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Pooya Javidan, Nima Kabirian, Gregory M. Mundis Jr. and Behrooz A. Akbarnia

. Case Report This 7-year- and 3-month-old boy with a history of congenital kyphoscoliosis ( Fig. 1A–C ) underwent a combined anterior and posterior spinal fusion with instrumentation from T-9 to S-1 for correction of the deformity ( Fig. 1D and E ). One year after the initial surgery, the patient developed a proximal junctional kyphosis with failure of the cephalad hook construct. Revision surgery included extension of instrumentation to T-4 with limited fusion and the use of transverse process hooks bilaterally. Two rods were contoured and placed bilaterally

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Amir Ahmadian, Sean Verma, Gregory M. Mundis Jr., Rod J. Oskouian Jr., Donald A. Smith and Juan S. Uribe

of disc height with larger lordotic interbody cages such as is possible in both ALIF and MIS-LIF. 12 Marchi et al. presented their case series on stand-alone lateral interbody fusion for lumbar listhesis with a significant improvement in lumbar lordosis and disc height, although their subsidence rate and revision surgery rate were 17% and 13%, respectively. 17 Transient Sensory Deficits Approach-related neural complications of the retroperitoneal transpsoas approach, despite directional EMG monitoring, have been well established in the literature. 7 , 14

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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

surgery (p = 0.84), or radiographic complications (p = 0.62). Absolute weight (odds ratio 1.16, p = 0.064), rather than BMI (p = 0.80), showed a trend toward an increased risk of implant-related complications ( Table 4 ). TABLE 4. Multivariate poisson and logistic regression showing the IRR and odds ratio of specific complications in obese patients * Complications, 2 Yrs IRR/Odds Ratio p Value Neurological 0.03 0.881 Radiographic −0.139 0.626 Revision surgery 1.07 0.846 Infection 4.88 0.02 Implant (BMI

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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

truncal versus pelvic correction remains unclear. 8 , 24 , 44 , 45 To our knowledge, no reports exist regarding the relationship between the apex of LL and the degree of sagittal plane correction. In addition, while studies have reported complication rates after 3CO of up to 50% and revision surgery rates of up to 44%, 2 , 5 , 11 , 16 , 28 little is known regarding the impact of osteotomy level on complications and revisions. The purpose of the present study was to investigate the impact of the osteotomy level and postoperative lordosis apex on sagittal correction and

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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

demonstrated that complication rates increase for patients undergoing revision surgery, 13 3-column osteotomies, 8 , 23 , 30 , 49 , 50 and those of older age. 2 , 16 , 20 , 39 Despite the abundant literature characterizing complication rates and the types of complications in ASD surgery, 47 , 48 there is currently no model to predict which patients may develop complications following the surgical correction of ASD. The ability to accurately identify these patients preoperatively constitutes a significant challenge, yet an accurate predictive model could be beneficial for

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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

patients underwent complete baseline examinations and 2-year clinical and radiographic follow-ups. Data Collection, Radiographic Assessment, and Classification Demographic and surgical data collected included patient age, sex, body mass index, fixation levels, PSO/VCR sites, operating room time, estimated blood loss, and revision surgery indications. All radiographic measures were performed at a central location with standard techniques 25 (Spineview, ENSAM, Laboratory of Biomechanics) and included SVA (that is, C-7 plumb line relative to S-1), pelvic tilt, and

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Justin K. Scheer, Jessica A. Tang, Justin S. Smith, Eric Klineberg, Robert A. Hart, Gregory M. Mundis Jr., Douglas C. Burton, Richard Hostin, Michael F. O'Brien, Shay Bess, Khaled M. Kebaish, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group

the consequent need for revision surgery. 1 , 5 , 7 However, few studies 9 , 10 , 19 have focused on the effects of reoperation and pseudarthrosis on patients' scores on outcome measures, including the SRS-22 and the ODI. While most of these studies address in detail the challenges of spine surgery that frequently result in reoperation, each examines a collection of individual issues, such as specific complications, risk factors, techniques to prevent reoperation, or outcome measures. However, there has yet to be a comprehensive analysis combining all aspects

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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

great advances, an important source of complications and patient morbidity remains the inherent limitations of the durability of spinal implants. 1 , 3 , 4 , 6 , 13–17 , 19–21 , 23 , 25–27 , 30 , 32 , 33 , 38 , 44–47 , 50 , 51 Although development of rod fracture may have significant consequences for patients, including pain, loss of deformity correction, and the need for revision surgery, the literature regarding rod fracture remains relatively limited. 1 , 4 , 9 , 11 , 15 , 19 , 23 , 29 , 38 , 49 , 51 , 52 Previous reports discussing rod fracture have many

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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

cm, or pelvic tilt > 25°. Patients with inflammatory, posttraumatic, neuromuscular, infectious, or neoplastic etiologies were excluded, as were patients who underwent revision spine fusion. We queried this database using additional criteria to create 2 cohorts: 1 male and 1 female cohort. Additional criteria were primary ASD surgery, instrumented arthrodesis of at least 5 levels, posterior-only approach, and minimum 2-year follow-up. Primary outcomes were estimated blood loss (EBL), operative duration, radiographic correction, need for revision surgery, peri- and

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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

radiographic complication and a common reason for reoperation in the present series was PJK. Advancements in our understanding of optimal radiographic alignment are promising in helping reduce this complication, 2 , 25 , 35 , 38 , 51 and a classification has been developed to better appreciate factors associated with the need for revision surgery for PJK. 36 In addition, a recent report from Bess and colleagues suggests that posterior polyethylene tethers at the proximal junction may reduce the stress at the junctional level and in turn may reduce the risk of PJK. 7