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October 15, 2018

AOSpine-SRS Scoli-RISK-1 study: impactful research for adult spinal deformity patients

AOSpine-SRS Scoli-RISK-1 study produces impactful research for adult spinal deformity patients undergoing complex surgery

The landmark Scoli-RISK-1 study evaluating the neurologic complications associated with surgical correction of complex adult spinal deformity recently published its two-year results in The Journal of Bone and Joint Surgery (JBJS).

Scoli RISK-1-complex adult scoliosis study

Larry Lenke and Michael Fehlings leading the Scoli-RISK-1 study meeting (Istanbul, Turkey, 2012)

​Scoli-RISK-1 is an example of successful academic collaboration between two leading societies—the Scoliosis Research Society (SRS) and AOSpine.

"Even for someone who has practiced spinal deformity surgery for 27 years, one of the biggest fears is that the patient has neurologic complications during these complex operations," principal investigator (PI) Lawrence Lenke explains. Co-PI Michael Fehlings agrees that even with the many advances in adult spinal deformity (ASD) techniques, the risk of peri-operative neurologic deficits remains high.

ScoliRisk1 - quoteFor the first time, the prospective multicenter observational study Scoli-RISK-1 did a formal neurologic assessment of patients undergoing complex ASD surgery. The 15 participating institutions from North America, Europe, and Asia collected information on all complications and patient reported outcomes from 272 patients. Data was collected before surgery and at various timepoints after surgery up to 2-year postoperative.

Data helps understand risks and increases patient satisfaction

ScoliRisk1-Quote2The Scoli-RISK-1 6-month outcomes were published in Spine in 2016 and established an early complication rate two to three times higher than previously reported. "Nearly one in four patients had neurologic deficits at the point of discharge, and the non-neurologic complication rate was at 60 %," says Kenneth Cheung, site investigator. The 2-year outcomes recently published in the JBJS showed a significant improvement in neurologic outcomes at 2-years postoperative; more than half the patients having improved their neurologic weakness or deficits.

"The rate in neurologic decline was much higher than expected, which gives us a baseline to work off to lower the rate of complications," Lenke states. Site investigators believe surgeons can already better inform their patients of the risks.

ScoliRisk1-Quote3Risk factors for postoperative neurologic decline and factors that predict patient reported outcomes were also identified and published in The Spine Journal and Spine Deformity, respectively. "If surgeons can identify the individuals that are prone to developing complications, we can take preventative measures preoperatively. This will not only save on health costs, but with proper counselling, increase patient satisfaction," Fehlings adds. The data can be used for risk stratification or to strategize how to reduce complications.

Michael Fehlings MD

Michael Fehlings sees collaboration possibilities between the AOSpine Knowledge Forums in developing guidelines and care pathways.

Landmark collaboration changing clinical practice

ScoliRisk1-Quote4All participating surgeons see Scoli-RISK-1 as a great example of a mutually beneficial collaboration between two leading spine societies, the SRS and AOSpine. Many AOSpine Knowledge Forum Deformity members are also members of the SRS, so intellectual collaboration is ongoing, and the hope is that such study collaborations will continue whenever opportunity arises.

Lenke and Fehlings are proud to describe Scoli-RISK-1 as a landmark and collaborative study that will be referred to as one that changed practice. "It is one of the most detailed, well-orchestrated, and thorough studies ever done on complex ASD for complications and outcomes," Lenke says and adds AOCID's expertise was instrumental for its success. 

The next step is to take this knowledge and research activities to the next level and optimize outcomes by developing care pathways and guidelines for prevention and management of high-risk surgeries.


Scoli-RISK 1 was awarded the Whitecloud Award for Best Clinical Paper at the International Meeting on Advanced Spine Techniques (IMAST) two years in a row (2015 and 2016), won the Russell A. Hibbs Award for the Best Clinical Research Presentation at the SRS Annual Meeting 2013, and was nominated in 2016 and 2017. It was also the winner of the Best Paper Award at the Global Spine Congress 2015.

Read more about KF Deformity and the ongoing studies at www.aospine.org/kf-deformity

The AOSpine Knowledge Forum Deformity sponsored study was performed with the AO Clinical Investigation and Documentation support.

Original article posted 10.1.18—browse the full article.

"The AO has a high integrity scientific process for collecting this kind of data and translating it into meaningful outcomes. Both the data we acquired and the AO tracking and processing it, helping us present and publish it, it is a class act, it's like a well-oiled machine," Lawrence Lenke says.