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adult_spinal_deformity_diagnosis

Adult spinal deformity diagnosis

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.

CT / MRI

Both are recommended for the evaluation of symptomatic spondylosis and ASD to determine extent of neural compression.

DEXA

(dual-energy X-ray absorptiometry). Patients should be evaluated for osteopenia/osteoporosis prior to surgical planning. Medical treatment may be beneficial in the perioperative period.

Some surgeons use teriparatide (Forteo®) for 3 months to quickly increase osteoporotic bone strength for surgery.

Radiographs

Standing scoliosis X-rays

Recommended for the evaluation of global and regional spinal balance. Pre- and postoperative plain films help confirm that alignment objectives are achieved.

Measurements related to sagittal balance are taken from standing scoliosis X-rays (CT & MRI are obtained supine and are not equivalent). Technical requirements for the lateral image:

● X-ray must image from C7 down to the femoral heads

● the patient needs to try to keep their knees straight (extended)

● arms should be folded in front of the chest (and they should not lean or hold on to anything) Dynamic scoliosis X-rays (“lateral bending films”) help determine the degree of curve rigidity preoperatively.


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 1).

1)
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.
adult_spinal_deformity_diagnosis.txt · Last modified: 2019/10/20 11:48 by administrador