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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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Paul S. Issack, Suhel Y. Kotwal and Oheneba Boachie-Adjei

Interbody Arthrodesis There are 3 well-established methods to obtain L5–S1 interbody arthrodesis. An ALIF requires a retroperitoneal approach to reach the L5–S1 interspace below the bifurcation of the aorta into the left and right common iliac arteries. 10 This direct access allows for release of the anterior longitudinal ligament and restoration of sagittal alignment using a lordotic graft with a large footprint. The anterior approach can help restore sagittal balance, increase neural foraminal height, and lead to high fusion rates. 5 , 14 , 32 However, the exposure

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Virginie Lafage, Frank Schwab, Shaleen Vira, Robert Hart, Douglas Burton, Justin S. Smith, Oheneba Boachie-Adjei, Alexis Shelokov, Richard Hostin, Christopher I. Shaffrey, Munish Gupta, Behrooz A. Akbarnia, Shay Bess and Jean-Pierre Farcy

S pinal deformity in the adult is commonly a 3D pathology. However, evidence points toward the clinical impact of deformity being mostly related to the sagittal plane, with little correlation between coronal deformity and self-reported disability. The Classification of Adult Deformity 20 was primarily built on clinical impact parameters, and it highlights lumbar lordosis as well as global sagittal alignment. Work leading to the classification did not identify a significant clinical impact of coronal plane parameters. 20 Additionally, in the commonly known

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Hong-Lei Yi, Michael Faloon, Stuart Changoor, Thomas Ross and Oheneba Boachie-Adjei

techniques to achieving lumbosacral interbody fusion have been described including anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF). Each approach has well-described advantages and disadvantages. ALIF allows for the release of the anterior longitudinal ligament and the placement of a lordotic cage with a large footprint, which can help restore sagittal alignment, indirectly decompress neuroforamina, and enhance fusion rates. 6 However, the approach increases surgical time and adds approach

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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

sagittal alignment to maintain upright posture. Recently, increased PT has also been shown to correlate with worse HRQOL scores. 11 In certain cases of sagittal malalignment, a corrective osteotomy can be performed to restore balance. Pedicle subtraction osteotomy is an increasingly used technique to correct sagittal plane deformities and can obtain approximately 25° of increased lordosis when performed in the lumbar spine. 4 , 12 , 23 One of the challenges of the PSO technique is accurately predicting the postoperative spinopelvic alignment. Achieving spinopelvic

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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

in SS (9.5° ± 9° vs 8.1° ± 10.1°, respectively, p = 0.59), or postoperative SS (32.4° ± 10.6° vs 35.5° ± 11.3°, respectively, p = 0.30). Discussion Sagittal spinopelvic malalignment is a major cause of pain and loss of function associated with ASD. 1 , 13 , 21 Surgical restoration of optimal sagittal alignment is indicated for symptomatic patients and has demonstrated superior clinical and radiographic outcomes compared with nonoperative management. 5 , 32 Previous studies have shown that realignment of SVA and PT is critical to optimize clinical outcomes

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examined include presence of interbody fusion, rod diameter, rod material, age and preop sagittal alignment. Methods: A retrospective review of a multicenter, prospective ASD database was conducted. Inclusion criteria: age=18yr, ASD, no revisions between >6wk and <2yrs postop. Spinal pelvic parameters, thoracic kyphosis (TK:T2-T12) and lumbar lordosis (LL:L1-S1) were measured overall and within and outside of the instrumented segments. Changes for SVA, PT, PI-LL, TK, and LL between 6wks-2yrs postop were calculated. Of these pts, the amount of thoracic loss and TL

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surveys than NONOP (p<0.05). OP and NONOP had similar coronal alignment (p<0.05). OP had worse sagittal spinopelvic alignment for all measures than NONOP except cervical lordosis, TK and pelvic incidence (PI). OP had greater percentage of pure sagittal classification (type S; OP=23%, NON=14%; p<0.05). OP had worse grades for all modifier categories: PT (26% vs 16%), PI-lumbar lordosis mismatch (37% vs 21%) and global sagittal alignment (29% vs 9%), OP vs NONOP, respectively (p<0.05). Conclusion: Prospective analysis of OP vs NONOP treated ASD patients demonstrated

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30; p<0.001). Conclusions The addition of PPI seems to have a protective effect on the development of PJK. The analysis controlled for preoperative sagittal alignment as well as for correction of PI-LL. HYB was effective in restoring sagittal global alignment and cMIS in maintaining it. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2014.3.FOC-DSPNABSTRACTS Abstract Mayfield Clinical Science 243. Microendoscopic Decompression for Cervical Spondylotic Myelopathy

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greater Charlson comorbidity index (1.1 vs 0.85) than NONOP (n=446), respectively (p<0.05). OP had worse HRQOL scores on all surveys than NONOP (p<0.05). OP and NONOP had similar coronal alignment (p<0.05). OP had worse sagittal spinopelvic alignment for all measures than NONOP except cervical lordosis, TK and pelvic incidence (PI). OP had greater percentage of pure sagittal classification (type S; OP=23%, NON=14%; p<0.05). OP had worse grades for all modifier categories: PT (26% vs 16%), PI-lumbar lordosis mismatch (37% vs 21%) and global sagittal alignment (29% vs 9