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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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Justin K. Scheer, Taemin Oh, Justin S. Smith, Christopher I. Shaffrey, Alan H. Daniels, Daniel M. Sciubba, D. Kojo Hamilton, Themistocles S. Protopsaltis, Peter G. Passias, Robert A. Hart, Douglas C. Burton, Shay Bess, Renaud Lafage, Virginie Lafage, Frank Schwab, Eric O. Klineberg, Christopher P. Ames and the International Spine Study Group

A dult spinal deformity (ASD) surgery remains technically challenging and is associated with high rates of complications, one of which is pseudarthrosis. 8–11 , 22 , 27 The rates of pseudarthrosis in ASD have ranged from 0% to 35%, 5 , 8–10 with one comprehensive review citing pseudarthrosis as the most frequent long-term complication of those studied, reporting a rate of 7.6%. 27 Patients who develop pseudarthrosis are at risk for instrumentation failure and may require revision surgery. Risk factors for pseudarthrosis have been studied and include

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Rafael De la Garza Ramos, Jonathan Nakhla, Daniel M. Sciubba and Reza Yassari

less complications than iliac screws in adult lumbosacropelvic fixation . Spine (Phila Pa 1976) 42 : E142 – E149 , 2017 10.1097/BRS.0000000000001722 6 Gödde S , Fritsch E , Dienst M , Kohn D : Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion . Spine (Phila Pa 1976) 28 : 1693 – 1699 , 2003 12897494 10.1097/01.BRS.0000083167.78853.D5 7 Guler UO , Cetin E , Yaman O , Pellise F , Casademut AV , Sabat MD , : Sacropelvic fixation in adult spinal deformity (ASD); a very high rate of

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Seba Ramhmdani, Marc Comair, Camilo A. Molina, Daniel M. Sciubba and Ali Bydon

. reported a 4.8% reoperation rate for adjacent-segment disease (ASD) associated with the coflex device compared with 11.1% of cases treated with posterolateral fusion (p = 0.2777). 43 This has not been corroborated with other long-term clinical follow-up studies. The FDA approval of coflex was based on a clinical trial comprising 322 cases randomized to the coflex device or a pedicle screw fusion system in a 2:1 ratio. 8 At the 2-year follow-up, both groups had equivalent clinical outcomes; however, the reoperation rate in the coflex cohort was higher (10.7% vs 7.5%, p

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Rafael De la Garza-Ramos, Amit Jain, Khaled M. Kebaish, Ali Bydon, Peter G. Passias and Daniel M. Sciubba

A dult spinal deformity (ASD) is a common spinal disorder in patients over 60 years of age, with studies suggesting prevalence as high as 68%. 17 Although corrective surgery achieves better outcomes in terms of leg pain and disability compared with nonoperative treatment, 15 , 19 complication rates range from 37% to 78% in the literature. 1 , 3 , 9 , 18 Risk factors for complication development include age over 65 years, longer constructs, female sex, revision procedures, and having surgery performed by a low-volume surgeon or at a low-volume hospital

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Mohamad Bydon, Risheng Xu, David Santiago-Dieppa, Mohamed Macki, Daniel M. Sciubba, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

the lumbar spine, its role in affecting L5–S1 biomechanics remains unclear. 13 , 22 , 28 , 29 , 34 Thus, although some studies demonstrate increased adjacent-segment disease (ASD) after floating fusion, others have shown that including L5–S1 in the fusion construct appears to be protective against ASD development. 16 , 17 , 21 To better understand the natural history of degenerative spinal disease progression after instrumented fusion, we present a series of 511 patients who received posterior lumbar instrumented fusion for degenerative etiologies at a single

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Rafael De la Garza-Ramos, Risheng Xu, Seba Ramhmdani, Thomas Kosztowski, Mohamad Bydon, Daniel M. Sciubba, Jean-Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan and Ali Bydon

. Covariates Patient data such as age, sex, comorbidities, presenting symptoms, neck visual analog scale (VAS) pain score, and Nurick scores were collected from clinical notes. Intraoperative data, including discectomy levels, type of bone graft, and estimated blood loss, were gathered from operative notes. Outcomes included perioperative complications, fusion rates, need for revision surgery due to pseudarthrosis or adjacent-segment disease (ASD), symptoms at last follow-up, Nurick score, pain score, narcotic usage, and Odom's criteria. Odom's criteria defines outcomes

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Emily K. Miller, Brian J. Neuman, Amit Jain, Alan H. Daniels, Tamir Ailon, Daniel M. Sciubba, Khaled M. Kebaish, Virginie Lafage, Justin K. Scheer, Justin S. Smith, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group

predict mortality and self-management ability in nonoperatively treated populations, these indices have recently been shown to be better predictors of perioperative adverse events than chronological age alone. 6 , 11 , 12 , 17 Numerous methods for frailty quantification have been developed and validated. 3 , 4 , 7 , 13 , 15–18 Searle et al. proposed and validated a method for creating frailty indices by using large, existing patient databases. This step-by-step method was used to create a frailty index (the adult spinal deformity frailty index [ASD-FI]) in this study

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Amit Jain, Hamid Hassanzadeh, Varun Puvanesarajah, Eric O. Klineberg, Daniel M. Sciubba, Michael P. Kelly, D. Kojo Hamilton, Virginie Lafage, Aaron J. Buckland, Peter G. Passias, Themistocles S. Protopsaltis, Renaud Lafage, Justin S. Smith, Christopher I. Shaffrey, Khaled M. Kebaish and the International Spine Study Group

T he incidence of scoliosis in the elderly has been reported to be from 30% to 68%. 25 , 27 Surgical treatment for adult spinal deformity (ASD) is associated with high complication rates. 16 , 17 , 35 A recent study found that approximately 27% of patients with ASD experience at least one medical complication perioperatively. 33 High perioperative complication rates have been reported in elderly patients (aged 65 years or older) surgically treated for ASD and range from 37% to 71%. 1 , 10 , 30 , 32 A large proportion of the morbidity in the elderly is caused

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Michael P. Kelly, Lukas P. Zebala, Han Jo Kim, Daniel M. Sciubba, Justin S. Smith, Christopher I. Shaffrey, Shay Bess, Eric Klineberg, Gregory Mundis Jr., Douglas Burton, Robert Hart, Alex Soroceanu, Frank Schwab, Virginie Lafage and International Spine Study Group

C omplex adult spinal deformity (ASD) surgeries are increasing in incidence, as the population ages and the revision burden grows. 15 , 16 Reconstructive surgeries for ASD are associated with long operative times and high estimated blood losses (EBLs). Consequently, resuscitation of these patients frequently requires transfusions of autologous (AUTO) or allogeneic (ALLO) packed red blood cells (PRBCs) to maintain circulating hemoglobin levels, in an effort to minimize perioperative complications. 18 In fact, spine surgery is one of the most common