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spinal_deformity

Spinal deformity

Chiari type 1 deformity, with syringomyelia (CIM+SM) is often associated with spinal deformity.

Spinal deformities are frequent and disabling complications of movement disorders such as Parkinson disease and multiple system atrophy. The most distinct spinal deformities include camptocormia, antecollis, Pisa syndrome, and scoliosis.

Early diagnosis of spinal tuberculosis and prompt treatment is necessary to prevent permanent neurological disability and to minimize spinal deformity 1) 2).

see Adolescent spinal deformity

see Adult spinal deformity

see Sagittal spinal deformity


The correction of spinal deformity may be achieved by a variety of methods, each of which has advantages and disadvantages. The goals of spinal deformity surgery include reasonable correction of the curvature, prevention of further deformation, improvement of sagittal and coronal balance, optimization of cosmetic issues, and restoration/preservation of function. The failure to consider all these factors appropriately may result in a suboptimal outcome. Understanding fundamental biomechanical principles involved in the formation, progression, and treatment of spinal deformities is essential in the clinical decision-making process 3).

Case series

2017

A cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses.

The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission ( P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive ( P < .05).

The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery 4).

1)
Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 2010;92(7):905–13
2)
Jain AK, Dhammi IK. Tuberculosis of the spine: a review. Clin Orthop Relat Res 2007;460(July):39–49
3)
Schlenk RP, Kowalski RJ, Benzel EC. Biomechanics of spinal deformity. Neurosurg Focus. 2003 Jan 15;14(1):e2. Review. PubMed PMID: 15766219.
4)
Zygourakis CC, Liu CY, Keefe M, Moriates C, Ratliff J, Dudley RA, Gonzales R, Mummaneni PV, Ames CP. Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity. Neurosurgery. 2017 May 9. doi: 10.1093/neuros/nyx218. [Epub ahead of print] PubMed PMID: 28486687.
spinal_deformity.txt · Last modified: 2018/05/03 19:36 by administrador