Selection of fusion levels in adults with spinal deformity: an update.

BACKGROUND CONTEXT: Adult spinal deformity (ASD) is commonly associated with disability and represents a challenging condition for physicians. Although surgical management has been reported as superior to conservative care, the choice of patient-specific optimal strategy has been poorly defined. A key question remains selection of fusion levels as this implies careful balance of risks and benefits. PURPOSE: The aim of this review is to propose an update on current knowledge related to optimal fusion levels in the surgical treatment of ASD. STUDY DESIGN: Literature review. METHODS: Based on a comprehensive literature search, recent studies focusing on the management of ASD were reviewed to establish current concepts on fusion levels in the management of symptomatic ASD. RESULTS: Despite numerous published studies, the management of ASD and specifically optimal fusion levels is incompletely defined. Described approaches carry benefits and risks. However, the need for detailed analysis and preoperative planning is confirmed as a prerequisite to obtaining realignment objectives and good outcomes. CONCLUSIONS: The treatment of ASD is emerging as an important health-care issue of the 21st century because of prevalence and cost. Despite technical advances related to ASD surgery, complication rates remain elevated, particularly in the older population. Recent research, mostly driven by outcome measures, has improved our understanding of optimal treatment approaches to ASD. The development of a widely accepted classification system will help to share knowledge and improve our ability to treat these complex patients.

Health-related quality of life for patients with rheumatoid arthritis foot involvement.

HYPOTHESIS: Rheumatoid arthritis is a common disabling form of arthritis that frequently affects the hands and feet. With time, the majority of affected individuals will become disabled. METHODS: Sixty-nine consecutively selected mild to moderately affected individuals with rheumatoid arthritis provided demographic data and agreed to complete the Short Musculoskeletal Function Assessment (SFMA) instrument. Focus group subjects selectively used minimally adaptive nonprescription footwear. Control subjects had similar disease expression, but did not alter their choice of footwear due to their disease. RESULTS: Adult patients with rheumatoid arthritis demonstrate a significant negative impact on their quality of life with mild or moderate disease expression, as evidenced by poor scores in all six domains of the SFMA. Subjects who used even mildly adaptive nonprescription footwear demonstrated a statistically significant negative impact in mobility (p < .044) and functional index (p < .052) domains as compared with the control population having similar overall disease expression. Focus subjects also demonstrated a trend to less favorable scores in the arm and hand domain. Mean scores of the daily activity, emotional status, and bother index domains fared worse than population norms, but there was no statistical difference between subjects using, or not using, adaptive footwear. CONCLUSIONS: Individuals affected with mild to moderate rheumatoid arthritis are disabled as compared with the general population. There is a severe negative impact on mobility and functional capacity when the disease process begins to affect their feet.