Team Approach: Degenerative Spinal Deformity

Degenerative spinal deformity is common and affects a large percentage of the aging population. The burden of degenerative spinal deformity is high when measured on the basis of prevalence, impact, and cost of care. A broad spectrum of specialists treat degenerative spinal deformities with use of both nonoperative and operative approaches to care. Treatment is characterized by substantial variability between and within specialties. Optimal care maximizes clinical benefit while limiting risks and costs. This review describes the case of a 68-year-old woman with symptomatic degenerative scoliosis and presents perspectives on management from specialists in physical therapy, pain management, neurosurgery, and orthopaedic surgery. The approaches to care presented here encompass a spectrum of risks, costs, and expected outcomes. Each specialist presents a perspective that is appropriate and reasonable, with its expected risks and benefits. The best approach is one that is not monolithic; collaboration between providers from multiple disciplines permits an approach to care that is responsive to the values and preferences of the individual patient. Clinical research, including prospective multidisciplinary comparative studies, is important for guiding an evidence-based approach to specific clinical scenarios and for developing a consensus regarding appropriate management strategies.