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Emmanuelle Ferrero, Barthelemy Liabaud, Jensen K. Henry, Christopher P. Ames, Khaled Kebaish, Gregory M. Mundis, Richard Hostin, Munish C. Gupta, Oheneba Boachie-Adjei, Justin S. Smith, Robert A. Hart, Ibrahim Obeid, Bassel G. Diebo, Frank J. Schwab and Virginie Lafage

timing of revision surgery (up to 2 years postoperatively). Radiographic Measurement Radiographs were analyzed using validated software (Spineview, ENSAM Paris-Tech). 34 Sagittal spinopelvic radiographic parameters included cervical lordosis, T2–12 thoracic kyphosis (TK), LL, PI-LL mismatch, and pelvic parameters (PI, PT, and sacral slope). 46 Global sagittal alignment parameters included SVA and T-1 spinopelvic inclination (T1SPi) ( Fig. 1 ). The 3CO resection angle was defined as the change in the angle formed by the upper endplate of the vertebra below the 3CO and

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Themistocles S. Protopsaltis, Justin K. Scheer, Jamie S. Terran, Justin S. Smith, D. Kojo Hamilton, Han Jo Kim, Greg M. Mundis Jr., Robert A. Hart, Ian M. McCarthy, Eric Klineberg, Virginie Lafage, Shay Bess, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames and International Spine Study Group

A dult spinal deformity has been studied extensively in the literature with a majority of publications focusing on thoracolumbar deformity and its effect on health-related quality of life (HRQOL) measures. 1 , 3 , 6 , 7 , 10 , 11 , 13 , 14 , 16 , 17 Among patients with thoracolumbar deformities, positive sagittal alignment has been associated with pain and disability. 2 , 7 , 11 , 13 , 16 Few studies have correlated validated health measures and positive cervical sagittal alignment. 16 , 17 Tang et al. 16 demonstrated that a C2–7 sagittal vertical axis

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Aaron J. Clark, Jessica A. Tang, Jeremi M. Leasure, Michael E. Ivan, Dimitriy Kondrashov, Jenni M. Buckley, Vedat Deviren and Christopher P. Ames

fatigue loading, the slope of the cephalad L-3 endplate was monitored with a goniometer. The slope at maximum loading every 1000 cycles was compared with the initial slope. If the change in maximum loading slope exceeded 20°, the test was stopped and was noted as failure. The cycle count to failure was recorded for each specimen. Following fatigue loading, each specimen was subjected to FE ROM testing to evaluate the stability of the construct postfatigue. This simulated a significant change in lower lumbar angulation, which could impact standing sagittal alignment

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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Benjamin Blondel, Frank Schwab, Richard Hostin, Robert Hart, Brian O'Shaughnessy, Shay Bess, Serena S. Hu, Vedat Deviren, Christopher P. Ames and International Spine Study Group

P ositive sagittal malalignment (defined as anterior deviation of the C-7 plumb line >5 cm from the posterior superior corner of S-1) is recognized as a cause of pain and disability in cases of ASD. 8 , 20 , 28 , 30 , 31 Poor sagittal alignment has been shown to require increased energy expenditure, and multiple compensatory measures have been described, including knee flexion, pelvic retroversion, and thoracic hypokyphosis. 20 , 30 , 31 Surgical correction of positive sagittal malalignment has been correlated with significant improvement in health

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Justin K. Scheer, Jessica A. Tang, Justin S. Smith, Frank L. Acosta Jr., Themistocles S. Protopsaltis, Benjamin Blondel, Shay Bess, Christopher I. Shaffrey, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher P. Ames and the International Spine Study Group

bodies from C-2 to C-7 and then summing the segmental angles for an overall cervical curvature angle. Translation of the cervical spine in the sagittal plane is measured through the cervical SVA, for which there are different methods of measurement. Both C-2 SVA ( Figs. 2 and 3 left ) and C-7 SVA have been used to define sagittal alignment globally by measuring the distance between the C-2 and C-7 plumb lines, respectively, from the posterior superior corner of the sacrum. Cervical SVA can also be defined regionally using the distance between a plumb line dropped

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Murat Pekmezci, Jessica A. Tang, Liu Cheng, Ashin Modak, R. Trigg McClellan, Jenni M. Buckley and Christopher P. Ames

length, and identical diameter end caps were used for each donor. The effect of sagittal alignment on endplate contact profile was examined for the expandable cages only, by imposing 3 different clinical scenarios: hyperlordosis, hypolordosis, and normal sagittal alignment. These conditions were imposed sequentially on each expandable cage specimen by the surgeon, choosing the appropriately angled cage end caps necessary to induce that state. Biomechanical testing was performed after each deployment to record the cage-endplate contact force profile. For the fixed cages

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

. 13 It has been established that global sagittal alignment and coronal spinal alignment are strongly correlated with functional disability and pain outcomes, as has been validated by various health-related quality of life scores (HRQLS)—greater imbalance leading to greater functional disability. 12 , 14 , 21 , 39 Fortunately, the surgical correction and reestablishment of age-appropriate global spinal alignment and spinopelvic parameters have been demonstrated to significantly improve patient function, pain, and appearance. 19 , 29 , 36 In general, the objective

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

deformity . Curr Rev Musculoskelet Med 4 : 159 – 167 , 2011 10.1007/s12178-011-9101-z 22021017 10 Harroud A , Labelle H , Joncas J , Mac-Thiong JM : Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis . Eur Spine J 22 : 849 – 856 , 2013 23184183 10.1007/s00586-012-2591-6 11 Kelly MP , Lenke LG , Shaffrey CI , Ames CP , Carreon LY , Lafage V , : Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli

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

relationship between global sagittal alignment (GSA) and health-related quality of life. 15 Subsequent studies have confirmed this relationship and defined the importance of pelvic morphology and alignment. 70 Global coronal alignment and GSA can be assessed based on standing full-length spine radiographs ( Fig. 3A and B ). GSA can be expressed as the sagittal vertical axis (SVA; Fig. 3B ). Alternatively, thoracic spinopelvic inclination ( Fig. 3B ) or novel measures, such as the T1 pelvic angle, 55 can be used to quantify GSA. Basic regional measures of sagittal

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Justin K. Scheer, Peter G. Passias, Alexandra M. Sorocean, Anthony J. Boniello, Gregory M. Mundis Jr., Eric Klineberg, Han Jo Kim, Themistocles S. Protopsaltis, Munish Gupta, Shay Bess, Christopher I. Shaffrey, Frank Schwab, Virginie Lafage, Justin S. Smith, Christopher P. Ames and The International Spine Study Group

, all of the demographic differences were similar between patients with and without preoperative cervical malalignment, with the exception of CK. Patients with CK were significantly younger by an average of 10 years. This result is in line with both Park et al. 20 and Smith et al. 25 The study by Park and colleagues assessed the effect of age on cervical sagittal alignment in 100 asymptomatic subjects and found that the C2–7 lordosis increased with age. Smith et al. also found that patients with CK were significantly younger than those without CK in a large