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Michael Y. Wang, Praveen V. Mummaneni, Kai-Ming G. Fu, Neel Anand, David O. Okonkwo, Adam S. Kanter, Frank La Marca, Richard Fessler, Juan Uribe, Christopher I. Shaffrey, Virginie Lafage, Raqeeb M. Haque, Vedat Deviren and Gregory M. Mundis Jr.

S urgery for adult spinal deformity (ASD) remains a challenging proposition. Several factors contribute to create a high likelihood of intraoperative and postoperative complication rates. Medical comorbidities, patient deconditioning due to pain and immobility, associated osteoporosis, a rigid skeletal deformity, and abnormal spinal anatomy all increase the likelihood of a complication from ASD surgery. 6 , 9 Furthermore, the surgical enterprise needed to destabilize, realign, and fuse the spine over multiple segments is painful and debilitating

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Pierce D. Nunley, Gregory M. Mundis Jr., Richard G. Fessler, Paul Park, Joseph M. Zavatsky, Juan S. Uribe, Robert K. Eastlack, Dean Chou, Michael Y. Wang, Neel Anand, Kelly A. Frank, Marcus B. Stone, Adam S. Kanter, Christopher I. Shaffrey, Praveen V. Mummaneni and the International Spine Study Group

F or hospitals to continue to provide excellent care for adult spinal deformity (ASD) surgery, they must be able to adequately recover their costs for these procedures. The introduction of Medicare’s Prospective Payment System (PPS) in 1983 led to the development of a fixed payment amount for each patient upon hospital discharge ( https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html ). 1 The fixed payment amount is determined based on the particular diagnosis-related group (DRG) coded at patient discharge and it is intended

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Paul Park, Kai-Ming Fu, Robert K. Eastlack, Stacie Tran, Gregory M. Mundis Jr., Juan S. Uribe, Michael Y. Wang, Khoi D. Than, David O. Okonkwo, Adam S. Kanter, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Dean Chou, Mark E. Oppenlander, Praveen V. Mummaneni and the International Spine Study Group

I n the surgical treatment of symptomatic adult spinal deformity (ASD), spinopelvic alignment is considered an important factor in achieving a successful result. Specifically, several parameters, including pelvic tilt (PT), pelvic incidence to lumbar lordosis (PI-LL) mismatch, and sagittal vertical axis (SVA), have been correlated with clinical outcomes. It has been proposed that optimal spinopelvic alignment goals should consist of a PT < 20°, a PI-LL mismatch ± 9°, and an SVA < 50 mm. 9 Based predominantly on correlation studies, it has been presumed that

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Paul Park, Michael Y. Wang, Virginie Lafage, Stacie Nguyen, John Ziewacz, David O. Okonkwo, Juan S. Uribe, Robert K. Eastlack, Neel Anand, Raqeeb Haque, Richard G. Fessler, Adam S. Kanter, Vedat Deviren, Frank La Marca, Justin S. Smith, Christopher I. Shaffrey, Gregory M. Mundis Jr. and Praveen V. Mummaneni

, including adult spinal deformity (ASD). Anand et al. 3 initially reported the feasibility of applying several different MIS techniques to treat symptomatic lumbar scoliosis. Subsequent reports have all confirmed successful MIS treatment of ASD. 5 , 17 , 21 , 24 These studies, however, have been limited by the relatively small numbers of patients evaluated, as well as the lack of focus on sagittal alignment and spinopelvic parameters, which are factors known to significantly impact long-term disability. 12 , 18 In addition, there has been no uniform MIS technique or

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Michael Y. Wang, Stacie Tran, G. Damian Brusko, Robert Eastlack, Paul Park, Pierce D. Nunley, Adam S. Kanter, Juan S. Uribe, Neel Anand, David O. Okonkwo, Khoi D. Than, Christopher I. Shaffrey, Virginie Lafage, Gregory M. Mundis Jr., Praveen V. Mummaneni and the MIS-ISSG Group

T he morbidity of adult spinal deformity (ASD) surgery has been well proven through several large multiinstitutional studies. 6 , 9 , 14 Although these operations carry inherent risk, the benefits of such interventions have been shown as well, provided that the tenets of the surgical goals have been met. 2 , 10 , 11 Given these conditions, substantial enthusiasm has been demonstrated for minimally invasive surgery (MIS) options. 5 , 7 , 18 , 22 Various technical methods have been developed to achieve these ends, including 1) leveraging alternate access routes

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Khoi D. Than, Praveen V. Mummaneni, Kelly J. Bridges, Stacie Tran, Paul Park, Dean Chou, Frank La Marca, Juan S. Uribe, Todd D. Vogel, Pierce D. Nunley, Robert K. Eastlack, Neel Anand, David O. Okonkwo, Adam S. Kanter and Gregory M. Mundis Jr.

deformity (ASD). 25 Methods Study Design and Patient Population We performed a retrospective analysis of data collected from a multicenter database of patients with ASD who had been treated with a component of minimally invasive surgical techniques between 2009 and 2013. Eleven participating institutions contributed data, and each site obtained institutional review board approval. Inclusion criteria for entry into the multicenter database were patient age of ≥ 18 years and at least 1 of the following factors: a coronal Cobb angle (CCA) of > 20°, a sagittal vertical axis

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Juan S. Uribe, Armen R. Deukmedjian, Praveen V. Mummaneni, Kai-Ming G. Fu, Gregory M. Mundis Jr., David O. Okonkwo, Adam S. Kanter, Robert Eastlack, Michael Y. Wang, Neel Anand, Richard G. Fessler, Frank La Marca, Paul Park, Virginie Lafage, Vedat Deviren, Shay Bess and Christopher I. Shaffrey

O ver the past several decades, surgical treatment options for adult spinal deformity (ASD) have expanded, including both minimally invasive and open techniques. 3 , 12 , 14 , 18 , 27 Determining the most suitable approach in patients should take into account the risks and benefits of each surgical technique. Unfortunately, studies comparing the different operative techniques are lacking. Moreover, outcomes and complications of ASD are largely reported in terms of patient characteristics following traditional open techniques with little published data

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Paul Park, Kai-Ming Fu, Praveen V. Mummaneni, Juan S. Uribe, Michael Y. Wang, Stacie Tran, Adam S. Kanter, Pierce D. Nunley, David O. Okonkwo, Christopher I. Shaffrey, Gregory M. Mundis Jr., Dean Chou, Robert Eastlack, Neel Anand, Khoi D. Than, Joseph M. Zavatsky, Richard G. Fessler and the International Spine Study Group

A dult spinal deformity (ASD) can cause significant pain and disability. When the deformity is refractory to medical management, spinal deformity surgery can effectively improve pain and function. 14 Presently, there are many options for the surgical treatment of ASD, including minimally invasive surgery (MIS). 2 , 4 , 9 , 10 , 16 , 17 The potential advantages of MIS primarily reflect a significantly diminished exposure-related morbidity resulting in decreased bleeding, length of stay, and pain, and possibly faster recovery. Initial applications of MIS for ASD

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Khoi D. Than, Paul Park, Kai-Ming Fu, Stacie Nguyen, Michael Y. Wang, Dean Chou, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Christopher I. Shaffrey, Shay Bess, Behrooz A. Akbarnia, Vedat Deviren, Juan S. Uribe, Frank La Marca, Adam S. Kanter, David O. Okonkwo, Gregory M. Mundis Jr., Praveen V. Mummaneni and the International Spine Study Group

M invasive surgery (MIS) techniques are increasingly used in spine surgery, including in the treatment of adult spinal deformity (ASD). Such techniques include minimally invasive transpsoas retroperitoneal approaches for lateral lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Previous work has suggested that minimally invasive spinal deformity correction is associated with fewer intraoperative complications than open or hybrid techniques 9 with comparable clinical outcomes. 2 However, with the

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between the two forms of treatment emerge. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2015.3.FOC-DSPNABSTRACTS 103. A Prospective, Multi-Center Assessment of the Best Versus Worst Clinical Outcomes for Adult Spinal Deformity (ASD) Surgery Justin S. Smith , MD PhD , Christopher I. Shaffrey , MD FACS , Virginie Lafage , PhD , Frank Schwab , MD, PhD , Themistocles Protopsaltis , MD , Eric Klineberg , MD , Munish