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Michael Akbar, Haidara Almansour, Renaud Lafage, Bassel G. Diebo, Bernd Wiedenhöfer, Frank Schwab, Virginie Lafage and Wojciech Pepke

maintenance or restoration of normal sagittal alignment by using the Cotrel-Dubousset technique. 7 With this surgical method combined with Ponte osteotomy, 27 it is possible to correct hypokyphosis of the thoracic spine while preserving a normal LL in a notable percentage of patients with AIS. 2 , 8 , 17 Recent clinical and radiological investigations of surgically treated patients showed a correlation between the loss of normal TK and the development of CK, which was associated with frequent axial neck pain. 15 , 30 It has already been shown that sagittal plane

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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

levels above UIV. Statistical Analysis The collected demographic, surgical, and radiographic data were described and analyzed at baseline and immediate postoperative follow-up. Changes in radiographic alignment were also investigated, including a preoperative to postoperative analysis of sagittal alignment and the rate of radiographic PJK. Patients were stratified into 5 groups based on the preoperative to postoperative degree of change in LL: decrease in LL (kyphotic change > 5°), stable (change between −5° and 5°), 5°–15° increase (lordotic change of 5°–15°), 15

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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

M uch has been written on the relationship between patient-reported outcomes and sagittal alignment in thoracolumbar deformities. 5–8 , 12 , 17 , 18 , 23 Although simple equations were initially used to identify thoracolumbar deformities, more recently, patient-specific formulas have been developed to more specifically quantify each deformity. 10 , 22 However, cervical spine studies have yet to define a fundamental equation, let alone patient-specific descriptors, that both elucidate a deformity and suggest a nidus for correction. The cervical sagittal

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Emmanuelle Ferrero, Barthelemy Liabaud, Vincent Challier, Renaud Lafage, Bassel G. Diebo, Shaleen Vira, Shian Liu, Jean Marc Vital, Brice Ilharreborde, Themistocles S. Protopsaltis, Thomas J. Errico, Frank J. Schwab and Virginie Lafage

O ver the past few decades, there have been significant advances in the treatment of patients with adult spinal deformity (ASD) due to the development of spinal deformity analysis. Specifically, sagittal alignment has been analyzed in numerous studies that have demonstrated the importance of pelvic morphology in the setting of spinal pathology. 6 , 37 , 40 , 46 In addition, correlations between spinal and pelvic parameters have been well documented in the asymptomatic population and in patients with spinal disease. 3 , 5 , 20 , 23 , 41 , 43 Several

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Ziad Bakouny, Nour Khalil, Joeffroy Otayek, Aren Joe Bizdikian, Fares Yared, Michel Salameh, Naji Bou Zeid, Ismat Ghanem, Khalil Kharrat, Gaby Kreichati, Renaud Lafage, Virginie Lafage and Ayman Assi

classification. 6 , 8 , 12 Recently, there has been increased interest in cervical deformity evaluation, and a number of radiographic parameters analogous to those of global sagittal alignment evaluation have been developed. 7 , 10 , 13 A Delphi consensus-based classification for adult cervical deformities has recently been proposed and shown to be reproducible. 2 This classification encompasses a qualitative description of cervical deformity, a clinical myelopathy score modifier (modified Japanese Orthopaedic Association [mJOA] scale score), and the SRS

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Bassel G. Diebo, Jonathan H. Oren, Vincent Challier, Renaud Lafage, Emmanuelle Ferrero, Shian Liu, Shaleen Vira, Matthew Adam Spiegel, Bradley Yates Harris, Barthelemy Liabaud, Jensen K. Henry, Thomas J. Errico, Frank J. Schwab and Virginie Lafage

in a patient with deformity offers insight into the relationship between deformity and compensation. However, performing these analyses could be cumbersome for clinicians, because they require time and experience with multiple parameters. The GSA offers a simple and efficient method to capture clinically relevant information on standing alignment and to understand the implied disability. Indeed, the value of the GSA as a simple method to assess standing sagittal alignment should support its use as a screening tool. Once the deformity is identified, more detailed

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Shian Liu, Renaud Lafage, Justin S. Smith, Themistocles S. Protopsaltis, Virginie C. Lafage, Vincent Challier, Christopher I. Shaffrey, Kris Radcliff, Paul M. Arnold, Jens R. Chapman, Frank J. Schwab, Eric M. Massicotte, S. Tim Yoon, Michael G. Fehlings and Christopher P. Ames

Population A total of 110 patients with CSM from the AOSpine North America study database met inclusion criteria for this analysis. The average age was 56.9 ± 12.0 years and 42% of patients were women (n = 46). The mean duration of symptoms at baseline was 28.4 months. Baseline Presentation: Nurick Grade, HRQOL Measures, and Sagittal Alignment Mean Nurick grade and HRQOL measures demonstrated disability at baseline. More than 90% of patients (n = 100) presented clinically with a Nurick grade between 1 and 3 at baseline ( Table 1 ). Patient-reported outcomes

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Nitin Agarwal, Federico Angriman, Ezequiel Goldschmidt, James Zhou, Adam S. Kanter, David O. Okonkwo, Peter G. Passias, Themistocles Protopsaltis, Virginie Lafage, Renaud Lafage, Frank Schwab, Shay Bess, Christopher Ames, Justin S. Smith, Christopher I. Shaffrey, Douglas Burton, D. Kojo Hamilton and the International Spine Study Group

single center (New York University Hospital for Joint Disease). Explanatory Variables and Outcomes The primary outcome was change in global sagittal alignment at 1 year after surgery. The primary independent variable considered was baseline (preoperative) BMI. Additional important clinical predictors extracted included age, sex, smoking status, active malignancy, chronic lung disease, chronic arthritis, and major depression. Secondary outcomes included HRQoL determined by use of the ODI and SRS-22. Statistical Analysis Descriptive statistics were used to determine

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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

. Spine (Phila Pa 1976) 37 : 1077 – 1082 , 2012 22045006 10.1097/BRS.0b013e31823e15e2 51 Schwab FJ , Blondel B , Bess S , Hostin R , Shaffrey CI , Smith JS , : Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multi-center analysis . Spine (Phila Pa 1976) 38 : E803 – E812 , 2013 52 Smith JS , Bess S , Shaffrey CI , Burton DC , Hart RA , Hostin R , : Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction

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Samantha R. Horn, Peter G. Passias, Cheongeun Oh, Virginie Lafage, Renaud Lafage, Justin S. Smith, Breton Line, Neel Anand, Frank A. Segreto, Cole A. Bortz, Justin K. Scheer, Robert K. Eastlack, Vedat Deviren, Praveen V. Mummaneni, Alan H. Daniels, Paul Park, Pierce D. Nunley, Han Jo Kim, Eric O. Klineberg, Douglas C. Burton, Robert A. Hart, Frank J. Schwab, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group

line through the sacral midpoint to the center of the 2 femoral heads). FIG. 1. Schematic of the measured sagittal alignment parameters for the cervical ( left ) and global spinopelvic ( right ) spinal regions. CBVA = chin-brow vertical angle; cSVA = cervical sagittal vertical axis; C2–7 CL = cervical lordosis; TK = thoracic kyphosis; LL = lumbar lordosis; SVA = sagittal vertical axis; PT = pelvic tilt; PI = pelvic incidence. Figure is available in color online only. Defining a Poor Outcome A poor outcome was defined as having all 3 of the following categories met: 1