Britspine Debate

1
Britspine Debate

• Degenerative scoliosis requires full deformity
  correction
• The case for.....

Ian Harding and Sean Molloy Wednesday 4.15pm 2nd
April 2014
2
Evidence It is common

• Prevalence rates for scoliosis in US adults
  Results from the first National Health and
  Nutrition Examination Survey.
• Carter OD, Haynes SG.
• Int J Epidemiol. 198716537544
• The adult scoliosis.
• Aebi M.
• Eur Spine J. 200514(10)925948
• Abnormalities of the lumbar spine in the coronal
  plane on plain abdominal radiographs
• RPBaker, M Kilshaw, R Gardner, S Charosky, and
  IJHardingEur Spine J. 2011 Mar20(3)429-33

Overall 5-70 with gt30 over 70s
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Deformity Imbalance v. local
4
Evidence Deformity matters
A Clinical Impact Classification of Scoliosis in
the Adult Frank Schwab MD, Jean-Pierre Farcy MD,
Keith Bridwell MD, Sigurd Berven MD, Steven
Glassman MD, John Harrast MS, William Horton MD.
Spine. 200631(18)21092114 The impact of
positive sagittal balance in adult spinal
deformity. Glassman SD, Bridwell K, Dimar JR,
Horton W, Berven S, Schwab F Spine.
200530(18)20242029.   Lumbar disc
degeneration below a long arthrodesis (performed
for scoliosis in adults) to L4 or L5 Harding IJ,
Charosky S, Vialle R, Chopin DH Eur Spine J.
2008 Feb17(2)250-4
5
Evidence Spinal shape

• Radiographic analysis of the sagittal alignment
  and balance of the spine in asymptomatic subjects
• Vialle R, Levassor N, Rillardon L, Templier A,
  Skalli W, Guigui P
• J Bone Joint Surg Am. 2005 Feb87(2)260-7

6
Evidence Ageing and deformity

• The effect of age on sagittal plane profile of
  the lumbar spine according to standing, supine,
  and various sitting positions
• Lee ES, Ko CW, Suh SW, Kumar S, Kang IK, Yang
  JH.
• J Orthop Surg Res. 2014 Feb 279(1)11

7
Evidence assessment and risk
Complications and risk factors of primary adult
scoliosis surgery a multicenter study of 306
patients. Charosky S, Guigui P, Blamoutier A,
Roussouly P, Chopin D Study Group on
Scoliosis Spine (Phila Pa 1976). 2012 Apr
1537(8)693-700
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The case for

• Full deformity correction
• Full for the particular individual with
  particular functional needs at a particular time
  of life, nothing more nothing less