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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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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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Darryl Lau, Andrew K. Chan, Vedat Deverin and Christopher P. Ames

A dult spinal deformity (ASD) can result in sagittal and/or coronal imbalance, which is generally the result of asymmetrical degeneration of vertebral bodies, intervertebral discs, and facet joints. 9 This progressive degenerative process can be hastened in the setting of concurrent spinal disease (chronic fractures and remote infection) or in patients with a history of prior spinal surgery with or without spinal instrumentation. Patients with ASD typically present with debilitating axial back and neck pain, neurological deficits, and functional impairment

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Cecilia L. Dalle Ore, Christopher P. Ames, Vedat Deviren and Darryl Lau

study compares perioperative and long-term outcomes of RA adult spinal deformity (ASD) patients to a matched cohort of non-RA ASD patients based on demographics, comorbidities, surgical approach, and spinal construct similarity. Methods This study was formally approved by the Committee of Human Research at the University of California, San Francisco. Patient Cohort Patients were identified via a comprehensive retrospective review of the electronic medical record. This study included all adult patients (over age 18 years at time of surgery) who underwent a posterior

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Darryl Lau, Joseph A. Osorio, Vedat Deviren and Christopher P. Ames

A dult spinal deformity (ASD) arises from multiple etiologies, but most commonly from arthritic spondylosis leading to asymmetrical degeneration of discs, facet joints, and other spinal elements. 13 This degenerative process can be hastened by iatrogenic factors (such as prior spine surgery) that result in instability, which further leads to instrumentation failure and junctional kyphosis/failure. ASD can be asymptomatic but is most often progressive, leading to severe axial back pain and neurological deficits in the setting of compression of neural elements

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Michael M. Safaee, Cecilia L. Dalle Ore, Corinna C. Zygourakis, Vedat Deviren and Christopher P. Ames

A dult spinal deformity (ASD) is associated with significant pain and disability. 43 Surgical correction produces significant improvements in a number of health-related quality of life (HRQOL) metrics. 4 , 14 , 35 , 38 , 40 The incidence of ASD in the US has increased over the past decade and is expected to rise even higher as a result of a growing aging population and increased life expectancy. 35 , 39 Consistent with these trends, the incidence of deformity correction surgery has more than doubled over the past decade. 30 An increased incidence of deformity

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Russell G. Strom, Junseok Bae, Jun Mizutani, Frank Valone III, Christopher P. Ames and Vedat Deviren

L oss of sagittal balance is associated with pain and disability, and its restoration is the primary goal of adult spinal deformity (ASD) surgery. 13 , 16 Facet osteotomies often provide limited sagittal correction because stiff, collapsed disc spaces impair posterior shortening. Moderate to severe ASD generally requires anterior disc space augmentation and/or posterior 3-column osteotomy. 6 Anterior lumbar interbody fusion (ALIF) and pedicle subtraction osteotomy (PSO) each carry significant risks. 5 , 11 , 17 , 29 , 33 , 34 Lateral lumbar interbody

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Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames, Mitsuru Yagi, Ahmet Alanay and Yoon Ha

I t has been recognized for more than 35 years that adult spinal deformity (ASD) is a common condition in the elderly that can frequently cause significant pain and disability. 2 , 6 Adults with painful and disabling spinal deformity appear to benefit from surgical treatment when compared with nonsurgical treatment, given the proper indications, but the surgery is costly and is associated with a high rate of complications. 1 , 5 , 7 , 11 , 12 For many years it was thought that the principal cause of the pain and disability associated with ASD was the severity

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Aaron J. Clark, Roxanna M. Garcia, Malla K. Keefe, Tyler R. Koski, Michael K. Rosner, Justin S. Smith, Joseph S. Cheng, Christopher I. Shaffrey, Paul C. McCormick and Christopher P. Ames

maintaining a solid contemporary neurosurgical knowledge base in the practice of modern spinal surgery. Adult spinal deformity (ASD) is now recognized as a significant cause of pain and disability. Deformity in the sagittal plane, 17 spinopelvic alignment, 15 understanding of appropriate deformity-specific work-up, including hip joint evaluation, comprehensive knowledge of normal lumbar anatomy and lordosis, and indications for pelvic fixation must be included in the spinal surgeon's knowledge base. 10 , 13 Failure to do so can result in treatment failure and poor