While reconstructive spine surgery enables patients with adult spinal deformity to remain active well into their 70s and 80s, the risk of complications with major surgery increases with age. Orthopaedic spine surgeons at Johns Hopkins are working to reduce that risk using a comprehensive, data-driven approach to care.

Hamid Hassanzadeh, chief of orthopaedic surgery for Johns Hopkins Medicine in the National Capitol Region, is an expert in treating older adults with adult spinal deformity and studying their surgical outcomes. The primary focus of his research and practice is determining what combination of factors — both in the patient’s health and in the surgical setting — contribute to a successful result and minimize risk.

“The key is not the latest and greatest technologies, although, of course, we have robotic, navigation and enabling technology to help us expedite the surgical aspects of treatment,” he says. “The key is how to manage these patients, how to risk-stratify them, and how to treat them so that they have a great result despite their age and the complexity of the surgery.”

Hassanzadeh and his colleagues emphasize three elements in their evaluation and treatment of patients with adult spinal deformity: risk stratification based on objective measures, the involvement of a team of experts in optimizing patients’ health before surgery, and the identification of the appropriate level of surgery for each patient with care to ensure safety throughout the procedure. “This combination,” Hassanzadeh says, “is the reason we have such good results in complex surgery in older patients.”

Risk stratification: Because Johns Hopkins spine surgeons and researchers follow their patients with outcomes data, they have extensive information to draw on when assessing their patients’ risk factors. Risk stratification based on these objective measures enables them to predict the likelihood that a patient will benefit from surgery; it also allows surgeons to identify underlying issues that they can treat in advance to reduce the patient’s risk.

Team approach: The surgical team collaborates with neurologists, nutritionists, endocrinologists and bone health specialists to ensure that the patient’s heart, lungs and other organs are as healthy as possible, and that their bone quality has been strengthened before surgery. Because sarcopenia and frailty are among the most important predictors of complications of spine surgery in older patients, it is important to evaluate and treat each patient’s overall condition, including their muscle mass and nutritional status.

Appropriate surgery: When patients have nonmodifiable risk factors, Hassanzadeh says, “we have to figure out what we can do to minimize the risk but maximize the benefit.” Sometimes the best choice is a less-invasive surgery to alleviate specific symptoms. An expert in both open and minimally invasive techniques, Hassanzadeh notes that “not everyone requires massive reconstructive surgery. Sometimes a smaller, less-invasive surgery can help.”

Hassanzadeh believes that the rich tradition of investing in research and treatment in adult spinal deformity is what makes Johns Hopkins a leader in providing complex spine surgery. “Good outcomes come from a combination of a very scientific approach, data-driven optimization, technical skills and technology.” Johns Hopkins, he says, has it all.

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