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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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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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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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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

established and treatment options defined and clarified. Therefore, the purpose of this article is to provide a comprehensive review of cervical alignment parameters and related outcome measures that may provide guidance for proper surgical treatment and highlight deficiencies in the current literature. Comparisons to established spinal pelvic parameters that predict disability in thoracolumbar surgery will be described. Other pathologies that are closely influenced by cervical deformity, including ASD and myelopathy, are also discussed. Cervical Spine Alignment

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Micheal Raad, Brian J. Neuman, Amit Jain, Hamid Hassanzadeh, Peter G. Passias, Eric Klineberg, Gregory M. Mundis Jr., Themistocles S. Protopsaltis, Emily K. Miller, Justin S. Smith, Virginie Lafage, D. Kojo Hamilton, Shay Bess, Khaled M. Kebaish, Daniel M. Sciubba and the International Spine Study Group

T here has been a sharp spike in the number of adult spinal deformity (ASD) surgeries performed in the US over the past decade ( ). Compared with some of the most prevalent chronic diseases such as diabetes, congestive heart failure, or chronic lung disease, ASD has been shown to have a significantly greater impact on health-related quality of life (HRQOL) and higher cost of treatment. 17 , 23 This increased burden of ASD places substantial pressure on the scientific community to better delineate treatment effectiveness in

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Joshua Bakhsheshian, Justin K. Scheer, Jeffrey L. Gum, Richard Hostin, Virginie Lafage, Shay Bess, Themistocles S. Protopsaltis, Douglas C. Burton, Malla Kate Keefe, Robert A. Hart, Gregory M. Mundis Jr., Christopher I. Shaffrey, Frank Schwab, Justin S. Smith, Christopher P. Ames and The International Spine Study Group

I t is well known that deformity of the spine has a significant impact on the health-related quality of life (HRQOL) of adults; 2 , 17 however, the impact of the mental health burden in patients with adult spinal deformity (ASD) treated with surgical spinal reconstruction is less clear. Although screening for a history of mental health disease has been advocated in the preoperative planning for reconstructive spine surgery, 14 a survey completed by 110 spine surgeons from the US revealed that only 37% routinely use some form of mental health screening

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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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Taemin Oh, Justin K. Scheer, Robert Eastlack, Justin S. Smith, Virginie Lafage, Themistocles S. Protopsaltis, Eric Klineberg, Peter G. Passias, Vedat Deviren, Richard Hostin, Munish Gupta, Shay Bess, Frank Schwab, Christopher I. Shaffrey and Christopher P. Ames

A dult spinal deformity (ASD) is a pathological condition defined as spinal malalignment in the axial, coronal, or sagittal plane and is derivative of congenital, iatrogenic, degenerative, or idiopathic etiology. 30 The restoration of sagittal alignment, as established by the sagittal vertical axis (SVA; target < 5 cm) and pelvic tilt (PT; target < 20°) on sagittal radiography, is important in surgical deformity correction. 6 , 21 , 22 Although coronal plane correction also has clinical relevance, sagittal corrections appear to have greater importance, 5

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Emmanuelle Ferrero, Barthelemy Liabaud, Vincent Challier, Renaud Lafage, Bassel G. Diebo, Shaleen Vira, Shian Liu, Jean Marc Vital, Brice Ilharreborde, Themistocles S. Protopsaltis, Thomas J. Errico, Frank J. Schwab and Virginie Lafage

O ver the past few decades, there have been significant advances in the treatment of patients with adult spinal deformity (ASD) due to the development of spinal deformity analysis. Specifically, sagittal alignment has been analyzed in numerous studies that have demonstrated the importance of pelvic morphology in the setting of spinal pathology. 6 , 37 , 40 , 46 In addition, correlations between spinal and pelvic parameters have been well documented in the asymptomatic population and in patients with spinal disease. 3 , 5 , 20 , 23 , 41 , 43 Several