Adult Deformity

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Health and Function of Patients With Untreated Idiopathic Scoliosis: A 50-Year Natural History Study.

Weinstein SL, Dolan LA, Spratt KF, Spoonamore MJ, Ponseti IV.

JAMA.  2003; 289: 559-567.

PMID:  12578488

This natural history study compared 117 unoperated late-onset idiopathic scoliosis patients with 62 matched volunteer controls at an incredible 51-year follow-up.  They found that leaving LIS untreated caused little impairment other than cosmetic concerns and minor differences in back pain, compared to matched undeformed controls.  An utterly unique lifetime perspective.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

Adult Spinal Deformity – Postoperative Standing Imbalance: How Much Can You Tolerate? An Overview of Key Parameters in Assessing Alignment and Planning Corrective Surgery.

Schwab F, Patel A, Ungar B, Farcy J-P, Lafage V.

Spine.  2010; 35: 2224-2231.

PMID:  21102297

Synthesizing extensive previous research, this bioengineering paper provides guidance on the radiographic goals of correction surgery, with three clear case illustrations.  Its framework of three key spinopelvic parameters (SVA, PT, LL/PI) defines a new era of surgical planning, beyond the traditional focus on Cobb angle.  Essential reading for deformity surgeons.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

Adult scoliosis surgery outcomes: a systematic review.

Yadla S, Maltenfort MG, Ratliff JK, Harrop JS.

Neurosurg Focus.  2010; 28: E3.

PMID: 20192664.

This systematic review included 49 studies, mostly level III, and discusses clinical outcomes, radiographic curve correction, and complications.  It found that corrective surgery does on average result in meaningful clinical improvement at 2-year follow-up.  This paper provides the definitive account of what outcomes can be expected from corrective surgery.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

A Systematic Literature Review of Nonsurgical Treatment in Adult Scoliosis.

Everett CR, Patel RK.

Spine.  2007; 32:  S130-S134.

PMID: 17728680.

This rigorous systematic review found only level III evidence for injections, and only level IV evidence for bracing, physical therapy, or chiropractice.  Only the weakest recommendation was given to any form of conservative care.  The main message is that evidence for conservative care is lacking and research is sorely needed.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

Scoliosis Research Society Morbidity and Mortality of Adult Scoliosis Surgery.

Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW Jr, Perra JH, Boachie-Adjei O, Shaffrey CI.

Spine.  2011; 36: E593-E597.

PMID:  21325989

This paper used a large patient registry to report on complications in surgery for adult idiopathic or degenerative scoliosis.  Among 4980 cases, there were 669 (13.4%) complications in 521 (10.5%) patients, including 17 (0.3%) deaths.  This study provides a definitive complication rate for use in counseling patients.


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Preparing the Adult Deformity Patient for Spinal Surgery.

Hu SS, Berven SH.

Spine.  2006; 31: S126-S131.

PMID:  16946629.

This narrative paper discusses how the medical team can better prepare the adult deformity patient for correction surgery.  It covers the pulmonary, cardiac, nutritional, osteoporotic, pharmacological, and psychosocial facets of preparation.  This paper takes an interesting health-promotion approach, which should make a valuable contribution toward reducing complications and improving outcomes.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

Medical Complications of Surgical Treatment of Adult Spinal Deformity and How to Avoid Them.

Baron EM, Albert TJ.

Spine.  2006; 31: S106-S118.

PMID: 16946627.

This narrative review presents the incidence of medical complications (such as pulmonary abnormalities, urinary infections, and delirium) from adult deformity surgery, including useful tips on how to prevent and treat them.  Surgical complications (such as wound infections or vascular injury) are not covered.  This is crucial reading for patient safety.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

Adult Degenerative Scoliosis: A Review.

Birknes JK, White AP, Albert TJ, Shaffrey CI, Harrop JS.

Neurosurgery.  2008; 63: A94-A103.

PMID: 18812938

This narrative review paper provides a comprehensive and balanced overview of the surgical strategies for correction of adult degenerative scoliosis, including clinical presentation, pre-operative evaluation, spinal balance, fusion constructs, treatment goals, fixation tactics for osteoporotic bone, and complications.  This is the best available general introduction to surgery of adult scoliosis.

web:  [dead link]

Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

The prevalence and radiological findings in 1347 elderly patients with scoliosis.

Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.

J Bone Joint Surg Br.  2010; 92: 980-983.

PMID: 20595118.

In a mere 3 pages, this large cross-sectional epidemiological study on elderly volunteers (not patients) provides a solid amount of radiographic data, statistical analysis, and review of related epidemiological literature.  This population-level picture is important for estimating healthcare needs and serving as a reference framework when assessing individual patients.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments

A Clinical Impact Classificaiton of Scoliosis in the Adult.

Schwab F, Farcy J-P, Bridwell K, Berven S, Glassman S, Harrast J, Horton W.

Spine.  2006; 31: 2109-2114.

PMID:  16915098

This study applied a recent radiographic classification system to a large multicenter database of adult deformity patients.  The classification system has good reliability and shows correlations to clinical severity.  This may serve as a framework for better understanding of patients’ specific forms of spinal deformity.


Posted by on Nov 16, 2011 in Adult Deformity | 0 comments