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DeWald, Christopher et al.: 2024 Spinal Deformities DOI: 10.1055/b-0044-203435
Section I-C Clinical and Radiographic Evaluation of Spinal Deformities

12 Evaluation of the Adult Spinal Deformity Patient

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Editors: DeWald, Christopher; DeWald, Ronald L.

Authors: Ackshota, Nissim; Ahn, Nicholas U.; Alazzeh, Mohanad; Albert, Todd J.; Algattas, Hanna; An, Howard S.; Anari, Jason B.; Arlet, Vincent; Asher†, Marc A.; Belanger, Evan H.; Blakemore, Laurel C.; Blanke, Kathleen M.; Bondar, Kevin; Buchowski, Jacob M.; Bunch, Joshua T.; Burton, Douglas C.; Cahill, Patrick J.; Campbell, Robert; Carl, Allen L.; Caruso, Steven; Cerpa, Meghan; Charosky, Sebastien; Cognetti, Daniel J.; Crawford, Alvin H.; Crawford III, Charles H.; Cui, Shari; Daffner, Scott D.; Dede, Ozgur; Dekutoski, Mark B.; DeWald, Christopher J.; Dormans, John P.; Drayer, Nicholas J.; Drummond†, Denis S.; Emery, Sanford E.; Farcy, Jean-Pierre C.; Farrell, James P.; Fontes, Ricardo B. V.; Forsthoefel, Craig; Frost, Chelsea; Gaines, Robert W.; Gandhi, Sapan D.; Gehrchen, Martin; Glassman, Steven D.; Guiroy, Alfredo; Gupta, Munish C.; Ha, Alex S.; Hadeed, Michael M.; Haher, Thomas R.; Hamill, Christopher L.; Hamilton, D. Kojo; Hariharan, Arun R.; Harrop, James S.; Hashmi, Sohaib Z.; Hassanzadeh, Hamid; Heydemann, John A.; Horowitz, Jason A.; Howard, Roland; Hu, Ming-Hsiao; Hu, Serena S.; Hwang, Steven W.; Iyer, Sravisht; Jain, Amit; Jain, Viral V.; Janjua, M. Burhan; Jorgensen, Anton; Kang, Daniel G.; Kawakami, Noriaki; Kebaish, Khaled M.; Kelly, Michael P.; Kim, Han Jo; Labaran, Lawal A.; Lafage, Virginie; Laratta, Joseph L.; Lehman, Ronald A.; Lenke, Lawrence G.; Loder, Randall T.; Lonstein, John E.; Louie, Philip K.; Lubicky, John P.; Malik, Mohammad Saad; Marco, Rex A.W.; Mardjetko, Steven M.; Marrache, Majd; Maslak, Joseph P.; McCarthy, Michael H.; Melikian, Rojeh; Miller, Catherine; Min, Kan; Moquin, Ross R.; Morrison, Pamela R.; Mummaneni, Praveen V.; Nelson, Scott; Newton, Peter O.; Nolte, Michael T.; O’Brien†, Michael F.; Oetgen, Matthew E.; Ogilvie, James W.; Pannu, Tejbir S.; Petfield, Joseph L.; Riccio, Alexander R.; Roussouly, Pierre; Rymarczuk, George; Saifi, Comron; Salari, Pooria A.; Samdani, Amer F.; Sanders, James O.; Sarwark, John F.; Schwab, Frank J.; Sebaaly, Amer; Sengupta, Dilip K.; Shafi, Karim; Shah, Suken A.; Sheha, Evan D.; Shen, Francis H.; Shimer, Adam L.; Shtewe, Anan H.; Singla, Priyanka; Sponseller, Paul; Staub, Blake N.; Stricsek, Geoffrey P.; Sturm, Peter F.; Suk, Se-Il; Theologis, Alekos A.; Thompson, George H.; Thottempudi, Santan; Uribe, Juan S.; Vivas, Andrew C.; Wallace, Christopher S.; Witte, Zackery W.; Wood, Kirkham B.; York, Philip J.; Yu, Henry H.; Zebala, Lukas P.; Zhang, Bo; Zhao, Yiyu

Title: Spinal Deformities

Subtitle: The Comprehensive Text

Print ISBN: 9781626233720; Online ISBN: 9781684203604; Book DOI: 10.1055/b000000246

2. Edition © 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc., New York

Subjects: Neurosurgery;Orthopaedics and Trauma Surgery

Thieme Clinical Collections (English Language)



 
Sapan D. Gandhi, Evan D. Sheha, and Mark B. Dekutoski

Abstract

Although challenging, successful evaluation of the adult spinal deformity patient can be accomplished with a careful, systematic approach. A thorough history and physical examination with attention to alleviating and aggravating factors are the first step in evaluation. The patient’s past medical and surgical history, as well as medications and social history can play an instrumental role in management of the adult spinal deformity patient. Standing plain film radiographs, as well as supine and bending films, are the workhorse imaging modalities for the treating surgeon. These modalities should be carefully examined to determine the patients global balance, as well as spinopelvic parameters that can guide decision-making. Any neurologic symptoms should prompt obtaining an MRI scan, while CT scans can be utilized for more in-depth surgical planning. When nonoperative management fails, surgical intervention should be considered. Bone quality must be assessed preoperatively, generally utilizing dual-energy X-ray absorptiometry. The most critical and final step in adult spinal deformity patient evaluation is a thorough discussion regarding patient’s expectation management.

Key words

evaluation of adult deformity - adult spinal deformity - imaging in spinal deformity - complications in adult deformity - patient expectations
 
  • 3 Kobayashi T, Atsuta Y, Takemitsu M, Matsuno T, Takeda N. A prospective study of de novo scoliosis in a community based cohort.. Spine 2006; 31 (2) 178-182 PubMed (PMID: 16418637)
    PubMedGoogle Scholar
  • 4 Schwab F, Dubey A, Gamez L et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population.. Spine 2005; 30 (9) 1082-1085 PubMed (PMID: 15864163)
    PubMedGoogle Scholar
  • 8 Bess S, Line B, Fu K-M, et al. The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases.. Spine 2016; 41 (3) 224-233 PubMed (PMID: 26571174)
    PubMedGoogle Scholar
  • 9 Pellisé F, Vila-Casademunt A, Ferrer M, et al. Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions.. Eur Spine J 2015; 24 (1) 3-11 PubMed (PMID: 25218732)
    PubMedGoogle Scholar
  • 10 Diebo BG, Lavian JD, Murray DP et al. The impact of comorbid mental health disorders on complications following adult spinal deformity surgery with minimum 2-year surveillance.. Spine 2018; 43 (17) 1176-1183 PubMed (PMID: 29419714)
    PubMedGoogle Scholar
  • 11 Fehlings MG, Tetreault LA, Aarabi B et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of anticoagulant thromboprophylaxis.. Global Spine J 2017; 7 (3) (Suppl. Suppl) 212S-220S PubMed (PMID: 29164026)
    PubMedGoogle Scholar
  • 12 Arnold PM, Harrop JS, Merli G et al. Efficacy, safety, and timing of anticoagulant thromboprophylaxis for the prevention of venous thromboembolism in patients with acute spinal cord injury: a systematic review.. Global Spine J 2017; 7 (3) (Suppl. Suppl) 138S-150S PubMed (PMID: 29164021)
    PubMedGoogle Scholar
  • 13 Bono CM, Watters III WC, Heggeness MH et al. An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery.. Spine J 2009; 9 (12) 1046-1051 PubMed (PMID: 19931184)
    PubMedGoogle Scholar
  • 14 Glassman SD, Alegre GM. Adult spinal deformity in the osteoporotic spine: options and pitfalls.. Instr Course Lect 2003; 52: 579-588 PubMed (PMID: 12690884)
    PubMedGoogle Scholar
  • 15 Ponnusamy KE, Iyer S, Gupta G, Khanna AJ. Instrumentation of the osteoporotic spine: biomechanical and clinical considerations.. Spine J 2011; 11 (1) 54-63 PubMed (PMID: 21168099)
    PubMedGoogle Scholar
  • 16 Seki S, Hirano N, Kawaguchi Y et al. Teriparatide versus low-dose bisphosphonates before and after surgery for adult spinal deformity in female Japanese patients with osteoporosis.. Eur Spine J 2017; 26 (8) 2121-2127 PubMed (PMID: 28116510)
    PubMedGoogle Scholar
  • 17 Smith JS, Shaffrey CI, Glassman SD, et al. Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults.. Eur Spine J 2013; 22 (2) 402-410 PubMed (PMID: 23073746)
    PubMedGoogle Scholar
  • 18 Raad M, Jain A, Neuman BJ, et al. Association of patient-reported narcotic use with short- and long-term outcomes after adult spinal deformity surgery: multicenter study of 425 patients with 2-year follow-up.. Spine 2018; 43 (19) 1340-1346 PubMed (PMID: 29538242)
    PubMedGoogle Scholar
  • 19 Mesfin A, Lenke LG, Bridwell KH et al. Does preoperative narcotic use adversely affect outcomes and complications after spinal deformity surgery? A comparison of nonnarcotic- with narcotic-using groups.. Spine J 2014; 14 (12) 2819-2825 PubMed (PMID: 24704676)
    PubMedGoogle Scholar
  • 20 Hadley MN, Reddy SV. Smoking and the human vertebral column: a review of the impact of cigarette use on vertebral bone metabolism and spinal fusion.. Neurosurgery 1997; 41 (1) 116-124 PubMed (PMID: 9218303)
    PubMedGoogle Scholar
  • 21 Andersen T, Christensen FB, Laursen M, Høy K, Hansen ES, Bünger C. Smoking as a predictor of negative outcome in lumbar spinal fusion.. Spine 2001; 26 (23) 2623-2628 PubMed (PMID: 11725245)
    PubMedGoogle Scholar
  • 22 Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect of cigarette smoking and smoking cessation on spinal fusion.. Spine 2000; 25 (20) 2608-2615 PubMed (PMID: 11034645)
    PubMedGoogle Scholar
  • 23 Nielsen PR, Jørgensen LD, Dahl B, Pedersen T, Tønnesen H. Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial.. Clin Rehabil 2010; 24 (2) 137-148 PubMed (PMID: 20103575)
    PubMedGoogle Scholar
  • 24 Gometz A, Maislen D, Youtz C et al. The effectiveness of prehabilitation (prehab) in both functional and economic outcomes following spinal surgery: a systematic review.. Cureus 2018; 10 (5) e2675 PubMed (PMID: 30050730)
    PubMedGoogle Scholar
  • 25 Deviren V, Berven S, Kleinstueck F, Antinnes J, Smith JA, Hu SS. Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic scoliosis.. Spine 2002; 27 (21) 2346-2349 PubMed (PMID: 12438982)
    PubMedGoogle Scholar
  • 26 Bradford DS, Tay BK, Hu SS. Adult scoliosis: surgical indications, operative management, complications, and outcomes.. Spine 1999; 24 (24) 2617-2629 PubMed (PMID: 10635525)
    PubMedGoogle Scholar
  • 27 Korovessis P, Stamatakis M, Baikousis A, . Segmental roentgenographic analysis of vertebral inclination on sagittal plane in asymptomatic versus chronic low back pain patients.. J Spinal Disord 1999; 12 (2) 131-137 PubMed (PMID: 10229527)
    PubMedGoogle Scholar
  • 28 Schwab F, Patel A, Ungar B, Farcy J, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery.. Spine 2010; 35 (25) 2224-2231 PubMed (PMID: 21102297)
    PubMedGoogle Scholar
  • 29 Presciutti SM, Louie PK, Khan JM et al. Sagittal spinopelvic malalignment in degenerative scoliosis patients: isolated correction of symptomatic levels and clinical decision-making.. Scoliosis Spinal Disord 2018; 13 (1) 28 PubMed (PMID: 30607367)
    PubMedGoogle Scholar
  • 30 Schwab F, Blondel B, Chay E et al. The comprehensive anatomical spinal osteotomy classification.. Neurosurgery 2015; 76 (Suppl. Suppl 1) S33-S41, discussion S41 PubMed (PMID: 25692366)
    PubMedGoogle Scholar
  • 31 Terran J, Schwab F, Shaffrey CI, et al. The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort.. Neurosurgery 2013; 73 (4) 559-568 PubMed (PMID: 23756751)
    PubMedGoogle Scholar
  • 32 Mundis Jr GM, Turner JD, Kabirian N, et al. Anterior column realignment has similar results to pedicle subtraction osteotomy in treating adults with sagittal plane deformity.. World Neurosurg 2017; 105: 249-256 PubMed (PMID: 28559074)
    PubMedGoogle Scholar
  • 33 Saigal R, Mundis Jr GM, Eastlack R, Uribe JS, Phillips FM, Akbarnia BA. Anterior column realignment (ACR) in adult sagittal deformity correction: technique and review of the literature.. Spine 2016; 41 (8) (Suppl. Suppl 8) S66-S73 PubMed (PMID: 26839994)
    PubMedGoogle Scholar
  • 34 Stoker GE, Buchowski JM, Bridwell KH, Lenke LG, Riew KD, Zebala LP. Preoperative vitamin D status of adults undergoing surgical spinal fusion.. Spine 2013; 38 (6) 507-515 PubMed (PMID: 22986835)
    PubMedGoogle Scholar
  • 36 Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH. Adult spinal deformity surgery: complications and outcomes in patients over age 60.. Spine 2007; 32 (20) 2238-2244 PubMed (PMID: 17873817)
    PubMedGoogle Scholar
  • 37 Schwab FJ, Hawkinson N, Lafage V, et al. Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients.. Eur Spine J 2012; 21 (12) 2603-2610 PubMed (PMID: 22592883)
    PubMedGoogle Scholar
  • 38 Smith JS, Klineberg E, Lafage V, et al. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.. J Neurosurg Spine 2016; 25 (1) 1-14 PubMed (PMID: 26918574)
    PubMedGoogle Scholar
  • 39 Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG. The impact of perioperative complications on clinical outcome in adult deformity surgery.. Spine 2007; 32 (24) 2764-2770 PubMed (PMID: 18007258)
    PubMedGoogle Scholar
  • 40 Hart RA, Cabalo A, Bess S, et al. Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery.. Spine 2013; 38 (9) 732-736 PubMed (PMID: 24477053)
    PubMedGoogle Scholar
  • 41 Haefeli M, Elfering A, Aebi M et al. What comprises a good outcome in spinal surgery? A preliminary survey among spine surgeons of the SSE and European spine patients.. Eur Spine J 2008; 17 (1) 104-116 PubMed (PMID: 17990007)
    PubMedGoogle Scholar