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Michael P. Kelly, Lukas P. Zebala, Han Jo Kim, Daniel M. Sciubba, Justin S. Smith, Christopher I. Shaffrey, Shay Bess, Eric Klineberg, Gregory Mundis Jr., Douglas Burton, Robert Hart, Alex Soroceanu, Frank Schwab, Virginie Lafage and International Spine Study Group

C omplex adult spinal deformity (ASD) surgeries are increasing in incidence, as the population ages and the revision burden grows. 15 , 16 Reconstructive surgeries for ASD are associated with long operative times and high estimated blood losses (EBLs). Consequently, resuscitation of these patients frequently requires transfusions of autologous (AUTO) or allogeneic (ALLO) packed red blood cells (PRBCs) to maintain circulating hemoglobin levels, in an effort to minimize perioperative complications. 18 In fact, spine surgery is one of the most common

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Alexander A. Theologis, Tamir Ailon, Justin K. Scheer, Justin S. Smith, Christopher I. Shaffrey, Shay Bess, Munish Gupta, Eric O. Klineberg, Khaled Kebaish, Frank Schwab, Virginie Lafage, Douglas Burton, Robert Hart, Christopher P. Ames and The International Spine Study Group

A dult spinal deformity (ASD) is associated with marked physical and mental impairment. 10 Although evidence exists indicating that surgical treatment improves the quality of life of patients with ASD that causes pain and disability, 18 certain concomitant preoperative medical comorbidities and mental health disorders differentially affect the success of surgical intervention. 16 , 22 For example, prior work from a large population of patients with ASD demonstrated a significantly higher proportion of patients with a history of baseline depression in

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Blake N. Staub, Renaud Lafage, Han Jo Kim, Christopher I. Shaffrey, Gregory M. Mundis Jr., Richard Hostin, Douglas Burton, Lawrence Lenke, Munish C. Gupta, Christopher Ames, Eric Klineberg, Shay Bess, Frank Schwab, Virginie Lafage and the International Spine Study Group

data is based on 2 separate databases: a multicenter database of surgical adult spinal deformity (ASD) patients collected through the International Spine Study Group (ISSG) and an adult spine normative database that was used as a control. Inclusion criteria for the ISSG database included patients older than 18 years who underwent surgical intervention for documented thoracolumbar spinal deformity based on at least one of the following measures: coronal Cobb angle > 20°, sagittal vertical axis (SVA) > 5 cm, PT > 25°, or TK > 60°. In addition, cervical spine data

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Renaud Lafage, Ibrahim Obeid, Barthelemy Liabaud, Shay Bess, Douglas Burton, Justin S. Smith, Cyrus Jalai, Richard Hostin, Christopher I. Shaffrey, Christopher Ames, Han Jo Kim, Eric Klineberg, Frank Schwab, Virginie Lafage and the International Spine Study Group

A dult spinal deformity (ASD) is an increasingly recognized source of pain and disability in our aging population. Increased ASD severity, characterized by a flattening of lumbar lordosis (LL) 1 as well as an anterior trunk inclination, 23 corresponds to worsened patient-reported health-related quality-of-life (HRQOL) scores. 9 , 23 When the severity of ASD starts to negatively impact patients’ lives and livelihoods, symptomatic and definitive treatment should be identified and pursued. Fortunately, the majority of symptomatic ASD patients can be sufficiently

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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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Alexander A. Theologis, Gregory M. Mundis Jr., Stacie Nguyen, David O. Okonkwo, Praveen V. Mummaneni, Justin S. Smith, Christopher I. Shaffrey, Richard Fessler, Shay Bess, Frank Schwab, Bassel G. Diebo, Douglas Burton, Robert Hart, Vedat Deviren and Christopher Ames

L umbar /thoracolumbar scoliosis is a common feature of adult spinal deformity (ASD) and is frequently accompanied by global spinal malalignment, back and leg pain, and decreased quality of life. Operative intervention for ASD has proven cost effective compared with nonoperative management, 25 as many patients have persistent pain and curve progression with nonoperative treatment. 27 , 29 , 37 Keys to achieving good postoperative outcomes include correction of scoliosis, decompression of neural elements, avoidance of pseudarthrosis, and restoration

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Alan H. Daniels, Daniel B. C. Reid, Wesley M. Durand, D. Kojo Hamilton, Peter G. Passias, Han Jo Kim, Themistocles S. Protopsaltis, Virginie Lafage, Justin S. Smith, Christopher I. Shaffrey, Munish Gupta, Eric Klineberg, Frank Schwab, Douglas Burton, Shay Bess, Christopher P. Ames, Robert A. Hart and the International Spine Study Group

S urgery for adult spinal deformity (ASD) has been shown to improve both radiographic spinal alignment parameters and health-related quality of life (HRQOL) measures in appropriately selected patients, 2 , 17 , 18 , 20 although it has also been associated with a substantial complication rate. 3 , 9 , 19 , 21 , 22 Some complications, such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), have been previously associated with choice of upper instrumented vertebra (UIV) level. 1 , 5 , 10 , 13 However, despite an early understanding of

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Han Jo Kim, Sohrab Virk, Jonathan Elysee, Peter Passias, Christopher Ames, Christopher I. Shaffrey, Gregory Mundis Jr., Themistocles Protopsaltis, Munish Gupta, Eric Klineberg, Justin S. Smith, Douglas Burton, Frank Schwab, Virginie Lafage, Renaud Lafage and the International Spine Study Group

steps in better understanding how cervical sagittal alignment impacts clinical outcomes in CD is to classify the various types of sagittal alignment deformity involved in CD. A previous classification by Ames et al. provided a common language for CD. This classification, however, was defined a priori, based only on surgeon experience, and was not linked to health-related quality of life (HRQOL) measurements. 3 In addition, this classification was largely based on a previous thoracolumbar classification of ASD. 21 We ultimately aim to create a new, data

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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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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