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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

A dult spinal deformity (ASD) is associated with marked physical and mental impairment. 10 Although evidence exists indicating that surgical treatment improves the quality of life of patients with ASD that causes pain and disability, 18 certain concomitant preoperative medical comorbidities and mental health disorders differentially affect the success of surgical intervention. 16 , 22 For example, prior work from a large population of patients with ASD demonstrated a significantly higher proportion of patients with a history of baseline depression in

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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

S agittal spinopelvic malalignment is increasingly recognized as a cause of pain and disability in patients with ASD. 8 , 11 , 21 , 22 Positive sagittal balance, defined as anterior deviation of the C-7 plumb line more than 50 mm from the posterosuperior corner of the sacrum, is a reliable predictor of adverse clinical symptoms. As the magnitude of positive sagittal balance increases, HRQOL measures have been shown to worsen among patients with ASD. 8 , 9 , 11 , 17 Pelvic tilt is a compensatory mechanism that reflects the body's attempt to correct

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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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Justin K. Scheer, Peter G. Passias, Alexandra M. Sorocean, Anthony J. Boniello, Gregory M. Mundis Jr., Eric Klineberg, Han Jo Kim, Themistocles S. Protopsaltis, Munish Gupta, Shay Bess, Christopher I. Shaffrey, Frank Schwab, Virginie Lafage, Justin S. Smith, Christopher P. Ames and The International Spine Study Group

I ncreasingly , the management of adult spinal deformity (ASD) is considered from a global perspective. 1 , 14 , 16 , 26 The majority of literature regarding the management of ASD has focused on the thoracolumbar region with little regard for the adjacent regions. Several recent studies have demonstrated that regional spinal alignment and pathology can affect other spinal regions. These studies highlight the importance of considering the entire spine when planning for the surgical correction of ASD. Ames et al. 1 reported a significant chain of

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Justin K. Scheer, Justin S. Smith, Aaron J. Clark, Virginie Lafage, Han Jo Kim, John D. Rolston, Robert Eastlack, Robert A. Hart, Themistocles S. Protopsaltis, Michael P. Kelly, Khaled Kebaish, Munish Gupta, Eric Klineberg, Richard Hostin, Christopher I. Shaffrey, Frank Schwab, Christopher P. Ames and the International Spine Study Group

I ndividuals who have adult spinal deformity (ASD) typically experience pain and disability. 2 , 14 , 26 , 28 , 29 The pain typically affects the back, legs, or both, and its etiology is multifactorial. 26 , 28 , 29 Over the last decade, most research into ASD has focused on patient-reported outcomes and on general measures of health status and function, such as the Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and the Scoliosis Research Society 22-question Questionnaire (SRS-22). However, pain is the primary concern for

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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

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Justin S. Smith, Christopher I. Shaffrey, Eric Klineberg, Virginie Lafage, Frank Schwab, Renaud Lafage, Han Jo Kim, Richard Hostin, Gregory M. Mundis Jr., Munish Gupta, Barthelemy Liabaud, Justin K. Scheer, Bassel G. Diebo, Themistocles S. Protopsaltis, Michael P. Kelly, Vedat Deviren, Robert Hart, Doug Burton, Shay Bess and Christopher P. Ames

A lthough multiple studies have shown the potential for significant improvement in pain and disability with surgery for adult spinal deformity (ASD), 11 , 12 , 53 , 56 , 59–61 these procedures are associated with high rates of complications. 47 , 53 , 54 , 57 , 61 , 63 Correction of ASD often relies upon the use of osteotomies that range from simple facet releases to 3-column osteotomies (3COs), which include pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). 13 , 14 , 49 Use of 3CO is typically reserved for the most severe and often

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Taemin Oh, Justin K. Scheer, Robert Eastlack, Justin S. Smith, Virginie Lafage, Themistocles S. Protopsaltis, Eric Klineberg, Peter G. Passias, Vedat Deviren, Richard Hostin, Munish Gupta, Shay Bess, Frank Schwab, Christopher I. Shaffrey and Christopher P. Ames

A dult spinal deformity (ASD) is a pathological condition defined as spinal malalignment in the axial, coronal, or sagittal plane and is derivative of congenital, iatrogenic, degenerative, or idiopathic etiology. 30 The restoration of sagittal alignment, as established by the sagittal vertical axis (SVA; target < 5 cm) and pelvic tilt (PT; target < 20°) on sagittal radiography, is important in surgical deformity correction. 6 , 21 , 22 Although coronal plane correction also has clinical relevance, sagittal corrections appear to have greater importance, 5

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Justin S. Smith, Eric Klineberg, Virginie Lafage, Christopher I. Shaffrey, Frank Schwab, Renaud Lafage, Richard Hostin, Gregory M. Mundis Jr., Thomas J. Errico, Han Jo Kim, Themistocles S. Protopsaltis, D. Kojo Hamilton, Justin K. Scheer, Alex Soroceanu, Michael P. Kelly, Breton Line, Munish Gupta, Vedat Deviren, Robert Hart, Douglas C. Burton, Shay Bess, Christopher P. Ames and the International Spine Study Group

I t is well recognized that many developed countries, including the United States, are experiencing an unprecedented demographic shift toward an older population. As the ranks of the elderly grow, it will be increasingly important to appreciate and address their health care needs. Although the prevalence of adult spinal deformity (ASD) has been estimated to range from 2% to 32% in the general population, 7 , 10 , 21 , 35 , 38 its prevalence has been estimated to be as high as 68% among the elderly. 41 The finding of spinal deformity in many adults may be

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adjacent segment disease (ASD) in the cervical spine. Methods: 888 patients received ACDFs for symptomatic degenerative disease of the cervical spine over the past 22 years at our institution. Of these, 108 patients received repeat ACDF surgeries due to symptomatic ASD. 77 received revision surgeries anteriorly, and 31 received posterior surgeries. Pre, intra, peri, and post-operative data were collected via clinical notes and patient interviews. Patients were followed up for an average of 111.8±76.5 months after the first ACDF. Results: In general, patients