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Virginie Lafage, Frank Schwab, Shaleen Vira, Robert Hart, Douglas Burton, Justin S. Smith, Oheneba Boachie-Adjei, Alexis Shelokov, Richard Hostin, Christopher I. Shaffrey, Munish Gupta, Behrooz A. Akbarnia, Shay Bess and Jean-Pierre Farcy

S pinal deformity in the adult is commonly a 3D pathology. However, evidence points toward the clinical impact of deformity being mostly related to the sagittal plane, with little correlation between coronal deformity and self-reported disability. The Classification of Adult Deformity 20 was primarily built on clinical impact parameters, and it highlights lumbar lordosis as well as global sagittal alignment. Work leading to the classification did not identify a significant clinical impact of coronal plane parameters. 20 Additionally, in the commonly known

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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

, all of the demographic differences were similar between patients with and without preoperative cervical malalignment, with the exception of CK. Patients with CK were significantly younger by an average of 10 years. This result is in line with both Park et al. 20 and Smith et al. 25 The study by Park and colleagues assessed the effect of age on cervical sagittal alignment in 100 asymptomatic subjects and found that the C2–7 lordosis increased with age. Smith et al. also found that patients with CK were significantly younger than those without CK in a large

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Christopher P. Ames, Justin S. Smith, Robert Eastlack, Donald J. Blaskiewicz, Christopher I. Shaffrey, Frank Schwab, Shay Bess, Han Jo Kim, Gregory M. Mundis Jr., Eric Klineberg, Munish Gupta, Michael O’Brien, Richard Hostin, Justin K. Scheer, Themistocles S. Protopsaltis, Kai-Ming G. Fu, Robert Hart, Todd J. Albert, K. Daniel Riew, Michael G. Fehlings, Vedat Deviren, Virginie Lafage and International Spine Study Group

posterosuperior corner of the C-7 vertebral body. The horizontal line with an arrow represents the C2–7 SVA. Given the significant impact of sagittal alignment on HRQOL among patients with thoracolumbar spinal deformities, and the studies of Tang et al. 54 and Smith et al. 45 demonstrating correlations between cervical sagittal alignment and multiple measures of HRQOL, the C2–7 SVA was selected as a modifier for the CSD classification. Based on regression analysis from Tang et al., a C2–7 SVA threshold of 4 cm was found to correlate with moderate disability based on the

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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

Slover J , Abdu WA , Hanscom B , Weinstein JN : The impact of comorbidities on the change in short-form 36 and Oswes-try scores following lumbar spine surgery . Spine (Phila Pa 1976) 31 : 1974 – 1980 , 2006 41 Smith JS , Bess S , Shaffrey CI , Burton DC , Hart RA , Hostin R , : Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques . Spine (Phila Pa 1976) 37 : 845 – 853 , 2012 42 Smith JS , Fu

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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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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

sagittal alignment to maintain upright posture. Recently, increased PT has also been shown to correlate with worse HRQOL scores. 11 In certain cases of sagittal malalignment, a corrective osteotomy can be performed to restore balance. Pedicle subtraction osteotomy is an increasingly used technique to correct sagittal plane deformities and can obtain approximately 25° of increased lordosis when performed in the lumbar spine. 4 , 12 , 23 One of the challenges of the PSO technique is accurately predicting the postoperative spinopelvic alignment. Achieving spinopelvic

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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

substantial or complete correction of an SVA significantly improved the rates of reaching MCID for the ODI and PCS scores and the SCB for the ODI score. Blondel et al. set substantial curve correction as a 66% or greater improvement from preoperative SVA. However, it is unclear how many of the patients in that study underwent a 3CO, and the authors examined only the SVA. The SVA is often considered the most influential radiographic parameter for HRQOL measures, but because total sagittal alignment is the ultimate goal of 3COs, it is crucial to correlate clinical outcomes

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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

. Spine (Phila Pa 1976) 37 : 1077 – 1082 , 2012 22045006 10.1097/BRS.0b013e31823e15e2 51 Schwab FJ , Blondel B , Bess S , Hostin R , Shaffrey CI , Smith JS , : Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multi-center analysis . Spine (Phila Pa 1976) 38 : E803 – E812 , 2013 52 Smith JS , Bess S , Shaffrey CI , Burton DC , Hart RA , Hostin R , : Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction

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examined include presence of interbody fusion, rod diameter, rod material, age and preop sagittal alignment. Methods: A retrospective review of a multicenter, prospective ASD database was conducted. Inclusion criteria: age=18yr, ASD, no revisions between >6wk and <2yrs postop. Spinal pelvic parameters, thoracic kyphosis (TK:T2-T12) and lumbar lordosis (LL:L1-S1) were measured overall and within and outside of the instrumented segments. Changes for SVA, PT, PI-LL, TK, and LL between 6wks-2yrs postop were calculated. Of these pts, the amount of thoracic loss and TL

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surveys than NONOP (p<0.05). OP and NONOP had similar coronal alignment (p<0.05). OP had worse sagittal spinopelvic alignment for all measures than NONOP except cervical lordosis, TK and pelvic incidence (PI). OP had greater percentage of pure sagittal classification (type S; OP=23%, NON=14%; p<0.05). OP had worse grades for all modifier categories: PT (26% vs 16%), PI-lumbar lordosis mismatch (37% vs 21%) and global sagittal alignment (29% vs 9%), OP vs NONOP, respectively (p<0.05). Conclusion: Prospective analysis of OP vs NONOP treated ASD patients demonstrated