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Ali A. Baaj, Juan S. Uribe, Fernando L. Vale, Mark C. Preul and Neil R. Crawford

. 2–4 A better understanding of ASD, however, has been slowly changing attitudes toward fusion. Hilibrand et al. 17 demonstrated an ASD rate of 2.9%/year, leading to a significant number of reoperations. Similar studies by Katsuura et al. 18 and Goffin et al. 13 reported ASD rates as high as 50 and 36%, respectively. With biomechanical 10 and clinical 13 , 17 , 18 , 30 data demonstrating progression of ASD in the cervical spine after arthrodesis, interest in motion-preserving technology is likely to continue. The goal of this review was to highlight the

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S. Shelby Burks, Juan S. Uribe, John Paul G. Kolcun, Adisson Fortunel, Jakub Godzik, Konrad Bach and Michael Y. Wang

use of percutaneous fixation for traumatic spinal fractures with instability. 6 , 16 However, these assumptions have not been validated in the treatment of degenerative disorders. In adult spinal deformity (ASD), rostral extension to the lower- or mid-thoracic spine is often required to ensure adequate stabilization and correction. The question of whether the rostral portion of these constructs develops solid arthrodesis has not been adequately investigated. As such we sought to analyze patients undergoing long-segment MIS thoracolumbar fusions for ASD in which at

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Joshua M. Beckman, Berney Vincent, Michael S. Park, James B. Billys, Robert E. Isaacs, Luiz Pimenta and Juan S. Uribe

Postop Outcome Anti-Coagulation Comorbidities 65, M 27.5 Spondy; LSS Rt Lt No NA Psoas fluid collection Intact No 65, M 30.7 ASD; LSS Lt Rt No NA Psoas fluid collection at L4–5 Intact No 62, M 29.0 DDD; LSS Rt Lt (evolved to bilat) Yes 45 Psoas fluid collection, evolved to deep infection requiring surgical drainage Residual deficit (lt L4–S1) No Alcoholism 54, F 41.73 Spondy Lt Rt Yes 37 Psoas hematoma presenting w/proximal ip/q weakness (1/5) Residual deficit (rt ip/q 1

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Juan S. Uribe, Jaya Kolla, Hesham Omar, Elias Dakwar, Naomi Abel, Devanand Mangar and Enrico Camporesi

were permitted to rest at the table level; 5 supine pts had no sequelae; 3 patients in different positions had sequelae elevating the elbow 6” above the table level will prevent injury of brachial plexus in the “hands-up” position. limit arm abduction to 90º max, esp limit posterior displacement Po & Hansen, 1969 5 13–43; 4 M & 1 F 2 ASD repairs; partial gastrectomy; thoracotomy; I&D of abscess; 3–11 hrs rt ant lat w/ arms hyper-extended, supine w/ arms abducted > 90º UE weakness & paresthesia 3 mos–2 yrs arm board angle <90º to table; arms

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Pierce D. Nunley, Gregory M. Mundis Jr., Richard G. Fessler, Paul Park, Joseph M. Zavatsky, Juan S. Uribe, Robert K. Eastlack, Dean Chou, Michael Y. Wang, Neel Anand, Kelly A. Frank, Marcus B. Stone, Adam S. Kanter, Christopher I. Shaffrey, Praveen V. Mummaneni and the International Spine Study Group

F or hospitals to continue to provide excellent care for adult spinal deformity (ASD) surgery, they must be able to adequately recover their costs for these procedures. The introduction of Medicare’s Prospective Payment System (PPS) in 1983 led to the development of a fixed payment amount for each patient upon hospital discharge ( https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html ). 1 The fixed payment amount is determined based on the particular diagnosis-related group (DRG) coded at patient discharge and it is intended

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Paul Park, Kai-Ming Fu, Robert K. Eastlack, Stacie Tran, Gregory M. Mundis Jr., Juan S. Uribe, Michael Y. Wang, Khoi D. Than, David O. Okonkwo, Adam S. Kanter, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Dean Chou, Mark E. Oppenlander, Praveen V. Mummaneni and the International Spine Study Group

I n the surgical treatment of symptomatic adult spinal deformity (ASD), spinopelvic alignment is considered an important factor in achieving a successful result. Specifically, several parameters, including pelvic tilt (PT), pelvic incidence to lumbar lordosis (PI-LL) mismatch, and sagittal vertical axis (SVA), have been correlated with clinical outcomes. It has been proposed that optimal spinopelvic alignment goals should consist of a PT < 20°, a PI-LL mismatch ± 9°, and an SVA < 50 mm. 9 Based predominantly on correlation studies, it has been presumed that

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Paul Park, Michael Y. Wang, Virginie Lafage, Stacie Nguyen, John Ziewacz, David O. Okonkwo, Juan S. Uribe, Robert K. Eastlack, Neel Anand, Raqeeb Haque, Richard G. Fessler, Adam S. Kanter, Vedat Deviren, Frank La Marca, Justin S. Smith, Christopher I. Shaffrey, Gregory M. Mundis Jr. and Praveen V. Mummaneni

, including adult spinal deformity (ASD). Anand et al. 3 initially reported the feasibility of applying several different MIS techniques to treat symptomatic lumbar scoliosis. Subsequent reports have all confirmed successful MIS treatment of ASD. 5 , 17 , 21 , 24 These studies, however, have been limited by the relatively small numbers of patients evaluated, as well as the lack of focus on sagittal alignment and spinopelvic parameters, which are factors known to significantly impact long-term disability. 12 , 18 In addition, there has been no uniform MIS technique or

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Juan S. Uribe, Armen R. Deukmedjian, Praveen V. Mummaneni, Kai-Ming G. Fu, Gregory M. Mundis Jr., David O. Okonkwo, Adam S. Kanter, Robert Eastlack, Michael Y. Wang, Neel Anand, Richard G. Fessler, Frank La Marca, Paul Park, Virginie Lafage, Vedat Deviren, Shay Bess and Christopher I. Shaffrey

O ver the past several decades, surgical treatment options for adult spinal deformity (ASD) have expanded, including both minimally invasive and open techniques. 3 , 12 , 14 , 18 , 27 Determining the most suitable approach in patients should take into account the risks and benefits of each surgical technique. Unfortunately, studies comparing the different operative techniques are lacking. Moreover, outcomes and complications of ASD are largely reported in terms of patient characteristics following traditional open techniques with little published data

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Michael Y. Wang, Stacie Tran, G. Damian Brusko, Robert Eastlack, Paul Park, Pierce D. Nunley, Adam S. Kanter, Juan S. Uribe, Neel Anand, David O. Okonkwo, Khoi D. Than, Christopher I. Shaffrey, Virginie Lafage, Gregory M. Mundis Jr., Praveen V. Mummaneni and the MIS-ISSG Group

T he morbidity of adult spinal deformity (ASD) surgery has been well proven through several large multiinstitutional studies. 6 , 9 , 14 Although these operations carry inherent risk, the benefits of such interventions have been shown as well, provided that the tenets of the surgical goals have been met. 2 , 10 , 11 Given these conditions, substantial enthusiasm has been demonstrated for minimally invasive surgery (MIS) options. 5 , 7 , 18 , 22 Various technical methods have been developed to achieve these ends, including 1) leveraging alternate access routes

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Khoi D. Than, Praveen V. Mummaneni, Kelly J. Bridges, Stacie Tran, Paul Park, Dean Chou, Frank La Marca, Juan S. Uribe, Todd D. Vogel, Pierce D. Nunley, Robert K. Eastlack, Neel Anand, David O. Okonkwo, Adam S. Kanter and Gregory M. Mundis Jr.

deformity (ASD). 25 Methods Study Design and Patient Population We performed a retrospective analysis of data collected from a multicenter database of patients with ASD who had been treated with a component of minimally invasive surgical techniques between 2009 and 2013. Eleven participating institutions contributed data, and each site obtained institutional review board approval. Inclusion criteria for entry into the multicenter database were patient age of ≥ 18 years and at least 1 of the following factors: a coronal Cobb angle (CCA) of > 20°, a sagittal vertical axis