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Bong Ju Moon, Justin S. Smith, Christopher P. Ames, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Morio Matsumoto, Jong Sam Baik and Yoon Ha

P arkinson 's disease (PD) is a degenerative neurological condition characterized by tremor, rigidity, bradykinesia, and loss of postural reflexes. In addition, a postural deformity is often present in patients with PD. A retrospective observational study has suggested that up to one-third of patients with PD exhibit a postural deformity. 2 The overall prevalence of spinal deformities in PD has been reported to be higher than that of age-matched adults without PD. 20 Patients with PD may also have concomitant neuromuscular and degenerative diseases that

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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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Manish K. Kasliwal, Justin S. Smith, Christopher I. Shaffrey, Leah Y. Carreon, Steven D. Glassman, Frank Schwab, Virginie Lafage, Kai-Ming G. Fu and Keith H. Bridwell

–46 Recent studies have shown the potential benefit of operative treatment for patients with scoliosis who have symptoms that fail to respond to nonoperative measures. 7 , 8 , 30 , 42–44 However, selecting the best surgical procedure for adults with symptomatic scoliosis may not be straightforward, with the spine surgeon often facing the challenge of whether it is necessary to surgically address the entire deformity. 16 , 19 , 21 , 27 , 33 , 40 , 46 , 47 , 49 Short-segment procedures can involve less surgical morbidity and represent an attempt to preserve lifestyle and

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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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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Benjamin Blondel, Frank Schwab, Richard Hostin, Robert Hart, Brian O'Shaughnessy, Shay Bess, Serena S. Hu, Vedat Deviren, Christopher P. Ames and International Spine Study Group

-related quality of life measures. 8 , 31 Although most improvement in sagittal alignment after spinal deformity surgery occurs within the instrumented and fused spinal segments, there is increasing appreciation of the changes in spinopelvic alignment that occur outside the fused spinal segments. These alignment changes have been termed “reciprocal changes” and have been reported for the thoracic and lumbar regions, as well as the pelvis. Klineberg et al. 15 recently reported that a thoracic osteotomy with limited fusion for correction of kyphosis results in a spontaneous

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Antonio A. Faundez and Jean Charles Le Huec

: Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine caucasian asymptomatic adults . Spine (Phila Pa 1976) 35 : E1193 – E1198 , 2010 3 Roussouly P , Gollogly S , Berthonnaud E , Dimnet J : Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position . Spine (Phila Pa 1976) 30 : 346 – 353 , 2005 4 Roussouly P , Nnadi C : Sagittal plane deformity: an overview of interpretation and management . Eur Spine J 19 : 1824

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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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Michael P. Kelly, Lawrence G. Lenke, Jakub Godzik, Ferran Pellise, Christopher I. Shaffrey, Justin S. Smith, Stephen J. Lewis, Christopher P. Ames, Leah Y. Carreon, Michael G. Fehlings, Frank Schwab and Adam L. Shimer

A dult spinal deformity (ASD) surgery has become increasingly complex, with patients with severe deformities undergoing 3-column osteotomies (3COs), such as pedicle subtraction osteotomy or vertebral column resection (VCR). 1 , 2 , 4–6 , 9–11 , 13–16 , 20 , 22 , 32 Complication rates exceeding 50% have been reported in this patient population. 15–17 , 29 , 30 Neurological deficits, such as weakness and paralysis, are less common and have been estimated at 10% or lower. 8 , 10 , 21 These data come largely from retrospective cohort studies and are subject to a

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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

M uch has been written on the relationship between patient-reported outcomes and sagittal alignment in thoracolumbar deformities. 5–8 , 12 , 17 , 18 , 23 Although simple equations were initially used to identify thoracolumbar deformities, more recently, patient-specific formulas have been developed to more specifically quantify each deformity. 10 , 22 However, cervical spine studies have yet to define a fundamental equation, let alone patient-specific descriptors, that both elucidate a deformity and suggest a nidus for correction. The cervical sagittal