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Emmanuelle Ferrero, Barthelemy Liabaud, Jensen K. Henry, Christopher P. Ames, Khaled Kebaish, Gregory M. Mundis, Richard Hostin, Munish C. Gupta, Oheneba Boachie-Adjei, Justin S. Smith, Robert A. Hart, Ibrahim Obeid, Bassel G. Diebo, Frank J. Schwab and Virginie Lafage

timing of revision surgery (up to 2 years postoperatively). Radiographic Measurement Radiographs were analyzed using validated software (Spineview, ENSAM Paris-Tech). 34 Sagittal spinopelvic radiographic parameters included cervical lordosis, T2–12 thoracic kyphosis (TK), LL, PI-LL mismatch, and pelvic parameters (PI, PT, and sacral slope). 46 Global sagittal alignment parameters included SVA and T-1 spinopelvic inclination (T1SPi) ( Fig. 1 ). The 3CO resection angle was defined as the change in the angle formed by the upper endplate of the vertebra below the 3CO and

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Themistocles S. Protopsaltis, Justin K. Scheer, Jamie S. Terran, Justin S. Smith, D. Kojo Hamilton, Han Jo Kim, Greg M. Mundis Jr., Robert A. Hart, Ian M. McCarthy, Eric Klineberg, Virginie Lafage, Shay Bess, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames and International Spine Study Group

A dult spinal deformity has been studied extensively in the literature with a majority of publications focusing on thoracolumbar deformity and its effect on health-related quality of life (HRQOL) measures. 1 , 3 , 6 , 7 , 10 , 11 , 13 , 14 , 16 , 17 Among patients with thoracolumbar deformities, positive sagittal alignment has been associated with pain and disability. 2 , 7 , 11 , 13 , 16 Few studies have correlated validated health measures and positive cervical sagittal alignment. 16 , 17 Tang et al. 16 demonstrated that a C2–7 sagittal vertical axis

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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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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 K. Scheer, Jessica A. Tang, Justin S. Smith, Frank L. Acosta Jr., Themistocles S. Protopsaltis, Benjamin Blondel, Shay Bess, Christopher I. Shaffrey, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher P. Ames and the International Spine Study Group

bodies from C-2 to C-7 and then summing the segmental angles for an overall cervical curvature angle. Translation of the cervical spine in the sagittal plane is measured through the cervical SVA, for which there are different methods of measurement. Both C-2 SVA ( Figs. 2 and 3 left ) and C-7 SVA have been used to define sagittal alignment globally by measuring the distance between the C-2 and C-7 plumb lines, respectively, from the posterior superior corner of the sacrum. Cervical SVA can also be defined regionally using the distance between a plumb line dropped

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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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Virginie Lafage, Frank Schwab, Shaleen Vira, Robert Hart, Douglas Burton, Justin S. Smith, Oheneba Boachie-Adjei, Alexis Shelokov, Richard Hostin, Christopher I. Shaffrey, Munish Gupta, Behrooz A. Akbarnia, Shay Bess and Jean-Pierre Farcy

S pinal deformity in the adult is commonly a 3D pathology. However, evidence points toward the clinical impact of deformity being mostly related to the sagittal plane, with little correlation between coronal deformity and self-reported disability. The Classification of Adult Deformity 20 was primarily built on clinical impact parameters, and it highlights lumbar lordosis as well as global sagittal alignment. Work leading to the classification did not identify a significant clinical impact of coronal plane parameters. 20 Additionally, in the commonly known

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Antonio A. Faundez and Jean Charles Le Huec

: Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine caucasian asymptomatic adults . Spine (Phila Pa 1976) 35 : E1193 – E1198 , 2010 3 Roussouly P , Gollogly S , Berthonnaud E , Dimnet J : Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position . Spine (Phila Pa 1976) 30 : 346 – 353 , 2005 4 Roussouly P , Nnadi C : Sagittal plane deformity: an overview of interpretation and management . Eur Spine J 19 : 1824

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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