Research Agenda

Research Mission

The SRS research mission is to enhance the creation of meaningful discoveries for all patients with spinal deformity.

Research Vision

As the leading global platform for sharing and disseminating new knowledge of spinal deformity, the SRS will create, link and support research.

Research Agenda 2024-2030

Creation and validation of improved patient-reported outcomes measures (PROMS) for the assessment of spinal deformity patients

Background: Assessment of the clinical impact of spinal deformity and the effectiveness of interventions for its treatment require effective tools to measure outcomes.

Knowledge gap: Currently, the only spine deformity specific outcome measure is the SRS-22r. This tool has multiple recognized limitations, including effectively capturing outcomes of adult spinal deformity.

Study of the utility and limitations of enabling technologies such as 3D planning/robotics in the treatment of spinal deformity patients

Background: Over the past decade, there have been rapid advances in enabling technologies for spine deformity surgery, including 3D planning, navigation, and robotics.

Knowledge gap: Currently, the optimal applications, benefits, and limitations of enabling technologies for spine deformity treatment have not been fully defined.

Assessment of the potential relationships between biomarkers for aging/senescence and disease etiology, treatment decisions, and patient counseling in adult deformity patients

Background: Significant advances have been made in understanding aging and senescence. Applying these advances to spine deformity may provide insight into the development of degenerative deformities, as well as facilitating treatment decisions and patient counseling for adult spinal deformities.

Knowledge gap: How does the aging process contribute to the development of degenerative spinal deformities? Can markers of the aging process contribute to treatment decisions and patient couseling in the management of adult spinal deformity?

Applications of predictive analytics/AI to spinal deformity care, including classification, management decisions, complication risk, and outcomes assessment

Background: Rapid advances have been made in predicitive analytics and artificial intelligence. These powerful techniques, in combination with large datasets, may provide improved understanding of complex aspects of spine deformity classification, management, and outcomes assessment.

Knowledge gap: Can applications of predictive analytics and artificial intelligence provide previously unrecognized insights into spine deformity?

Strategies to effectively address the European Medical Device Regulations

Background: The new European Medical Device Regulations (EUMDR) threaten innovation and patient access to care by imposing onerous requirements for implant approval.

Knowledge gap: Are there novel approaches to effectively address the EUMDR regulations through new data acquisition and/or mining of large data sets?

Establishment of patient registries to enable larger datasets to address important clinical and research questions

Background: Large numbers of patients are required to address many clinical and research questions related to spine deformity. Pooling of data through registries across surgeons and centers can generate adequate data resources to address clinical and research questions.

Knowledge gap: What are the mechanisms to facilitate surgeons and centers to create and contribute to large spine deformity patient registries?

Improved understanding of why proximal junctional kyphosis (PJK) develops and techniques to reduce its occurrence

Background: Proximal junctional kyphosis (PJK) is a common cause of postoperative morbidity and need for extensive revision surgery. Our understanding of this complication remains incomplete, and our ability to prevent its occurrence remains limited.

Knowledge gap: What are the factors associated with development of PJK, and how can its occurrence be prevented or mitigated?

Establishment of standard data sets in the care and study of spinal deformity patients in order to facilitate improved assessment of patient outcomes and multicenter studies

Background: There is a seemingly endless number of clinical, radiographic, operative, and outcomes variables that can be collected for spine deformity patients. However, if the same or similar variables are not collected across surgeons and centers, it is difficult to meaningfully compare patient outcomes.

Knowledge gap: Currently, there are no widely accepted standard data sets recommended for collection for spine deformity patients.

Study of the utility and limitations of fusion-less technologies in spinal deformity patients

Background: Although fusion-less technologies may offer the ability to treat some deformities with reduced morbidity and fewer long-term consequences, the optimal application and limitations of these technologies remain incompletely defined.

Knowledge gap: Which spine deformity patients may benefit from fusion-less technologies, and what are the limitations and outcomes of these treatments.

Improved strategies to assess growth status in pediatric spinal deformity patients

Background: Current strategies to assess growth status in pediatric spinal deformity patients have recognized limitations and many require imaging with associated radiation exposure.

Knowledge gap: Are there more effective strategies to assess growth status in pediatric spinal deformity patients, preferably with no or negligible radiation exposure?

Creation, application, and study of outcomes of non-op protocols/treatment strategies for spinal deformity patients

Background: Although many patients with spinal deformity benefit from nonoperative treatments, study of nonoperative approaches lags behind that of operative care.

Knowledge gap: Can development and application of effective protocols/strategies for nonoperative treatment for spinal deformity result in improved patient outcomes?

Application of low-dose CT in the assessment and treatment of spinal deformity patients as a means of reducing radiation exposure

Background: Spine imaging is necessary when evaluating and treating spinal deformities. These imaging techniques often involve radiation exposure which has associated risks. Advances have been made in low-dose CT imaging that reduce radiation exposure.

Knowledge gap: What is the limit in lowering the radiation dose with low-dose CT for evaluation of spinal deformity, while still maintaining sufficient imaging?

Past Research Agendas

2020-2024 Research Agenda

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Pediatric and Young Adult High Grade Spondylolisthesis

Background
Pediatric and Young Adult High Grade Spondylolisthesis is a relatively rare kyphotic deformity of the L5-S1 junction, leading to back and radicular leg pain, significantly impacting QoL in adulthood, often requiring surgical treatment. Due to the low incidence institutional cohorts are small, and data spans many years.

Knowledge Gap
Currently it is not known which treatment options are most effective and safe to treat pediatric and young adult high grade spondylolisthesis.

Identifying the Optimal Evaluation of Pulmonary Function to Follow for Pediatric Spine Deformity

Background
Deformities of trunk, chest and spine (especially when they occur early in life) are accompanied by exercise intolerance and shortness of breath, often leading to decreased QoL in adulthood.

Knowledge Gap
Currently it is not known how to adequately evaluate pulmonary function in pediatric and adult patients with a spinal deformity.

Study of Syndromic and Other Rare Deformities (e.g. SMA, Pediatric Cervical Spine, etc.)

Background
Many rare diseases are accompanied by abnormal growth of the spine, leading to a spinal deformity.

Knowledge Gap
For rare diseases (‘orphan diseases’) etiology, natural history and optimal treatment of the spinal deformity are unknown

Growth Modulation (e.g. Anterior Vertebral Body Tethering)

Background
Scoliosis and other spinal deformities that develop during growth are a result of abnormal, asymmetric growth of the spine and trunk. Brace or surgical treatment has been shown to be effective in selected patients.

Knowledge Gap
Currently it is not known how optimally to modulate abnormal spinal growth (operatively and non-operatively) in order to reduce or treat the spine and trunk deformity.

Carcinogenic Effects of (Cobalt Chrome) Implants

Background
Surgical treatment of spinal deformities employs the use of metal alloy implants. Concern has been raised (also in total joint arthroplasty surgery) about increased serum metal ion levels in patients, especially when Cobalt Chrome alloys are implanted.

Knowledge Gap
Currently it is not known whether metal alloy implants employed in spinal deformity surgery have long term toxicological effects.

Global Screening Program for AIS

Background
Early treatment of adolescent idiopathic scoliosis (AIS) by brace treatment has been shown to modulate the natural history, can reduce the severity of the spinal deformity at the end of growth, and may reduce the need for surgery.

Knowledge Gap
Currently it is not known whether early detection of AIS by a (global) screening program can lead to early intervention and improved patient outcomes in a cost-effective manner.

Prediction and Modelling

Background
There is a large variation in presentation and outcomes of patients with a spinal deformity, due to the complex combination of unique patient factors over time, including general health, spine specific factors, spinal imaging and underlying etiology. It is not possible to predict individual patient outcomes.

Knowledge Gap
Currently there is a lack of adequate models (based on biomechanical modeling, biofidelity, patient registry data sets, Machine learning etc). to predict outcomes of natural history (e.g. progression of AIS and ASD) and treatment (eg Proximal junctional kyphosis) for pediatric and adult patients with a spinal deformity.

Etiology

Background
Much is still unknown regarding the molecular biology and genetics of the etiology of AIS.

Knowledge Gap
A large scale database of DNA, blood samples, imaging, sensorineural testing among other variables would enhance research into the etiology of AIS.

Non-Operative Treatment of AIS (Physiotherapeutic Scoliosis Specific Exercises and Night-time Bracing)

Background
The efficacy of Physiotherapeutic Scoliosis Specific Exercises (PSSE) and night-time bracing are non-operative treatments of AIS that currently being used.

Knowledge Gap
What is the efficacy and what are the indications for use of PSSE and night-time bracing to treat AIS?

Long-term Outcomes of Pediatric and Adolescent Spinal Deformity

Background
Instrumentation for AIS has evolved from Harrington Instrumentation to complex screw and dual rod constructs over the last 35 years.

Knowledge Gap
What are the long-term outcomes (greater than 20 years) after surgery for AIS with use of third generation spine instrumentation (pedicle screw constructs)?

Natural History of AIS

Background
The current limited knowledge concerning natural history of untreated AIS has been defined by long term studies from Iowa and Scandinavia.

Knowledge Gap
What types and sizes of AIS curves, untreated in adolescence, are likely to be symptomatic and/or require surgery later in life?

Natural History of Degenerative Adult Spinal Deformity

Background
Our aging population lives longer and healthier that in the past. This has led to a growing number of patients with symptomatic adult deformity.

Knowledge Gap
What is the natural history of adult spinal deformity and what variables predict a symptomatic deformity?

Non-Operative Treatment of Adult Spinal Deformity: Evaluating and Defining Conservative Care in ASD

Background
Very little is known about efficacy of non-operative treatments of ASD.

Knowledge Gap
What non-operative treatments for ASD are efficacious and what is their indication for use?

Sarcopenia/Osteoporosis/Frailty in Pathogenesis of ASD

Background
The complication rate for ASD surgery is high and factors associated with aging such as sarcopenia, osteoporosis, and frailty have an association with increased risk of complication.

Knowledge Gap
How does sarcopenia, osteoporosis, and frailty effect ASD surgery and how can they be modified to improve outcomes?