Differences

This shows you the differences between two versions of the page.

--- adult_spinal_deformity_surgery [2025/07/10 06:21] – administrador
+++ adult_spinal_deformity_surgery [2025/07/10 06:22] (current) – administrador
@@ Line 3: / Line 3: @@
 {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1NGmwZeh8JwXIzruhIPaXrHY4vAtO01ESFM_T-5mx5oKPotQx0/?limit=15&utm_campaign=pubmed-2&fc=20230321164733}}
 ----
-====== Alignment Goals in Adult Spinal Deformity Surgery ======
-In a narrative review
-Pizones et al.
-from La Paz Univ. Hosp, Madrid; additional centers in San Antonio, San Diego, Toronto, Barcelona, Charlottesville, New York
-published in the [[Global Spine Journal]]
-to critically examine evolving strategies in [[sagittal alignment]] targets for [[adult spinal deformity surgery]], shifting focus from generic [[HRQoL]] goals to preventing mechanical [[complication]]s
-Traditional [[alignment]] [[metric]]s (PI‑LL, SVA, TK) are limited for personalized [[planning]]; compensatory strategies (pelvic retroversion, knee flexion) are essential; individualized, structure-shape–based alignment (e.g., GAP, Roussouly, T4‑L1‑Hip‑Axis) reduces mechanical failure risk, though reoperation rates remain high
-((Pizones J, Hills J, Kelly MP, Alavi F, Nuñez-Pereira S, Smith JS, Sardar ZM, Lenke LG, Lewis SJ, Pellisé F; [[AO Spine Knowledge Forum Deformity]]. [[Alignment]] Goals in [[Adult Spinal Deformity Surgery]]. Global Spine J. 2025 Jul;15(3_suppl):108S-122S. doi: 10.1177/21925682251331048. Epub 2025 Jul 9. PMID: 40632289.)).
-==== Critical Review ====
-The narrative review offers a comprehensive appraisal of alignment paradigms, yet:
-* **Strengths:** Integrates key classification systems; emphasizes pelvic and lower-extremity compensation; aligns recent evidence on shape-based vs. quality-of-life–based targets; timely discussion given recent advances (e.g., T4‑L1‑Hip‑Axis)
-* **Weaknesses:** Lacks systematic methodology or quantitative synthesis; conclusions primarily descriptive; limited [[critical appraisal]] of conflicting literature; evidence grade unclear
-* **Evidence gaps:** No robust [[meta-analysis]] to support superiority of new alignment strategies; minimal discussion on age-adjusted goals (e.g., Lafage et al., 2016, 2017) and their clinical endpoints
-==== Verdict ====
-The article is a well-informed narrative but falls short of high-level [[evidence]]. It’s [[hypothesis-generating]] rather than definitive in guiding surgical [[decision-making]].
-**Rating: 6/10**
-==== Takeaway for Practicing Neurosurgeon ====
-Use alignment strategies that respect patient-specific morphology (like [[GAP]] and [[Roussouly]]) and consider whole-body compensation. However, be cautious—this guidance is based on emerging concepts, not on strong comparative trials or comprehensive outcomes data.
-==== Bottom Line ====
-An informative review on evolving alignment goals—but lacking in solid evidence. A step forward in concept, yet insufficient as a standalone clinical guide until validated by robust comparative studies.
-==== Metadata ====
-^ [[Category:Adult_Spinal_Deformity]]
-^ [[Category:Spinal_Surgery_Alignment]]
-^ Tags: ASD, sagittal_alignment, mechanical_complications, GAP_score, Roussouly, T4-L1-Hip-Axis
-==== Citation ====
-Alignment Goals in Adult Spinal Deformity Surgery. Pizones J et al. *Global Spine J.* 2025 Jul;15(3_suppl):108S‑122S. doi:10.1177/21925682251331048. Published July 9, 2025.
-Corresponding author: Javier Pizones, Spine Surgery Unit, La Paz University Hospital, Madrid, Spain.
 ----
 Adult [[spinal deformity]] surgery is a specialized surgical procedure aimed at correcting abnormal curvatures and alignment of the spine in adults. These deformities can result from various conditions, including degenerative changes, scoliosis, kyphosis, or a combination of factors. The primary goals of adult spinal deformity surgery are to alleviate pain, improve spinal alignment, restore function, and enhance the patient's quality of life.
 ===== Patient Evaluation =====