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Ian McCarthy, Michael O'Brien, Christopher Ames, Chessie Robinson, Thomas Errico, David W. Polly Jr., and Richard Hostin

B ased on the Nationwide Inpatient Sample, the total number of adult spinal deformity (ASD) surgeries more than doubled over the past decade, from 9400 in 2000 to more than 20,600 in 2010 ( ). This compares to just a 20% increase in the frequency of all other spine primary diagnosis codes over the same time period (from 675,500 in 2000 to 813,800 in 2010; ). Adult spinal deformity surgery is likely to increase in frequency with as much as 32% of the adult population suffering

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Kseniya Slobodyanyuk, Caroline E. Poorman, Justin S. Smith, Themistocles S. Protopsaltis, Richard Hostin, Shay Bess, Gregory M. Mundis Jr., Frank J. Schwab, and Virginie Lafage

A dult spinal deformity (ASD) is a significant source of disability worldwide. 8 , 10 , 12 In the absence of significant or progressive neurological deficits, initial treatment is usually nonoperative, with conversion to surgery for nonresponders; the idea is that successful nonoperative management can spare the risks and pain of more invasive treatment. 9 , 20 The nonoperative approach generally consists of a combination of treatments including bracing, physical therapy and exercise, narcotic and nonnarcotic pain medications, interventional procedures

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Alex Soroceanu, Douglas C. Burton, Bassel Georges Diebo, Justin S. Smith, Richard Hostin, Christopher I. Shaffrey, Oheneba Boachie-Adjei, Gregory M. Mundis Jr., Christopher Ames, Thomas J. Errico, Shay Bess, Munish C. Gupta, Robert A. Hart, Frank J. Schwab, Virginie Lafage, and International Spine Study Group

number is expected to increase. Adult spinal deformity (ASD) is common, and its incidence increases with age. The prevalence of ASD in the elderly population has been investigated, with Schwab et al. 56 reporting rates of ASD up to 68% in patients over the age of 65 years. Regarding ASD treatment, multiple reports have documented the superiority of surgical intervention and its potential ability to improve pain and disability, the 2 primary presenting complaints of patients with ASD. 5 , 23 , 61 , 62 However, several authors have identified high complication

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Taemin Oh, Justin K. Scheer, Justin S. Smith, Richard Hostin, Chessie Robinson, Jeffrey L. Gum, Frank Schwab, Robert A. Hart, Virginie Lafage, Douglas C. Burton, Shay Bess, Themistocles Protopsaltis, Eric O. Klineberg, Christopher I. Shaffrey, Christopher P. Ames, and the International Spine Study Group

A dult spinal deformity (ASD) is a debilitating disease affecting up to one-third of the general population, and its prevalence markedly increases with age. 5 As the population of the US ages, ASD is becoming increasingly recognized as a disease that could reach epidemic proportions. 5 , 41 Importantly, the substantial burden of symptomatic ASD on patient health and well-being has been well established, which underscores the need for treating ASD safely and efficiently. 8 , 13 , 22 , 34 Although there is still some debate regarding optimum management paradigms

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Blake N. Staub, Renaud Lafage, Han Jo Kim, Christopher I. Shaffrey, Gregory M. Mundis Jr., Richard Hostin, Douglas Burton, Lawrence Lenke, Munish C. Gupta, Christopher Ames, Eric Klineberg, Shay Bess, Frank Schwab, Virginie Lafage, and the International Spine Study Group

data is based on 2 separate databases: a multicenter database of surgical adult spinal deformity (ASD) patients collected through the International Spine Study Group (ISSG) and an adult spine normative database that was used as a control. Inclusion criteria for the ISSG database included patients older than 18 years who underwent surgical intervention for documented thoracolumbar spinal deformity based on at least one of the following measures: coronal Cobb angle > 20°, sagittal vertical axis (SVA) > 5 cm, PT > 25°, or TK > 60°. In addition, cervical spine data

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Renaud Lafage, Ibrahim Obeid, Barthelemy Liabaud, Shay Bess, Douglas Burton, Justin S. Smith, Cyrus Jalai, Richard Hostin, Christopher I. Shaffrey, Christopher Ames, Han Jo Kim, Eric Klineberg, Frank Schwab, Virginie Lafage, and the International Spine Study Group

A dult spinal deformity (ASD) is an increasingly recognized source of pain and disability in our aging population. Increased ASD severity, characterized by a flattening of lumbar lordosis (LL) 1 as well as an anterior trunk inclination, 23 corresponds to worsened patient-reported health-related quality-of-life (HRQOL) scores. 9 , 23 When the severity of ASD starts to negatively impact patients’ lives and livelihoods, symptomatic and definitive treatment should be identified and pursued. Fortunately, the majority of symptomatic ASD patients can be sufficiently

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David B. Bumpass, Lawrence G. Lenke, Jeffrey L. Gum, Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames, Shay Bess, Brian J. Neuman, Eric Klineberg, Gregory M. Mundis Jr., Frank Schwab, Virginie Lafage, Han Jo Kim, Douglas C. Burton, Khaled M. Kebaish, Richard Hostin, Renaud Lafage, Michael P. Kelly, and for the International Spine Study Group

T he role of sex in adult spinal deformity (ASD) surgery outcomes has not been extensively investigated. In contrast, several studies in the pediatric deformity population have demonstrated that sex does play a role in perioperative outcomes. 11 , 16 , 22 These studies found that male adolescent idiopathic scoliosis (AIS) patients had greater preoperative curve magnitude, less preoperative curve flexibility, and less deformity correction than female patients. Male patients also had greater estimated blood loss (EBL), longer operative duration, and higher

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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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Joshua Bakhsheshian, Justin K. Scheer, Jeffrey L. Gum, Richard Hostin, Virginie Lafage, Shay Bess, Themistocles S. Protopsaltis, Douglas C. Burton, Malla Kate Keefe, Robert A. Hart, Gregory M. Mundis Jr., Christopher I. Shaffrey, Frank Schwab, Justin S. Smith, Christopher P. Ames, and The International Spine Study Group

I t is well known that deformity of the spine has a significant impact on the health-related quality of life (HRQOL) of adults; 2 , 17 however, the impact of the mental health burden in patients with adult spinal deformity (ASD) treated with surgical spinal reconstruction is less clear. Although screening for a history of mental health disease has been advocated in the preoperative planning for reconstructive spine surgery, 14 a survey completed by 110 spine surgeons from the US revealed that only 37% routinely use some form of mental health screening

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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