Objective: The rate of adult spinal deformity (ASD) surgery is increasing internationally. However, an understanding of the trends in England remains unknown. This study examines the trends in hospital admission and surgical intervention for complex ASD in order to predict the future health demands for NHS England.

Methods: Hospital episode statistics data for England were reviewed between 2005-2015 in order to determine the number of patients diagnosed and surgically treated for ASD. The future tenyear demand for surgery was modelled on demographic changes and admission trends, with the consequence on inpatient bed-days
and costs calculated.

Results: Over the time-course, the number of patients admitted has more than doubled, with an almost 3-fold increase in those older than 60-years. This contrasts the less than 10% increase in the adult population of England over the same time-period. The volume of ASD surgery has increased 3.5-fold, with the greatest increase in those older than 60years (6.4-fold increase).The average length of stay (LOS) has reduced from 10.1 to 8.4 days. If these trends continue, we estimate an additional 330
patients per year receiving ASD surgery, equivalent to an annual increase of 4.5 inpatients per day per year and additional financial cost of £8.1-11.5 million per year.

Conclusion: Severe ASD, unresponsive to conservative therapy, is a growing problem within England. The complex surgery required needs to be matched by the availability of the necessary expertise and considerable resources to meet this inevitable growing demand.