Treatment of adult thoracolumbar spinal deformity: past, present, and future.

Smith, Justin S

Shaffrey, Christopher I

Ames, Christopher P

Lenke, Lawrence G

2019-08-01T13:30:08Z

2019-08-01T13:30:08Z

2019-05

2019-08-01T13:30:07Z

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.

2019.1.SPINE181494

1547-5654

1547-5646

https://hdl.handle.net/10161/19127

eng

Journal of Neurosurgery Publishing Group (JNSPG)

Journal of neurosurgery. Spine

10.3171/2019.1.spine181494

ASD = adult spinal deformity

CAT = 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

Treatment of adult thoracolumbar spinal deformity: past, present, and future.

Journal article

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

551

567

5

School of Medicine

Duke

Orthopaedics

Clinical Science Departments

Neurosurgery

Published

30