Understanding Adult Spinal Deformity: Clinical Perspectives and Therapeutic Approaches
Keywords:
Adult spinal deformity, Etiology and pathophysiology, Non-surgical treatment, Surgical interventions, Quality of lifeAbstract
Adult spinal deformity (ASD) stands as a multifaceted and demanding condition, characterized by a wide array of anomalies that result in spinal misalignment and curvature loss. This review article aims to deliver an all-encompassing overview of adult spinal deformity, covering its clinical implications and treatment strategies. The review sheds light on clinical perspectives, discussing the classification systems for various types of adult spinal deformities, their etiology and pathophysiology, diagnostic measures for precise evaluation, and the significance of prompt and accurate diagnosis. The review pivots to therapeutic approaches for ASD management, exploring both non-surgical conservative methods and surgical interventions for treatment. Non-surgical options include physical therapy, bracing, medications, injections, and aquatic therapy; while surgical procedures embrace osteotomies, decompression, and instrumented spinal fusion. Additionally, the article underlines the interdisciplinary nature of ASD management and outlines its impact on the quality of life of those affected, demonstrating how ASD can lead to both physical and psychological impairments. It delves into the multitude of challenges and considerations in ASD treatment to offer deeper insight into treatment planning and patient satisfaction. In summary, this review amalgamates the current knowledge in the field of ASD, providing clinicians with a wide-ranging resource to deepen understanding and enhance the management of this challenging condition.
Downloads
Metrics
References
Kim, H.J., et al., Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management. Asian Spine J, 2020. 14(6): p. 886-897.
Kim, H.J., et al., Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions. Asian Spine J, 2022. 16(5): p. 776-788.
Ames, C.P., et al., Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management. Spine Deform, 2016. 4(4): p. 310-322.
Hawes, M.C. and P. O'Brien J, The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment. Scoliosis, 2006. 1(1): p. 3.
Ailon, T., et al., Degenerative Spinal Deformity. Neurosurgery, 2015. 77 Suppl 4: p. S75-91.
Yaman, O. and S. Dalbayrak, Kyphosis and review of the literature. Turk Neurosurg, 2014. 24(4): p. 455-65.
Sparrey, C.J., et al., Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration. Neurosurg Focus, 2014. 36(5): p. E1.
Been, E. and L. Kalichman, Lumbar lordosis. Spine J, 2014. 14(1): p. 87-97.
Orlin, M.N., et al., The continuum of care for individuals with lifelong disabilities: role of the physical therapist. Phys Ther, 2014. 94(7): p. 1043-53.
Safaee, M.M., C.P. Ames, and J.S. Smith, Epidemiology and Socioeconomic Trends in Adult Spinal Deformity Care. Neurosurgery, 2020. 87(1): p. 25-32.
Diebo, B.G., et al., Adult spinal deformity. Lancet, 2019. 394(10193): p. 160-172.
Briggs, A.M., et al., Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord, 2009. 10: p. 77.
Raciborski, F., R. Gasik, and A. Kłak, Disorders of the spine. A major health and social problem. Reumatologia, 2016. 54(4): p. 196-200.
Friedly, J., C. Standaert, and L. Chan, Epidemiology of spine care: the back pain dilemma. Phys Med Rehabil Clin N Am, 2010. 21(4): p. 659-77.
Fehlings, M.G., et al., The Aging of the Global Population: The Changing Epidemiology of Disease and Spinal Disorders. Neurosurgery, 2015. 77 Suppl 4: p. S1-5.
Schoutens, C., et al., Outcomes of Nonsurgical Treatments for Symptomatic Adult Degenerative Scoliosis: A Systematic Review. Pain Med, 2020. 21(6): p. 1263-1275.
Faraj, S.S.A., et al., Functional outcome of non-surgical and surgical management for de novo degenerative lumbar scoliosis: a mean follow-up of 10 years. Scoliosis Spinal Disord, 2017. 12: p. 35.
Kotwal, S., et al., Degenerative scoliosis: a review. Hss j, 2011. 7(3): p. 257-64.
Ledonio, C.G., et al., Adult Degenerative Scoliosis Surgical Outcomes: A Systematic Review and Meta-analysis. Spine Deform, 2013. 1(4): p. 248-258.
Liang, C.Z., et al., Surgery is an effective and reasonable treatment for degenerative scoliosis: a systematic review. J Int Med Res, 2012. 40(2): p. 399-405.
Li, G., et al., Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine (Phila Pa 1976), 2009. 34(20): p. 2165-70.
Weinstein, S.L., et al., Adolescent idiopathic scoliosis. Lancet, 2008. 371(9623): p. 1527-37.
Yagi, M., K.B. Akilah, and O. Boachie-Adjei, Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976), 2011. 36(1): p. E60-8.
Negrini, A., et al., Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study. Scoliosis, 2015. 10(1): p. 20.
Shapiro, G.S., G. Taira, and O. Boachie-Adjei, Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes. Spine (Phila Pa 1976), 2003. 28(4): p. 358-63.
Takahashi, S., J. Delécrin, and N. Passuti, Surgical treatment of idiopathic scoliosis in adults: an age-related analysis of outcome. Spine (Phila Pa 1976), 2002. 27(16): p. 1742-8.
Konstantin, B., V. Rerikh, and V. Borin, Complications of the treatment of post-traumatic deformities of the thoracic and lumbar spine using staged surgical interventions. Hirurgiâ pozvonočnika (Spine Surgery), 2020. 17: p. 6-14.
Rerikh VV, B.K., Staged surgical treatment of posttraumatic deformities in the thoracic and lumbar spine. Russian Journal of Spine Surgery. Khirurgiya Pozvonochnika, 2016. 13((4):21-7).
Martini, C., et al., Revision strategies for failed adult spinal deformity surgery. Eur Spine J, 2020. 29(Suppl 1): p. 116-125.
Lee, B.H., et al., Clinical and Radiological Outcomes of Posterior Vertebral Column Resection for Severe Spinal Deformities. J Korean Neurosurg Soc, 2018. 61(2): p. 251-257.
Barone, G., et al., Mechanical Complications in Adult Spine Deformity Surgery: Retrospective Evaluation of Incidence, Clinical Impact and Risk Factors in a Single-Center Large Series. J Clin Med, 2021. 10(9).
Lindsay, S.E., et al., Nonsteroidal Anti-inflammatory Drugs in the Acute Post-operative Period Are Associated With an Increased Incidence of Pseudarthrosis, Hardware Failure, and Revision Surgery Following Single-level Spinal Fusion. Spine (Phila Pa 1976), 2023. 48(15): p. 1057-1063.
Iorio, J.A., P. Reid, and H.J. Kim, Neurological complications in adult spinal deformity surgery. Curr Rev Musculoskelet Med, 2016. 9(3): p. 290-8.
Kim, H.J., et al., Perioperative Neurologic Complications in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 564 Patients. Spine (Phila Pa 1976), 2017. 42(6): p. 420-427.
Boishardy, A., et al., Surgical site infection is a major risk factor of pseudarthrosis in adult spinal deformity surgery. Spine J, 2022. 22(12): p. 2059-2065.
Pizones, J., et al., Adult Congenital Spine Deformity: Clinical Features and Motivations for Surgical Treatment. Int J Spine Surg, 2021. 15(6): p. 1238-1245.
Campbell, R.M., Jr., Spine deformities in rare congenital syndromes: clinical issues. Spine (Phila Pa 1976), 2009. 34(17): p. 1815-27.
Rajavelu, R., et al., Analysis of risk factors and treatment outcome in patients presenting with neglected congenital spinal deformity and neurological deficit. Spine Deform, 2022. 10(2): p. 401-410.
Janjua, M.B., et al., Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis. Pediatr Neurosurg, 2019. 54(2): p. 108-115.
Halawi, M.J., R.K. Lark, and R.D. Fitch, Neuromuscular Scoliosis: Current Concepts. Orthopedics, 2015. 38(6): p. e452-6.
Roberts, S.B. and A.I. Tsirikos, Factors influencing the evaluation and management of neuromuscular scoliosis: A review of the literature. J Back Musculoskelet Rehabil, 2016. 29(4): p. 613-623.
Lin, J.L., et al., Health and Economic Outcomes of Posterior Spinal Fusion for Children With Neuromuscular Scoliosis. Hosp Pediatr, 2020. 10(3): p. 257-265.
Rumalla, K., et al., Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes. J Neurosurg Spine, 2016. 25(4): p. 500-508.
Wollowick, A.L., et al., Patient evaluation and clinical assessment of adult spinal deformity. Instr Course Lect, 2012. 61: p. 469-79.
Bess, S., et al., Clinical and Radiographic Evaluation of Adult Spinal Deformity. Clin Spine Surg, 2016. 29(1): p. 6-16.
Smith, J.S., et al., Clinical and radiographic evaluation of the adult spinal deformity patient. Neurosurg Clin N Am, 2013. 24(2): p. 143-56.
Ruiz Santiago, F., et al., The role of radiography in the study of spinal disorders. 2020, 2020. 10(12): p. 2322-2355.
Moal, B., et al., Radiographic Outcomes of Adult Spinal Deformity Correction: A Critical Analysis of Variability and Failures Across Deformity Patterns. Spine Deform, 2014. 2(3): p. 219-225.
Frost, L.R., et al., Deficits in foot skin sensation are related to alterations in balance control in chronic low back patients experiencing clinical signs of lumbar nerve root impingement. Gait Posture, 2015. 41(4): p. 923-8.
Drake, J., et al., Intraoperative neurophysiological monitoring during complex spinal deformity cases in pediatric patients: methodology, utility, prognostication, and outcome. Childs Nerv Syst, 2010. 26(4): p. 523-44.
Chen, Y., et al., Neurophysiological monitoring of lumbar spinal nerve roots: A case report of postoperative deficit and literature review. Int J Surg Case Rep, 2017. 30: p. 218-221.
Glassman, S.D., et al., The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine (Phila Pa 1976), 2007. 32(1): p. 93-7.
Jia, Y., et al., Surgical versus Nonsurgical Treatment for Adult Spinal Deformity: A Systematic Review and Meta-Analysis. World Neurosurgery, 2022. 159: p. 1-11.
Youssef, J.A., et al., Current status of adult spinal deformity. Global Spine J, 2013. 3(1): p. 51-62.
Bradford, D.S., B.K. Tay, and S.S. Hu, Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine (Phila Pa 1976), 1999. 24(24): p. 2617-29.
Laverdière, C., et al., Adult Spinal Deformity Surgery and Frailty: A Systematic Review. Global Spine J, 2022. 12(4): p. 689-699.
Fujishiro, T., et al., Adult spinal deformity surgical decision-making score. Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with adult spinal deformity. European Spine Journal, 2020. 29(1): p. 45-53.
Ali, Z., et al., Pre-optimization of spinal surgery patients: Development of a neurosurgical Enhanced Recovery After Surgery (ERAS) protocol. Clinical Neurology and Neurosurgery, 2017. 164.
Weiss, H.R. and M. Werkmann, Treatment of chronic low back pain in patients with spinal deformities using a sagittal re-alignment brace. Scoliosis, 2009. 4: p. 7.
Weiss, H.R. and G.M. Weiss, Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): a prospective trial comparing two different concepts. Pediatr Rehabil, 2005. 8(3): p. 199-206.
Nachemson, A.L. and L.E. Peterson, Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am, 1995. 77(6): p. 815-22.
Danielsson, A.J., et al., A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity. Spine (Phila Pa 1976), 2007. 32(20): p. 2198-207.
Kotwicki, T., et al., Estimation of the stress related to conservative scoliosis therapy: an analysis based on BSSQ questionnaires. Scoliosis, 2007. 2: p. 1.
Schreiber, S., et al., Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial. PLoS One, 2016. 11(12): p. e0168746.
Özyemişci Taşkıran, Ö., Rehabilitation in adult spinal deformity. Turk J Phys Med Rehabil, 2020. 66(3): p. 231-243.
Salem, Y. and S.J. Gropack, Aquatic therapy for a child with type III spinal muscular atrophy: a case report. Phys Occup Ther Pediatr, 2010. 30(4): p. 313-24.
Everett, C.R. and R.K. Patel, A systematic literature review of nonsurgical treatment in adult scoliosis. Spine (Phila Pa 1976), 2007. 32(19 Suppl): p. S130-4.
Glassman, S.D., et al., The costs and benefits of nonoperative management for adult scoliosis. Spine (Phila Pa 1976), 2010. 35(5): p. 578-82.
Lafage, V., et al., Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis. Spine (Phila Pa 1976), 2012. 37(3): p. E180-7.
Iyer, S., et al., Sagittal Spinal Alignment in Adult Spinal Deformity: An Overview of Current Concepts and a Critical Analysis Review. JBJS Rev, 2018. 6(5): p. e2.
Smith, J.S., et al., Treatment of adult thoracolumbar spinal deformity: past, present, and future. J Neurosurg Spine, 2019. 30(5): p. 551-567.
Silva, F.E. and L.G. Lenke, Adult degenerative scoliosis: evaluation and management. Neurosurg Focus, 2010. 28(3): p. E1.
Enercan, M., et al., Osteotomies/spinal column resections in adult deformity. Eur Spine J, 2013. 22 Suppl 2(Suppl 2): p. S254-64.
Dorward, I.G. and L.G. Lenke, Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review. Neurosurg Focus, 2010. 28(3): p. E4.
Schwab, F., et al., The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2014. 74(1): p. 112-20; discussion 120.
Luo, D., H. Zhang, and W. Zhang, Comparison of three approaches of Bernese periacetabular osteotomy. Ther Clin Risk Manag, 2016. 12: p. 67-72.
Khan, O.H., et al., Minimally invasive periacetabular osteotomy using a modified Smith-Petersen approach: technique and early outcomes. Bone Joint J, 2017. 99-b(1): p. 22-28.
Ivanova, A., et al., The Effect of Smith-Peterson Osteotomy on Blood Loss during Surgical Correction of Adolescent Idiopathic Scoliosis. Folia Med (Plovdiv), 2020. 62(3): p. 503-508.
Mummaneni, P.V., et al., Pedicle subtraction osteotomy. Neurosurgery, 2008. 63(3 Suppl): p. 171-6.
Daubs, M.D., et al., Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity? Spine (Phila Pa 1976), 2013. 38(6): p. 476-83.
Bridwell, K.H., et al., Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am, 2003. 85(3): p. 454-63.
Alzakri, A., et al., L5 pedicle subtraction osteotomy: indication, surgical technique and specificities. Eur Spine J, 2018. 27(3): p. 644-651.
Eskilsson, K., et al., Pedicle subtraction osteotomy: a comprehensive analysis in 104 patients. Does the cause of deformity influence the outcome? J Neurosurg Spine, 2017. 27(1): p. 56-62.
Bekmez, S., et al., Pedicle Subtraction Osteotomy Versus Multiple Posterior Column Osteotomies in Severe and Rigid Neuromuscular Scoliosis. Spine (Phila Pa 1976), 2018. 43(15): p. E905-e910.
Hamzaoglu, A., et al., Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine (Phila Pa 1976), 2011. 36(5): p. E340-4.
Yang, C., et al., Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J, 2016. 25(8): p. 2368-75.
Lenke, L.G., et al., Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res, 2010. 468(3): p. 687-99.
Wang, S., et al., The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. Eur Spine J, 2017. 26(7): p. 1817-1825.
Kanter, A.S., et al., A Review of Minimally Invasive Procedures for the Treatment of Adult Spinal Deformity. Spine (Phila Pa 1976), 2016. 41 Suppl 8: p. S59-65.
Ghogawala, Z., et al., Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med, 2016. 374(15): p. 1424-34.
Patel, M.S., et al., A comparative study of the outcomes of primary and revision lumbar discectomy surgery. Bone Joint J, 2013. 95-b(1): p. 90-4.
Wong, A.P., et al., Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy. World Neurosurg, 2014. 81(3-4): p. 634-40.
Nerland, U.S., et al., Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. Bmj, 2015. 350: p. h1603.
Dietz, N., et al., Outcomes of decompression and fusion for treatment of spinal infection. Neurosurg Focus, 2019. 46(1): p. E7.
Yang, L.H., et al., Lumbar decompression and lumbar interbody fusion in the treatment of lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore), 2020. 99(27): p. e20323.
Chang, W., et al., Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2017. 137(5): p. 637-650.
Akıntürk, N., M. Zileli, and O. Yaman, Complications of adult spinal deformity surgery: A literature review. J Craniovertebr Junction Spine, 2022. 13(1): p. 17-26.
Buser, Z., et al., Allograft Versus Demineralized Bone Matrix in Instrumented and Noninstrumented Lumbar Fusion: A Systematic Review. Global Spine J, 2018. 8(4): p. 396-412.
Park, J.H., et al., Radiographic Analysis of Instrumented Posterolateral Fusion Mass Using Mixture of Local Autologous Bone and b-TCP (PolyBone®) in a Lumbar Spinal Fusion Surgery. J Korean Neurosurg Soc, 2011. 49(5): p. 267-72.
Selby, M.D., et al., Radiologic assessment of spinal fusion. J Am Acad Orthop Surg, 2012. 20(11): p. 694-703.
Hsieh, M.K., et al., Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes. BMC Surg, 2015. 15: p. 26.
Zhu, Y., et al., [Long-term clinical outcomes of selective segmental transforaminal lumbar interbody fusion and posterior spinal fusion for degenerative lumbar scoliosis]. Zhonghua Yi Xue Za Zhi, 2013. 93(45): p. 3577-81.
Castro, W.H., et al., Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976), 1996. 21(11): p. 1320-4.
Ha, K.Y., Y.H. Kim, and J.H. Ahn, Is it real adjacent segment pathology by stress concentration after limited fusion in degenerative lumbar scoliosis? Spine (Phila Pa 1976), 2014. 39(13): p. 1059-66.
Phillips, F.M., et al., Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up. Spine (Phila Pa 1976), 2013. 38(21): p. 1853-61.
Debono, B., et al., Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction. Neurosurg Focus, 2019. 46(4): p. E6.
Starkweather, A.R., et al., The multiple benefits of minimally invasive spinal surgery: results comparing transforaminal lumbar interbody fusion and posterior lumbar fusion. J Neurosci Nurs, 2008. 40(1): p. 32-9.
Lovecchio, F. and S.A. Qureshi, The Current State of Minimally Invasive Approaches to Adult Spinal Deformity. Curr Rev Musculoskelet Med, 2019. 12(3): p. 318-327.
Tateiwa, T., et al., Hip disorders and spinopelvic alignment: a current literature review. Journal of Joint Surgery and Research, 2023. 1.
Makino, T., et al., The Biological Enhancement of Spinal Fusion for Spinal Degenerative Disease. Int J Mol Sci, 2018. 19(8).
Lopez, C.D., et al., Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review. Global Spine J, 2021. 11(6): p. 936-949.
Provaggi, E., J.J.H. Leong, and D.M. Kalaskar, Applications of 3D printing in the management of severe spinal conditions. Proc Inst Mech Eng H, 2017. 231(6): p. 471-486.
Pellisé, F., et al., Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J, 2015. 24(1): p. 3-11.
Riley, M.S., et al., Health-related quality of life outcomes in complex adult spinal deformity surgery. J Neurosurg Spine, 2018. 28(2): p. 194-200.
Tones, M., N. Moss, and D.W. Polly, Jr., A review of quality of life and psychosocial issues in scoliosis. Spine (Phila Pa 1976), 2006. 31(26): p. 3027-38.
Chikani, M.C., et al., Changing Trends and Challenges of Spine Surgery in a Developing Country. World Neurosurgery, 2019. 130: p. e815-e821.
Patel, R.V., et al., Advances and Evolving Challenges in Spinal Deformity Surgery. J Clin Med, 2023. 12(19).
Wang, T.Y. and M.Y. Wang Advances and Challenges in Minimally Invasive Spine Surgery. Journal of Clinical Medicine, 2024. 13, DOI: 10.3390/jcm13113329.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
