AN OVERVIEW OF ADULT SPINAL DEFORMITY
Journal Title: Journal of Turkish Spinal Surgery - Year 2003, Vol 14, Issue 1
Abstract
INTRODUCTION The evaluation and treatment of adult spinal deformity remains a challenging clinical entity. Many factors must be analyzed to help decide the best treatment plan for these patients ranging from conservative care with physical therapy, epidural steroid injections and lifestyle adjustments to major surgical intervention consisting of anterior and posterior spinal fusions, vertebral osteotomy or resection procedures. This manuscript will highlight the essentials of the evaluation, conservative and surgical treatment of patients will all forms of adult spinal deformity. EVALUATION The history of a patient presenting with adult spinal deformity must be quiet detailed regarding the patient’s main complaints, past treatments and future expectations. Patients usually present because of increasing axial, and less commonly appendicular pain. In addition, they may feel their deformity is progressing by the noticing loss of height, altered fitting of clothes, increasing rib or lumbar prominences, or because of comments regarding these features made by family members and/or friends. Rarely do patients present with increasing dyspnea which obviously manifests itself in a severely neglected thoracic deformity. It is extremely important to identify the primary reason(s) that the patient came to see the spinal deformity physician, as this will be extremely helpful in deciding what level of treatment is necessary to meet the patients’ expectations. There are several basic subdivisions of adult spinal deformity including whether the patient presents with a primary deformity or with a previously treated deformity. In my practice, approximately 50% of patients evaluated have a primary deformity, while 50% have had prior surgery in the past, most commonly in the distant past with first generation (i.e. Harrington rod instrumentation) implants in place. Although the presentation of these patients is somewhat different, the expectations and analyses are quite similar. It is important to try and detail exactly the type of prior surgical intervention the patient has undergone, including how many prior surgeries, type of implants placed, and source of bone graft harvest. This last point is extremely important, since the availability of autogeneous posterior iliac crest bone graft is important, not only for future bone graft harvests, but also the placement of iliac screws for additional sacropelvic fixation, which is commonly utilized for long fusions extending to the sacrum.
Authors and Affiliations
Lawrence G. LENKE, MD
Keywords
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