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Robert F. Heary and Christopher M. Bono

several forms. Conceptually, the procedure must be “lordogenic”—that is, it must produce lordosis. This can be achieved by lengthening the anterior elements, shortening the posterior elements, or a combination of the two. Pedicle subtraction osteotomy was developed to achieve significant deformity correction. In a single-stage, posterior-approach procedure, portions of the VB and posterior neural arch are resected. 2 , 5 , 14 , 24 Conceptually the procedure entails a shortening of the posterior elements but, in reality, it involves shortening of portions of the

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Devender Singh, Eeric Truumees, Dana Hawthorne, John K. Stokes and Matthew J. Geck

, especially those with major thoracolumbar deformity. Often the signs and symptoms of myelopathy are subtle or attributed to another spinal pathology or neurological disease. For example, gait dysfunction may be attributed to spinal imbalance or lumbar stenosis. Cervical stenosis is common in older patients. 3 Stenosis and cord compressions are often recorded in asymptomatic adults. 2 , 4 To our knowledge, there have been no reports on the incidence of stenosis in older patients with thoracolumbar deformity. Moreover, to our knowledge, there have been no reports on the

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Krishn Khanna and Sigurd H. Berven

C omplication rates following adult spinal deformity surgery are high, 14 with the most recent literature reporting nearly a 70% incidence of complications. 13 Preoperative vascular disease is a significant independent predictor of postoperative complications in patients undergoing spine surgery. 1 , 10 In anterior approaches to the spine, vascular injury can result from direct injury to the artery or vein that occurs when manipulating the arteries and veins during exposure, with a reported incidence of approximately 3%. 7 Posterior approaches have

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Chris J. Neal, Kara Mandell, Ellen Tasikas, John J. Delaney, Charles A. Miller, Cody D. Schlaff and Michael K. Rosner

population increases in age, we will continue to see more patients with adult spinal deformities. Unfortunately, the literature is lacking in quality studies that evaluate the cost-effectiveness of treatment in this patient population. As fiscal restraints become more of an issue, we must be able to determine that an intervention improves the quality of life of a patient and is cost-effective or more so than nonsurgical management. Determining whether adult spinal deformity surgery meets cost-effectiveness measures has been more elusive. With its longer operative times

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D. Kojo Hamilton, Justin S. Smith, Tanya Nguyen, Vincent Arlet, Manish K. Kasliwal and Christopher I. Shaffrey

A substantial shift in population demographics is underway in many developed countries, with the proportion of elderly expanding to unprecedented levels. For example, between the years 2000 and 2030, the number of individuals at least 65 years of age in the US is expected to double to more than 70 million. 24 As these shifts occur, it will become increasingly important to better appreciate and effectively manage the medical and surgical conditions that commonly afflict the elderly. According to Schwab et al., 18 the prevalence of spinal deformity

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Raheel Ahmed, Arnold H. Menezes, Olatilewa O. Awe, Kelly B. Mahaney, James C. Torner and Stuart L. Weinstein

A dvancements in neurosurgical techniques and neurophysiological monitoring have enabled improvements in resection of pediatric intramedullary spinal cord tumors (IMSCTs). This has enabled improved tumor control with favorable disease survival and neurological function outcomes. These surgical approaches are complicated, however, by the development of secondary spinal deformity. Spinal deformity associated with the development and treatment of pediatric IMSCT is an important determinant of overall disease outcomes. Progression in spinal deformity is

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Cecilia L. Dalle Ore, Christopher P. Ames, Vedat Deviren and Darryl Lau

deformities via high-grade osteotomies, 41 the complication profile is unique, and associated morbidity in patients with RA can be more severe. 29 In a series by Mesfin et al. regarding outcomes in scoliosis surgery in patients with RA, 23 complications were observed in 14 patients with RA; this was significantly higher than the 11 complications observed in their 14 matched controls. 29 To our knowledge, there is a great paucity in studies examining the outcomes of RA patients who undergo thoracolumbar 3-column osteotomy. However, correction of thoracolumbar deformities

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Qinghua Zhao, Benlong Shi, Xu Sun, Zhen Liu, Hao Su, Yang Li, Zezhang Zhu and Yong Qiu

C ongenital scoliosis (CS) stems from the failure of vertebral formation or segmentation, which most frequently occurs at 4–6 weeks of gestation. 2 , 15 Since the formation of bony elements, completion of neuroaxis infolding, and closing of the neural tube are closely related during this period, any event that precipitates the development of congenital spinal deformity may also lead to intraspinal anomalies. According to the literature, the documented incidences of intraspinal anomalies in CS patients range from 18% to 58%, and tethered cord, split cord

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Suhas Udayakumaran, Sajesh K. Menon, Chiazor U. Onyia and Naveen Tahasildar

N eurogenic kyphoscoliosis in children has varied etiology with similarly diverse management options. 6 , 14 Association of neural axis abnormalities as well as intraspinal abnormalities with various types of kyphoscoliosis is well documented. 9 These cases are commonly characterized by an early onset and a double curve. 9 Commonly documented neurogenic pathologies that may lead to spinal deformity include Chiari malformation Type I (CM-I) (particularly with syringomyelia), tethered cord syndrome, and intramedullary as well as intradural extramedullary spinal

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Steven W. Hwang, Amer F. Samdani, Ben Wormser, Hari Amin, Jeff S. Kimball, Robert J. Ames, Alexander S. Rothkrug and Patrick J. Cahill

E arly instrumented correction of scoliotic deformities largely involved Harrington rod instrumentation. 9 , 10 Harrington rod distraction helped improve the coronal deformity but did not surgically address the sagittal or axial plane, and has thus been associated with a higher incidence of flatback syndrome. 5 , 6 , 35 The advent of Cotrel-Dubousset instrumentation significantly advanced surgical management of AIS by allowing surgical therapy to address all 3 planes of deformity. However, the impact of Cotrel-Dubousset instrumentation on axial deformity