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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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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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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

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Justin S. Smith, Christopher I. Shaffrey, Christopher P. Ames and Lawrence G. Lenke

H istorically , care for adult spinal deformity (ASD) focused on supportive measures with few surgical options that were often deemed high risk. Improvements in anesthesia and critical care, surgical techniques, and instrumentation have led to remarkable advances in ASD care over the last few decades. The population seeking ASD treatment continues to expand, as life expectancies increase and the desire to stay active into later life remains a priority. Although care for ASD has evolved from supportive to corrective, many challenges remain. Complication rates

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Kang Lu, Po-Chou Liliang, Hao-Kuang Wang, Cheng-Loong Liang, Jui-Sheng Chen, Tai-Been Chen, Kuo-Wei Wang and Han-Jung Chen

A djacent-segment degeneration (ASD) is a well-documented sequela of lumbar and lumbosacral fusions. The incidence of radiographically verified ASD reported in the literature varies from 5.6% to 100%. 13 , 16 , 17 A number of clinical observations indicate that the level proximal to fusion is more likely to undergo degenerative changes than the level distal to the fusion. 16 ASD may manifest as disc degeneration, disc herniation, facet joint hypertrophy, stenosis, segmental instability, and spondylolisthesis. 4 , 11 , 15 , 21 Symptomatic ASD, or adjacent

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Tomiya Matsumoto, Shinya Okuda, Takafumi Maeno, Tomoya Yamashita, Ryoji Yamasaki, Tsuyoshi Sugiura and Motoki Iwasaki

A lthough posterior lumbar interbody fusion (PLIF) with pedicle screw fixation has produced satisfactory clinical results, solid fusion has been reported to accelerate degenerative changes at adjacent unfused levels. 9 , 19 , 21 This spinal pathology is well known as adjacent-segment disease (ASD). Previous studies have reported on the incidence of ASD after lumbar spinal fusion, with radiological ASD in 36%–84% of patients and symptomatic ASD in 0%–24% of patients. 9 , 10 , 12 , 13 , 15–17 , 24 In terms of the risk factors for ASD after lumbar spinal