Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management

Ames, Christopher P.; Scheer, Justin K.; Lafage, Virginie; Smith, Justin S.; Bess, Shay; Berven, Sigurd; Mundis, Gregory M.; Sethi, Rajiv K.; Deinlein, Donald; Coe, Jeffrey D.; Hey, Lloyd A.; Daubs, Michael D.

doi:10.1016/j.jspd.2015.12.009

Cited by 206 publications

(153 citation statements)

References 73 publications

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“…The reported prevalence of adult spinal deformity (ASD) in the general population ranges from 2% to 32% [1][2][3]. The impact of ASD on a patient's quality of life can be debilitating, and in our aging world, increased numbers of patients with ASD are predicted.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study

et al. 2018

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“…1 The prevalence of adult spinal deformity (ASD) has been reported to be between 32% and 68%. 2 Individuals with ASD present with a variety of symptoms, including pain, postural asymmetry, balance dysfunction, diminished endurance, and selfimage issues, as well as diminished quality of life. 1 As the activity level and age of patients with scoliosis continues to increase, there has been a growing need for nonoperative treatment to circumvent risks of undergoing a major operation at an older age.…”

Section: Introductionmentioning

confidence: 99%

Surgeon Attitudes Toward Physiotherapeutic Scoliosis-Specific Exercises in Adult Patients With Spinal Deformities

et al. 2020

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Background: Physiotherapeutic scoliosis-specific exercise (PSSE) has proven to be an important treatment for patients with adolescent idiopathic scoliosis. However, there is a lack of understanding of the role of PSSE in older adults with spinal deformity. Methods: An electronic, 14-question survey with questions regarding the use of physical therapy (PT) and PSSE for adult spinal deformity was administered to all Scoliosis Research Society members. Physician location, age, specialty, years in experience, and management preferences were quantified using descriptive analyses. Results: Of the 98 surgeons who participated in this study, the majority of respondents were from North America (71.1%), and the mean age was 51.87 6 10.93 years; approximately 98% of respondents were orthopedic surgeons, and 48.0% had been in practice for more than 21 years. Sixty-four percent reported they prescribed PT in their practice, with 52% of respondents often using PT as nonoperative treatment; 21.4%, preoperative; and 40.8% postoperative. The primary reason for PT referral was persistent pain (40.3%), followed by impairments to the patient's balance or gait (34.3%) and difficulty with daily living activities (25.4%). The primary indications for not referring postoperative patients to PT were lack of perceived value from PT (50%), lack of evidence supporting the benefits from PT (31.3%), and a lack of physical therapists appropriately trained for scoliosis (18.8%). Of the respondents, 74% were familiar with PSSE and 66% were comfortable prescribing PSSE postoperatively. In addition, 28% of respondents agreed that .12 weeks postoperation was the ideal time for PSSE referral, followed by 6 to 8 weeks postoperation (26.2%) and immediately postoperation (18%). Conclusions: The results show that the majority of respondents prescribed PSSE solely for nonoperative treatment. Respondents who did not prescribe PSSE reported skepticism due to a lack of perceived value. This suggests the need for further research into the benefits of PSSE. Level of Evidence: 5. Clinical Relevance: Physiotherapeutic Scoliosis Specific Exercises (PSSE) is an important non-operative treatment for patients with Adolescent Idiopathic Scoliosis (AIS) but is understudied in Adult Spinal Deformity (ASD) patients, suggesting further clinical research. This study demonstrates that only two-thirds of the respondents familiar with PSSE were comfortable prescribing PSSE postoperatively suggesting the need for further research into the effectiveness and benefits of PSSE in ASD patients.

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“…2 Prevalence estimates indicate that adult spinal deformity affects approximately 27.5 million elderly patients, which will likely be closer to 60 million patients in 2050. 3 In this growing, elderly population, the appropriate management of spinal deformity is not well-defined. 4 In the past decade, there has been a significant increase in both the rate and complexity of spine surgeries for elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients

Ibrahim

Singh

Beckerman

et al. 2019

Global Spine Journal

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Study Design: Retrospective case series. Objectives: Both the rate and complexity of spine surgeries in elderly patients has increased. This study reports the outcomes of multilevel spine fusion in elderly patients and provides evidence on the appropriateness of complex surgery in elderly patients. Methods: We identified 101 patients older than70 years who had ≥5 levels of fusion. Demographic, medical, and surgical data, and change between preoperative and >500 days postoperative health survey scores were collected. Health surveys were visual analogue scale (VAS), EuroQoL 5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-30), and Short Form health survey (SF-12) (physical composite score [PCS] and mental composite score [MCS]). Minimal clinically important differences (MCIDs) were defined for each survey. Results: Complications included dural tears (19%), intensive care unit admission (48%), revision surgery within 2 to 5 years (24%), and death within 2 to 5 years (16%). The percentage of patients who reported an improvement in health-related quality of life (HRQOL) of at least an MCID was: VAS Back 69%; EQ-5D 41%; ODI 58%; SRS-30 45%; SF-12 PCS 44%; and SF-12 MCS 48%. Improvement after a primary surgery, as compared with a revision, was on average 13 points higher in ODI ( P = .007). Patients who developed a surgical complication averaged an improvement 11 points lower on ODI ( P = .042). Patients were more likely to find improvement in their health if they had a lower American Society of Anesthesiologists or Charlson Comorbidity Index score or a higher metabolic equivalent score. Conclusions: In multilevel surgery in patients older than 70 years, complications are common, and on average 77% of patients attain some improvement, with 51% reaching an MCID. Physiological status is a stronger predictor of outcomes than chronological age.

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Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management

Cited by 206 publications

References 73 publications

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study

Surgeon Attitudes Toward Physiotherapeutic Scoliosis-Specific Exercises in Adult Patients With Spinal Deformities

Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients

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