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

AOSpine Knowledge Forum Deformity

doi:10.1007/s00586-017-5241-1

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

AOSpine Knowledge Forum Deformity

Department of Clinical Medicine

9 Citations (Scopus)

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.

Original language	English
Journal	European Spine Journal
Volume	27
Issue number	3
Pages (from-to)	585-596
Number of pages	12
ISSN	0940-6719
DOIs	https://doi.org/10.1007/s00586-017-5241-1
Publication status	Published - 2018

Keywords

Adult spinal deformity
Appropriateness
Consensus
Delphi
Surgery

Access to Document

10.1007/s00586-017-5241-1

Cite this

@article{aa1e3558bec5401e98868e433c2c8b72,

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 spinal deformity, Appropriateness, Consensus, Delphi, Surgery",

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",

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",

}

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

Y1 - 2018

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 spinal deformity

KW - Appropriateness

KW - Consensus

KW - Delphi

KW - Surgery

U2 - 10.1007/s00586-017-5241-1

DO - 10.1007/s00586-017-5241-1

M3 - Journal article

C2 - 28780621

AN - SCOPUS:85026801401

SN - 0940-6719

VL - 27

SP - 585

EP - 596

JO - European Spine Journal

JF - European Spine Journal

IS - 3

ER -

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

Abstract

Keywords

Access to Document

Fingerprint

Cite this