An international consensus on the appropriate evaluation and treatment for adults with spinal deformity

  • Sigurd H. Berven
  • Steven J. Kamper
  • Niccole M. Germscheid
  • Benny Dahl
  • Christopher I. Shaffrey
  • Lawrence G. Lenke
  • Stephen J. Lewis
  • Kenneth M. Cheung
  • Ahmet Alanay
  • Manabu Ito
  • David W. Polly
  • Yong Qiu
  • Marinus de Kleuver
  • AOSpine Knowledge Forum Deformity
Original Article



Evaluation and surgical management for adult spinal deformity (ASD) patients varies between health care providers. The purpose of this study is to identify appropriateness of specific approaches and management strategies for the treatment of ASD.


From January to July 2015, the AOSpine Knowledge Deformity Forum performed a modified Delphi survey where 53 experienced deformity surgeons from 24 countries, rated the appropriateness of management strategies for multiple ASD clinical scenarios. Four rounds were performed: three surveys and a face-to-face meeting. Consensus was achieved with ≥70% agreement.


Appropriate surgical goals are improvement of function, pain, and neural symptoms. Appropriate preoperative patient evaluation includes recording information on history and comorbidities, and radiographic workup, including long standing films and MRI for all patients. Preoperative pulmonary and cardiac testing and DEXA scan is appropriate for at-risk patients. Intraoperatively, appropriate surgical strategies include long fusions with deformity correction for patients with large deformity and sagittal imbalance, and pelvic fixation for multilevel fusions with large curves, sagittal imbalance, and osteoporosis. Decompression alone is inappropriate in patients with large curves, sagittal imbalance, and progressive deformity. It is inappropriate to fuse to L5 in patients with symptomatic disk degeneration at L5–S1.


These results provide guidance for informed decision-making in the evaluation and management of ASD. Appropriate care for ASD, a very diverse spectrum of disease, must be responsive to patient preference and values, and considerations of the care provider, and the healthcare system. A monolithic approach to care should be avoided.


Adult spinal deformity Surgery Appropriateness Consensus Delphi 

Supplementary material

586_2017_5241_MOESM1_ESM.docx (29 kb)
Supplementary material 1 (DOCX 29 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Sigurd H. Berven
    • 1
  • Steven J. Kamper
    • 2
  • Niccole M. Germscheid
    • 3
  • Benny Dahl
    • 4
  • Christopher I. Shaffrey
    • 5
  • Lawrence G. Lenke
    • 6
  • Stephen J. Lewis
    • 7
  • Kenneth M. Cheung
    • 8
  • Ahmet Alanay
    • 9
  • Manabu Ito
    • 10
  • David W. Polly
    • 11
  • Yong Qiu
    • 12
  • Marinus de Kleuver
    • 13
  • AOSpine Knowledge Forum Deformity
  1. 1.Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Musculoskeletal DivisionThe George Institute for Global HealthSydneyAustralia
  3. 3.Research DepartmentAOSpine InternationalDavosSwitzerland
  4. 4.Spine Unit, Department of Orthopedic SurgeryRigshospitalet and University of CopenhagenCopenhagenDenmark
  5. 5.Department of Neurosurgery and Orthopaedic SurgeryUniversity of VirginiaCharlottesvilleUSA
  6. 6.Department of Orthopedic SurgeryColumbia University College of Physicians and SurgeonsNew YorkUSA
  7. 7.Department of SurgeryToronto Western HospitalTorontoCanada
  8. 8.Department of Orthopaedics and TraumatologyThe University of Hong KongHong KongChina
  9. 9.Faculty of MedicineAcibadem UniversityIstanbulTurkey
  10. 10.Department of Orthopedic SurgeryNational Hospital Organization Hokkaido Medical CenterSapporoJapan
  11. 11.Department of Orthopaedic SurgeryUniversity of MinnesotaMinneapolisUSA
  12. 12.Department of Spine SurgeryThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjingChina
  13. 13.Department of OrthopedicsRadboud University Medical CenterNijmegenThe Netherlands

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