Adult Spinal Deformity Guidelines
To standardize the evaluation and treatment of adult spinal deformity (ASD), an international team of researchers has published new work titled, “An international consensus on the appropriate evaluation and treatment for adults with spinal deformity.” The article appears in the March 2018 edition of the European Spine Journal.
Sigurd Berven, M.D., chief of Spine Service at the University of San Francisco and co-author told OTW, “The topic is important and of interest because there is significant variability in the evaluation and treatment of adults with spinal deformity.”
“This variability reflects the absence of an evidence-based approach to care. A consensus of international experts offers the opportunity to identify evaluation strategies and treatment options that are clearly appropriate or inappropriate. The absence of a consensus also highlights areas that are important as a focus for future prospective investigation.”
“The study design was a modified Delphi survey including input from a panel of 53 experienced deformity surgeons from 24 countries. Through the AO knowledge forum, we have been able to bring together surgeons from around the world and learn from one another and develop evidence-based approaches to care that reflect the combined perspectives of a broad spectrum of experienced surgeons.”
“The surgeons rated the appropriateness of management strategies for multiple ASD clinical scenarios using the RAND/UCLA Appropriate Use Criteria system. Appropriate Use Criteria is a useful technique to identify evidence-based approaches to quite specific scenarios with variation of quite granular details.”
“Our study demonstrated that there is significant agreement on the appropriateness of specific surgical goals in adult deformity, including improvement of function, pain, and neural symptoms.”
“The panel agreed that preoperative evaluations with advanced imaging, and preoperative optimization of specific risk factors for poor outcome is important in patients with adult deformity.”
“Regarding intraoperative strategies, the panel agreed on the priority of sagittal plane alignment in deformity, and on the importance of pelvic fixation in long fusions.”
“The panel also agreed that surgical strategies that involve decompression without realignment are inappropriate for patients with large, and progressive deformity.”
“Other surgical strategies including the role of cement augmentation, postoperative chemoprophylaxis, and the role of limited vs extensive fusions had less agreement between experts and are therefore areas that may be appropriate for future research.”
“This work empowers surgeons to develop evidence-based protocols regarding preoperative optimization of patients prior to surgery, intraoperative standardization regarding techniques, and postoperative accountability regarding the result of care. The paper is useful for surgeons who seek to adopt optimal strategies for management of patients with adult deformity.”
“We would like for orthopedic and neuro surgeons to recognize that there is not a monolithic or dogmatic approach to the management of adult spinal deformity.”
“There are many areas regarding surgical strategies and approaches to care in which many alternatives many be appropriate. It is also important to recognize specific strategies that may be optimal, or in some cases inappropriate, for the management of quite specific scenarios.”
“The goal of the paper is to promote consensus in an evidence-based approach to optimal care.”
