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Adult spinal deformity

Adult degenerative scoliosis is a spinal deformity with Cobb angle > 10 º 1) in a skeletally mature individual 2).

Adult spinal deformity or adult degenerative scoliosis, is a broad term that refers to a wide spectrum of structural abnormalities of a mature spine.

This condition also goes by the name, “de novo” scoliosis. As the name implies, this variety begins in the adult patient due to degeneration of the discs, arthritis of the adjacent facet joints and collapse and wedging of the disc spaces.

It encompasses abnormality in the coronal plane (scoliosis) and sagittal imbalance.


see Adult spinal deformity epidemiology.

A survey of neurosurgeon AANS membership assessed the deformity knowledge base and impact of current training, education, and practice experience to identify opportunities for improved education. Eleven questions developed and agreed upon by experienced spinal deformity surgeons tested ASD knowledge and were subgrouped into 5 categories:

1) radiology/spinopelvic alignment

2) health-related quality of life

3) surgical indications

4) operative technique

5) clinical evaluation.

Chi-square analysis was used to compare differences based on participant demographic characteristics (years of practice, spinal surgery fellowship training, percentage of practice comprising spinal surgery).

Responses were received from 1456 neurosurgeons. Of these respondents, 57% had practiced less than 10 years, 20% had completed a spine fellowship, and 32% devoted more than 75% of their practice to spine. The overall correct answer percentage was 42%. Radiology/spinal pelvic alignment questions had the lowest percentage of correct answers (38%), while clinical evaluation and surgical indications questions had the highest percentage (44%). More than 10 years in practice, completion of a spine fellowship, and more than 75% spine practice were associated with greater overall percentage correct (p < 0.001). More than 10 years in practice was significantly associated with increased percentage of correct answers in 4 of 5 categories. Spine fellowship and more than 75% spine practice were significantly associated with increased percentage correct in all categories. Interestingly, the highest error was seen in risk for postoperative coronal imbalance, with a very low rate of correct responses (15%) and not significantly improved with fellowship (18%, p = 0.08).

The results of this survey suggest that ASD knowledge could be improved in neurosurgery. Knowledge may be augmented with neurosurgical experience, spinal surgery fellowships, and spinal specialization.

Neurosurgical education should particularly focus on radiology/spinal pelvic alignment, especially pelvic obliquity and coronal imbalance and operative techniques for ASD 3).


A literature analysis highlighted several classification schemes developed for degenerative scoliosis patients: the Simmons classification system, the Aebi system, the Faldini working classification system, the Schwab system, and the Scoliosis Research Society system 4).


Clinical features


There are few radiographic markers to predict presence of radiculopathy. Emerging data suggest that spondylolisthesis, obliquity, foraminal stenosis and curve concavity may be associated with radiculopathy in ADS.


Full length standing radiographs in both the coronal and sagittal plane that include all segments of the spine as well as the pelvis and hips are essential in the diagnostic evaluation of adults with spinal deformity. From such radiographs the segmental alignment, regional curvatures and global balance can be measured. Pelvic parameters such as pelvic incidence and pelvic tilt will also help define compensatory mechanisms of deformity. Focal imaging studies may be necessary to assess for instability (flexion-extension radiographs). Advanced imaging studies (i.e. MRI or CT myelography) may be needed to assess patients with lower extremity symptoms or other neurologic signs or symptoms.

Coronal deformity is usually less symptomatic than a sagittal deformity because there is less expenditure of energy and hence less effort to maintain upright posture. However, nerve root compression at the fractional curve or at the concave side of the main curve can give rise to debilitating radiculopathy.

Findings demonstrate significant variability in health-related quality-of-life measures and radiographic parameters between North American and Japanese patients, supporting the need for population-adjusted sagittal modifiers to more accurately classify deformity 5).


Case series

Case reports

High-Frequency Spinal Cord Stimulation for the Treatment of Primarily Axial Back Pain due to Degenerative Scoliosis with Spinopelvic Imbalance 6).

Cobb JR. Outline for the study of scoliosis. American Academy of Orthopaedic Surgeons Instr Course Lect. 1948;5:261–275
Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010 Mar;28(3):E1. doi: 10.3171/2010.1.FOCUS09271. PubMed PMID: 20192655.
Clark AJ, Garcia RM, Keefe MK, Koski TR, Rosner MK, Smith JS, Cheng JS, Shaffrey CI, McCormick PC, Ames CP; , and the International Spine Study Group. Results of the AANS membership survey of adult spinal deformity knowledge: impact of training, practice experience, and assessment of potential areas for improved education. J Neurosurg Spine. 2014 Jul 18:1-8. [Epub ahead of print] PubMed PMID: 25036219.
Faldini C, Di Martino A, De Fine M, Miscione MT, Calamelli C, Mazzotti A, Perna F. Current classification systems for adult degenerative scoliosis. Musculoskelet Surg. 2013 Apr;97(1):1-8. doi: 10.1007/s12306-013-0245-4. Epub 2013 Apr 4. Review. PubMed PMID: 23553440.
Ames C, Gammal I, Matsumoto M, Hosogane N, Smith JS, Protopsaltis T, Yamato Y, Matsuyama Y, Taneichi H, Lafage R, Ferrero E, Schwab FJ, Lafage V. Geographic and Ethnic Variations in Radiographic Disability Thresholds: Analysis of North American and Japanese Operative Adult Spinal Deformity Populations. Neurosurgery. 2016 Jun;78(6):793-801. doi: 10.1227/NEU.0000000000001184. PubMed PMID: 26692107.
Tate Q, House LM, McCormick ZL, Mahan MA. High-Frequency Spinal Cord Stimulation for the Treatment of Primarily Axial Back Pain due to Degenerative Scoliosis with Spinopelvic Imbalance: Case Report. Pain Med. 2019 Mar 11. pii: pnz043. doi: 10.1093/pm/pnz043. [Epub ahead of print] PubMed PMID: 30856267.
adult_spinal_deformity.txt · Last modified: 2019/03/12 18:34 by administrador