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Justin K. Scheer, Justin S. Smith, Frank Schwab, Virginie Lafage, Christopher I. Shaffrey, Shay Bess, Alan H. Daniels, Robert A. Hart, Themistocles S. Protopsaltis, Gregory M. Mundis Jr., Daniel M. Sciubba, Tamir Ailon, Douglas C. Burton, Eric Klineberg, Christopher P. Ames and The International Spine Study Group

T he surgical management of adult spinal deformity (ASD) can provide significant improvements in pain, disability, and health-related quality of life (HRQOL). 6 , 7 , 28 , 34 , 36–38 , 40–45 However, these procedures are technically demanding and are associated with a high complication rate. The patient population suitable for these complicated surgeries continues to increase, including patients of advanced age. 2 , 16 , 17 , 27 The reported complication rates in the literature are varied and range from 14% to 71%. 11 , 13 , 39 , 47 , 48 It has been

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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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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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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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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

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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

I ncreasingly , the management of adult spinal deformity (ASD) is considered from a global perspective. 1 , 14 , 16 , 26 The majority of literature regarding the management of ASD has focused on the thoracolumbar region with little regard for the adjacent regions. Several recent studies have demonstrated that regional spinal alignment and pathology can affect other spinal regions. These studies highlight the importance of considering the entire spine when planning for the surgical correction of ASD. Ames et al. 1 reported a significant chain of

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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

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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

A dults with spinal deformity characteristically present with pain and disability. 6 , 8 , 10 , 18 , 19 , 22 , 37 , 42–44 , 46 , 47 , 49 , 51 , 52 In the absence of significant or progressive neurological deficit, first-line treatments for symptomatic adult spinal deformity (ASD) are typically nonoperative and may include physical therapy, steroid injections, non-steroidal antiinflammatory drugs, and, potentially, narcotics. 2 , 48 For patients who do not achieve a satisfactory response with nonoperative approaches, surgical treatment may become an