Team Approach: Degenerative Spinal Deformity
Degenerative spinal deformity involves a spectrum of pathological changes, including spondylolisthesis, lateral subluxation, scoliosis, and loss of lumbar lordosis with sagittal plane deformity. Patients characteristically present with back pain, neural symptoms (including numbness and weakness in the legs), functional limitations (including neurogenic claudication), and disability. Degenerative spinal deformity is common and has a measurable impact on patient-reported health status1. Compared with other common medical conditions of aging (including hip and knee arthritis, cardiovascular disease, pulmonary disease, and peripheral vascular disease), degenerative disorders of the spine have a greater impact on health-related quality of life measures2-4. Treatment commonly involves individuals from multiple disciplines, including specialists in nonoperative treatment (i.e., specialists in physical therapy, physiatry, anesthesia pain management, interventional radiology, manual manipulation, family practice) and specialists in operative treatment. The continuum of care for patients with degenerative deformity of the spine encompasses a spectrum of risks, costs, and expected benefits. An evidence-based approach to care for the individual patient is not firmly established and requires consideration of clinical presentation, structural pathological changes, and the preferences and values of the patient within the health-care system. The purposes of the present article are (1) to present perspectives on treatment strategies and goals of care from providers who commonly treat degenerative spinal deformities and (2) to demonstrate the value of interdisciplinary communication and collaboration in guiding an evidence-based approach to care for the individual patient.