Comprising a wide spectrum of pathology, adult spinal deformity (ASD) is not really a single disease. The patient population is inherently heterogeneous in terms of demographics, the etiology of the condition, and various clinical symptoms and associated comorbidities. A new AO Spine tool will support clinicians in systematic decision-making.
“There is no simple linear thinking. It is not one single disease but a spectrum of diseases.”
Senior project author and former AO Spine Knowledge Forum Deformity Chairperson Marinus de Kleuver recently spoke to AO TV about the project. “There is no simple linear thinking. It is not one single disease but a spectrum of diseases," he says, explaining the complexity of the condition.
First author J Naresh-Babu stresses all three domains—clinical, radiological, and comorbidity—have to be considered. The complexity of the condition makes the treatment algorithm difficult. It is generally agreed that the management of this group of patients depends not only on the radiographic measurements but also on factors such as back pain, leg pain, neurological status, comorbidities, frailty, and social support.
Currently, there is no guidance on how to weigh all factors and logically translate them into daily practice.
Spine surgeons all over the world long for a systematic approach to treating these patients and making surgeries safer and more effective.
“Spine surgeons all over the world long for a systematic approach to treating these patients and making surgeries safer and more effective,” says Manabu Ito, project member.
Recognizing the urgency and the need, Naresh-Babu initiated the AO ASD Classification project. The goal of the project was to develop a comprehensive classification to guide the decision-making process and choice of a suitable treatment strategies for individual cases.
This new tool will allow physicians treating ASD patients to systematically consider the factors that could contribute to optimal management of the condition. All adult deformity surgeons are encouraged to use the tool in their daily clinical practice and/or for training purposes.
Manabu predicts the patient profile will make spine surgeons more aware of the complexity of ASD.
"It will help surgeons make balanced decisions and consult colleagues of other expertise, such as geriatricians, anesthesiologists, and nutritionists,” he says. “This will help the many super aging societies in the Asia Pacific region tremendously."
The relevance of this project is evident from the overwhelming response to the call for participation in the Delphi process to bring consensus on the items to be included in the patient profile: Within 48 hours of the call opening, 175 ASD experts from around the world responded. Eventually, 54 panelists representing five continents were selected on the basis of clinical experience, publication record, and geographical location.
Supported by the evidence generated through a systematic literature review and the consensus from the Delphi process, the AO Spine Knowledge Forum (KF) Deformity has developed the final AO Spine ASD Patient Profile. The content validity and usability of this patient profile have been tested, and the results have been published.
AO Spine KF Deformity thanks the panelists for their participation and contribution in the project.
Download the AO Spine Adult Spinal Deformity Patient Profile.
Learn more about the AO Spine Knowledge Forum Deformity and its clinical research activities.
For more information on the AO Spine Knowledge Forum Deformity and their clinical research activities, see here.
Main publication AO Spine Adult Spinal Deformity Patient Profile
Naresh-Babu J, Kwan KYH, Wu Y, et al. AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care. Global Spine Journal. August 2021.
Kwan KYH, Naresh-Babu J, Jacobs W, De Kleuver M, Polly DW, Yilgor C, Wu Y, Park JB, Ito M, Van Hooff ML. Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity. Neurosurgery, 2021.
Interview with Marinus de Kleuver on AO Spine Adult Spinal Deformity Patient Profile is available in the AO Video Hub (December 2020).
A one-hour webinar on "Adult Spine Deformity Patient Profile – A Paradigm Shift in Treatment Planning to Improve Patient Care" with Marinus de Kleuver, Lawrence Lenke, Naresh Babu, Kenny Kwan, Miranda van Hooff, Caglar Yilgor (December 2020).
Call for expert panelists for AO ASD with J Naresh-Babu (November 2018).