An update on improvement and innovation in the management of adult thoracolumbar spinal deformity
Abstract Adult spinal deformity (ASD) is a spectrum of abnormalities of the thoracic and lumbar spine and has an increasing prevalence. It is associated with significant physical and mental disability in symptomatic patients. Given the increased rates and the morbidity associated with this disease,...
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2025-03-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-025-08497-z |
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| author | Thomas Pieters Gabrielle Santangelo Taylor Furst Daniel M. Sciubba |
| author_facet | Thomas Pieters Gabrielle Santangelo Taylor Furst Daniel M. Sciubba |
| author_sort | Thomas Pieters |
| collection | DOAJ |
| description | Abstract Adult spinal deformity (ASD) is a spectrum of abnormalities of the thoracic and lumbar spine and has an increasing prevalence. It is associated with significant physical and mental disability in symptomatic patients. Given the increased rates and the morbidity associated with this disease, novel innovation in the diagnosis and treatment of such deformity is required. The SRS-Schwab classification system described coronal scoliotic deformity with sagittal modifiers. Other parameters, such as the sagittal vertical axis, pelvic tilt, T1 pelvic angle, pelvic incidence and lumbar lordosis attempted to quantify global sagittal balance. More recently, a focus on more patient specific parameters has been targeted to improve patient outcomes. The Roussouly classification system attempted to predict sagittal alignment parameters based on fixed parameters of the pelvis. Others determined the parameters based on patient age. Technological advances have also enhanced our understanding of ASD. Long cassette films and automated analyses have allowed standardization of these measurements across physicians. 3D printing has been used as an adjunct for both surgical planning and implants, both generic and patient specific, to improve outcomes. With these, advances in minimally invasive approaches have allowed ASD correction with lower complications and blood loss. Intraoperative navigation and the use of robotics has allowed improved accuracy in the care of these patients. Development of complex osteotomies have allowed for correction of advanced deformity. Fusion, however, is the ultimate goal of surgical ASD correction. Advances in biologics such as the use of recombinant Human Bone Morphogenetic Protein-2 have been used to improve fusion rates and combat pseudoarthrosis. Finally, post-operative advances in ASD patient care with emphasis on enhanced recovery after surgery has allowed improvements in hospital length of stay and pain scores. ASD is becoming a more ubiquitous diagnosis for spine surgeons with an increasing aging population. Improvement in the understanding of the diagnosis, spinopelvic parameters, imaging techniques, and post operative care are all aimed toward helping patients in whom care can be extremely difficult. Further study in ASD patient care will target advanced innovation to provide optimal treatment to these patients and allow for best possible outcomes. |
| format | Article |
| id | doaj-art-9299db6985cf4aa9bf456fddf10869ae |
| institution | DOAJ |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-9299db6985cf4aa9bf456fddf10869ae2025-08-20T02:51:27ZengBMCBMC Musculoskeletal Disorders1471-24742025-03-0126111010.1186/s12891-025-08497-zAn update on improvement and innovation in the management of adult thoracolumbar spinal deformityThomas Pieters0Gabrielle Santangelo1Taylor Furst2Daniel M. Sciubba3Department of Neurosurgery, Zucker School of Medicine at Hofstra/NorthwellDepartment of Neurosurgery, University of RochesterDepartment of Neurosurgery, University of RochesterDepartment of Neurosurgery, Zucker School of Medicine at Hofstra/NorthwellAbstract Adult spinal deformity (ASD) is a spectrum of abnormalities of the thoracic and lumbar spine and has an increasing prevalence. It is associated with significant physical and mental disability in symptomatic patients. Given the increased rates and the morbidity associated with this disease, novel innovation in the diagnosis and treatment of such deformity is required. The SRS-Schwab classification system described coronal scoliotic deformity with sagittal modifiers. Other parameters, such as the sagittal vertical axis, pelvic tilt, T1 pelvic angle, pelvic incidence and lumbar lordosis attempted to quantify global sagittal balance. More recently, a focus on more patient specific parameters has been targeted to improve patient outcomes. The Roussouly classification system attempted to predict sagittal alignment parameters based on fixed parameters of the pelvis. Others determined the parameters based on patient age. Technological advances have also enhanced our understanding of ASD. Long cassette films and automated analyses have allowed standardization of these measurements across physicians. 3D printing has been used as an adjunct for both surgical planning and implants, both generic and patient specific, to improve outcomes. With these, advances in minimally invasive approaches have allowed ASD correction with lower complications and blood loss. Intraoperative navigation and the use of robotics has allowed improved accuracy in the care of these patients. Development of complex osteotomies have allowed for correction of advanced deformity. Fusion, however, is the ultimate goal of surgical ASD correction. Advances in biologics such as the use of recombinant Human Bone Morphogenetic Protein-2 have been used to improve fusion rates and combat pseudoarthrosis. Finally, post-operative advances in ASD patient care with emphasis on enhanced recovery after surgery has allowed improvements in hospital length of stay and pain scores. ASD is becoming a more ubiquitous diagnosis for spine surgeons with an increasing aging population. Improvement in the understanding of the diagnosis, spinopelvic parameters, imaging techniques, and post operative care are all aimed toward helping patients in whom care can be extremely difficult. Further study in ASD patient care will target advanced innovation to provide optimal treatment to these patients and allow for best possible outcomes.https://doi.org/10.1186/s12891-025-08497-zAdult spinal deformitySagittal balanceDeformity correctionSpine surgery |
| spellingShingle | Thomas Pieters Gabrielle Santangelo Taylor Furst Daniel M. Sciubba An update on improvement and innovation in the management of adult thoracolumbar spinal deformity BMC Musculoskeletal Disorders Adult spinal deformity Sagittal balance Deformity correction Spine surgery |
| title | An update on improvement and innovation in the management of adult thoracolumbar spinal deformity |
| title_full | An update on improvement and innovation in the management of adult thoracolumbar spinal deformity |
| title_fullStr | An update on improvement and innovation in the management of adult thoracolumbar spinal deformity |
| title_full_unstemmed | An update on improvement and innovation in the management of adult thoracolumbar spinal deformity |
| title_short | An update on improvement and innovation in the management of adult thoracolumbar spinal deformity |
| title_sort | update on improvement and innovation in the management of adult thoracolumbar spinal deformity |
| topic | Adult spinal deformity Sagittal balance Deformity correction Spine surgery |
| url | https://doi.org/10.1186/s12891-025-08497-z |
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