Stuart Hershman, MD, an orthopedic spine surgeon at Massachusetts General Hospital in Boston, discusses the big trends in spinal deformity surgery today.
Question: What are some key trends in adult deformity surgery?
Dr. Stuart Hershman: For the last decade-plus, we've been trying to identify ways to prevent proximal junctional kyphosis.
Recently, there have been two schools of thought, both of which use spinopelvic parameters as a reference for pre-surgical planning. One of these theories uses the Global Alignment and Proportion Score, which analyzes the sagittal plane to help predict mechanical complications in patients undergoing surgery for adult spinal deformity. The second school of thought uses age-adjusted parameters, suggesting that we may have been overcorrecting patients and should consider striving for less correction.
At the American Academy of Orthopaedic Surgeons Annual Meeting, many of the talks focused on these areas and discussed concepts to try to reduce and prevent PJK. New research addressed key points, focusing on how much lordosis should be restored to help reduce the incidence of PJK.
Q: What should surgeons know about reducing narcotic consumption in adult deformity surgery?
SH: It is important to look at the research being done in other areas of medicine; using a multi-modal approach to pain management is going to be key in reducing narcotic consumption following adult deformity surgery. This approach involves utilizing various medications given both pre- and postoperatively, local anesthetics, behavior modification techniques, educating patients and managing their expectations.
At AAOS, a study out of Arizona discussed using of a long-acting liposomal bupivacaine injection during wound closure. The research found that using this type of local anesthetic was successful in reducing narcotic consumption in the acute perioperative period.
Learn more about key trends in spine surgery at the Becker's 17th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference, June 13-15 in Chicago. Click here to learn more and register. For more information about exhibitor and sponsor opportunities, contact Maura Jodoin at mjodoin@beckershealthcare.com.