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Lafage R, Bass RD, Klineberg E, Smith JS, Bess S, Shaffrey C, Burton DC, Kim HJ, Eastlack R, Mundis G, Ames CP, Passias PG, Gupta M, Hostin R, Hamilton K, Schwab F, Lafage V. Complication Rates Following Adult Spinal Deformity Surgery: Evaluation of the Category of Complication and Chronology. Spine (Phila Pa 1976) 2024; 49:829-839. [PMID: 38375636 DOI: 10.1097/brs.0000000000004969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Provide benchmarks for the rates of complications by type and timing. STUDY DESIGN Prospective multicenter database. BACKGROUND Complication rates following adult spinal deformity (ASD) surgery have been previously reported. However, the interplay between timing and complication type warrants further analysis. METHODS The data for this study were sourced from a prospective, multicenter ASD database. The date and type of complication were collected and classified into three severity groups (minor, major, and major leading to reoperation). Only complications occurring before the two-year visit were retained for analysis. RESULTS Of the 1260 patients eligible for two-year follow-up, 997 (79.1%) achieved two-year follow-up. The overall complication rate was 67.4% (N=672). 247 patients (24.8%) experienced at least one complication on the day of surgery (including intraoperatively), 359 (36.0%) between postoperative day 1 and six weeks postoperatively, 271 (27.2%) between six weeks and one-year postoperatively, and finally 162 (16.3%) between one year and two years postoperatively. Using Kaplan-Meier survival analysis, the rate of remaining complication-free was estimated at different time points for different severities and types of complications. Stratification by type of complication demonstrated that most of the medical complications occurred within the first 60 days. Surgical complications presented over two distinct timeframes. Operative complications, incision-related complications, and infections occurred early (within 60 d), while implant-related and radiographic complications occurred at a constant rate over the two-year follow-up period. Neurological complications had the highest occurrence within the first 60 days but continued to increase up to the two-year visit. CONCLUSION Only one-third of ASD patients remained complication-free by two years, and 2 of 10 patients had a complication requiring a reoperation or revision. An estimation of the timing and type of complications associated with surgical treatment may prove useful for more meaningful patient counseling and aid in assessing the cost-effectiveness of treatment. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Renaud Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - R Daniel Bass
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Eric Klineberg
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | | | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Robert Eastlack
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA
| | - Gregory Mundis
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA
| | - Christopher P Ames
- Department of Neurosurgery, University of California School of Medicine, San Francisco, CA
| | - Peter G Passias
- Departments of Orthopedic Surgery, NYU Langone, New York, NY
| | - Munish Gupta
- Department of Orthopedic Surgery, Washington University, St Louis, MO
| | | | - Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Frank Schwab
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Virginie Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
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Azam F, Anand S, Dragun A, Furtado K, Nguyen M, Shukla I, Hicks WH, Hall K, Akbik OS, Bagley CA. Identifying Correlation Among Patient-Reported Outcome Measures: A Study of PROMIS-29, ODI, and VAS in Adult Spinal Deformity Patients. World Neurosurg 2024; 181:e1059-e1070. [PMID: 37967743 DOI: 10.1016/j.wneu.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Adult spinal deformity (ASD) is becoming increasingly common in aging populations. Patient-reported outcome measures (PROMs) are self-reported patient surveys administered pre- and postoperatively that provide insight into patient improvement. We aim to compare 3 of the most utilized PROMs: PROMIS-29, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS), to investigate whether they provide unique and independent assessments of patient outcomes when assessed longitudinally. METHODS We retrospectively reviewed a database of ASD at UT Southwestern Medical Center between 2016 and 2021. Adult patients (>18 years old) were included if they underwent long-segment (>4 levels) thoracolumbar fusion. PROMIS-29, ODI, and VAS scores were collected preoperatively and at 3-, 6-, 12-, 18-, 24-, 30-, and 36-month follow-ups. Scores were recorded ±1 month of the time points. Pearson correlation coefficients for each PROM were then calculated in a pairwise fashion. RESULTS A total of 163 patients were included in our analysis. ODI and VAS showed significant covariance, with VAS Neck and VAS Back having Pearson coefficients of 0.95 and 0.94, respectively. ODI and PROMIS-29 also showed significant covariance, with Physical Function and ODI showing a Pearson coefficient of 0.95. PROMIS-29 and VAS demonstrated less correlation regarding Pain and Physical Function; however, they showed a significantly high Pearson coefficient when comparing VAS Back with PROMIS-29 Sleep and Pain Intensity (r = 0.97 and r = 0.96, respectively). CONCLUSIONS All 3 PROMs demonstrated significant correlation over 36 months, indicating that simultaneous administration of each during follow-up is redundant. The measure that provided the least unique information was ODI, as both VAS and PROMIS-29 demonstrated similar progression and assessed additional metrics. PROMIS-29 provided the same information as VAS and ODI, with extra facets of patient-reported outcomes, indicating that it may be a more comprehensive measure of longitudinal patient improvement.
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Affiliation(s)
- Faraaz Azam
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Soummitra Anand
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anthony Dragun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kailee Furtado
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madelina Nguyen
- Department of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ishav Shukla
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William H Hicks
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Omar S Akbik
- Department of Neurological Surgery, CHI Health, Omaha, Nebraska, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, Missouri, USA.
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Smith JS, Mundis GM, Osorio JA, Nicolau RJ, Temple-Wong M, Lafage R, Bess S, Ames CP. Analysis of Personalized Interbody Implants in the Surgical Treatment of Adult Spinal Deformity. Global Spine J 2023:21925682231216926. [PMID: 38124314 DOI: 10.1177/21925682231216926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
STUDY DESIGN Multicenter cohort. OBJECTIVES A report from the International Spine Study Group (ISSG) noted that surgeons failed to achieve alignment goals in nearly two-thirds of 266 complex adult deformity surgery (CADS) cases. We assess whether personalized interbody spacers are associated with improved rates of achieving goal alignment following adult spinal deformity (ASD) surgery. METHODS ASD patients were included if their surgery utilized 3D-printed personalized interbody spacer(s) and they met ISSG CADS inclusion criteria. Planned alignment was personalized by the surgeon during interbody planning. Planned vs achieved alignment was assessed and compared with the ISSG CADS series that used stock interbodies. RESULTS For 65 patients with personalized interbodies, 62% were women, mean age was 70.3 years (SD = 8.3), mean instrumented levels was 9.9 (SD = 4.1), and the mean number of personalized interbodies per patient was 2.2 (SD = .8). Segmental alignment was achieved close to plan for levels with personalized interbodies, with mean difference between goal and achieved as follows: intervertebral lordosis = .9° (SD = 5.2°), intervertebral coronal angle = .1° (SD = 4.7°), and posterior disc height = -0.1 mm (SD = 2.3 mm). Achieved pelvic incidence-to-lumbar lordosis mismatch (PI-LL) correlated significantly with goal PI-LL (r = .668, P < .001). Compared with the ISSG CADS cohort, utilization of personalized interbodies resulted in significant improvement in achieving PI-LL <5° of plan (P = .046) and showed a significant reduction in cases with PI-LL >15° of plan (P = .012). CONCLUSIONS This study supports use of personalized interbodies as a means of better achieving goal segmental sagittal and coronal alignment and significantly improving achievement of goal PI-LL compared with stock devices.
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Affiliation(s)
- Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Gregory M Mundis
- Department of Orthopedic Surgery, Scripps Clinic, San Diego, CA, USA
| | - Joseph A Osorio
- Department of Neurological Surgery, University of California, San Diego, San Diego, CA, USA
| | | | | | - Renaud Lafage
- Department of Orthopedic Surgery, Lennox Hill Hospital, New York City, NY, USA
| | - Shay Bess
- Presbyterian St Lukes Medical Center, Denver, CO, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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Smith JS, Kelly MP, Buell TJ, Ben-Israel D, Diebo B, Scheer JK, Line B, Lafage V, Lafage R, Klineberg E, Kim HJ, Passias P, Gum JL, Kebaish K, Mullin JP, Eastlack R, Daniels A, Soroceanu A, Mundis G, Hostin R, Protopsaltis TS, Hamilton DK, Gupta M, Lewis SJ, Schwab FJ, Lenke LG, Shaffrey CI, Burton D, Ames CP, Bess S. Adult Cervical Deformity Patients Have Higher Baseline Frailty, Disability, and Comorbidities Compared With Complex Adult Thoracolumbar Deformity Patients: A Comparative Cohort Study of 616 Patients. Global Spine J 2023:21925682231214059. [PMID: 37948666 DOI: 10.1177/21925682231214059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
STUDY DESIGN Multicenter comparative cohort. OBJECTIVE Studies have shown markedly higher rates of complications and all-cause mortality following surgery for adult cervical deformity (ACD) compared with adult thoracolumbar deformity (ATLD), though the reasons for these differences remain unclear. Our objectives were to compare baseline frailty, disability, and comorbidities between ACD and complex ATLD patients undergoing surgery. METHODS Two multicenter prospective adult spinal deformity registries were queried, one ATLD and one ACD. Baseline clinical and frailty measures were compared between the cohorts. RESULTS 616 patients were identified (107 ACD and 509 ATLD). These groups had similar mean age (64.6 vs 60.8 years, respectively, P = .07). ACD patients were less likely to be women (51.9% vs 69.5%, P < .001) and had greater Charlson Comorbidity Index (1.5 vs .9, P < .001) and ASA grade (2.7 vs 2.4, P < .001). ACD patients had worse VR-12 Physical Component Score (PCS, 25.7 vs 29.9, P < .001) and PROMIS Physical Function Score (33.3 vs 35.3, P = .031). All frailty measures were significantly worse for ACD patients, including hand dynamometer (44.6 vs 55.6 lbs, P < .001), CSHA Clinical Frailty Score (CFS, 4.0 vs 3.2, P < .001), and Edmonton Frailty Scale (EFS, 5.15 vs 3.21, P < .001). Greater proportions of ACD patients were frail (22.9% vs 5.7%) or vulnerable (15.6% vs 10.9%) based on EFS (P < .001). CONCLUSIONS Compared with ATLD patients, ACD patients had worse baseline characteristics on all measures assessed (comorbidities/disability/frailty). These differences may help account for greater risk of complications and all-cause mortality previously observed in ACD patients and facilitate strategies for better preoperative optimization.
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Affiliation(s)
- Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, CA, USA
| | - Thomas J Buell
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Ben-Israel
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Bassel Diebo
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Breton Line
- Presbyterian St Lukes Medical Center, Denver, CO, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lennox Hill Hospital, New York City, NY, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lennox Hill Hospital, New York City, NY, USA
| | - Eric Klineberg
- Department of Orthopedic Surgery, University of Texas Health Houston, Houston, TX, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Peter Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | | | - Khal Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Robert Eastlack
- Department of Orthopedic Surgery, Scripps Clinic, San Diego, USA
| | - Alan Daniels
- Department of Orthopedic Surgery, Brown University, Providence, RI, USA
| | - Alex Soroceanu
- Department of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Gregory Mundis
- Department of Orthopedic Surgery, Scripps Clinic, San Diego, USA
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA
| | | | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Munish Gupta
- Department of Orthopedic Surgery, Washington University, St Louis, MO, USA
| | - Stephen J Lewis
- Department of Surgery, Division of Orthopedic Surgery, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Frank J Schwab
- Department of Orthopedic Surgery, Lennox Hill Hospital, New York City, NY, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | | | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Shay Bess
- Presbyterian St Lukes Medical Center, Denver, CO, USA
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5
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Elias E, Bess S, Line B, Lafage V, Lafage R, Klineberg E, Kim HJ, Passias PG, Nasser Z, Gum JL, Kebaish K, Eastlack R, Daniels AH, Mundis G, Hostin R, Protopsaltis TS, Soroceanu A, Hamilton DK, Kelly MP, Gupta M, Hart R, Schwab FJ, Burton D, Ames CP, Shaffrey CI, Smith JS. Outcomes of operative treatment for adult spinal deformity: a prospective multicenter assessment with mean 4-year follow-up. J Neurosurg Spine 2022; 37:607-616. [PMID: 35535835 DOI: 10.3171/2022.3.spine2295] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current literature has primarily focused on the 2-year outcomes of operative adult spinal deformity (ASD) treatment. Longer term durability is important given the invasiveness, complications, and costs of these procedures. The aim of this study was to assess minimum 3-year outcomes and complications of ASD surgery. METHODS Operatively treated ASD patients were assessed at baseline, follow-up, and through mailings. Patient-reported outcome measures (PROMs) included scores on the Oswestry Disability Index (ODI), Scoliosis Research Society-22r (SRS-22r) questionnaire, mental component summary (MCS) and physical component summary (PCS) of the SF-36, and numeric rating scale (NRS) for back and leg pain. Complications were classified as perioperative (≤ 90 days), delayed (90 days to 2 years), and long term (≥ 2 years). Analyses focused on patients with minimum 3-year follow-up. RESULTS Of 569 patients, 427 (75%) with minimum 3-year follow-up (mean ± SD [range] 4.1 ± 1.1 [3.0-9.6] years) had a mean age of 60.8 years and 75% were women. Operative treatment included a posterior approach for 426 patients (99%), with a mean ± SD 12 ± 4 fusion levels. Anterior lumbar interbody fusion was performed in 35 (8%) patients, and 89 (21%) underwent 3-column osteotomy. All PROMs improved significantly from baseline to last follow-up, including scores on ODI (45.4 to 30.5), PCS (31.0 to 38.5), MCS (45.3 to 50.6), SRS-22r total (2.7 to 3.6), SRS-22r activity (2.8 to 3.5), SRS-22r pain (2.3 to 3.4), SRS-22r appearance (2.4 to 3.5), SRS-22r mental (3.4 to 3.7), SRS-22r satisfaction (2.7 to 4.1), NRS for back pain (7.1 to 3.8), and NRS for leg pain (4.8 to 3.0) (all p < 0.001). Degradations in some outcome measures were observed between the 2-year and last follow-up evaluations, but the magnitudes of these degradations were modest and arguably not clinically significant. Overall, 277 (65%) patients had at least 1 complication, including 185 (43%) perioperative, 118 (27%) delayed, and 56 (13%) long term. Notably, the 142 patients who did not achieve 3-year follow-up were similar to the study patients in terms of demographic characteristics, deformities, and baseline PROMs and had similar rates and types of complications. CONCLUSIONS This prospective multicenter analysis demonstrated that operative ASD treatment provided significant improvement of health-related quality of life at minimum 3-year follow-up (mean 4.1 years), suggesting that the benefits of surgery for ASD remain durable at longer follow-up. These findings should prove useful for counseling, cost-effectiveness assessments, and efforts to improve the safety of care.
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Affiliation(s)
- Elias Elias
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Shay Bess
- 2Presbyterian St. Luke's Medical Center, Denver, Colorado
| | - Breton Line
- 2Presbyterian St. Luke's Medical Center, Denver, Colorado
| | - Virginie Lafage
- 3Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York
| | - Renaud Lafage
- 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric Klineberg
- 5Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Han Jo Kim
- 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter G Passias
- 6Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Zeina Nasser
- 7Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | | | - Khal Kebaish
- 9Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Alan H Daniels
- 11Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
| | | | - Richard Hostin
- 12Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | | | - Alex Soroceanu
- 13Department of Orthopedic Surgery, University of Calgary, Alberta, Canada
| | - D Kojo Hamilton
- 14Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael P Kelly
- 15Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California
| | - Munish Gupta
- 16Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | - Robert Hart
- 17Department of Orthopaedic Surgery, Swedish Medical Center, Seattle, Washington
| | - Frank J Schwab
- 3Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York
| | - Douglas Burton
- 18Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Christopher P Ames
- 19Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Christopher I Shaffrey
- 20Departments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Justin S Smith
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Adhikari P, Çetin E, Çetinkaya M, Nabi V, Yüksel S, Vila Casademunt A, Obeid I, Sanchez Perez-Grueso F, Acaroğlu E. Ability of Visual Analogue Scale to predict Oswestry Disability Index improvement and surgical treatment decision in patients with adult spinal deformity. BRAIN & SPINE 2022; 2:100934. [PMID: 36605390 PMCID: PMC9808375 DOI: 10.1016/j.bas.2022.100934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
Introduction The effect of pain on HRQoL scores in ASD patients is not well studied. Disability is a major factor on decision and outcomes. On the other hand, little is known about the effect of perceived and reported pain on these parameters, especially in the elderly population. We hypothesized that baseline back and leg pain would not affect the treatment decision whereas may have a negative effect on outcomes. Research question To determine the correlation between preoperative ODI and VAS scores; and to identify the effect of baseline VAS score on treatment decision and ODI improvement following treatment. Material and methods In this retrospective study, patients with a follow-up duration of minimum 2 years were enrolled from a prospective multicentric ASD database. Pearson and Spearman correlation tests were used to evaluate the correlation between ODI and VAS scores; univariate binary logistic regression method was used to analyze the effect of VAS on treatment decision as well as the outcomes. Results 1050 patients (mean age 48.2) were analyzed. Baseline ODI and back, leg pain VAS scores were significantly correlated (P < 0.001). One unit increase in baseline back and leg pain VAS scores, increased the probability of improvement in ODI by 1.219 (P = 0.016) and 1.182 times (P = 0.029), respectively in surgically treated patients; and reduced it by 0.894 times (P = 0.012) for conservatively treated patients. For patients >70 years old, one-unit increase in baseline leg pain VAS score increased the probability of deciding on surgical treatment by 1.121 times (p = 0.016). Discussion and conclusions Preoperative back and leg pain VAS scores were found to be significantly correlated with the preoperative ODI scores. Additionally, preoperative baseline back and leg pain VAS scores were useful in predicting the improvement in disability as assessed by ODI. Another important finding was that, higher baseline leg pain (but not back pain) VAS scores increased the rate of elderly patients preferring surgical treatment.
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Affiliation(s)
- Prashant Adhikari
- Hospital for Advance Medicine and Surgery (HAMS), Dhumbarai, Mandhikatar Road, Kathmandu, Nepal,Corresponding author. Hospital for Advance Medicine and Surgery (HAMS), Dhumbarai, Mandhikatar Road, Kathmandu, Nepal.
| | - Engin Çetin
- Gaziosmanpasa Training and Research Hospital, Karayolları Mahallesi, Osmanbey Caddesi, 621, Sokak, 34255, Gaziosmanpaşa, Istanbul, Turkey
| | - Mehmet Çetinkaya
- Başakşehir Çam ve Sakura City Hospital, Başakşehir Olimpiyat Bulvarı Yolu, 34480, Başakşehir, Istanbul, Turkey
| | - Vugar Nabi
- Antalya Training and Research Hospital, Varlık Mh, Kazım Karabekir Cd, 07100, Antalya, Turkey
| | - Selcen Yüksel
- Yıldırım Beyazıt University, Department of Biostatistics, Yıldırım Beyazıt Üniversitesi Biyoistatistik Departmenı, Ankara, Turkey
| | | | - Ibrahim Obeid
- Bordeaux University Department of Orthopaedics, Bordeaux University Hospital, Department of Orthopaedics, Bordeaux, France
| | | | - Emre Acaroğlu
- Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, 06700, Ankara, Turkey
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Dereli EE, Gong S, Çolak TK, Turnbull D. Guidelines for the conservative treatment of spinal deformities - Questionnaire for a Delphi consensus. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1587. [PMID: 34957343 PMCID: PMC8678962 DOI: 10.4102/sajp.v77i2.1587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background Spinal deformity is the oldest disease known to humankind. Many types of treatment methods, including both conservative and surgical, are in use. Objective We aimed to validate a published guideline protocol based on the conservative treatment of spinal deformities. Method A modified Delphi technique was used with a questionnaire sent out to professionals worldwide regarding the conservative treatment of spinal deformities. Results Our study was completed after two rounds. A strong level of agreement of 80% and more (consensus cut-off point) was achieved in most questions in the first round. Some statements were below this margin, and they were sent to the participants via email in the second round for re-evaluation. Consensus was achieved in almost all of the statements in the second round. Only two items did not reach the cut-off point but were close to this value. Conclusion This proposed Guideline Protocol was approved by the participants using the Delphi method and can be used as a valid tool for the conservative treatment of spinal deformities. Clinical implications A conservative treatment guideline in spinal deformity management, will provide consistency in treatment and will facilitate comparability with surgery. It will be useful in determining the cost-effectiveness of treatment and in choosing the right patient for the right method of treatment. This guideline might help in this context, and may also create a systematic method for clinicians to use as a reference in both research and clinical practice.
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Affiliation(s)
- Elif E Dereli
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Program, Istanbul Bilgi University, Istanbul, Turkey
| | - Shaopeng Gong
- Wuhan Schroth Scoliosis Service Center, Wuhan, Hubei, China
| | - Tuğba Kuru Çolak
- Faculty of Health Sciences, Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Deborah Turnbull
- School of Health and Social Care, University of Teesside, Middleborough, MA, United States of America.,The London Orthotic Consultancy, Kingston upon Thames, United Kingdom
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8
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Cawley DT, Takemoto M, Boissiere L, Larrieu D, Kieser DC, Fujishiro T, Hayashi K, Bourghli A, Yilgor C, Alanay A, Perez Grueso FJ, Pelisse F, Kleinstück F, Vital JM, Obeid I. The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2033-2039. [PMID: 33900475 DOI: 10.1007/s00586-021-06786-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. METHODS This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. RESULTS A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. CONCLUSION Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.
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Affiliation(s)
- D T Cawley
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France.
- Mater Private Hospital, Dublin 1, Ireland.
| | | | - L Boissiere
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D Larrieu
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D C Kieser
- Christchurch School of Medicine, University of Otago, Dunedin, New Zealand
| | - T Fujishiro
- Osaka Medical College, Takatsuki-shi, Osaka, Japan
| | - K Hayashi
- Osaka City University Graduate School of Medicine, Juso Hospital, Osaka, Japan
| | | | - C Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - A Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | | | - F Pelisse
- Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - J M Vital
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - I Obeid
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
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9
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Acaroglu E, Yuksel S, Ates C, Ayhan S, Bahadir S, Nabi V, Vila-Casademunt A, Sanchez Perez-Grueso FJ, Obeid I. Decision Analysis in Quest of the Ideal Treatment in Adult Spinal Deformity Adjusted for Minimum Clinically Important Difference. World Neurosurg 2020; 142:e278-e289. [PMID: 32622065 DOI: 10.1016/j.wneu.2020.06.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. METHODS From a multicenter database including 1452 patients, 698 with 2 years of follow-up were analyzed. Mean age of patients was 50.95 ± 19.44 years; 580 patients were women, and 118 were men. The surgical group comprised 369 patients, and the nonsurgical group comprised 329 patients. The surgical group was subcategorized into no complications (192 patients), minor complications (97 patients) and major complications (80 patients) groups to analyze the effect of complications on results. Minimum clinically important differences using Oswestry Disability Index were 14.31, 14.96, and 2.48 for overall, surgical, and nonsurgical groups. Utilities were calculated by visual analog scale mapping. RESULTS Surgical treatment provided higher utility (0.583) than nonsurgical treatment (0.549) that was sensitive to complications, being 0.634, 0.564, and 0.497 in no, minor, and major complications. Probabilities of improvement, unchanged, and deterioration were 38.3%, 39.2%, and 22.5% for surgical treatment and 39.4%, 10.5%, and 50.1% for nonsurgical treatment. Improvement in the surgical group was also sensitive to complications with rates of 40.1%, 39.3%, and 33.3%. CONCLUSIONS Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.
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Affiliation(s)
- Emre Acaroglu
- Department of Orthopaedic Surgery, Ankara Spine Center, Ankara, Turkey.
| | - Selcen Yuksel
- Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey
| | - Can Ates
- Department of Biostatistics, Van Yuzuncu Yil University, Van, Turkey
| | - Selim Ayhan
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Sinan Bahadir
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Vugar Nabi
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Alba Vila-Casademunt
- Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Department of Orthopedic Surgery, Bordeaux University Hospital, Bordeaux, France
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- Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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10
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Is Multilevel Anterior Lumbar Interbody Fusion (ALIF) Superior to Pedicle Subtraction Osteotomy (PSO) for Degenerative Lumbar Deformity? Clin Spine Surg 2020; 33:1-4. [PMID: 30932932 DOI: 10.1097/bsd.0000000000000817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Knight SR, Ots R, Maimbo M, Drake TM, Fairfield CJ, Harrison EM. Systematic review of the use of big data to improve surgery in low- and middle-income countries. Br J Surg 2019; 106:e62-e72. [PMID: 30620075 PMCID: PMC6590290 DOI: 10.1002/bjs.11052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022]
Abstract
Background Technological advances have led to the generation of large amounts of data, both in surgical research and practice. Despite this, it is unclear how much originates in low‐ and middle‐income countries (LMICs) and what barriers exist to the use of such data in improving surgical care. The aim of this review was to capture the extent and impact of programmes that use large volumes of patient data on surgical care in LMICs. Methods A PRISMA‐compliant systematic literature review of PubMed, Embase and Google Scholar was performed in August 2018. Prospective studies collecting large volumes of patient‐level data within LMIC settings were included and evaluated qualitatively. Results A total of 68 studies were included from 71 LMICs, involving 708 032 patients. The number of patients in included studies varied widely (from 335 to 428 346), with 25 reporting data on 3000 or more LMIC patients. Patient inclusion in large‐data studies in LMICs has increased dramatically since 2015. Studies predominantly involved Brazil, China, India and Thailand, with low patient numbers from Africa and Latin America. Outcomes after surgery were commonly the focus (33 studies); very few large studies looked at access to surgical care or patient expenditure. The use of large data sets specifically to improve surgical outcomes in LMICs is currently limited. Conclusion Large volumes of data are becoming more common and provide a strong foundation for continuing investigation. Future studies should address questions more specific to surgery.
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Affiliation(s)
- S R Knight
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - R Ots
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - M Maimbo
- Department of General Surgery, Kitwe Teaching Hospital, Kitwe, Zambia
| | - T M Drake
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - C J Fairfield
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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12
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Effect of Resident and Fellow Involvement in Adult Spinal Deformity Surgery. World Neurosurg 2019; 122:e759-e764. [DOI: 10.1016/j.wneu.2018.10.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 11/18/2022]
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13
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Ayhan S, Yuksel S, Nabiyev V, Adhikari P, Villa-Casademunt A, Pellise F, Perez-Grueso FS, Alanay A, Obeid I, Kleinstueck F, Acaroglu E. The Influence of Diagnosis, Age, and Gender on Surgical Outcomes in Patients With Adult Spinal Deformity. Global Spine J 2018; 8:803-809. [PMID: 30560031 PMCID: PMC6293420 DOI: 10.1177/2192568218772568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review of prospectively collected data from a multicentric database. OBJECTIVES To determine the clinical impact of diagnosis, age, and gender on treatment outcomes in surgically treated adult spinal deformity (ASD) patients. METHODS A total of 199 surgical patients with a minimum follow-up of 1 year were included and analyzed for baseline characteristics. Patients were separated into 2 groups based on improvement in health-related quality of life (HRQOL) parameters by minimum clinically important difference. Statistics were used to analyze the effect of diagnosis, age, and gender on outcome measurements followed by a multivariate binary logistic regression model for these results with statistical significance. RESULTS Age was found to affect SF-36 PCS (Short From-36 Physical Component Summary) score significantly, with an odds ratio of 1.017 (unit by unit) of improving SF-36 PCS score on multivariate analysis (P < .05). The breaking point in age for this effect was 37.5 years (AUC = 58.0, P = .05). A diagnosis of idiopathic deformity would increase the probability of improvement in Oswestry Disability Index (ODI) by a factor of 0.219 and in SF-36 PCS by 0.581 times (P < .05). Gender was found not to have a significant effect on any of the HRQOL scores. CONCLUSIONS Age, along with a diagnosis of degenerative deformity, may have positive effects on the likelihood of improvement in SF-36 PCS (for age) and ODI (for diagnosis) in surgically treated patients with ASD and the breaking point of this effect may be earlier than generally anticipated. Gender does not seem to affect results. These may be important in patient counseling for the anticipated outcomes of surgery.
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Affiliation(s)
- Selim Ayhan
- ARTES Spine Center, Ankara, Turkey,Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | | | | | | | | | | | - Ahmet Alanay
- Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | | | - Emre Acaroglu
- ARTES Spine Center, Ankara, Turkey,Emre Acaroglu, ARTES Spine Center, Iran
Caddesi, 45/2, Kavaklidere 06700, Cankaya, Ankara, Turkey.
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14
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Kang J, Hosogane N, Ames C, Schwab F, Hart R, Burton D, Shaffrey C, Smith JS, Bess S, Lafage V, Cho KJ, Ha Y. Diversity in Surgical Decision Strategies for Adult Spine Deformity Treatment: The Effects of Neurosurgery or Orthopedic Training Background and Surgical Experience. Neurospine 2018; 15:353-361. [PMID: 30157582 PMCID: PMC6347356 DOI: 10.14245/ns.1836086.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study is aimed to investigate whether surgical strategies for adult spinal deformity (ASD) treatment differed among Korean physicians. METHODS This study is retrospective questionnaire-based study. ASD is challenging to manage, with a broad range of clinical and radiological presentations. To investigate possible nationality- or ethnicity-related differences in the surgical strategies adopted for ASD treatment, the International Spine Study Group surveyed physicians' responses to 16 cases of ASD. We reviewed the answers to this survey from Korean physicians. Korean orthopedic surgeons (OS) and neurosurgeons (NS) received a questionnaire containing 16 cases and response forms via email. After reviewing the cases, physicians were asked to indicate whether they would treat each case with decompression or fusion. If fusion was chosen, physicians were also asked to indicate whether they would perform 3-column osteotomy. Retrospective chi-square analyses were performed to investigate whether the answers to each question differed according to training specialty or amount of surgical experience. RESULTS Twenty-nine physicians responded to our survey, of whom 12 were OS and 17 were NS. In addition, 18 (62.1%) had more than 10 years of experience in ASD correction and were assigned to the M10 group, while 11 (37.9%) had less than 10 years of experience and were assigned to the L10 group. We found that for all cases, the surgical strategies favored did not significantly differ between OS and NS or between the M10 and L10 groups. However, for both fusion surgery and 3-column osteotomy, opinions were divided regarding the necessity of the procedures in 4 of the 16 cases. CONCLUSION The surgical strategies favored by physicians were similar for most cases regardless of their training specialty or experience. This suggests that these factors do not affect the surgical strategies selected for ASD treatment, with patient clinical and radiological characteristics having greater importance.
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Affiliation(s)
- Jiin Kang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Naobumi Hosogane
- Department of Orthopedic Surgery, National Defense Medical College, Tokorozawa, Japan.,Keio Spine Research Group, Tokyo, Japan
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Frank Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Robert Hart
- Oregon Health & Science University, Portland, OR, USA
| | - Douglas Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, CO, USA
| | | | - Kyu-Jung Cho
- Department of Orthopedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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15
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Berven SH, Kamper SJ, Germscheid NM, Dahl B, Shaffrey CI, Lenke LG, Lewis SJ, Cheung KM, Alanay A, Ito M, Polly DW, Qiu Y, de Kleuver M. An international consensus on the appropriate evaluation and treatment for adults with spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:585-596. [DOI: 10.1007/s00586-017-5241-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/15/2017] [Accepted: 07/23/2017] [Indexed: 12/17/2022]
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