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Eitan M. Kohan, Venu M. Nemani, Stuart Hershman, Daniel G. Kang and Michael P. Kelly

B oth osteoporosis and adult spinal deformity (ASD) are associated with advancing age and often occur concurrently. 14 Osteoporosis is a common disease in the United States, affecting an estimated 53.6 million Americans in 2010. 39 While the exact prevalence of ASD is unknown, estimates range from 2.5% to 25% of the population. 2 , 7 , 13 , 24 , 27 , 31 Preoperative identification and treatment of patients with osteoporosis are important, as accurate measurement of BMD predicts postoperative instability and fracture risk. 17 , 21 However, the most widely

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Max S. Riley, Keith H. Bridwell, Lawrence G. Lenke, Jonathan Dalton and Michael P. Kelly

A dult spinal deformity (ASD) surgeries are associated with high complication rates, including new neurological deficits. 7–9 , 11 , 12 , 16 Complication rates exceeding 70% have recently been reported. 27 In addition to medical complications, the most complex deformities are associated with high neurological risks. Recent prospective studies of complex ASD surgeries have reported new neurological deficit rates of approximately 20%. 23 , 26 Despite these risks, the number of spinal deformity surgeries performed yearly is increasing. 13 , 15 Given the

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Michael P. Kelly, Lawrence G. Lenke, Christopher I. Shaffrey, Christopher P. Ames, Leah Y. Carreon, Virginie Lafage, Justin S. Smith and Adam L. Shimer

A dult spinal deformity is associated with relatively high rates of perioperative complications, with a concordant increased risk of a new neurological deficit. 6 , 7 , 10–12 , 15 The combination of an aging population and the increasing number of spine fusion procedures results in an increasing number of patients with adult spinal deformities (ASDs), as well as an increasingly complex revision burden. 13 , 14 With the rising revision burden, the diagnosis of fixed sagittal malalignment is increasingly common. 20 Numerous centers have reported their

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Michael P. Kelly, Michael A. Kallen, Christopher I. Shaffrey, Justin S. Smith, Douglas C. Burton, Christopher P. Ames, Virginie Lafage, Frank J. Schwab, Han Jo Kim, Eric O. Klineberg, Shay Bess and the International Spine Study Group

M easurement of health-related quality of life (HRQOL) outcomes in medicine is a necessary endeavor, as it makes possible comparisons of intervention effectiveness and evaluations of quality of care. 14 , 15 HRQOL measurements also aid healthcare-related decision making. In adult spinal deformity (ASD) surgery, for example, HRQOL measurements support patient and surgeon decision making with respect to both appropriate timing for surgery and the outcome expectations of patients and surgeons alike. HRQOL instruments may be generic measures of health, such as the

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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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Michael P. Kelly, Lawrence G. Lenke, Jakub Godzik, Ferran Pellise, Christopher I. Shaffrey, Justin S. Smith, Stephen J. Lewis, Christopher P. Ames, Leah Y. Carreon, Michael G. Fehlings, Frank Schwab and Adam L. Shimer

A dult spinal deformity (ASD) surgery has become increasingly complex, with patients with severe deformities undergoing 3-column osteotomies (3COs), such as pedicle subtraction osteotomy or vertebral column resection (VCR). 1 , 2 , 4–6 , 9–11 , 13–16 , 20 , 22 , 32 Complication rates exceeding 50% have been reported in this patient population. 15–17 , 29 , 30 Neurological deficits, such as weakness and paralysis, are less common and have been estimated at 10% or lower. 8 , 10 , 21 These data come largely from retrospective cohort studies and are subject to a

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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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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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Ferran Pellisé, Miquel Serra-Burriel, Justin S. Smith, Sleiman Haddad, Michael P. Kelly, Alba Vila-Casademunt, Francisco Javier Sánchez Pérez-Grueso, Shay Bess, Jeffrey L. Gum, Douglas C. Burton, Emre Acaroğlu, Frank Kleinstück, Virginie Lafage, Ibrahim Obeid, Frank Schwab, Christopher I. Shaffrey, Ahmet Alanay, Christopher Ames, the International Spine Study Group and the European Spine Study Group

A dult spinal deformity (ASD) can be a debilitating disease. Recent studies have shown that the burden of ASD in patients seeking specialized medical attention is substantial compared to that of other severe chronic conditions (i.e., diabetes, congestive heart failure, chronic lung disease, or arthritis). 3 , 26 Nonoperative care has not shown a significant impact on health-related quality of life (HRQOL), 5 , 9 while surgery is associated with HRQOL improvements 17 that are maintained over time. 18 , 30 Aging populations, the high prevalence of ASD, and an

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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