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Justin K. Scheer, Justin S. Smith, Frank Schwab, Virginie Lafage, Christopher I. Shaffrey, Shay Bess, Alan H. Daniels, Robert A. Hart, Themistocles S. Protopsaltis, Gregory M. Mundis Jr., Daniel M. Sciubba, Tamir Ailon, Douglas C. Burton, Eric Klineberg, Christopher P. Ames and The International Spine Study Group

T he surgical management of adult spinal deformity (ASD) can provide significant improvements in pain, disability, and health-related quality of life (HRQOL). 6 , 7 , 28 , 34 , 36–38 , 40–45 However, these procedures are technically demanding and are associated with a high complication rate. The patient population suitable for these complicated surgeries continues to increase, including patients of advanced age. 2 , 16 , 17 , 27 The reported complication rates in the literature are varied and range from 14% to 71%. 11 , 13 , 39 , 47 , 48 It has been

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Justin K. Scheer, Taemin Oh, Justin S. Smith, Christopher I. Shaffrey, Alan H. Daniels, Daniel M. Sciubba, D. Kojo Hamilton, Themistocles S. Protopsaltis, Peter G. Passias, Robert A. Hart, Douglas C. Burton, Shay Bess, Renaud Lafage, Virginie Lafage, Frank Schwab, Eric O. Klineberg, Christopher P. Ames and the International Spine Study Group

A dult spinal deformity (ASD) surgery remains technically challenging and is associated with high rates of complications, one of which is pseudarthrosis. 8–11 , 22 , 27 The rates of pseudarthrosis in ASD have ranged from 0% to 35%, 5 , 8–10 with one comprehensive review citing pseudarthrosis as the most frequent long-term complication of those studied, reporting a rate of 7.6%. 27 Patients who develop pseudarthrosis are at risk for instrumentation failure and may require revision surgery. Risk factors for pseudarthrosis have been studied and include

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Michael P. Kelly, Michael A. Kallen, Christopher I. Shaffrey, Justin S. Smith, Douglas C. Burton, Christopher P. Ames, Virginie Lafage, Frank J. Schwab, Han Jo Kim, Eric O. Klineberg, Shay Bess and the International Spine Study Group

M easurement of health-related quality of life (HRQOL) outcomes in medicine is a necessary endeavor, as it makes possible comparisons of intervention effectiveness and evaluations of quality of care. 14 , 15 HRQOL measurements also aid healthcare-related decision making. In adult spinal deformity (ASD) surgery, for example, HRQOL measurements support patient and surgeon decision making with respect to both appropriate timing for surgery and the outcome expectations of patients and surgeons alike. HRQOL instruments may be generic measures of health, such as the

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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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Taemin Oh, Justin K. Scheer, Justin S. Smith, Richard Hostin, Chessie Robinson, Jeffrey L. Gum, Frank Schwab, Robert A. Hart, Virginie Lafage, Douglas C. Burton, Shay Bess, Themistocles Protopsaltis, Eric O. Klineberg, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group

A dult spinal deformity (ASD) is a debilitating disease affecting up to one-third of the general population, and its prevalence markedly increases with age. 5 As the population of the US ages, ASD is becoming increasingly recognized as a disease that could reach epidemic proportions. 5 , 41 Importantly, the substantial burden of symptomatic ASD on patient health and well-being has been well established, which underscores the need for treating ASD safely and efficiently. 8 , 13 , 22 , 34 Although there is still some debate regarding optimum management paradigms

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David B. Bumpass, Lawrence G. Lenke, Jeffrey L. Gum, Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames, Shay Bess, Brian J. Neuman, Eric Klineberg, Gregory M. Mundis Jr., Frank Schwab, Virginie Lafage, Han Jo Kim, Douglas C. Burton, Khaled M. Kebaish, Richard Hostin, Renaud Lafage, Michael P. Kelly and for the International Spine Study Group

T he role of sex in adult spinal deformity (ASD) surgery outcomes has not been extensively investigated. In contrast, several studies in the pediatric deformity population have demonstrated that sex does play a role in perioperative outcomes. 11 , 16 , 22 These studies found that male adolescent idiopathic scoliosis (AIS) patients had greater preoperative curve magnitude, less preoperative curve flexibility, and less deformity correction than female patients. Male patients also had greater estimated blood loss (EBL), longer operative duration, and higher

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Joshua Bakhsheshian, Justin K. Scheer, Jeffrey L. Gum, Richard Hostin, Virginie Lafage, Shay Bess, Themistocles S. Protopsaltis, Douglas C. Burton, Malla Kate Keefe, Robert A. Hart, Gregory M. Mundis Jr., Christopher I. Shaffrey, Frank Schwab, Justin S. Smith, Christopher P. Ames and The International Spine Study Group

I t is well known that deformity of the spine has a significant impact on the health-related quality of life (HRQOL) of adults; 2 , 17 however, the impact of the mental health burden in patients with adult spinal deformity (ASD) treated with surgical spinal reconstruction is less clear. Although screening for a history of mental health disease has been advocated in the preoperative planning for reconstructive spine surgery, 14 a survey completed by 110 spine surgeons from the US revealed that only 37% routinely use some form of mental health screening

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Shayan Fakurnejad, Justin K. Scheer, Virginie Lafage, Justin S. Smith, Vedat Deviren, Richard Hostin, Gregory M. Mundis Jr., Douglas C. Burton, Eric Klineberg, Munish Gupta, Khaled Kebaish, Christopher I. Shaffrey, Shay Bess, Frank Schwab, Christopher P. Ames and The International Spine Study Group

R igid adult spinal deformity (ASD) may be surgically corrected with 3-column osteotomy (3CO) techniques such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). 4 , 5 , 8 , 17 , 35 , 38 These techniques allow for significant correction of severe rigid spinal deformity in the sagittal, coronal, and axial planes simultaneously through a posterior-only approach. 1 , 4 , 8 , 17 , 18 , 35 , 36 , 38 Both 3CO procedures are technically challenging and are associated with significant morbidity rates, but have resulted in significant

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Ferran Pellisé, Miquel Serra-Burriel, Justin S. Smith, Sleiman Haddad, Michael P. Kelly, Alba Vila-Casademunt, Francisco Javier Sánchez Pérez-Grueso, Shay Bess, Jeffrey L. Gum, Douglas C. Burton, Emre Acaroğlu, Frank Kleinstück, Virginie Lafage, Ibrahim Obeid, Frank Schwab, Christopher I. Shaffrey, Ahmet Alanay, Christopher Ames, the International Spine Study Group and the European Spine Study Group

A dult spinal deformity (ASD) can be a debilitating disease. Recent studies have shown that the burden of ASD in patients seeking specialized medical attention is substantial compared to that of other severe chronic conditions (i.e., diabetes, congestive heart failure, chronic lung disease, or arthritis). 3 , 26 Nonoperative care has not shown a significant impact on health-related quality of life (HRQOL), 5 , 9 while surgery is associated with HRQOL improvements 17 that are maintained over time. 18 , 30 Aging populations, the high prevalence of ASD, and an

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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Justin K. Scheer, Themistocles Protopsaltis, Eric Klineberg, Munish Gupta, Richard Hostin, Kai-Ming G. Fu, Gregory M. Mundis Jr., Han Jo Kim, Vedat Deviren, Alex Soroceanu, Robert A. Hart, Douglas C. Burton, Shay Bess, Christopher P. Ames and the International Spine Study Group

A dults with spinal deformity characteristically present with pain and disability. 6 , 8 , 10 , 18 , 19 , 22 , 37 , 42–44 , 46 , 47 , 49 , 51 , 52 In the absence of significant or progressive neurological deficit, first-line treatments for symptomatic adult spinal deformity (ASD) are typically nonoperative and may include physical therapy, steroid injections, non-steroidal antiinflammatory drugs, and, potentially, narcotics. 2 , 48 For patients who do not achieve a satisfactory response with nonoperative approaches, surgical treatment may become an