Considerations for focused surgical intervention in the presence of adult spinal deformity.

Abstract

Case studies, literature review. The goal of this review is to raise awareness and stimulate contributions on this topic. Surgical management of adult patients presenting with intractable back and leg pain in conjunction with spinal deformity often raises the question of need for curve arthrodesis. Meticulous patient assessment is essential in determining if the deformity underlies patient symptoms. If so, then the deformity must be stabilized according to criteria established in the literature. However, when patient evaluation suggests that the deformity is not the source of symptoms, other surgical options may be considered. These include limited decompression without fusion or decompression with short fusion limited only to the site of pathology. Three cases are presented illustrating situations where decompression alone or decompression with short fusion was indicated. When an adult spinal deformity is stable and is not the source of symptoms, symptomatic relief may be provided through limited decompression within the curve but without curve arthrodesis. Similarly, symptomatic pathology arising from levels adjacent to or remote from the deformity may be addressed with short-segment decompression and fusion. This brief and limited communication reviews some of the pertinent issues and provides several examples of selective surgical treatment options without curve arthrodesis in patients with deformity. These options are typically much smaller surgical undertakings, particularly in adult patients who generally have complicating comorbidities. Little has been published to guide surgical management for these conditions.