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Alex Soroceanu, Douglas C. Burton, Bassel Georges Diebo, Justin S. Smith, Richard Hostin, Christopher I. Shaffrey, Oheneba Boachie-Adjei, Gregory M. Mundis Jr., Christopher Ames, Thomas J. Errico, Shay Bess, Munish C. Gupta, Robert A. Hart, Frank J. Schwab, Virginie Lafage and International Spine Study Group

number is expected to increase. Adult spinal deformity (ASD) is common, and its incidence increases with age. The prevalence of ASD in the elderly population has been investigated, with Schwab et al. 56 reporting rates of ASD up to 68% in patients over the age of 65 years. Regarding ASD treatment, multiple reports have documented the superiority of surgical intervention and its potential ability to improve pain and disability, the 2 primary presenting complaints of patients with ASD. 5 , 23 , 61 , 62 However, several authors have identified high complication

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Virginie Lafage, Neil J. Bharucha, Frank Schwab, Robert A. Hart, Douglas Burton, Oheneba Boachie-Adjei, Justin S. Smith, Richard Hostin, Christopher Shaffrey, Munish Gupta, Behrooz A. Akbarnia and Shay Bess

S agittal spinopelvic malalignment is increasingly recognized as a cause of pain and disability in patients with ASD. 8 , 11 , 21 , 22 Positive sagittal balance, defined as anterior deviation of the C-7 plumb line more than 50 mm from the posterosuperior corner of the sacrum, is a reliable predictor of adverse clinical symptoms. As the magnitude of positive sagittal balance increases, HRQOL measures have been shown to worsen among patients with ASD. 8 , 9 , 11 , 17 Pelvic tilt is a compensatory mechanism that reflects the body's attempt to correct

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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

A dult spinal deformity (ASD) is a debilitating disorder that is increasingly prevalent, especially in the elderly. 1–4 , 10 ASD is often manifested by a loss of lumbar lordosis (LL) with anterior global malalignment, pelvic retroversion, and multiple attempts at compensation. 1 , 14 , 20 , 31 , 33 , 38 Because of the complexity of structural pathologies and clinical presentations, ASD correction remains challenging, thus underscoring the need for better evidence-based treatment. 19 , 38 Surgical treatment of ASD requires sufficient restoration of sagittal

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Frank J. Schwab, Ashish Patel, Christopher I. Shaffrey, Justin S. Smith, Jean-Pierre Farcy, Oheneba Boachie-Adjei, Richard A. Hostin, Robert A. Hart, Behrooz A. Akbarnia, Douglas C. Burton, Shay Bess and Virginie Lafage

A dult spinal deformity is a complex musculoskeletal pathology with varied clinical presentations. Recent reports have demonstrated that pain and disability resulting from ASD are strongly associated with sagittal spinopelvic malalignment. 13 , 21 , 29 Common etiologies for sagittal spinopelvic malalignment include degenerative conditions, iatrogenic or postoperative flatback, and posttraumatic conditions. 3 , 10 , 27 , 30 Surgery for spinopelvic malalignment can provide a more ergonomic standing posture, resulting in improved function and reduced pain

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Kristina Bianco, Robert Norton, Frank Schwab, Justin S. Smith, Eric Klineberg, Ibrahim Obeid, Gregory Mundis Jr., Christopher I. Shaffrey, Khaled Kebaish, Richard Hostin, Robert Hart, Munish C. Gupta, Douglas Burton, Christopher Ames, Oheneba Boachie-Adjei, Themistocles S. Protopsaltis and Virginie Lafage

S urgery for adult spinal deformity (ASD) is a challenging undertaking with significant complexity and technical demand. The surgical treatment of fixed sagittal and/or coronal plane deformities typically involves multilevel arthrodesis with one or more osteotomies for the restoration of global spinopelvic alignment. Three-column resection osteotomies (3COs) are powerful techniques allowing for simultaneous multiplanar deformity correction from a single posterior surgical approach. 21 These techniques involve Grade 3–5 resections and encompass pedicle

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adjacent segment disease (ASD) in the cervical spine. Methods: 888 patients received ACDFs for symptomatic degenerative disease of the cervical spine over the past 22 years at our institution. Of these, 108 patients received repeat ACDF surgeries due to symptomatic ASD. 77 received revision surgeries anteriorly, and 31 received posterior surgeries. Pre, intra, peri, and post-operative data were collected via clinical notes and patient interviews. Patients were followed up for an average of 111.8±76.5 months after the first ACDF. Results: In general, patients

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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

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remains stable comparing 3 and 12-month results. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2014.3.FOC-DSPNABSTRACTS Abstract Outcomes Award 103. Two Year Prospective, Multicenter Analysis of Consecutive Adult Spinal Deformity (ASD) Patients Demonstrates Higher Fusion Grade, Lower Implant Failures and Greater Improvement in SRS-22r Scores for Patients Treated with Recombinant Human Bone Morpho Kai-Ming G. Fu , MD PhD , Eric Klineberg , MD , Shay

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spinal deformity (ASD) remains a challenge for the spinal surgeon. 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 elusive using MIS an approach. This report describes the evolution of an MIS method for treating ASD with attention to sagittal correction. Methods: Over an 18 month period 25 patients with thoracolumbar scoliosis were treated surgically. The mean patient age was 72 years, with 68% females. Patients were treated with

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Association of Neurological Surgeons 2013.4.FOC-LSRSABSTRACTS Oral Presentation Abstracts Paper 47. Age, Sagittal Deformity and Operative Correction are Risk Factors for Proximal Junctional Failure (PJF) Following Adult Spinal Deformity (ASD) Surgery Robert Hart , MD , Richard Hostin , MD , Themistocles Protopsaltis , MD , Shay Bess , MD , Frank Schwab , MD , Virginie Lafage , PhD; , Praveen Mummaneni , MD , Christopher Ames , MD , Christopher Shaffrey , MD , Justin