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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

lordosis when operating on the cervical spine. The problem with this, however, is that there is no uniform normal cervical lordosis. Nearly 34% of asymptomatic subjects in one study were found to have a baseline cervical kyphosis, which indicates that cervical kyphosis can, in fact, be a normal physiological parameter. 19 Reliance on cSVA or simple cervical alignment parameters without a predicted ideal cervical lordosis (CL) makes cervical deformity correction difficult and less exact, leading to either residual deformity or the creation of iatrogenic deformity where

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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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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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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

blindness and cancer. 5 , 11 , 14 While there have been well-established parameters governing how overall sagittal alignment relates to patient outcomes in cases of thoracolumbar spinal deformity, such correlations between sagittal alignment and CD are not as clear. 9 , 20 Previous research has shown that changes in cervical lordosis impact outcomes related to thoracolumbar scoliosis and surgery for cervical myelopathy. 16 , 17 To date, the potential relationship between cervical sagittal alignment and outcomes for CD patients has not been well defined. One of the first

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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

performed using Spineview (ENSAM Laboratory of Biomechanics) at a central location and included global C7–S1 SVA, lumbar lordosis (LL), pelvic incidence (PI), PT, mismatch between PI and LL (PI-LL), and lumbar/thoracolumbar Cobb angle. Clinical outcome measures included the Oswestry Disability Index (ODI) 13 and pre- and postoperative back and leg pain as assessed with a 10-point visual analog scale (VAS). Statistical Analysis Frequency distributions and summary statistics were tabulated for all baseline and outcome variables. Mean values are given with standard

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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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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

assessed. Radiographic measures included baseline and 2-year C7–S1 SVA, TK, PT, pelvic incidence–lumbar lordosis mismatch (PI-LL), and thoracic and lumbar Cobb angles, which were used to classify each deformity using the SRS-Schwab classification. 24 All radiographic measurements were performed on full-length standing anteroposterior and lateral radiographs using Spineview (ENSAM Laboratory of Biomechanics) at a central location. Preoperative and 2-year HRQOL scores included the Oswestry Disability Index (ODI), 9 SF-36, 27 SRS-22r, 5 and back and leg pain numeric

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Nitin Agarwal, Federico Angriman, Ezequiel Goldschmidt, James Zhou, Adam S. Kanter, David O. Okonkwo, Peter G. Passias, Themistocles Protopsaltis, Virginie Lafage, Renaud Lafage, Frank Schwab, Shay Bess, Christopher Ames, Justin S. Smith, Christopher I. Shaffrey, Douglas Burton, D. Kojo Hamilton and the International Spine Study Group

found to be an independent risk factor for both superficial and deep surgical site infections (SSIs). 17 The effectiveness of deformity surgery in obese patients, however, remains an unexplored area of research. Many prior publications have explored the relationship between modifiable spinal parameters, such as lumbar lordosis (LL) and postoperative change of the SVA. 11 To our knowledge, however, no study to date has specifically addressed the relationship between preoperative BMI and the degree of achievable postoperative SVA. As such, we sought to define this

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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

Index (LSDI), Oswestry Disability Index (ODI), and Scoliosis Research Society 22-r questionnaire (SRS-22r). Surgical characteristics collected included EBL and operative duration. Each radiograph was reviewed by at least 2 readers. The accuracy and reliability of this approach has been previously validated. 11 Radiographic measures included baseline and 2-year change in alignment parameters (SVA, pelvic incidence−lumbar lordosis [PI-LL], PT, TK) as well as incidence of PJK, PJF, pseudarthrosis, and rod fracture. PJK was defined as UIV to UIV+2 angle > 10° or change

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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

Index (LSDI), Oswestry Disability Index (ODI), and Scoliosis Research Society 22-r questionnaire (SRS-22r). Surgical characteristics collected included EBL and operative duration. Each radiograph was reviewed by at least 2 readers. The accuracy and reliability of this approach has been previously validated. 11 Radiographic measures included baseline and 2-year change in alignment parameters (SVA, pelvic incidence−lumbar lordosis [PI-LL], PT, TK) as well as incidence of PJK, PJF, pseudarthrosis, and rod fracture. PJK was defined as UIV to UIV+2 angle > 10° or change