PEEDS—an AO Spine clinical study evaluating major deformity spine surgeries for elderly

As our populations continue to age, the prevalence of spinal deformity surgery for older patients grows. Questions regarding the suitability of these patients to undergo large spinal procedures and whether the outcomes merit the risks involved are not well known.

"As our populations continue to age, the prevalence of spinal deformity surgery for older patients grows."

PEEDS is the first multi-center multi-continent prospective study outlining the outcome and long-term results of older patients undergoing spinal deformity surgery. Principal investigator Stephen Lewis explains: "We aim to prove whether these surgeries are appropriate in older patients; whether the risk/benefit profile is favorable to make these surgeries worthwhile. Further, we set out to include centers from around the world to determine whether these results would be reproducible."

Improved quality of life

A total of 225 patients from 13 centers around the world (*), 60 years or older with moderate and severe adult spinal deformity requiring surgical correction were enrolled. In the study, spinal deformity was defined as any coronal or sagittal plane spinal deformity in patients who had not had previous spinal surgery necessitating a minimum 5-level spinal fusion procedure.

According to Lewis, the PEEDS results at 2-year follow up show patients had significantly improved in all outcomes from the surgery. "There were major significant improvements in their leg and back pain, and the patients enjoyed significantly improved function, especially in terms of their ability to stand and walk." Importantly, most patients were also very happy with their improved body image.

"There were major significant improvements."

The results show that carefully selected disabled patients over 60 years of age have a high chance of benefiting from a complex multilevel spinal deformity surgery with improved quality of life.

AO Spine KF Deformity is now running the 5 year follow up, closing at end of 2021, and a good follow up rate is extremely important for the final results.

Focus Issue will synthesize current knowledge

The AO Spine KF Deformity is planning a huge project covering several aspects of Spinal Deformity, first to publish a Focus Issue on Adult Spinal Deformity (ASD), followed by further clinical studies. The Focus Issue will highlight what is currently known, what the current practice is, identify deficiencies in our current practice, and highlight future research questions that need answers so that steady improvements can be made in the field.  

"The Focus Issue will be the basis of our future multi-center research projects and the members of the KF Deformity are working really hard on this," Lewis confirms.

"The Focus Issue will be the basis of our future multi-center research projects."

The study group is completing the design of a comprehensive classification of adverse events in spinal deformity surgery; they are finalizing a patient profile for ASD surgery, which will provide a comprehensive look at the major aspects considered when performing these surgeries; and they are in the middle of a large prospective multi-center study on intraoperative neuromonitoring which is expected to modernize the way in which neuromonitoring changes are interpreted. "It will provide surgeons with a better understanding to correlate alerts with intraoperative maneuvers," Lewis says.

The AO ASD Classification Patient Profile will be presented in a webinar at the AO Davos Courses 2020 on Sunday, 6 December at noon 12:00 CET. It will be further discussed on AO TV during the AO Davos Courses 2020. These events are free and open to all. Recordings will be available for AO members in the AO Video Hub afterwards https://aovideos.aofoundation.org/.