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Christopher P. Ames, Justin S. Smith, Justin K. Scheer, Christopher I. Shaffrey, Virginie Lafage, Vedat Deviren, Bertrand Moal, Themistocles Protopsaltis, Praveen V. Mummaneni, Gregory M. Mundis Jr., Richard Hostin, Eric Klineberg, Douglas C. Burton, Robert Hart, Shay Bess, Frank J. Schwab and the International Spine Study Group

D espite the complexity of CSD and the substantial impact on patient quality of life, there exists no comprehensive classification system to serve as the basis of communication among physicians and to facilitate effective clinical and radiographic study of patients with these deformities. Without a standardized classification system, studies of CSD may suffer from heterogeneity that compromises the study findings and negatively impacts communication of the results. Other spinal conditions, including adult and pediatric scoliosis, spondylolisthesis, and

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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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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

subjacent global spinal alignment and pelvic tilt as compensatory changes occur to maintain horizontal gaze. In the past, research conducted on the relationship between spinal malalignment and HRQOL has largely focused on the thoracolumbar and pelvic regions, and comparatively little attention has been given to the cervical spine. Currently, indications for surgery to correct cervical alignment are not well defined and there is no set standard to address the amount of correction to be achieved. Furthermore, classifications of cervical deformity have yet to be fully

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Michael M. Safaee, Vedat Deviren, Cecilia Dalle Ore, Justin K. Scheer, Darryl Lau, Joseph A. Osorio, Fred Nicholls and Christopher P. Ames

P roximal junctional kyphosis (PJK) is a well-recognized, yet incompletely defined, complication in patients undergoing instrumented fusion for spinal deformity. The condition most commonly presents with abnormal kyphosis immediately above the upper instrumented vertebra (UIV). The angle of kyphosis is measured using the sagittal Cobb angle between the inferior endplate of the UIV and superior endplate of the second vertebral body above the UIV (UIV+2). The definition of PJK varies in the literature, and some suggest that PJK represents a spectrum including

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Vedat Deviren, Justin K. Scheer and Christopher P. Ames

F ixed sagittal imbalance at the cervicothoracic junction is very debilitating to the patient, resulting in severe pain, possible neurological compromise, and loss of horizontal gaze. 5 , 6 Treatment of severe, rigid cervicothoracic kyphosis remains clinically challenging, and there is a continued effort to improve the treatment options available. Surgical correction of cervical deformity is technically demanding and poses high risks to the patient. 15–18 , 38 Following the lead of Smith-Petersen et al. 37 and their development of a lumbar spine

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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

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Christopher P. Ames, Justin S. Smith, Robert Eastlack, Donald J. Blaskiewicz, Christopher I. Shaffrey, Frank Schwab, Shay Bess, Han Jo Kim, Gregory M. Mundis Jr., Eric Klineberg, Munish Gupta, Michael O’Brien, Richard Hostin, Justin K. Scheer, Themistocles S. Protopsaltis, Kai-Ming G. Fu, Robert Hart, Todd J. Albert, K. Daniel Riew, Michael G. Fehlings, Vedat Deviren, Virginie Lafage and International Spine Study Group

D espite the complexity of cervical spine deformity (CSD) and its substantial impact on patient quality of life, there exists no comprehensive classification system to serve as the basis of communication among physicians and to facilitate effective clinical and radiographic study of patients with these deformities. Without a standardized classification system, studies of CSD may suffer from heterogeneity, which compromises the study findings and negatively impacts communication of the results. Other spinal conditions, including adult and pediatric

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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

M anagement of adult spinal deformity poses great challenges to the surgeon and has historically been associated with relatively high rates of complications and the need for reoperation. 20 Studies have documented the complications that arise, assessing the rates of reoperation, analyzing factors that increase the likelihood of reoperation, and suggesting methods to prevent the need for reoperation. These studies not only reported complications following primary spine surgery 3 , 8 but also compared complication rates between different types of spine

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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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Dominic Maggio, Tamir T. Ailon, Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Regis W. Haid Jr., Themistocles Protopsaltis, Eric Klineberg, Justin K. Scheer, Shay Bess, Paul M. Arnold, Jens Chapman, Michael G. Fehlings, Christopher Ames, AOSpine North America and International Spine Study Group

S urgical planning to address seemingly isolated lumbar pathology may lead to suboptimal results if a patient’s global spinal alignment is not taken into account. In recent years, there has been a greater appreciation of the interaction between different regions of the spine and the pelvis in producing harmonious global alignment. Malalignment in 1 region may result in compensatory changes in an adjacent (or even distant) region. This is particularly true in the setting of deformity surgery wherein correction of sagittal alignment can result in reciprocal