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Michael P. Kelly, Lukas P. Zebala, Han Jo Kim, Daniel M. Sciubba, Justin S. Smith, Christopher I. Shaffrey, Shay Bess, Eric Klineberg, Gregory Mundis Jr., Douglas Burton, Robert Hart, Alex Soroceanu, Frank Schwab, Virginie Lafage and International Spine Study Group

C omplex adult spinal deformity (ASD) surgeries are increasing in incidence, as the population ages and the revision burden grows. 15 , 16 Reconstructive surgeries for ASD are associated with long operative times and high estimated blood losses (EBLs). Consequently, resuscitation of these patients frequently requires transfusions of autologous (AUTO) or allogeneic (ALLO) packed red blood cells (PRBCs) to maintain circulating hemoglobin levels, in an effort to minimize perioperative complications. 18 In fact, spine surgery is one of the most common

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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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Alexander A. Theologis, Gregory M. Mundis Jr., Stacie Nguyen, David O. Okonkwo, Praveen V. Mummaneni, Justin S. Smith, Christopher I. Shaffrey, Richard Fessler, Shay Bess, Frank Schwab, Bassel G. Diebo, Douglas Burton, Robert Hart, Vedat Deviren and Christopher Ames

L umbar /thoracolumbar scoliosis is a common feature of adult spinal deformity (ASD) and is frequently accompanied by global spinal malalignment, back and leg pain, and decreased quality of life. Operative intervention for ASD has proven cost effective compared with nonoperative management, 25 as many patients have persistent pain and curve progression with nonoperative treatment. 27 , 29 , 37 Keys to achieving good postoperative outcomes include correction of scoliosis, decompression of neural elements, avoidance of pseudarthrosis, and restoration

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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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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Benjamin Blondel, Frank Schwab, Richard Hostin, Robert Hart, Brian O'Shaughnessy, Shay Bess, Serena S. Hu, Vedat Deviren, Christopher P. Ames and International Spine Study Group

P ositive sagittal malalignment (defined as anterior deviation of the C-7 plumb line >5 cm from the posterior superior corner of S-1) is recognized as a cause of pain and disability in cases of ASD. 8 , 20 , 28 , 30 , 31 Poor sagittal alignment has been shown to require increased energy expenditure, and multiple compensatory measures have been described, including knee flexion, pelvic retroversion, and thoracic hypokyphosis. 20 , 30 , 31 Surgical correction of positive sagittal malalignment has been correlated with significant improvement in health

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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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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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Kristina Bianco, Robert Norton, Frank Schwab, Justin S. Smith, Eric Klineberg, Ibrahim Obeid, Gregory Mundis Jr., Christopher I. Shaffrey, Khaled Kebaish, Richard Hostin, Robert Hart, Munish C. Gupta, Douglas Burton, Christopher Ames, Oheneba Boachie-Adjei, Themistocles S. Protopsaltis and Virginie Lafage

S urgery for adult spinal deformity (ASD) is a challenging undertaking with significant complexity and technical demand. The surgical treatment of fixed sagittal and/or coronal plane deformities typically involves multilevel arthrodesis with one or more osteotomies for the restoration of global spinopelvic alignment. Three-column resection osteotomies (3COs) are powerful techniques allowing for simultaneous multiplanar deformity correction from a single posterior surgical approach. 21 These techniques involve Grade 3–5 resections and encompass pedicle

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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

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between the two forms of treatment emerge. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2015.3.FOC-DSPNABSTRACTS 103. A Prospective, Multi-Center Assessment of the Best Versus Worst Clinical Outcomes for Adult Spinal Deformity (ASD) Surgery Justin S. Smith , MD PhD , Christopher I. Shaffrey , MD FACS , Virginie Lafage , PhD , Frank Schwab , MD, PhD , Themistocles Protopsaltis , MD , Eric Klineberg , MD , Munish