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Khoi D. Than, Paul Park, Kai-Ming Fu, Stacie Nguyen, Michael Y. Wang, Dean Chou, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Christopher I. Shaffrey, Shay Bess, Behrooz A. Akbarnia, Vedat Deviren, Juan S. Uribe, Frank La Marca, Adam S. Kanter, David O. Okonkwo, Gregory M. Mundis Jr., Praveen V. Mummaneni and the International Spine Study Group

M invasive surgery (MIS) techniques are increasingly used in spine surgery, including in the treatment of adult spinal deformity (ASD). Such techniques include minimally invasive transpsoas retroperitoneal approaches for lateral lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Previous work has suggested that minimally invasive spinal deformity correction is associated with fewer intraoperative complications than open or hybrid techniques 9 with comparable clinical outcomes. 2 However, with the

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Christopher P. Ames, Justin S. Smith, Justin K. Scheer, Christopher I. Shaffrey, Virginie Lafage, Vedat Deviren, Bertrand Moal, Themistocles Protopsaltis, Praveen V. Mummaneni, Gregory M. Mundis Jr., Richard Hostin, Eric Klineberg, Douglas C. Burton, Robert Hart, Shay Bess, Frank J. Schwab and the International Spine Study Group

D espite the complexity of CSD and the substantial impact on patient quality of life, there exists no comprehensive classification system to serve as the basis of communication among physicians and to facilitate effective clinical and radiographic study of patients with these deformities. Without a standardized classification system, studies of CSD may suffer from heterogeneity that compromises the study findings and negatively impacts communication of the results. Other spinal conditions, including adult and pediatric scoliosis, spondylolisthesis, and

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

deformities via high-grade osteotomies, 41 the complication profile is unique, and associated morbidity in patients with RA can be more severe. 29 In a series by Mesfin et al. regarding outcomes in scoliosis surgery in patients with RA, 23 complications were observed in 14 patients with RA; this was significantly higher than the 11 complications observed in their 14 matched controls. 29 To our knowledge, there is a great paucity in studies examining the outcomes of RA patients who undergo thoracolumbar 3-column osteotomy. However, correction of thoracolumbar deformities

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Justin S. Smith, Ellen Shaffrey, Eric Klineberg, Christopher I. Shaffrey, Virginie Lafage, Frank J. Schwab, Themistocles Protopsaltis, Justin K. Scheer, Gregory M. Mundis Jr., Kai-Ming G. Fu, Munish C. Gupta, Richard Hostin, Vedat Deviren, Khaled Kebaish, Robert Hart, Douglas C. Burton, Breton Line, Shay Bess, Christopher P. Ames and The International Spine Study Group

S ubstantial improvements in surgical techniques, instrumentation, perioperative management, and reduction of risk related to comorbid conditions have broadened the indications for correction of adult spinal deformity (ASD) and have enabled correction of increasingly more complex deformities. Although data thus far seem to indicate that selected adults with spinal deformity do have significant potential for improvement with surgical treatment, overall complication rates remain high and represent areas for continued improvement 7 , 8 , 32 , 39–43 Despite

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

P roximal junctional kyphosis (PJK) is a well-recognized complication in patients undergoing surgical correction for adult spinal deformity. It presents with abnormal kyphosis immediately above the upper instrumented vertebra (UIV) and is quantified by measuring the sagittal Cobb angle between the inferior endplate of the UIV and the superior endplate of the second vertebral body above the UIV (UIV+2). The definition of PJK varies but is generally defined as an increase in kyphosis of more than 10°–20°. 8 , 10 , 16 We consider proximal junctional failure (PJF

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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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Dominic Amara, Praveen V. Mummaneni, Christopher P. Ames, Bobby Tay, Vedat Deviren, Shane Burch, Sigurd H. Berven and Dean Chou

Research. All adult scoliosis patients treated at our medical center in the period from June 2006 to June 2016 were retrospectively screened for an FC > 10° and radiculopathy ipsilateral to the concavity of the FC. Patients with exclusively sagittal plane deformities, with only mechanical or axial back pain without radicular symptoms or without concomitant radicular leg pain from the FC, or with an FC < 10° were all excluded from this study. Patients without pre- and postoperative scoliosis radiography studies at our institution, with < 1 year of follow-up, or with

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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

subjacent global spinal alignment and pelvic tilt as compensatory changes occur to maintain horizontal gaze. In the past, research conducted on the relationship between spinal malalignment and HRQOL has largely focused on the thoracolumbar and pelvic regions, and comparatively little attention has been given to the cervical spine. Currently, indications for surgery to correct cervical alignment are not well defined and there is no set standard to address the amount of correction to be achieved. Furthermore, classifications of cervical deformity have yet to be fully