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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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Pooria Hosseini, Gregory M. Mundis Jr., Robert K. Eastlack, Ramin Bagheri, Enrique Vargas, Stacie Tran and Behrooz A. Akbarnia

R estoration of sagittal balance has been directly linked to satisfactory postsurgical outcomes as demonstrated by health-related quality of life data after adult spinal deformity (ASD) surgery. Even mild sagittal malalignment has been associated with a decline in quality of life. 5 , 7 , 10 In addition, it has been shown that the severity of symptoms increases in a linear fashion with progressive sagittal malalignment. 7 Realignment objectives for sagittal plane correction independent of surgical technique have been defined as pelvic tilt (PT) < 20°, sagittal

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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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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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Pierce D. Nunley, Gregory M. Mundis Jr., Richard G. Fessler, Paul Park, Joseph M. Zavatsky, Juan S. Uribe, Robert K. Eastlack, Dean Chou, Michael Y. Wang, Neel Anand, Kelly A. Frank, Marcus B. Stone, Adam S. Kanter, Christopher I. Shaffrey, Praveen V. Mummaneni and the International Spine Study Group

F or hospitals to continue to provide excellent care for adult spinal deformity (ASD) surgery, they must be able to adequately recover their costs for these procedures. The introduction of Medicare’s Prospective Payment System (PPS) in 1983 led to the development of a fixed payment amount for each patient upon hospital discharge ( ). 1 The fixed payment amount is determined based on the particular diagnosis-related group (DRG) coded at patient discharge and it is intended

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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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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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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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Paul Park, Kai-Ming Fu, Robert K. Eastlack, Stacie Tran, Gregory M. Mundis Jr., Juan S. Uribe, Michael Y. Wang, Khoi D. Than, David O. Okonkwo, Adam S. Kanter, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Dean Chou, Mark E. Oppenlander, Praveen V. Mummaneni and the International Spine Study Group

I n the surgical treatment of symptomatic adult spinal deformity (ASD), spinopelvic alignment is considered an important factor in achieving a successful result. Specifically, several parameters, including pelvic tilt (PT), pelvic incidence to lumbar lordosis (PI-LL) mismatch, and sagittal vertical axis (SVA), have been correlated with clinical outcomes. It has been proposed that optimal spinopelvic alignment goals should consist of a PT < 20°, a PI-LL mismatch ± 9°, and an SVA < 50 mm. 9 Based predominantly on correlation studies, it has been presumed that

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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 ( ). 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