Clinical Improvement Through Surgery for Adult Spinal Deformity: What Can Be Expected and Who Is Likely to Benefit Most ?
Article dans une revue avec comité de lecture
Study Design: Multicenter, prospective, nonconsecutive, surgical case series from the International Spine Study Group. Objectives: To evaluate the extent of clinical improvement after surgery for adult spinal deformity (ASD) based on minimal clinically important difference (MCID) and baseline measures. Summary of Background Data: For ASD, evaluation of surgical treatment success using clinical scores should take into account baseline disability and pain and the improvement defined relative to the MCID. Methods: Inclusion criteria included operative patients (age O18 years) with baseline and 2-year SRS-22 scores. Normative values for the SRS scores were included and improvement for patients was expressed in number of MCIDs. At baseline, patients were classified by differences in activity and pain scores from normative values in four groups: ‘‘worst,’’ ‘‘severe,’’ ‘‘poor,’’ and, ‘‘moderate.’’ At 2 years after surgery, patients were classified into four groups based on their change in SRS score as follows: ‘‘no improvement or deterioration,’’ ‘‘mediocre,’’ ‘‘satisfactory,’’ or ‘‘optimal.’’ Distinction among curve types was also performed based on the SRS-Schwab ASD classification. Results: A total of 223 patients (age 5 55 15 years) were included. At baseline, for 77% of the patients, the worst scores were in Activity or Pain. At baseline, the distribution was 36%‘‘worst,’’ 28%‘‘severe,’’ 19% ‘‘poor,’’ and 17% ‘‘moderate.’’ Patients with sagittal malalignment only were more likely to be in the ‘‘worst’’ state (54%). The overall distribution of improvement was as follows: 24% no improvement or deterioration, 17% mediocre, 25%satisfactory, and 33%optimal. Forty-one percent of baseline ‘‘moderate’’ patients achieved no improvement. Of the baseline ‘‘worst’’ patients, 20% achieved no improvement, and 36% and 19% achieved ‘‘satisfactory’’ and ‘‘optimal’’ improvement, respectively. Conclusion: Overall, 24% of patients did not experience improvement after surgery. Patients with baseline severe disability were more likely to perceive improvement than patients with less disability.
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Radiographic Outcomes of Adult Spinal Deformity Correction : A Critical Analysis of Variability and Failures Across Deformity Patterns Article dans une revue avec comité de lectureMOAL, Bertrand; SCHWAB, Franck; AMES, Christopher P.; SMITH, Justin; RYAN, Devon; PRAVEEN, Mummaneni; TERRAN, Jamie; KLINEBERG, Eric; HART, Robert; OHENEBA, Boachie-Adjei; SHAFFREY, Christopher; SKALLI, Wafa; LAFAGE, Virginie (Springer Verlag, 2014)Study Design: Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. Objectives: To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. ...
Spino-femoral muscles affect sagittal alignment and compensatory recruitment: a new look into soft tissues in adult spinal deformity Article dans une revue avec comité de lectureBAO, Hongda; MOAL, Bertrand; VIRA, Shaleen; BRONSARD, Nicolas; AMABILE, Célia; ERRICO, Thomas; SCHWAB, Frank; SKALLI, Wafa; DUBOUSSET, Jean; LAFAGE, Virginie (Springer Verlag, 2020)Objective To quantify muscle characteristics (volumes and fat infiltration) and identify their relationship to sagittal malalignment and compensatory mechanism recruitment. Methods Female adult spinal deformity patients ...
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Clinical and stereoradiographic analysis of adult spinal deformity with and without rotatory subluxation Article dans une revue avec comité de lectureFERRERO, Emmanuelle; LAFAGE, Renaud; CHALLIER, Vincent; DIEBO, Bassel G.; GUIGUI, Pierre; MAZDA, Keyvan; SCHWAB, Frank; SKALLI, Wafa; LAFAGE, Virginie (Elsevier Masson, 2015)Introduction: In degenerative adult spinal deformity (ASD), sagittal malalignment and rotatory sublux-ation (RS) correlate with clinical symptomatology. RS is defined as axial rotation with lateral listhesis.Stereoradiography, ...