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

dc.contributor.author

Berven, Sigurd H

dc.contributor.author

Kamper, Steven J

dc.contributor.author

Germscheid, Niccole M

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Dahl, Benny

dc.contributor.author

Shaffrey, Christopher I

dc.contributor.author

Lenke, Lawrence G

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Lewis, Stephen J

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Cheung, Kenneth M

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Alanay, Ahmet

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Ito, Manabu

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Polly, David W

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Qiu, Yong

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de Kleuver, Marinus

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AOSpine Knowledge Forum Deformity

dc.date.accessioned

2023-07-08T12:58:43Z

dc.date.available

2023-07-08T12:58:43Z

dc.date.issued

2018-03

dc.date.updated

2023-07-08T12:58:43Z

dc.description.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.
dc.identifier

10.1007/s00586-017-5241-1

dc.identifier.issn

0940-6719

dc.identifier.issn

1432-0932

dc.identifier.uri

https://hdl.handle.net/10161/28339

dc.language

eng

dc.publisher

Springer Science and Business Media LLC

dc.relation.ispartof

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

dc.relation.isversionof

10.1007/s00586-017-5241-1

dc.subject

AOSpine Knowledge Forum Deformity

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Humans

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Spinal Curvatures

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Venous Thrombosis

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Postoperative Complications

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Diagnostic Imaging

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Medical History Taking

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Physical Examination

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Orthopedic Procedures

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Postoperative Care

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Preoperative Care

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Delphi Technique

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Adult

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Aged

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Middle Aged

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Female

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Male

dc.title

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

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

585

pubs.end-page

596

pubs.issue

3

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

27

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