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Adult spinal deformity

Alexander A Theologis, Gregory M Mundis, Stacie Nguyen, David O Okonkwo, Praveen V Mummaneni, Justin S Smith, Christopher I Shaffrey, Richard Fessler, Shay Bess, Frank Schwab, Bassel G Diebo, Douglas Burton, Robert Hart, Vedat Deviren, Christopher Ames
OBJECTIVE The aim of this study was to evaluate the utility of supplementing long thoracolumbar posterior instrumented fusion (posterior spinal fusion, PSF) with lateral interbody fusion (LIF) of the lumbar/thoracolumbar coronal curve apex in adult spinal deformity (ASD). METHODS Two multicenter databases were evaluated. Adults who had undergone multilevel LIF of the coronal curve apex in addition to PSF with L5-S1 interbody fusion (LS+Apex group) were matched by number of posterior levels fused with patients who had undergone PSF with L5-S1 interbody fusion without LIF (LS-Only group)...
October 21, 2016: Journal of Neurosurgery. Spine
Mitsuru Yagi, Hideaki Ohne, Tsunehiko Konomi, Kanehiro Fujiyoshi, Shinjiro Kaneko, Masakazu Takemitsu, Masafumi Machida, Yoshiyuki Yato, Takashi Asazuma
BACKGROUND CONTEXT: Gait patterns and their relationship to demographic and radiographic data in patients with adult spinal deformity (ASD) have not been fully documented. PURPOSE: To assess gait pattern in patients with ASD and the effect of corrective spinal surgery on gait. STUDY DESIGN/SETTING: Prospective case series. PATIENT SAMPLE: The gait patterns of 33 consecutive female with ASD (age 67.1 years; body mass index (BMI) 22...
October 17, 2016: Spine Journal: Official Journal of the North American Spine Society
Shaishav Bhagat, Alexander Z E Durst, Am S Rai
With an increasingly aging population, adult spinal deformity is becoming more common. This can be associated with increased morbidity. Results from multicentre studies of deformity surgery correction confirm complication rates as high as 40 percent. Most often a bad result is associated with inadequate restoration of the sagittal balance. Posterior vertebral body resection has been described as a method to correct significant deformity, but this is a complicated procedure. It is possible to do this in the thoracic spine where nerve roots can be sacrificed, but it is difficult in the lumbar spine due to the significant role of the lumbar nerve roots...
September 2016: J Spine Surg
Michael Pickell, Stephen M Mann, Rajesh Chakravertty, Daniel P Borschneck
BACKGROUND: This is a prospective observational study examining the use of a surgeon-driven intraoperative neurophysiologic monitoring system. Intraoperative neurophysiologic monitoring is becoming the standard of care for spinal surgeries with potential post-operative neurologic deficits. This standard applies to both adult and pediatric spinal surgery, but a shortage of appropriately trained and certified technologists and physiologists can compromise monitoring capabilities in some centers...
September 2016: J Spine Surg
Leo Fradet, Xiaoyu Wang, Lawrence G Lenke, Carl-Eric Aubin
BACKGROUND: Proximal junctional failure is a severe proximal junctional complication following adult spinal instrumentation and involving acute proximal junctional kyphotic deformity, mechanical failure at the upper instrumented vertebra or just above, and/or proximal junctional osseoligamentous disruption. Clinical studies have identified potential risk factors, but knowledge on their biomechanics is still lacking for addressing the proximal junctional failure issues. The objective of this study was to develop comprehensive computational modeling and simulation techniques to investigate proximal junctional failure...
October 11, 2016: Clinical Biomechanics
D Kojo Hamilton, Christopher Kong, Jayme Hiratzka, Alec G Contag, Tamir Ailon, Breton Line, Alan Daniels, Justin S Smith, Peter Passias, Themistocles Protopsaltis, Daniel Sciubba, Douglas Burton, Christopher Shaffrey, Eric Klineberg, Gregory Mundis, Han-Jo Kim, Virginie Lafage, Renaud Lafage, Justin Scheer, Oheneba Boachie-Adjei, Shay Bess, Robert Hart
STUDY DESIGN: This is a multicenter retrospective review of prospectively collected cases. OBJECTIVE: Our objective was to evaluate the relationship between patient satisfaction, HRQoL scores, complications, and radiographic measures at 2 years post-operative follow-up. SUMMARY OF BACKGROUND DATA: For patients receiving operative management for adult spine deformity (ASD), the relationship between health-related quality of life (HRQoL) measures, radiographic parameters, post-operative complications, and self-reported satisfaction remains unclear...
September 29, 2016: Spine
Yong-Chan Kim, Lawrence G Lenke, Seon-Jong Lee, Jeffrey L Gum, Sirichai Wilartratsami, Kathy M Blanke
PURPOSE: Our study aimed to confirm the correlation between the Cranial Sagittal Vertical Axis (CrSVA) and patient-reported outcomes and to compare clinical correlation between CrSVA and C7 SVA in adult spinal deformity (ASD) patients. METHODS: 108 consecutive ASD patients were evaluated using the EOS(®) 2D/3D radio-imaging device. A vertical plumb line from the cranial center was utilized to measure the distance to the posterior corner of S1 (CrSVA-S), and to the centers of the hip (CrSVA-H), the knee (CrSVA-K), and ankle (CrSVA-A), as well as measuring the standard C7 SVA...
October 14, 2016: European Spine Journal
Martin H Pham, Alexander Tuchman, Lance Smith, Andre M Jakoi, Neil N Patel, Vivek A Mehta, Frank L Acosta
Proximal junctional kyphosis is an increasingly recognized complication following long-segment posterior spinal fusion for adult spinal deformity. The authors describe a novel technique for interspinous ligament reinforcement at the proximal adjacent levels using a cadaveric semitendinosus tendon graft secured with an Ethibond No. 2 double filament (Ethicon, Somerville, New Jersey) via the Krackow suture weave. A retrospective review identified 4 patients who had received this graft. No proximal junctional kyphosis was seen at a mean short-term follow-up of 5...
October 13, 2016: Orthopedics
Aladine A Elsamadicy, Owoicho Adogwa, Amanda Sergesketter, Shay Behrens, Cassie Hobbs, Keith H Bridwell, Isaac O Karikari
BACKGROUND: Spinal deformities that require ≥5 fusion levels are difficult and challenging for both the surgeon and patient. Corrections of moderate to severe deformities have been shown to improve patient reported outcomes (PRO), and provide patients a better quality of life. Self-Image is an important PRO as it sheds insight into the patient's perception of health, as well as serves as a proxy of satisfaction for spine deformity patients undergoing corrective surgery. However, with an aging population, the impact of age on long-term change in Self-Image is unknown...
October 3, 2016: World Neurosurgery
Sriram Balasubramanian, James R Peters, Lucy F Robinson, Anita Singh, Richard W Kent
PURPOSE: Based on the structural anatomy, loading condition and range of motion (ROM), no quadruped animal has been shown to accurately mimic the structure and biomechanical function of the human spine. The objective of this study is to quantify the thoracic vertebrae geometry of the kangaroo, and compare with adult human, pig, sheep, and deer. METHODS: The thoracic vertebrae (T1-T12) from whole body CT scans of ten juvenile kangaroos (ages 11-14 months) were digitally reconstructed and geometric dimensions of the vertebral bodies, endplates, pedicles, spinal canal, processes, facets and intervertebral discs were recorded...
October 4, 2016: European Spine Journal
Ali Babashahi, Morteza Taheri
Spinal kyphotic deformity after spinal laminectomy or laminoplasty is more common in pediatric patients than adults. Laminectomy can lead to decreased cartilage growth, anterior wedging and posterior spinal muscle insufficiency which can result in kyphotic deformity. Herein we outline a case report of a child presenting with kyphotic deformity after receiving a spinal laminectomy to treat a penetrating spinal trauma. The 8-year-old male presented with penetrating spinal trauma following a gunshot wound and subsequently underwent L1 laminectomy and thecal sac decompression to remove the foreign body...
March 2016: J Spine Surg
Jean-Claude Bernard, Karimann Abelin-Genevois, Isabelle Courtois
This is a national retrospective study realized by the Study Group of Scoliosis (GES) with the support of 7 competence centers about the follow up of the spine for patients with Marfan's disease. The sample consists of 167 patients: 99 women and 67 men. It is composed of children and adults and the mean age is 31 years. In this sample, we find 72% of spine deformity (scoliosis and kyphosis): in the literature, 63% for Sponseller and al, (JBJSa 1995), and 56% for Garreau and al, (JBJS, 2006). The discovery of the spine problem is effective of 12,8 years old (ET=4,2; range=1-53)...
September 2016: Annals of Physical and Rehabilitation Medicine
Mitsuru Yagi, Shinjiro Kaneko, Yoshiyuki Yato, Takashi Asazuma
STUDY DESIGN: Prospective case series. OBJECTIVE: To compare the standing balance and posture between patients with ASD and healthy volunteers (HV). SUMMARY OF BACKGROUND DATA: The effect of adult spinal deformity (ASD) on standing posture and balance has not been fully documented. METHODS: 40 consecutive female patients with ASD (65.4 ± 6.7 years, Cobb angle 48.6 ± 20.2°, C7PL 9.1 ± 6.4 cm, and PI-LL 41...
September 23, 2016: Spine
Junseok Bae, Alexander A Theologis, Jee-Soo Jang, Sang-Ho Lee, Vedat Deviren
STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To assess global and regional spinal sagittal radiographic parameters in adults with loss of lumbar lordosis ("flatback") before and after walking 10 minutes. SUMMARY OF BACKGROUND DATA: While routine activities of daily living may exacerbate functional disability of spinal sagittal-plane deformity, there is limited understanding of how sagittal parameters and compensatory mechanisms are affected by activity...
September 9, 2016: Spine
Jeffrey L Gum, Leah Y Carreon, Jacob M Buchowski, Lawrence G Lenke, Steven D Glassman
BACKGROUND: Increased awareness regarding the importance of the sagittal spinal profile has led to more aggressive correction of sagittal malalignment. The utilization trends of pedicle subtraction osteotomy (PSO) for sagittal plane correction in spinal deformity surgery have not been well characterized. METHODS: A commercially available database (PearlDiver, Inc) was queried for both Private Payor and 5 % Medicare claims from 2008 to 2011. Revision and clarification of the coding guidelines for PSO were introduced in 2008...
2016: Scoliosis and Spinal Disorders
Dante M Leven, Nathan J Lee, Parth Kothari, Jeremy Steinberger, Javier Guzman, Branko Skovrlj, John I Shin, John M Caridi, Samuel K Cho
STUDY DESIGN: Retrospective study of prospectively collected data. OBJECTIVE: To determine if the modified frailty index (mFI) could be used to predict postoperative complications in patients undergoing surgery for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Surgery for patients with ASD is associated with high complication rates and significant concerns present during risk stratification with older patients. The mFI is an evaluation tool to describe the frailness of an individual and how their preoperative status may impact postoperative survival and outcomes...
August 31, 2016: Spine
Yuki Taniguchi, Miwako Takahashi, Ko Matsudaira, Hiroyuki Oka, Toshimitsu Momose
Patients with adult spinal deformity (ASD) are surgically treated for pain relief; however, visualization of the exact origin of the pain with imaging modalities is still challenging. We report the first case of a 60-year-old female patient who presented with painful degenerative kyphoscoliosis and was evaluated with flourine-18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) preoperatively. Because her low back pain was resistant to conservative treatment, she was treated with posterior spinal correction and fusion surgery from Th2 to the ilium...
November 2016: Skeletal Radiology
Joshua Bakhsheshian, Justin K Scheer, Jeffrey L Gum, Richard Hostin, Virginie Lafage, Shay Bess, Themistocles S Protopsaltis, Douglas C Burton, Malla Kate Keefe, Robert A Hart, Gregory M Mundis, Christopher I Shaffrey, Frank Schwab, Justin S Smith, Christopher P Ames
OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up...
August 19, 2016: Journal of Neurosurgery. Spine
Jamal McClendon, Timothy R Smith, Patrick A Sugrue, Sara E Thompson, Brian A O'Shaughnessy, Tyler R Koski
OBJECTIVE: To evaluate spinal implant density and proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). METHODS: Consecutive ASD patients receiving >5 level fusions were retrospectively analyzed between 2007 and 2010. INCLUSION CRITERIA: ASD, elective fusions, minimum 2-year follow-up. EXCLUSION CRITERIA: Age < 18 years, neuromuscular or congenital scoliosis, cervical or cervicothoracic fusions, non-elective conditions (infection, tumor, trauma)...
August 12, 2016: World Neurosurgery
Jeffrey L Gum, Richard Hostin, Chessie Robinson, Michael P Kelly, Leah Yacat Carreon, David W Polly, R Shay Bess, Douglas C Burton, Christopher I Shaffrey, Justin S Smith, Virginie LaFage, Frank J Schwab, Christopher P Ames, Steven D Glassman
BACKGROUND CONTEXT: Over the past decade, the number of adult spinal deformity (ASD) surgeries has more than doubled in the United States. The complex surgeries needed to manage ASD are associated with significant resource utilization and high cost, making them a primary target for increased scrutiny. Accordingly, it is important to not only demonstrate value in ASD surgery as clinical effectiveness but also to translate outcome assessment to cost-effectiveness. PURPOSE: To compare the difference between Medicare allowable rates and the actual, direct hospital costs for ASD surgeries...
August 11, 2016: Spine Journal: Official Journal of the North American Spine Society
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