Spinal Post-traumatic Deformity: An International Expert Survey Among AO Spine Knowledge Forum Members
De Gendt, Erin E A; Schroeder, Greg D; Joaquim, Andrei; Tee, Jin; Kanna, Rishi M; Kandziora, Frank; Dhakal, Gaurav R; Vialle, Emiliano N; El-Sharkawi, Mohammad; Schnake, Klaus J; Rajasekaran, Shanmuganathan; Vaccaro, Alex R; Muijs, Sander P J; Benneker, Lorin M; Oner, F Cumhur
(2023) Clinical Spine Surgery, volume 36, issue 2, pp. E94 - E100
(Article)
Abstract
STUDY DESIGN: Survey among spine experts. OBJECTIVE: To investigate the different views and opinions of clinically relevant spinal post-traumatic deformity (SPTD). SUMMARY OF BACKGROUND DATA: There is no clear definition of clinically relevant SPTD. This leads to a wide variation in characteristics used for diagnosis and treatment indications of SPTD.
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To understand the current concepts of SPTD a survey was conducted among spine trauma surgeons. METHODS: Members of the AO Spine Knowledge Forum Trauma participated in an online survey. The survey was divided in 4 domains: Demographics, criteria to define SPTD, risk factors, and management. The data were collected anonymously and analyzed using descriptive statistics, absolute, and relative frequencies. Consensus on dichotomous outcomes was set to 80% of agreement. RESULTS: Fifteen members with extensive experience in treatment of spinal trauma participated, representing the 5 AO Spine Regions. Back pain was the only criterion for definition of SPTD with complete agreement. Consensus (≥80%) was reached for kyphotic angulation outside normative ranges and impaired function. Eighty-seven percent and 100% agreed that a full-spine conventional radiograph was necessary in diagnosing and treating SPTD, respectively. The "missed B-type injury" was rated at most important by all but 1 participant. There was no agreement on other risk factors leading to clinically relevant SPTD. Concerning the management, all participants agreed that an asymptomatic patient should not undergo surgical treatment and that neurological deficit is an absolute surgical indication. For most of the participants the preferred surgical treatment of acute injury in all spine regions but the subaxial region is posterior fixation. CONCLUSION: Some consensus exists among leading experts in the field of spine trauma care concerning the definition, diagnosis, risk factors, and management of SPTD. This study acts as the foundation for a Delphi study among the global spine community.
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Keywords: Humans, Kyphosis, Radiography, Spinal Injuries/complications, Spine/surgery, Surveys and Questionnaires, consensus, spine trauma, diagnosis, Delphi study, expert survey, spinal post-traumatic deformity, Clinical Neurology, Surgery, Orthopedics and Sports Medicine, Research Support, Non-U.S. Gov't, Journal Article
ISSN: 2380-0186
Publisher: Lippincott Williams & Wilkins
Note: Funding Information: This study was supported by AO Spine through the AO Spine Knowledge Forum Trauma, a focused group of international Trauma experts. AO Spine is a clinical division of the AO Foundation which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department. Dr Schroeder has received funds to travel from AO Spine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest. Funding Information: This study was supported by AO Spine through the AO Spine Knowledge Forum Trauma, a focused group of international Trauma experts. AO Spine is a clinical division of the AO Foundation which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department. Publisher Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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