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D. Kojo Hamilton, Justin S. Smith, Tanya Nguyen, Vincent Arlet, Manish K. Kasliwal and Christopher I. Shaffrey

A substantial shift in population demographics is underway in many developed countries, with the proportion of elderly expanding to unprecedented levels. For example, between the years 2000 and 2030, the number of individuals at least 65 years of age in the US is expected to double to more than 70 million. 24 As these shifts occur, it will become increasingly important to better appreciate and effectively manage the medical and surgical conditions that commonly afflict the elderly. According to Schwab et al., 18 the prevalence of spinal deformity

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A longitudinal survey of adult spine and peripheral nerve case entries during neurosurgery residency training

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Nitin Agarwal, Michael D. White and D. Kojo Hamilton

surgery exposure during residency and the number of applications to spine fellowships. Finally, it would be valuable to explore trends in resident exposure specifically to complex spine surgery, such as deformity or oncological procedures. Conclusions Graduating neurosurgical residents logged increasing case volumes for adult spinal cases during this 5-year period from 2013 to 2017. However, peripheral nerve operations did not demonstrate any significant change. Additional training methods, such as surgical simulation, could be utilized to ensure adequate training in

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Amit Jain, Hamid Hassanzadeh, Varun Puvanesarajah, Eric O. Klineberg, Daniel M. Sciubba, Michael P. Kelly, D. Kojo Hamilton, Virginie Lafage, Aaron J. Buckland, Peter G. Passias, Themistocles S. Protopsaltis, Renaud Lafage, Justin S. Smith, Christopher I. Shaffrey, Khaled M. Kebaish and the International Spine Study Group

T he incidence of scoliosis in the elderly has been reported to be from 30% to 68%. 25 , 27 Surgical treatment for adult spinal deformity (ASD) is associated with high complication rates. 16 , 17 , 35 A recent study found that approximately 27% of patients with ASD experience at least one medical complication perioperatively. 33 High perioperative complication rates have been reported in elderly patients (aged 65 years or older) surgically treated for ASD and range from 37% to 71%. 1 , 10 , 30 , 32 A large proportion of the morbidity in the elderly is caused

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R. Webster Crowley, Rebecca M. Burke, M. Beatriz S. Lopes, D. Kojo Hamilton and John A. Jane Sr.

and T5-L4 fusion to correct his substantial deformity. This required reoperation 2 years later for extension of the fusion. MRI and radiography performed 8 years following his initial surgery demonstrated expected postoperative changes and failed to show evidence of a syrinx or enhancing lesions ( Fig. 7 ). FIG. 7. Sagittal T2-weighted MR image (A) and radiographs ( B [anteroposterior] and C [lateral]) demonstrating expected postoperative changes and continued absence of disease. The MR image demonstrates transection of the spinal cord at T-6 with no

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Themistocles S. Protopsaltis, Justin K. Scheer, Jamie S. Terran, Justin S. Smith, D. Kojo Hamilton, Han Jo Kim, Greg M. Mundis Jr., Robert A. Hart, Ian M. McCarthy, Eric Klineberg, Virginie Lafage, Shay Bess, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames and International Spine Study Group

A dult spinal deformity has been studied extensively in the literature with a majority of publications focusing on thoracolumbar deformity and its effect on health-related quality of life (HRQOL) measures. 1 , 3 , 6 , 7 , 10 , 11 , 13 , 14 , 16 , 17 Among patients with thoracolumbar deformities, positive sagittal alignment has been associated with pain and disability. 2 , 7 , 11 , 13 , 16 Few studies have correlated validated health measures and positive cervical sagittal alignment. 16 , 17 Tang et al. 16 demonstrated that a C2–7 sagittal vertical axis

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Micheal Raad, Brian J. Neuman, Amit Jain, Hamid Hassanzadeh, Peter G. Passias, Eric Klineberg, Gregory M. Mundis Jr., Themistocles S. Protopsaltis, Emily K. Miller, Justin S. Smith, Virginie Lafage, D. Kojo Hamilton, Shay Bess, Khaled M. Kebaish, Daniel M. Sciubba and the International Spine Study Group

T here has been a sharp spike in the number of adult spinal deformity (ASD) surgeries performed in the US over the past decade ( https://hcup-us.ahrq.gov/overview.jsp ). Compared with some of the most prevalent chronic diseases such as diabetes, congestive heart failure, or chronic lung disease, ASD has been shown to have a significantly greater impact on health-related quality of life (HRQOL) and higher cost of treatment. 17 , 23 This increased burden of ASD places substantial pressure on the scientific community to better delineate treatment effectiveness in

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Justin K. Scheer, Taemin Oh, Justin S. Smith, Christopher I. Shaffrey, Alan H. Daniels, Daniel M. Sciubba, D. Kojo Hamilton, Themistocles S. Protopsaltis, Peter G. Passias, Robert A. Hart, Douglas C. Burton, Shay Bess, Renaud Lafage, Virginie Lafage, Frank Schwab, Eric O. Klineberg, Christopher P. Ames and the International Spine Study Group

A dult spinal deformity (ASD) surgery remains technically challenging and is associated with high rates of complications, one of which is pseudarthrosis. 8–11 , 22 , 27 The rates of pseudarthrosis in ASD have ranged from 0% to 35%, 5 , 8–10 with one comprehensive review citing pseudarthrosis as the most frequent long-term complication of those studied, reporting a rate of 7.6%. 27 Patients who develop pseudarthrosis are at risk for instrumentation failure and may require revision surgery. Risk factors for pseudarthrosis have been studied and include

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Gregory W. Poorman, Peter G. Passias, Samantha R. Horn, Nicholas J. Frangella, Alan H. Daniels, D. Kojo Hamilton, Hanjo Kim, Daniel Sciubba, Bassel G. Diebo, Cole A. Bortz, Frank A. Segreto, Michael P. Kelly, Justin S. Smith, Brian J. Neuman, Christopher I. Shaffrey, Virginie LaFage, Renaud LaFage, Christopher P. Ames, Robert Hart, Gregory M. Mundis Jr. and Robert Eastlack

C ervical deformity is a disabling condition resulting in not only impaired motor and physical functioning but also changes in appearance and mental well-being. The incidence of affective disorders such as depression and anxiety is high in patients with spinal disorders, including deformity. Determining the etiology of depression, whether in reaction to disability from deformity or as a stand-alone disease, is an important question in these patients with a high rate of comorbidities. Depression and anxiety are well characterized in the literature as having a

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Gurpreet S. Gandhoke, Christian Ricks, Zachary Tempel, Brian Zuckerbraun, D. Kojo Hamilton, David O. Okonkwo and Adam S. Kanter

In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure.

The video can be found here: https://youtu.be/r3bC4_vu1hQ.

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Zachary J. Tempel, Michael M. McDowell, David M. Panczykowski, Gurpreet S. Gandhoke, D. Kojo Hamilton, David O. Okonkwo and Adam S. Kanter

O ver the past decade, lateral lumbar interbody fusion (LLIF) has gained popularity among spine surgeons as a useful minimally invasive option in the operative management of a variety of spinal conditions. 3 , 12 , 23 , 24 , 29 , 30 , 34 , 39 LLIF furthermore functions as an adjunct approach to enhance complex spinal deformity correction. 2 , 4 , 6 , 9 , 14 , 25 , 39 , 43 Several studies have demonstrated that when compared with traditional open approaches to the spine, the minimally invasive LLIF procedure is associated with decreased anesthesia time, less