In his recent ReachMD podcast, When Your Patient Has a Spinal Deformity: Clinical Priorities, Penn orthopaedic spine surgeon Comron Saifi, MD, reviewed the treatment and management of spinal deformities in patients older than age 55.
In older patients, there are two primary types of spinal deformities: scoliosis and kyphosis. Kyphosis, Dr. Saifi explained, is when people drift forward in their posture — the so-called ‘hunchback’ deformity. Spinal deformities with stooped postures cause significant back pain, and have the highest impact on a patient’s quality of life.
Parallel approach to treatment
At Penn, Dr. Saifi is involved in both non-surgical and surgical management of spinal deformities. “I do get patients who are referred to me for surgical management from my colleagues who don’t perform surgery,” he explained. “But I also often see patients early on in their process, and I often recommend they seek non-surgical management. If I don't think they are in need of surgery, I may even refer them to physical therapy.”
Importance of Whole-Body Imaging and Monitoring
When diagnosing and treating spinal deformities, Dr. Saifi recommends imaging a patient’s entire body throughout treatment instead of incidental scans of the spine alone. The reason? Whole body scans permit surgeons to identify the origin of a patient’s pathology prior to surgery, to rectify it intraoperatively and ensure the patency of surgery thereafter.
“The University of Pennsylvania has now acquired an additional add-on technology for our whole-body imaging that allows us to create 3D models and 3D images from our 2D radiographs,” Dr. Saifi said. He explained that the radiographs are full body — from the occiput to the feet, which gives an overall understanding of the global sagittal alignment of the patient.
“We can see when the patient compensates for the posture with knee flexion or hip extension, and not just in the lumbar or the thoracic spines, because really these deformities affect the entire body.”
“Intraoperatively, in terms of imaging, we take full length imaging during the surgery to confirm that our correction is exactly what we want, confirming that we've done everything we wanted to do. Postoperatively, obviously, we will follow up with whole body x-ray imaging, as well.”
Minimally Invasive Options
Dr. Saifi offers several minimally invasive options for adult spinal deformity patients who meet strict inclusion criteria. Patients with more moderate spinal curves are able to undergo lateral lumbar interbody fusions (XLIF) or anterior lumbar interbody fusions (ALIF) and percutaneous screw placement.
“These are very small incisions that patients have very little pain from post-operatively,” Dr. Saifi explained. “There's no open surgery at all for the posterior portion, so the patients have much less pain postoperatively, lower narcotic usage and a shorter length of stay.”
During his interview, Dr. Saifi mentioned several clinical studies now underway at Penn, including motion analysis for spinal deformity patients to examine their functional disabilities preoperatively compared with their functional abilities after surgery. “Additionally, we do patient-reported outcomes for all of our patients who undergo surgery, and also for those who do not,” he explained. “We track those numbers and see, on a more objective basis, how our non-operative and our operative patients are doing over an extended period of time.”
Additional resources from Penn Spine Center
Dr. Saifi is Assistant Professor of Orthopaedic Surgery at the Hospital of the University of Pennsylvania.