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Challenges in Spinal Deformity
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Challenges in Spinal Deformity

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 15 January 2025 | Viewed by 2579

Special Issue Editor

Dr. Peter G. Passias

E-Mail Website
Guest Editor
Departments of Orthopedic and Neurological Surgery, NYU Langone Health/New York Spine Institute, New York, NY 10016, USA
Interests: scoliosis and spinal deformities; spondylolisthesis; cervical disc herniation; spinal cord compression; spinal stenosis; minimally invasive spine surgery; disc replacement; non-fusion technologies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The prevalence of Adult Spinal Deformity (ASD) has grown over the last three decades as the importance of spinal health is increasingly recognized.  Patients with adult spinal deformities often have other medical co-morbidities, including high levels of frailty, which makes ASD surgery particularly challenging and complex. Yet, surgical correction of ASD has been demonstrated to reduce the physiological and psychological burden of spinal malalignment, though significant challenges remain regarding the prevention and identification of post-operative outcomes complications. Whether it be the elucidating of novel hurdles of minimally invasive technique, or tackling complex multi-dimensional correction of severe deformity, improving corrective strategies and addressing the ever-increasing complexities and challenges that ASD surgery presents to physicians, patients, and institutions remains of paramount importance. In the present Special Issue, we present an overview of each technique, focusing our interest on the challenges of treating adult spinal deformity, as well as presenting the most recent approaches and techniques to address such hurdles.

Dr. Peter G. Passias
Guest Editor

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Keywords

  • osteoarthritis
  • cartilage
  • pain
  • pathogenesis
  • imaging
  • epidemiology
  • randomized controlled trial
  • cost-effectiveness
  • platelet rich plasma
  • stem cells
  • exercise therapy
  • arthroplasty
  • biomaterials

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Published Papers (2 papers)

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Research

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14 pages, 1028 KiB  
Article
Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery
by Peter G. Passias, Tyler K. Williamson, Jamshaid M. Mir, Justin S. Smith, Virginie Lafage, Renaud Lafage, Breton Line, Alan H. Daniels, Jeffrey L. Gum, Andrew J. Schoenfeld, David Kojo Hamilton, Alex Soroceanu, Justin K. Scheer, Robert Eastlack, Gregory M. Mundis, Bassel Diebo, Khaled M. Kebaish, Richard A. Hostin, Jr., Munish C. Gupta, Han Jo Kim, Eric O. Klineberg, Christopher P. Ames, Robert A. Hart, Douglas C. Burton, Frank J. Schwab, Christopher I. Shaffrey, Shay Bess and on behalf of the International Spine Study Groupadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(17), 5565; https://doi.org/10.3390/jcm12175565 - 26 Aug 2023
Viewed by 1266
Abstract
Background: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. Objective: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. Study [...] Read more.
Background: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. Objective: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. Study Design/Setting: Retrospective cohort study of a prospectively collected multicenter database. Methods: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. Results: A total of 930 patients were considered. Following PSM, 253 “optimal” (O) and 253 “not optimal” (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. Conclusions: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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Review

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18 pages, 10620 KiB  
Review
Instrumentation Failure in Adult Spinal Deformity Patients
by David P. Falk, Ravi Agrawal, Bijan Dehghani, Rohit Bhan, Sachin Gupta and Munish C. Gupta
J. Clin. Med. 2024, 13(15), 4326; https://doi.org/10.3390/jcm13154326 - 24 Jul 2024
Viewed by 772
Abstract
In recent years, advances in the surgical treatment of adult spinal deformity (ASD) have led to improved outcomes. Although these advances have helped drive the development of deformity surgery to meet the rising volume of patients seeking surgical treatment, many challenges have yet [...] Read more.
In recent years, advances in the surgical treatment of adult spinal deformity (ASD) have led to improved outcomes. Although these advances have helped drive the development of deformity surgery to meet the rising volume of patients seeking surgical treatment, many challenges have yet to be solved. Instrumentation failure remains one of the most common major complications following deformity surgery, associated with significant morbidity due to elevated re-operation rates among those experiencing mechanical complications. The two most frequently encountered subtypes of instrumentation failure are rod fracture (RF) and proximal junctional kyphosis/proximal junctional failure (PJK/PJF). While RF and PJK/PJF are both modes of instrumentation failure, they are two distinct entities with different clinical implications and treatment strategies. Considering that RF and PJK/PJF continue to represent a major challenge for patients with ASD and deformity surgeons alike, this review aims to discuss the incidence, risk factors, clinical impact, treatment strategies, preventive measures, and future research directions for each of these substantial complications. Full article
(This article belongs to the Special Issue Challenges in Spinal Deformity)
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