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Manish K. Kasliwal, Justin S. Smith, Christopher I. Shaffrey, Leah Y. Carreon, Steven D. Glassman, Frank Schwab, Virginie Lafage, Kai-Ming G. Fu and Keith H. Bridwell

–46 Recent studies have shown the potential benefit of operative treatment for patients with scoliosis who have symptoms that fail to respond to nonoperative measures. 7 , 8 , 30 , 42–44 However, selecting the best surgical procedure for adults with symptomatic scoliosis may not be straightforward, with the spine surgeon often facing the challenge of whether it is necessary to surgically address the entire deformity. 16 , 19 , 21 , 27 , 33 , 40 , 46 , 47 , 49 Short-segment procedures can involve less surgical morbidity and represent an attempt to preserve lifestyle and

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Charles H. Crawford III, Steven D. Glassman, Jeffrey L. Gum and Leah Y. Carreon

A dvancements in the understanding of adult spinal deformity have led to an increased focus on sagittal alignment. 4 Pelvic incidence has emerged as a key radiographic measurement that should closely match ideal lumbar lordosis. 3 , 7 As proper measurement of the pelvic incidence requires accurate identification of the S-1 endplate, lumbosacral transitional anatomy 1 may lead to errors. The current case highlights one of the potential complications that can be avoided with awareness. Case Report This 61-year-old man presented with symptomatic

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Jeffrey L. Gum, Steven D. Glassman and Leah Y. Carreon

and degenerative listhesis. Patients with scoliosis had an associated coronal plane deformity from 10° to 30° with involvement over a few segments in the lumbar spine. Patients with a more significant deformity were tracked in a separate adult deformity outcomes protocol. The instability subgroup included patients with abnormal motion (≥ 3 mm) on flexion and extension radiographs, substantial retrolisthesis, or lateral listhesis. Patients in the stenosis subgroup included patients with central or foraminal stenosis without any abnormalities listed above, or patients

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Manish P. Lambat, Steven D. Glassman and Leah Y. Carreon

complications on 1-year outcome scores (SF-12, ODI, and NRS) in patients who underwent surgical correction for adult spinal deformity. They found that a major perioperative complication adversely affects 1-year clinical outcome scores. To the best of our knowledge, no prior study has examined complications based on an array of validated outcome measures in a large group of lumbar fusion surgery cases. In this study, we analyzed clinical outcome based on standardized HRQOL measures in patients with major, minor, or no complications. We attempted to isolate the effect of

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Todd W. Vitaz, George H. Raque, Christopher B. Shields and Steven D. Glassman

laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85: 793–802, 1996 15. Frazier DD , Lipson SJ , Fossel AH , et al : Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine 22 : 2025 – 2029 , 1997 Frazier DD, Lipson SJ, Fossel AH, et al: Associations between spinal deformity and outcomes after decompression for spinal stenosis. Spine 22: 2025–2029, 1997 16. Garfin SR

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Zachary G. Ries, Steven D. Glassman, Ivan Vasilyev, Leanne Metcalfe and Leah Y. Carreon

reports being an employee of Norton Healthcare; being a consultant for AOSpine; receiving funds for travel from the University of Southern Denmark and University of Louisville; being a member of the Editorial Advisory Board for Spine Deformity , The Spine Journal , and Spine ; being a member of the University of Louisville IRB; and being a member of the Research Committee for the Scoliosis Research Society. Author Contributions Conception and design: Ries, Glassman. Acquisition of data: Vasilyev, Metcalfe. Analysis and interpretation of data: Carreon, Ries, Vasilyev

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Charles H. Crawford III, Steven D. Glassman, Praveen V. Mummaneni, John J. Knightly and Anthony L. Asher

S urgical treatment of lumbar stenosis is well supported by current medical evidence. 1 , 10–12 , 16 , 19 , 21 Controversy exists regarding the role of supplemental stabilization or fusion in the absence of gross instability or deformity. 3 , 6 , 15 , 17–18 , 20 Previous authors have noted the conventional theory that patients with significant back pain symptoms may not be adequately improved with decompression-only surgery. 3 , 15 Surgeons may use this theory to justify a fusion or other stabilization procedure, in addition to decompression of

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Charles H. Crawford III, Leah Y. Carreon, Mohamad Bydon, Anthony L. Asher and Steven D. Glassman

Grade I lumbar spondylolisthesis occurring from a congenital deformity of the pars interarticularis or from a degenerative process associated w/spinal canal &/or foraminal stenosis that results in mechanical back pain &/or radiating leg pain or neurogenic claudication in the distribution of the affected nerve roots; lumbar spondylolisthesis can be identified by either MRI or CT w/an anterior or posterior slip of an adjacent vertebral body by no more than 25%; patients w/a slip > 25%, Grades II, III, & IV spondylolisthesis are not included Lumbar stenosis Degenerative

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Joshua T. Bunch, Steven D. Glassman, Howard R. Underwood, Leanne N. Metcalfe, Stephen Ondra, Ivan Vasilyev and Leah Y. Carreon

A dult lumbar degenerative scoliosis (LDS) refers to a coronal deformity of the lumbar spine (lumbar Cobb measurement > 10°) that is often associated with spondylolisthesis, stenosis, loss of lordosis, axial rotation, and lateral listhesis. 2 , 14 It can form de novo, as an individual ages, or as a consequence of childhood scoliosis. 2 Associated degenerative changes can include facet hypertrophy, thickening of the ligamentum flavum, asymmetrical disc collapse, and disc herniation. 11 , 14 Conceptually, individuals with adult-onset LDS can often be divided

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Ikemefuna Onyekwelu, Steven D. Glassman, Anthony L. Asher, Christopher I. Shaffrey, Praveen V. Mummaneni and Leah Y. Carreon

-reported outcomes in adult spinal deformity surgery . J Neurosurg Spine 31 : 1 – 9 , 2015 29 Vaidya R , Carp J , Bartol S , Ouellette N , Lee S , Sethi A : Lumbar spine fusion in obese and morbidly obese patients . Spine (Phila Pa 1976) 34 : 495 – 500 , 2009 19212274 10.1097/BRS.0b013e318198c5f2 30 Watanabe M , Sakai D , Matsuyama D , Yamamoto Y , Sato M , Mochida J : Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation . J Neurosurg Spine 12 : 540 – 546 , 2010 10