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Practice Guideline
. 2023 Oct 1;36(8):E383-E389.
doi: 10.1097/BSD.0000000000001478. Epub 2023 Jun 26.

The Diagnostic Process of Spinal Post-traumatic Deformity: An Expert Survey of 7 Cases, Consensus on Clinical Relevance Does Exist

Erin E A De Gendt  1 , Lorin M Benneker  2 , Andrei F Joaquim  3 , Mohammad El-Sharkawi  4 , Gaurav R Dhakal  5 , Frank Kandziora  6 , Jin Tee  7 , Richard J Bransford  8 , Emiliano N Vialle  9 , Alex R Vaccaro  10 , Eugen C Popescu  11 , Rishi M Kanna  12 , David W Polly  13 , Klaus J Schnake  14 , Pedro Berjano  15 , Sergey Ryabykh  16 , Marko Neva  17 , Claudio Lamartina  15 , Dominique A Rothenfluh  18 , Stephan J Lewis  19 , Sander P J Muijs  1 , F Cumhur Oner  1
Affiliations
Practice Guideline

The Diagnostic Process of Spinal Post-traumatic Deformity: An Expert Survey of 7 Cases, Consensus on Clinical Relevance Does Exist

Erin E A De Gendt et al. Clin Spine Surg. .

Abstract

Study design: Survey of cases.

Objective: To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD).

Summary of background data: SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved.

Methods: The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated.

Results: Seventeen spinal surgeons reviewed the presented cases. The items' fracture type and complaints were rated by the participants as more important, but no agreement existed on the items of medical history. In patients with possible SPTD in the cervical spine (C) area, participants requested a conventional radiograph (CR) (76%-83%), a flexion/extension CR (61%-71%), a computed tomography (CT)-scan (76%-89%), and a magnetic resonance (MR)-scan (89%-94%). In thoracolumbar spine (ThL) cases, full spine CR (89%-100%), CT scan (72%-94%), and MR scan (65%-94%) were requested most often. There was a consensus on 5 out of 7 cases with clinically relevant SPTD (82%-100%). When consensus existed on the diagnosis of SPTD, there was a consensus on the case being compensated or decompensated and being symptomatic or asymptomatic.

Conclusions: There was strong agreement in 5 out of 7 cases on the presence of the diagnosis of clinically relevant SPTD. Among spine experts, there is a strong consensus to use CT scan and MR scan, a cervical CR for C-cases, and a full spine CR for ThL-cases. The lack of agreement on items of the medical history suggests that a Delphi study can help us reach a consensus on the essential items of clinically relevant SPTD.

Level of evidence: Level V.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Distribution of the different clinical aspects of the 7 cases. This figure shows the distribution of the different clinical aspects of the 7 cases. All aspects were rated as most and least important at least by 1 participant. No consensus was reached for the items overall or for the individual cases.
FIGURE 2
FIGURE 2
Distribution of the different aspects of the imaging of the 7 cases. This figure shows the distribution of the ratings of the different aspects of the imaging assessments. The participants were asked to rank from most to least important. All groups were rated at least once as most important and least important by 1 participant. No consensus was reached overall or in the individual cases.
FIGURE 3
FIGURE 3
Presence and type of SPTD per case. This figure shows whether the participants diagnosed the patients with SPTD per case. Consensus was present on the case being compensated or decompensated and being symptomatic or asymptomatic, when there was agreement on the presence of SPTD. SPTD indicate Spinal Post-traumatic Deformity.
FIGURE 4
FIGURE 4
Treatment choices per case. This figure shows the distribution of the treatment choices of the participants per case.
See this image and copyright information in PMC

References

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