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Degenerative Spinal Deformity.

Publication ,  Journal Article
Ailon, T; Smith, JS; Shaffrey, CI; Lenke, LG; Brodke, D; Harrop, JS; Fehlings, M; Ames, CP
Published in: Neurosurgery
October 2015

Degenerative spinal deformity afflicts a significant portion of the elderly and is increasing in prevalence. Recent evidence has revealed sagittal plane malalignment to be a key driver of pain and disability in this population and has led to a significant shift toward a more evidence-based management paradigm. In this narrative review, we review the recent literature on the epidemiology, evaluation, management, and outcomes of degenerative adult spinal deformity (ASD). ASD is increasing in prevalence in North America due to an aging population and demographic shifts. It results from cumulative degenerative changes focused in the intervertebral discs and facet joints that occur asymmetrically to produce deformity. Deformity correction focuses on restoration of global alignment, especially in the sagittal plane, and decompression of the neural elements. General realignment goals have been established, including sagittal vertical axis <50 mm, pelvic tilt <22°, and lumbopelvic mismatch <±9°; however, these should be tailored to the patient. Operative management, in carefully selected patients, yields satisfactory outcomes that appear to be superior to nonoperative strategies. ASD is characterized by malalignment in the sagittal and/or coronal plane and, in adults, presents with pain and disability. Nonoperative management is recommended for patients with mild, nonprogressive symptoms; however, evidence of its efficacy is limited. Surgery aims to restore global spinal alignment, decompress neural elements, and achieve fusion with minimal complications. The surgical approach should balance the desired correction with the increased risk of more aggressive maneuvers. In well-selected patients, surgery yields excellent outcomes.

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Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

October 2015

Volume

77 Suppl 4

Start / End Page

S75 / S91

Location

United States

Related Subject Headings

  • Zygapophyseal Joint
  • Spinal Fusion
  • Spinal Diseases
  • Spinal Cord Compression
  • Severity of Illness Index
  • Scoliosis
  • Neurology & Neurosurgery
  • Lordosis
  • Kyphosis
  • Intervertebral Disc Degeneration
 

Citation

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Ailon, T., Smith, J. S., Shaffrey, C. I., Lenke, L. G., Brodke, D., Harrop, J. S., … Ames, C. P. (2015). Degenerative Spinal Deformity. Neurosurgery, 77 Suppl 4, S75–S91. https://doi.org/10.1227/NEU.0000000000000938
Ailon, Tamir, Justin S. Smith, Christopher I. Shaffrey, Lawrence G. Lenke, Darrel Brodke, James S. Harrop, Michael Fehlings, and Christopher P. Ames. “Degenerative Spinal Deformity.Neurosurgery 77 Suppl 4 (October 2015): S75–91. https://doi.org/10.1227/NEU.0000000000000938.
Ailon T, Smith JS, Shaffrey CI, Lenke LG, Brodke D, Harrop JS, et al. Degenerative Spinal Deformity. Neurosurgery. 2015 Oct;77 Suppl 4:S75–91.
Ailon, Tamir, et al. “Degenerative Spinal Deformity.Neurosurgery, vol. 77 Suppl 4, Oct. 2015, pp. S75–91. Pubmed, doi:10.1227/NEU.0000000000000938.
Ailon T, Smith JS, Shaffrey CI, Lenke LG, Brodke D, Harrop JS, Fehlings M, Ames CP. Degenerative Spinal Deformity. Neurosurgery. 2015 Oct;77 Suppl 4:S75–S91.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

October 2015

Volume

77 Suppl 4

Start / End Page

S75 / S91

Location

United States

Related Subject Headings

  • Zygapophyseal Joint
  • Spinal Fusion
  • Spinal Diseases
  • Spinal Cord Compression
  • Severity of Illness Index
  • Scoliosis
  • Neurology & Neurosurgery
  • Lordosis
  • Kyphosis
  • Intervertebral Disc Degeneration