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Recognize, treat ‘hidden’ deformity in some patients with degenerative conditions
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SAN DIEGO — Neurosurgeons focused on the spine may need to resort to spinal correction techniques similar to those used to correct spinal deformity to obtain optimal outcomes in some patients with degenerative diseases of the spine, a presenter said at the Congress of Neurological Surgeons Annual Meeting, here.
Christopher I. Shaffrey, MD, FACS, said 15% to 33% of patients with degenerative diseases of the spine do not respond to decompression alone or to decompression with fusion and are at risk for an unrecognized, and possibly untreated, deformity.
When presented with a patient who is likely to fail those types of interventions, spine surgeons need to focus on spinopelvic alignment, measure lumbar lordosis (LL) and pelvic incidence (PI), and modify their surgical approach to improve those patients’ outcomes, according to Shaffrey.
“Degenerative conditions may have a component of spinal deformity. If you do not look, you will not recognize it. Understanding the pelvic parameters are important. Remember to measure alignment preoperatively. There are lots of techniques that can give you a good result,” he said.
“Spinopelvic alignment does influence outcomes,” Shaffrey said, noting it is the surgeon’s responsibility to establish spinal alignment in patients with degenerative diseases, which can restore LL, improve patient symptoms and help avoid disability.
In particular, “the lordosis at the bottom of the lumbar spine is critical,” Shaffrey said.
The difference between the measurements of LL and PI, which describes the position of a patient’s spine and how it fits into the pelvis, should not exceed 10°.
Shaffrey has studied these concepts with the International Spine Study Group and some of their work examined the effect of returning patients with a mismatch to normative values.
In a patient with 48° mismatch whose spine was realigned surgically, “we had greater than 90% improvement in pain and function by achieving this,” Shaffrey said.
For preoperative planning, a standing lumbar radiograph that includes the hips shows LL the best and enables these measurements to be made, he noted.
“By doing this measurement of the LL and the PI, you will be able to identify all patients who are at risk and to modify your surgical procedures to try to improve the LL in those patients who need the procedures the most,” Shaffrey said. – by Susan M. Rapp
Reference:
Shaffrey CI. Adapting spinal deformity alignment principles to achieve improved outcomes for many degenerative spine conditions. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 24-28, 2016; San Diego.
Disclosure: Shaffrey reports he has a consulting agreements with and receives intellectual fees and royalties from Biomet, Medtronic and NuVasive. He receives honoraria from Stryker.