vertical axis
UIV = uppermost instrumented vertebra
adult spinal deformity
complications
future
history
predictive analytics
robotics
surgery
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https://hdl.handle.net/10161/19127Published Version (Please cite this version)
10.3171/2019.1.spine181494Publication Info
Smith, Justin S; Shaffrey, Christopher I; Ames, Christopher P; & Lenke, Lawrence G (2019). Treatment of adult thoracolumbar spinal deformity: past, present, and future. Journal of neurosurgery. Spine, 30(5). pp. 551-567. 10.3171/2019.1.spine181494. Retrieved from https://hdl.handle.net/10161/19127.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Christopher Ignatius Shaffrey
Professor of Orthopaedic Surgery
I have more than 25 years of experience treating patients of all ages with spinal
disorders. I have had an interest in the management of spinal disorders since starting
my medical education. I performed residencies in both orthopaedic surgery and neurosurgery
to gain a comprehensive understanding of the entire range of spinal disorders. My
goal has been to find innovative ways to manage the range of spinal conditions, straightforward
to complex. I have a focus on managing patients with complex s

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