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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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Christopher I. Shaffrey and Justin S. Smith

spinal disorders have demonstrated substantial variability in decisions regarding nonoperative management, when to operate, who to operate on, when to perform a fusion, and what the appropriate indications are for the various types of spinal implants. The surgical management of adult spinal deformity (ASD) is rapidly growing despite the high costs and frequent complications associated with these procedures. From 2002 to 2007, the rate of complex fusion procedures in the Medicare population increased 15-fold and was accompanied by a 5.6% incidence of life

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Justin S. Smith, Christopher I. Shaffrey, Christopher P. Ames and Lawrence G. Lenke

H istorically , care for adult spinal deformity (ASD) focused on supportive measures with few surgical options that were often deemed high risk. Improvements in anesthesia and critical care, surgical techniques, and instrumentation have led to remarkable advances in ASD care over the last few decades. The population seeking ASD treatment continues to expand, as life expectancies increase and the desire to stay active into later life remains a priority. Although care for ASD has evolved from supportive to corrective, many challenges remain. Complication rates

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Christopher I. Shaffrey and Justin S. Smith

revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis”) is a study that provides some interesting perspectives on the surgical management of more complex disorders of the lumbar spine in older patients. 3 This study evaluated factors affecting clinical outcomes in 69 patients undergoing revision neural decompression and instrumented fusion for adjacent-segment disease (ASD), pseudarthrosis, or same-level recurrent stenosis. 3 An important aspect of this study was the inclusion of the Zung self

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Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames, Mitsuru Yagi, Ahmet Alanay and Yoon Ha

I t has been recognized for more than 35 years that adult spinal deformity (ASD) is a common condition in the elderly that can frequently cause significant pain and disability. 2 , 6 Adults with painful and disabling spinal deformity appear to benefit from surgical treatment when compared with nonsurgical treatment, given the proper indications, but the surgery is costly and is associated with a high rate of complications. 1 , 5 , 7 , 11 , 12 For many years it was thought that the principal cause of the pain and disability associated with ASD was the severity

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Aaron J. Clark, Roxanna M. Garcia, Malla K. Keefe, Tyler R. Koski, Michael K. Rosner, Justin S. Smith, Joseph S. Cheng, Christopher I. Shaffrey, Paul C. McCormick and Christopher P. Ames

maintaining a solid contemporary neurosurgical knowledge base in the practice of modern spinal surgery. Adult spinal deformity (ASD) is now recognized as a significant cause of pain and disability. Deformity in the sagittal plane, 17 spinopelvic alignment, 15 understanding of appropriate deformity-specific work-up, including hip joint evaluation, comprehensive knowledge of normal lumbar anatomy and lordosis, and indications for pelvic fixation must be included in the spinal surgeon's knowledge base. 10 , 13 Failure to do so can result in treatment failure and poor

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Bhargav D. Desai, Davis G. Taylor, Ching-Jen Chen, Thomas J. Buell, Jeffrey P. Mullin, Bhiken I. Naik, Justin S. Smith and Christopher I. Shaffrey

S urgical treatments for adult spinal deformity (ASD) are typically complex procedures associated with significant blood loss and the potential risk for perioperative coagulopathy, as well as requisite blood product administration, volume resuscitation, and their associated risks. 28 , 29 Acute intraoperative blood loss can be managed with allogeneic transfusions; however, the risks include transfusion-related acute lung injury, hemolytic transfusion reactions, and transfusion-associated sepsis. 31 Reducing perioperative blood loss in complex spine surgery is

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Kseniya Slobodyanyuk, Caroline E. Poorman, Justin S. Smith, Themistocles S. Protopsaltis, Richard Hostin, Shay Bess, Gregory M. Mundis Jr., Frank J. Schwab and Virginie Lafage

A dult spinal deformity (ASD) is a significant source of disability worldwide. 8 , 10 , 12 In the absence of significant or progressive neurological deficits, initial treatment is usually nonoperative, with conversion to surgery for nonresponders; the idea is that successful nonoperative management can spare the risks and pain of more invasive treatment. 9 , 20 The nonoperative approach generally consists of a combination of treatments including bracing, physical therapy and exercise, narcotic and nonnarcotic pain medications, interventional procedures

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Thomas J. Buell, James H. Nguyen, Marcus D. Mazur, Jeffrey P. Mullin, Juanita Garces, Davis G. Taylor, Chun-Po Yen, Mark E. Shaffrey, Christopher I. Shaffrey and Justin S. Smith

F ixed sagittal spinal malalignment (FSM) is a condition in which the weight-bearing line is displaced anterior to the sacrum. 1 , 3 , 6 Numerous adult spinal deformity (ASD) studies have demonstrated a significant correlation between sagittal malalignment and patient-reported clinical outcome measures such as worse back pain, increased disability, and an overall reduction in health-related quality of life. 23 , 24 , 37 Fixed sagittal spinal malalignment can occur after previous spinal fusion operations and has been cited as a potential long-term complication