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Chao-Hung Kuo, Wen-Cheng Huang, Jau-Ching Wu, Tsung-Hsi Tu, Li-Yu Fay, Ching-Lan Wu, and Henrich Cheng

-grade spondylolisthesis. 3 , 11–13 However, few reports have addressed the true incidence of adjacent-segment degeneration (ASD) after these spinal surgeries. The pathological process observed at the spinal disc adjacent to the level that was treated with arthrodesis is regarded as ASD. Owing to advances in image technology, asymptomatic ASD can be identified by abnormal findings on radiological examinations; these findings include disc degeneration, segmental instability, or spinal stenosis and are termed “radiological ASD.” These radiological ASDs can be completely free of symptoms

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Justin K. Scheer, Justin S. Smith, Frank Schwab, Virginie Lafage, Christopher I. Shaffrey, Shay Bess, Alan H. Daniels, Robert A. Hart, Themistocles S. Protopsaltis, Gregory M. Mundis Jr., Daniel M. Sciubba, Tamir Ailon, Douglas C. Burton, Eric Klineberg, Christopher P. Ames, and The International Spine Study Group

T he surgical management of adult spinal deformity (ASD) can provide significant improvements in pain, disability, and health-related quality of life (HRQOL). 6 , 7 , 28 , 34 , 36–38 , 40–45 However, these procedures are technically demanding and are associated with a high complication rate. The patient population suitable for these complicated surgeries continues to increase, including patients of advanced age. 2 , 16 , 17 , 27 The reported complication rates in the literature are varied and range from 14% to 71%. 11 , 13 , 39 , 47 , 48 It has been

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Justin K. Scheer, Taemin Oh, Justin S. Smith, Christopher I. Shaffrey, Alan H. Daniels, Daniel M. Sciubba, D. Kojo Hamilton, Themistocles S. Protopsaltis, Peter G. Passias, Robert A. Hart, Douglas C. Burton, Shay Bess, Renaud Lafage, Virginie Lafage, Frank Schwab, Eric O. Klineberg, Christopher P. Ames, and the International Spine Study Group

A dult spinal deformity (ASD) surgery remains technically challenging and is associated with high rates of complications, one of which is pseudarthrosis. 8–11 , 22 , 27 The rates of pseudarthrosis in ASD have ranged from 0% to 35%, 5 , 8–10 with one comprehensive review citing pseudarthrosis as the most frequent long-term complication of those studied, reporting a rate of 7.6%. 27 Patients who develop pseudarthrosis are at risk for instrumentation failure and may require revision surgery. Risk factors for pseudarthrosis have been studied and include

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Michael Y. Wang

Adult spinal deformities (ASD) pose a challenge for the spinal surgeon. Because the spine is often rigid, mobilization of the segments is critical for effective correction, particularly in the sagittal plane. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained problematic using MIS approaches, including MIS lateral methods. This video illustrates one method for achieving improvement of coronal and sagittal correction without the extensive exposure and soft tissue envelope disruption needed in open surgery, particularly for less severe deformities. By using multi-level TLIFs through a mini-open surgery, curves of less than 60° can be managed with minimal blood loss and within a reasonable surgical timeframe. While feasibility will have to be proven with larger series and improved surgical methods, this technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.

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Malgosia A. Kokoszka, Patricia E. McGoldrick, Maite La Vega-Talbott, Hillary Raynes, Christina A. Palmese, Steven M. Wolf, Cynthia L. Harden, and Saadi Ghatan

notes, pathology findings, and neurology and neurosurgery follow-up notes. Patients with the following diagnoses: autism; Asperger syndrome; Rett syndrome with autistic features; and pervasive developmental disorder, not otherwise specified (PDD-NOS) were included, regardless of etiology. These patients are collectively referred to throughout this report as those with autism spectrum disorder (ASD), based on recent changes in the Diagnostic and Statistical Manual, 5th Edition (DSM-5) guidelines for autism diagnosis. 1 , 2 Study Participants Fifty

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Hiroyuki Aono, Shota Takenaka, Hidekazu Tobimatsu, Yukitaka Nagamoto, Masayuki Furuya, Tomoya Yamashita, Hiroyuki Ishiguro, and Motoki Iwasaki

P osterior lumbar interbody fusion (PLIF) has become a widely accepted procedure for degenerative lumbar diseases because of the development of spinal instrumentation, including interbody cages. PLIF has a number of advantages over other forms of fusion surgery, including the circumferential decompression of neural elements, a high fusion rate, good correction, and maintenance of lumbar alignment. 1 , 2 Many reports are available about adjacent-segment disease (ASD) after PLIF, and ASD after fusion surgery is frequently observed at a cranial segment. 3 , 4 In

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Alex P. Michael, Matthew W. Weber, Kristin R. Delfino, and Venkatanarayanan Ganapathy

A djacent -segment disease (ASD) is a well-recognized long-term consequence of lumbar interbody fusion. 8 , 12 , 15 , 16 , 22 , 25 , 27 , 30 The literature has shown that minimally invasive lumbar fusion techniques result in similar clinical outcomes as open approaches and offer the advantages of a smaller incision, less soft-tissue trauma, and quicker return to normal activities. 31 Compared to other minimally invasive options, the axial lumbar interbody fusion (AxiaLIF) system (TranS1 Inc.) has the added benefit of avoiding the critical anterior neurovascular

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Ping-Guo Duan, Praveen V. Mummaneni, Jeremy M. V. Guinn, Joshua Rivera, Sigurd H. Berven, and Dean Chou

they showed that this system was reliable in grading LM muscle fat infiltration. 11 In addition, the amount of fat infiltration graded according to the Goutallier classification has been shown to be associated with disc degeneration. 12 We hypothesize that fat infiltration of the LM muscle may be associated with adjacent-segment degeneration (ASD) after lumbar fusion. We evaluated revision surgery rates for ASD in patients undergoing single-level L4–5 TLIF for spondylolisthesis and the correlation with fat infiltration by the Goutallier classification. Methods

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Yu Han, Jianguang Sun, Chenghan Luo, Shilei Huang, Liren Li, Xiang Ji, Xiaozong Duan, Zhenqing Wang, and Guofu Pi

L umbar spinal fusion surgery has grown in popularity dramatically over the past decade, and because of its high success rate it has served as the standard by which various disorders of the lumbar spine can be judged. However, fusion surgery alters endplate loading and increases adjacent-segment intradiscal pressures and range of motion. 4 Thus, fusion surgery is considered a major risk factor for adjacent-segment degeneration (ASD). ASD, an adverse sequela of lumbar arthrodesis, has been reported in many studies. ASD can be classified as symptomatic or

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Caroline Scemama, Baptiste Magrino, Philippe Gillet, and Pierre Guigui

developing a common complication called adjacent-segment disease (ASD). 9 ASD has been defined as the presentation of a new symptom referable to an adjacent level after patients have undergone successful surgical treatment of a spinal problem at an index level. At 10 years after surgery, about 25% of patients having undergone short lumbar fusion will develop ASD. 18 In prognostic studies, age greater than 60 years, preexisting facet or disc degeneration in the nonoperated segments, multilevel fusions, fusions not including the L5–S1 level, and laminectomy performed