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spinal deformity (ASD) remains a challenge for the spinal surgeon. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained elusive using MIS an approach. This report describes the evolution of an MIS method for treating ASD with attention to sagittal correction. Methods: Over an 18 month period 25 patients with thoracolumbar scoliosis were treated surgically. The mean patient age was 72 years, with 68% females. Patients were treated with

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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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Juan S. Uribe, Armen R. Deukmedjian, Praveen V. Mummaneni, Kai-Ming G. Fu, Gregory M. Mundis Jr., David O. Okonkwo, Adam S. Kanter, Robert Eastlack, Michael Y. Wang, Neel Anand, Richard G. Fessler, Frank La Marca, Paul Park, Virginie Lafage, Vedat Deviren, Shay Bess and Christopher I. Shaffrey

O ver the past several decades, surgical treatment options for adult spinal deformity (ASD) have expanded, including both minimally invasive and open techniques. 3 , 12 , 14 , 18 , 27 Determining the most suitable approach in patients should take into account the risks and benefits of each surgical technique. Unfortunately, studies comparing the different operative techniques are lacking. Moreover, outcomes and complications of ASD are largely reported in terms of patient characteristics following traditional open techniques with little published data

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Michael Y. Wang, Praveen V. Mummaneni, Kai-Ming G. Fu, Neel Anand, David O. Okonkwo, Adam S. Kanter, Frank La Marca, Richard Fessler, Juan Uribe, Christopher I. Shaffrey, Virginie Lafage, Raqeeb M. Haque, Vedat Deviren and Gregory M. Mundis Jr.

S urgery for adult spinal deformity (ASD) remains a challenging proposition. Several factors contribute to create a high likelihood of intraoperative and postoperative complication rates. Medical comorbidities, patient deconditioning due to pain and immobility, associated osteoporosis, a rigid skeletal deformity, and abnormal spinal anatomy all increase the likelihood of a complication from ASD surgery. 6 , 9 Furthermore, the surgical enterprise needed to destabilize, realign, and fuse the spine over multiple segments is painful and debilitating

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Justin S. Smith, Ellen Shaffrey, Eric Klineberg, Christopher I. Shaffrey, Virginie Lafage, Frank J. Schwab, Themistocles Protopsaltis, Justin K. Scheer, Gregory M. Mundis Jr., Kai-Ming G. Fu, Munish C. Gupta, Richard Hostin, Vedat Deviren, Khaled Kebaish, Robert Hart, Douglas C. Burton, Breton Line, Shay Bess, Christopher P. Ames and The International Spine Study Group

S ubstantial improvements in surgical techniques, instrumentation, perioperative management, and reduction of risk related to comorbid conditions have broadened the indications for correction of adult spinal deformity (ASD) and have enabled correction of increasingly more complex deformities. Although data thus far seem to indicate that selected adults with spinal deformity do have significant potential for improvement with surgical treatment, overall complication rates remain high and represent areas for continued improvement 7 , 8 , 32 , 39–43 Despite

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Paul Park, Michael Y. Wang, Virginie Lafage, Stacie Nguyen, John Ziewacz, David O. Okonkwo, Juan S. Uribe, Robert K. Eastlack, Neel Anand, Raqeeb Haque, Richard G. Fessler, Adam S. Kanter, Vedat Deviren, Frank La Marca, Justin S. Smith, Christopher I. Shaffrey, Gregory M. Mundis Jr. and Praveen V. Mummaneni

, including adult spinal deformity (ASD). Anand et al. 3 initially reported the feasibility of applying several different MIS techniques to treat symptomatic lumbar scoliosis. Subsequent reports have all confirmed successful MIS treatment of ASD. 5 , 17 , 21 , 24 These studies, however, have been limited by the relatively small numbers of patients evaluated, as well as the lack of focus on sagittal alignment and spinopelvic parameters, which are factors known to significantly impact long-term disability. 12 , 18 In addition, there has been no uniform MIS technique or

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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

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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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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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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