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M. Burhan Janjua, Jared C. Tishelman, Dennis Vasquez-Montes, Max Vaynrub, Thomas J. Errico, Aaron J. Buckland and Themistocles Protopsaltis

A dult spinal deformity (ASD) is associated with severe back pain, neurological symptoms, and limited functional mobility. With the advent of better healthcare, hexagenarians are becoming the fastest growing proportion of the US population. 11 As the percentage of middle-aged to elderly people in the US grows, more patients are expected to present with painful spinal pathologies. The prevalence of spinal deformity in the US population has been estimated to be as high as 60%, and this rate increases substantially with age. 26 As the functional expectations of

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Taemin Oh, Justin K. Scheer, Justin S. Smith, Richard Hostin, Chessie Robinson, Jeffrey L. Gum, Frank Schwab, Robert A. Hart, Virginie Lafage, Douglas C. Burton, Shay Bess, Themistocles Protopsaltis, Eric O. Klineberg, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group

A dult spinal deformity (ASD) is a debilitating disease affecting up to one-third of the general population, and its prevalence markedly increases with age. 5 As the population of the US ages, ASD is becoming increasingly recognized as a disease that could reach epidemic proportions. 5 , 41 Importantly, the substantial burden of symptomatic ASD on patient health and well-being has been well established, which underscores the need for treating ASD safely and efficiently. 8 , 13 , 22 , 34 Although there is still some debate regarding optimum management paradigms

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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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Paraspinal muscle size as an independent risk factor for proximal junctional kyphosis in patients undergoing thoracolumbar fusion

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Zach Pennington, Ethan Cottrill, A. Karim Ahmed, Peter Passias, Themistocles Protopsaltis, Brian Neuman, Khaled M. Kebaish, Jeff Ehresman, Erick M. Westbroek, Matthew L. Goodwin and Daniel M. Sciubba

BG , Protopsaltis TS , Hart RA , Smith JS , Ames CP , : Bimodal incidence and causes of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) . Spine J 16 : S327 , 2016 10.1016/j.spinee.2016.07.255 7 Hostin R , McCarthy I , OʼBrien M , Bess S , Line B , Boachie-Adjei O , : Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity . Spine (Phila Pa 1976) 38 : 1008 – 1015 , 2013 10.1097/BRS.0b013e318271319c 22986834 8 Hyun SJ , Kim YJ , Rhim SC

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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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adjacent segment disease (ASD) in the cervical spine. Methods: 888 patients received ACDFs for symptomatic degenerative disease of the cervical spine over the past 22 years at our institution. Of these, 108 patients received repeat ACDF surgeries due to symptomatic ASD. 77 received revision surgeries anteriorly, and 31 received posterior surgeries. Pre, intra, peri, and post-operative data were collected via clinical notes and patient interviews. Patients were followed up for an average of 111.8±76.5 months after the first ACDF. Results: In general, patients

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between the two forms of treatment emerge. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2015.3.FOC-DSPNABSTRACTS 103. A Prospective, Multi-Center Assessment of the Best Versus Worst Clinical Outcomes for Adult Spinal Deformity (ASD) Surgery Justin S. Smith , MD PhD , Christopher I. Shaffrey , MD FACS , Virginie Lafage , PhD , Frank Schwab , MD, PhD , Themistocles Protopsaltis , MD , Eric Klineberg , MD , Munish

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Association of Neurological Surgeons 2013.4.FOC-LSRSABSTRACTS Oral Presentation Abstracts Paper 47. Age, Sagittal Deformity and Operative Correction are Risk Factors for Proximal Junctional Failure (PJF) Following Adult Spinal Deformity (ASD) Surgery Robert Hart , MD , Richard Hostin , MD , Themistocles Protopsaltis , MD , Shay Bess , MD , Frank Schwab , MD , Virginie Lafage , PhD; , Praveen Mummaneni , MD , Christopher Ames , MD , Christopher Shaffrey , MD , Justin

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Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written permission from JNSPG. 2015 Introduction The neurologic complication rate following complex adult spinal deformity surgery (ASD) has not been ascertained in any prospective, multicenter, observational study. Here, we compare preoperative lower extremity motor scores (LEMS) to 6 month postoperative scores. Methods 276 complex ASD patients from 15 sites worldwide were enrolled in this prospective, multicenter

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(PI-LL), and C7 SVA, in which disability occurs based on an ODI greater than 40. However, thresholds do not account for age and ODI has been shown to vary with age. The objective was to determine new thresholds based on age. Methods Multicenter, prospective study of consecutive ASD patients. Inclusion criteria: greater than 18yr, ASD. Patients were stratified into groups: less than 45yrs, 46–64, 65–74, greater than 75. Multivariate linear regressions were conducted for baseline PT, PI-LL, and SVA, with baseline ODI and age. ODI of 40 was used as the threshold