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Erschienen in: European Spine Journal 3/2018

05.08.2017 | Original Article

An international consensus on the appropriate evaluation and treatment for adults with spinal deformity

verfasst von: Sigurd H. Berven, Steven J. Kamper, Niccole M. Germscheid, Benny Dahl, Christopher I. Shaffrey, Lawrence G. Lenke, Stephen J. Lewis, Kenneth M. Cheung, Ahmet Alanay, Manabu Ito, David W. Polly, Yong Qiu, Marinus de Kleuver, AOSpine Knowledge Forum Deformity

Erschienen in: European Spine Journal | Ausgabe 3/2018

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Abstract

Purpose

Evaluation and surgical management for adult spinal deformity (ASD) patients varies between health care providers. The purpose of this study is to identify appropriateness of specific approaches and management strategies for the treatment of ASD.

Methods

From January to July 2015, the AOSpine Knowledge Deformity Forum performed a modified Delphi survey where 53 experienced deformity surgeons from 24 countries, rated the appropriateness of management strategies for multiple ASD clinical scenarios. Four rounds were performed: three surveys and a face-to-face meeting. Consensus was achieved with ≥70% agreement.

Results

Appropriate surgical goals are improvement of function, pain, and neural symptoms. Appropriate preoperative patient evaluation includes recording information on history and comorbidities, and radiographic workup, including long standing films and MRI for all patients. Preoperative pulmonary and cardiac testing and DEXA scan is appropriate for at-risk patients. Intraoperatively, appropriate surgical strategies include long fusions with deformity correction for patients with large deformity and sagittal imbalance, and pelvic fixation for multilevel fusions with large curves, sagittal imbalance, and osteoporosis. Decompression alone is inappropriate in patients with large curves, sagittal imbalance, and progressive deformity. It is inappropriate to fuse to L5 in patients with symptomatic disk degeneration at L5–S1.

Conclusions

These results provide guidance for informed decision-making in the evaluation and management of ASD. Appropriate care for ASD, a very diverse spectrum of disease, must be responsive to patient preference and values, and considerations of the care provider, and the healthcare system. A monolithic approach to care should be avoided.
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Metadaten
Titel
An international consensus on the appropriate evaluation and treatment for adults with spinal deformity
verfasst von
Sigurd H. Berven
Steven J. Kamper
Niccole M. Germscheid
Benny Dahl
Christopher I. Shaffrey
Lawrence G. Lenke
Stephen J. Lewis
Kenneth M. Cheung
Ahmet Alanay
Manabu Ito
David W. Polly
Yong Qiu
Marinus de Kleuver
AOSpine Knowledge Forum Deformity
Publikationsdatum
05.08.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 3/2018
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5241-1

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