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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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Khoi D. Than, Paul Park, Kai-Ming Fu, Stacie Nguyen, Michael Y. Wang, Dean Chou, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Christopher I. Shaffrey, Shay Bess, Behrooz A. Akbarnia, Vedat Deviren, Juan S. Uribe, Frank La Marca, Adam S. Kanter, David O. Okonkwo, Gregory M. Mundis Jr., Praveen V. Mummaneni and the International Spine Study Group

that the spines of patients who do the worst are not appropriately corrected in the sagittal plane and are perhaps fused into a fixed sagittal plane deformity. The increased mean SVA in both groups probably represents the limited ability to improve sagittal alignment with early MIS techniques. Similarly, the unchanged PILL mismatch in the worst group reflects a lack of sagittal alignment improvement obtained by the early MIS approaches we used. These results highlight the basis of the MISDEF algorithm we created to guide MIS versus open treatment in patients with