Adult Spinal Deformity
Treatment Options

The treatment approach of adult deformity must be driven by the symptoms of the patient above all. The physician must have a good understanding of his / her patient to understand the impact of the deformity (and associated pathologies) as well as the expectations through treatment. What may be an acceptable functional level of one patient may be intolerable to another patient. With the exception of patients who present with significant neurologic deficits or severe progressive deformity, non-operative measures should be initiated prior to considering surgical alternatives. Typical non-operative measures include physical therapy (emphasizing core strengthening), activity modification, medication and pain management (including injection therapies). A sincere effort should be exhausted to resolve pain associated with deformity without surgery.

When should surgery be considered? In simple terms, surgery is reserved for either severe or progressive deformity, or for deformity with unacceptable symptoms that have not responded well to non-operative means. In general, curvatures in younger adults (AISA) are approached surgically when they are around 50 degrees or greater. These have been shown to be at high risk for continuing progression over time. If surgery is considered for treatment of severe deformity or for symptoms unresponsive to conservative measures then a careful risk / benefit analysis is necessary prior to planning an intervention. While targeted minor, or minimally invasive procedures are occasionally applied, many procedures related to adult deformity are extensive with risks that must be carefully considered. Age and co-morbidities, previous surgery, degree of imbalance, anticipated level of fusion, and degree of baseline functional deterioration all weigh upon the likelihood of success and complications. Although excellent results can be obtained, risks of some peri-operative or post- operative complication developing are as high as 40 percent. Despite this, in a recent large analysis of a multi-center adult deformity population the vast majority of surgically treated patients were significantly improved by standard outcomes measures at two years follow up. If surgery is planned, and the risk / benefit ratio is deemed favorable, then careful preparation is necessary. Medical optimization, physical conditioning, and post operative preparation (family support and rehabilitation program) are all important. In anticipation of blood loss, pre-operative donation may be helpful. Psychological preparation of the patient is also very important. Surgery for adult deformity is a substantial commitment on the part of the entire treating team and the patient. Recovery will often take many months and the full benefit from intervention may not be appreciated for some time. Complications may develop and in some instances staged surgical procedures with long hospitalizations will be necessary. However, despite these serious considerations, operative interventions, when properly planned and for the right indications can markedly improve the quality of life of our patients.