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Cecilia L. Dalle Ore, Christopher P. Ames, Vedat Deviren and Darryl Lau

study compares perioperative and long-term outcomes of RA adult spinal deformity (ASD) patients to a matched cohort of non-RA ASD patients based on demographics, comorbidities, surgical approach, and spinal construct similarity. Methods This study was formally approved by the Committee of Human Research at the University of California, San Francisco. Patient Cohort Patients were identified via a comprehensive retrospective review of the electronic medical record. This study included all adult patients (over age 18 years at time of surgery) who underwent a posterior

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Darryl Lau, Joseph A. Osorio, Vedat Deviren and Christopher P. Ames

A dult spinal deformity (ASD) arises from multiple etiologies, but most commonly from arthritic spondylosis leading to asymmetrical degeneration of discs, facet joints, and other spinal elements. 13 This degenerative process can be hastened by iatrogenic factors (such as prior spine surgery) that result in instability, which further leads to instrumentation failure and junctional kyphosis/failure. ASD can be asymptomatic but is most often progressive, leading to severe axial back pain and neurological deficits in the setting of compression of neural elements

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Michael M. Safaee, Cecilia L. Dalle Ore, Corinna C. Zygourakis, Vedat Deviren and Christopher P. Ames

A dult spinal deformity (ASD) is associated with significant pain and disability. 43 Surgical correction produces significant improvements in a number of health-related quality of life (HRQOL) metrics. 4 , 14 , 35 , 38 , 40 The incidence of ASD in the US has increased over the past decade and is expected to rise even higher as a result of a growing aging population and increased life expectancy. 35 , 39 Consistent with these trends, the incidence of deformity correction surgery has more than doubled over the past decade. 30 An increased incidence of deformity

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Russell G. Strom, Junseok Bae, Jun Mizutani, Frank Valone III, Christopher P. Ames and Vedat Deviren

L oss of sagittal balance is associated with pain and disability, and its restoration is the primary goal of adult spinal deformity (ASD) surgery. 13 , 16 Facet osteotomies often provide limited sagittal correction because stiff, collapsed disc spaces impair posterior shortening. Moderate to severe ASD generally requires anterior disc space augmentation and/or posterior 3-column osteotomy. 6 Anterior lumbar interbody fusion (ALIF) and pedicle subtraction osteotomy (PSO) each carry significant risks. 5 , 11 , 17 , 29 , 33 , 34 Lateral lumbar interbody

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Junseok Bae, Alexander A. Theologis, Russell Strom, Bobby Tay, Shane Burch, Sigurd Berven, Praveen V. Mummaneni, Dean Chou, Christopher P. Ames and Vedat Deviren

T reatment options for adult spinal deformity (ASD) are varied according to the patient’s baseline condition. Patients with minimal pain and mild thoracolumbar coronal deformity might benefit from conservative treatment. 18 The goal of surgical treatment for patients with ASD is to achieve sagittal and coronal balance, relieve axial and radiating pain, and achieve fusion. The surgical treatment of ASD is an effective endeavor that can be accomplished using a variety of surgical strategies. Interbody fusion has been advocated as an important surgical option in

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Darryl Lau, Cecilia L. Dalle Ore, Patrick Reid, Michael M. Safaee, Vedat Deviren, Justin S. Smith, Christopher I. Shaffrey and Christopher P. Ames

surgical interventions. Pediatric cases often involve scoliosis, coronal imbalance, and the thoracic region, whereas adult spinal deformity (ASD) cases more often involve sagittal imbalance, spinopelvic mismatch, and the lumbar spine. Thus, the results from pediatric studies may not be directly applicable to an ASD population. MEP use is best understood in spine surgery as a measure for spinal cord monitoring, and the true utility of using transcranial MEPs when operating in the lumbar spine (a region of thecal sac and nerve roots without spinal cord) remains

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Michael Y. Wang, Praveen V. Mummaneni, Kai-Ming G. Fu, Neel Anand, David O. Okonkwo, Adam S. Kanter, Frank La Marca, Richard Fessler, Juan Uribe, Christopher I. Shaffrey, Virginie Lafage, Raqeeb M. Haque, Vedat Deviren and Gregory M. Mundis Jr.

S urgery for adult spinal deformity (ASD) remains a challenging proposition. Several factors contribute to create a high likelihood of intraoperative and postoperative complication rates. Medical comorbidities, patient deconditioning due to pain and immobility, associated osteoporosis, a rigid skeletal deformity, and abnormal spinal anatomy all increase the likelihood of a complication from ASD surgery. 6 , 9 Furthermore, the surgical enterprise needed to destabilize, realign, and fuse the spine over multiple segments is painful and debilitating

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Justin K. Scheer, Jessica A. Tang, Justin S. Smith, Frank L. Acosta Jr., Themistocles S. Protopsaltis, Benjamin Blondel, Shay Bess, Christopher I. Shaffrey, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher P. Ames and the International Spine Study Group

established and treatment options defined and clarified. Therefore, the purpose of this article is to provide a comprehensive review of cervical alignment parameters and related outcome measures that may provide guidance for proper surgical treatment and highlight deficiencies in the current literature. Comparisons to established spinal pelvic parameters that predict disability in thoracolumbar surgery will be described. Other pathologies that are closely influenced by cervical deformity, including ASD and myelopathy, are also discussed. Cervical Spine Alignment

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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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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