Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine

Berjano, Pedro; Lamartina, Claudio

doi:10.1007/s00586-014-3219-9

Cited by 66 publications

(45 citation statements)

References 24 publications

(37 reference statements)

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“…Symptomatic patients commonly complain of pain and disability evidenced by poor health-related quality of life (HRQOL) scores [4]. The recognition of key spinopelvic parameters and disability thresholds [5][6][7], in conjunction with new classification systems [8,9], has helped guide the treatment of ASD. Operative intervention has been shown to improve HRQOL [10].…”

Section: Introductionmentioning

confidence: 99%

Neurological complications in adult spinal deformity surgery

Iorio

Reid

Kim

2016

Curr Rev Musculoskelet Med

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The number of surgeries performed for adult spinal deformity (ASD) has been increasing due to an aging population, longer life expectancy, and studies supporting an improvement in health-related quality of life scores after operative intervention. However, medical and surgical complication rates remain high, and neurological complications such as spinal cord injury and motor deficits can be especially debilitating to patients. Several independent factors potentially influence the likelihood of neurological complications including surgical approach (anterior, lateral, or posterior), use of osteotomies, thoracic hyperkyphosis, spinal region, patient characteristics, and revision surgery status. The majority of ASD surgeries are performed by a posterior approach to the thoracic and/or lumbar spine, but anterior and lateral approaches are commonly performed and are associated with unique neural complications such as femoral nerve palsy and lumbar plexus injuries. Spinal morphology, such as that of hyperkyphosis, has been reported to be a risk factor for complications in addition to three-column osteotomies, which are often utilized to correct large deformities. Additionally, revision surgeries are common in ASD and these patients are at an increased risk of procedure-related complications and nervous system injury. Patient selection, surgical technique, and use of intraoperative neuromonitoring may reduce the incidence of complications and optimize outcomes.

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Section: Introductionmentioning

confidence: 99%

Neurological complications in adult spinal deformity surgery

Iorio

Reid

Kim

2016

Curr Rev Musculoskelet Med

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“…Recent classifications [4,5] of adult deformity take into account sagittal alignment as a major factor determining outcomes. Recently, a validated, comprehensive classification of sagittal deformities has improved the comprehension of the deformity, showing how sagittal misalignment in any region of the spine has an influence on the rest of the spine, with reciprocal compensatory changes that express as deformity patterns (regional deformity plus typical compensatory changes for each type of deformity are a deformity pattern), and assisting the surgical planning [6].…”

Section: Introductionmentioning

confidence: 99%

Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities

Berjano

Aebi

2014

Eur Spine J

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Introduction The narrow correlation between sagittal alignment parameters and clinical outcomes has been widely established, demonstrating that improper sagittal alignment is a clinical condition that is associated with increased pain and limitations in patients' functional ability. Indication Lumbar pedicle subtraction osteotomy (PSO) is indicated in the treatment of large sagittal (more than 25°o f rigid loss of lordosis) deformities of the lumbar spine or its combination with coronal deformity, especially when they are rigid. Indication should be based on careful assessment of the severity of symptoms, functional impairment, functional expectations of the patient, general clinical condition and surgical and anesthesiological team experience. Risk should be carefully assessed and discussed to obtain appropriate informed consent. Surgical procedure Surgical planning includes selection of the safest levels for the upper and lower instrumented vertebra, site of the osteotomy, modality of fixation, and, most importantly angular value of the correction goal (target lumbar lordosis). Failure to adequately obtain the necessary amount of sagittal correction is the most frequent cause of failure and reoperation. Conclusion PSO is a valuable surgical procedure in correction of severe hypolordosis (=relative kyphosis) in the lumbar spine. It is a demanding procedure for the surgeon, the anesthesiologist and the intensive care team. Although its complication rate is high, it has a substantial positive impact in the quality of life of patients, including the elderly.

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“…The treatmentoriented classification system proposed by Berjano and Lamartina [5] addresses this issue and provides a guide for surgical planning in these cases. This classification provides also guidance for the identification of patients that need aggressive techniques of correction of sagittal misalignment Watch Master Lecture online & Pedro Berjano pberjano@gmail.com (such as PSO or ACR).…”

Section: Resultsmentioning

confidence: 99%