This literature review aims to determine potential clinical factors or comorbidities besides radiological parameters that affect the outcome of adult spinal deformity (ASD) management and review existing classifications associated with ASD. ASD is a multifactorial disease that comprises pathologies like radiological spine deformity, coexistence of spinal canal stenosis, radiculopathy, and multiple comorbidities. The available classification systems of ASD are predominantly based on radiological parameters and do not consider related clinical conditions. ASD patients with different combinations of these parameters behave differently and need different management strategies. We conducted a narrative literature review with search limited to English language of PubMed/MEDLINE using Medical Subject Heading (MeSH) terms. The terms specific to the review were ASD and several other related terminologies. We analyzed the information of the selected papers including factors affecting surgical outcomes for degenerative scoliosis. We reviewed 614 citations. Based on the inclusion criteria, 39 citations were selected for full-text retrieval; of these, 28 were excluded because of not fulfilling the inclusion criteria. Thus, 11 studies were selected and included for the final analysis. The presence of leg pain, spinal stenosis, obesity, osteoporosis, smoking, and age of patients were major influencing factors. Furthermore, the factors included in the available classifications, such as the Scoliosis Research Society–Schwab classifications, were reviewed and results were tabulated. This review highlights the significance of neurological symptoms, spinal stenosis, osteoporosis, obesity, age, and smoking, which markedly affect the management of ASD. With increasing number of patients being diagnosed and treated with ASD, there has been a growing need to comprehensively classify these patients into clinicoradiological subgroups.

Diffusion is the only source of nutrition to the intervertebral discs, and alteration of diffusion is considered to be the final common pathway for disc degeneration. Yet diffusion remains poorly understood due to the paucity of reliable methods to study diffusion noninvasively in humans in vivo. In recent years, postcontrast MRI has emerged as a powerful and reliable tool for analyzing diffusion in lumbar discs. Since it is noninvasive and safe, it can be used to document the process of diffusion temporally over a period of 24 hours. Well-designed studies have shown that diffusion is a very slow process, and that the endplate is the main structure that controls the process of diffusion. Contrast MRI studies have also made it possible to identify endplate breaks in vivo. In the future this technique may be applied to study the influence of smoking, mechanical loading of the discs, abnormal posture, and atherosclerosis of the lumbar arteries on diffusion. These conditions have all been implicated in disc degeneration through a final common pathway of altered diffusion and decreased nutrition. This review article focuses on the current knowledge, methodology, various factors that influence the diffusion properties of the discs, and future applications of this promising technique.

Notable morphological changes occurred in both the kyphosis fusion mass and the uninvolved levels above and below the lesion in children with healed spinal tuberculosis. These changes occurred during growth, after complete healing of the disease was achieved, and were responsible for the variability in progression of the deformity during growth seen in these children. Our results imply that all children with spinal tuberculosis must be followed up regularly till the entire growth potential is completed.

Study Design:Observational study.Purpose:The purpose of this study is to analyze the surgeon's neck postures while performing lumbar spinal surgeries.Overview of Literature:Lumbar spinal surgeries are on rising trend, and with increase in number of procedures, the average time spent by a spine surgeon performing surgical procedures is also increasing. The effect of operating posture on the surgeon's neck is largely unknown. From the studies conducted on usage of smartphones, abnormal neck postures, especially the forward head posture (FHP), were found to adversely affect the cervical spine of individuals. The present study analyzes the neck position of spine surgeons during lumbar spine surgeries.Methodology:Sixty video recordings (25 open transforaminal lumbar interbody fusions [TLIFs] and 35 lumbar decompression [LD] procedures – 15 with headlight and 20 with operating microscope) of surgeries performed by three spine surgeons of different heights were analyzed. Running videos of the surgeries were recorded concentrating on the surgeons with reflective markers taped to their surface landmarks corresponding to C7 spinous process, tragus of the ear, and outer canthus of the eye. Video recordings were standardized by a fixed video recorder in the same operating theater. Snapshots from the video were obtained whenever the surgeon changes the position. Head flexion angle (HFA), neck flexion angle (NFA), and cervical angle (CA) were measured and analyzed.Results:During TLIF, HFA and NFA were significantly higher during the phases of decompression and fusion (P < 0.05). The average CA of all surgeons was lower, thereby adversely affecting the cervical spine (20.15° ± 5.05°). During LD, CA showed significant difference between usage of microscope and headlight (P < 0.001).Conclusion:Surgeon's FHP is frequently caused by a compromise between the need to perform surgery with hands, without elevating the arms, and simultaneous control of gaze at surgical field. The usage of microscope was found to reduce the stress on neck while performing surgery.

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