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

2019 ◽  
Vol 29 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Takashi Fujishiro ◽  
◽  
Louis Boissière ◽  
Derek Thomas Cawley ◽  
Daniel Larrieu ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Deformity ◽  
Scoring System ◽  
Adult Spinal Deformity ◽  
Treatment Modalities ◽  
Surgical Decision ◽  
Development And Validation ◽  
Surgical Decision Making ◽  
Selection Of

Adult spinal deformity surgical decision-making score

2019 ◽  
Vol 28 (7) ◽  
pp. 1652-1660 ◽  
Author(s):  
Takashi Fujishiro ◽  
◽  
Louis Boissière ◽  
Derek Thomas Cawley ◽  
Daniel Larrieu ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Surgical Decision ◽  
Surgical Decision Making

scholarly journals Upper-thoracic versus lower-thoracic upper instrumented vertebra in adult spinal deformity patients undergoing fusion to the pelvis: surgical decision-making and patient outcomes

2020 ◽  
Vol 32 (4) ◽  
pp. 600-606 ◽  
Author(s):  
Alan H. Daniels ◽  
Daniel B. C. Reid ◽  
Wesley M. Durand ◽  
D. Kojo Hamilton ◽  
Peter G. Passias ◽  
...  
Keyword(s):  
Decision Making ◽  
Blood Loss ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Sagittal Vertical Axis ◽  
Surgical Decision ◽  
Estimated Blood Loss ◽  
Upper Thoracic ◽  
Surgical Decision Making

OBJECTIVEOptimal patient selection for upper-thoracic (UT) versus lower-thoracic (LT) fusion during adult spinal deformity (ASD) correction is challenging. Radiographic and clinical outcomes following UT versus LT fusion remain incompletely understood. The purposes of this study were: 1) to evaluate demographic, radiographic, and surgical characteristics associated with choice of UT versus LT fusion endpoint; and 2) to evaluate differences in radiographic, clinical, and health-related quality of life (HRQOL) outcomes following UT versus LT fusion for ASD.METHODSRetrospective review of a prospectively collected multicenter ASD database was performed. Patients with ASD who underwent fusion from the sacrum/ilium to the LT (T9–L1) or UT (T1–6) spine were compared for demographic, radiographic, and surgical characteristics. Outcomes including proximal junctional kyphosis (PJK), reoperation, rod fracture, pseudarthrosis, overall complications, 2-year change in alignment parameters, and 2-year HRQOL metrics (Lumbar Stiffness Disability Index, Scoliosis Research Society-22r questionnaire, Oswestry Disability Index) were compared after controlling for confounding factors via multivariate analysis.RESULTSThree hundred three patients (169 LT, 134 UT) were evaluated. Independent predictors of UT fusion included greater thoracic kyphosis (odds ratio [OR] 0.97 per degree, p = 0.0098), greater coronal Cobb angle (OR 1.06 per degree, p < 0.0001), and performance of a 3-column osteotomy (3-CO; OR 2.39, p = 0.0351). While associated with longer operative times (ratio 1.13, p < 0.0001) and greater estimated blood loss (ratio 1.31, p = 0.0018), UT fusions resulted in greater sagittal vertical axis improvement (−59.5 vs −41.0 mm, p = 0.0035) and lower PJK rates (OR 0.49, p = 0.0457). No significant differences in postoperative HRQOL measures, reoperation, or overall complication rates were detected between groups (all p > 0.1).CONCLUSIONSGreater deformity and need for 3-CO increased the likelihood of UT fusion. Despite longer operative times and greater blood loss, UT fusions resulted in better sagittal correction and lower 2-year PJK rates following surgery for ASD. While continued surveillance is necessary, this information may inform patient counseling and surgical decision-making.

Clinical Performance and Concurrent Validity of the Adult Spinal Deformity Surgical Decision-making Score

Spine ◽  
2020 ◽  
Vol 45 (14) ◽  
pp. E847-E855
Author(s):  
Takashi Fujishiro ◽  
Louis Boissière ◽  
Derek Thomas Cawley ◽  
Daniel Larrieu ◽  
Olivier Gille ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Deformity ◽  
Concurrent Validity ◽  
Clinical Performance ◽  
Adult Spinal Deformity ◽  
Surgical Decision ◽  
Surgical Decision Making

scholarly journals A simple weighted scoring system to guide surgical decision-making in patients with parapneumonic pleural effusion

2016 ◽  
Vol 8 (11) ◽  
pp. 3168-3174
Author(s):  
Che-Chia Chang ◽  
Tzu-Ping Chen ◽  
Chi-Hsiao Yeh ◽  
Pin-Fu Huang ◽  
Yao-Chang Wang ◽  
...  
Keyword(s):  
Decision Making ◽  
Pleural Effusion ◽  
Scoring System ◽  
Surgical Decision ◽  
Parapneumonic Pleural Effusion ◽  
Surgical Decision Making

The impact of preoperative supine radiographs on surgical strategy in adult spinal deformity

2021 ◽  
pp. 1-7
Author(s):  
Francis Lovecchio ◽  
Jonathan Charles Elysee ◽  
Renaud Lafage ◽  
Jeff Varghese ◽  
Mathieu Bannwarth ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Surgical Decision ◽  
Spinal Flexibility ◽  
Grade 3 ◽  
Upper Instrumented Vertebra ◽  
Invasive Techniques ◽  
The Impact ◽  
Surgical Decision Making

OBJECTIVE Preoperative planning for adult spinal deformity (ASD) surgery is essential to prepare the surgical team and consistently obtain postoperative alignment goals. Positional imaging may allow the surgeon to evaluate spinal flexibility and anticipate the need for more invasive techniques. The purpose of this study was to determine whether spine flexibility, defined by the change in alignment between supine and standing imaging, is associated with the need for an osteotomy in ASD surgery. METHODS A single-center, dual-surgeon retrospective analysis was performed of adult patients with ASD who underwent correction of a thoracolumbar deformity between 2014 and 2018 (pelvis to upper instrumented vertebra between L1 and T9). Patients were stratified into osteotomy (Ost) and no-osteotomy (NOst) cohorts according to whether an osteotomy was performed (Schwab grade 2 or higher). Demographic, surgical, and radiographic parameters were compared. The sagittal correction from intraoperative prone positioning alone (sagittal flexibility percentage [Sflex%]) was assessed by comparing the change in lumbar lordosis (LL) between preoperative supine to standing radiographs and preoperative to postoperative alignment. RESULTS Demographics and preoperative and postoperative sagittal alignment were similar between the Ost (n = 60, 65.9%) and NOst (n = 31, 34.1%) cohorts (p > 0.05). Of all Ost patients, 71.7% had a grade 2 osteotomy (mean 3 per patient), 21.7% had a grade 3 osteotomy, and 12.5% underwent both grade 3 and grade 2 osteotomies. Postoperatively, the NOst and Ost cohorts had similar pelvic incidence minus lumbar lordosis (PI-LL) mismatch (mean PI-LL 5.2° vs 1.2°; p = 0.205). Correction obtained through positioning (Sflex%) was significantly lower for in the osteotomy cohort (38.0% vs 76.3%, p = 0.004). A threshold of Sflex% < 70% predicted the need for osteotomy at a sensitivity of 78%, specificity of 56%, and positive predictive value of 77%. CONCLUSIONS The flexibility of the spine is quantitatively related to the use of an osteotomy. Prospective studies are needed to determine thresholds that may be used to standardize surgical decision-making in ASD surgery.

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