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Virginie Lafage, Neil J. Bharucha, Frank Schwab, Robert A. Hart, Douglas Burton, Oheneba Boachie-Adjei, Justin S. Smith, Richard Hostin, Christopher Shaffrey, Munish Gupta, Behrooz A. Akbarnia and Shay Bess

S agittal spinopelvic malalignment is increasingly recognized as a cause of pain and disability in patients with ASD. 8 , 11 , 21 , 22 Positive sagittal balance, defined as anterior deviation of the C-7 plumb line more than 50 mm from the posterosuperior corner of the sacrum, is a reliable predictor of adverse clinical symptoms. As the magnitude of positive sagittal balance increases, HRQOL measures have been shown to worsen among patients with ASD. 8 , 9 , 11 , 17 Pelvic tilt is a compensatory mechanism that reflects the body's attempt to correct

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Mark L. Prasarn, Dinah Baria, Edward Milne, Loren Latta and William Sukovich

C ervical spondylosis is a degenerative disorder that can result in radiculopathy and myelopathy. Anterior cervical discectomy and instrumented fusion is a well-established treatment modality that can achieve good to excellent clinical results in the appropriately chosen patient. 1–5 , 9 , 11 , 19 However, studies have suggested an increased rate of ASD after ACDF that may necessitate further surgery. 10 , 12 , 15 , 16 , 24 , 26 Many factors have been implicated in the development of ASD. It is currently unclear as to what contribution the cervical

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Owoicho Adogwa, Scott L. Parker, David N. Shau, Stephen K. Mendenhall, Clinton J. Devin, Joseph S. Cheng and Matthew J. McGirt

F ailed back surgery syndrome is common, affecting 10%–40% of the patients who have previously undergone lumbosacral spine surgery. 7 , 15 A marked increase in lumbar spine surgery over the past 2 decades is well documented. 9 , 12 Adjacent-segment disease is a potential long-term complication of lumbar spine fusion. Management of patients with low-back and radicular pain secondary to ASD is costly and challenging to health care providers. 1 , 8 , 10 In this era of value-based purchasing, treatment cost is becoming an increasingly important component of

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Cheerag D. Upadhyaya, Jau-Ching Wu, Gregory Trost, Regis W. Haid, Vincent C. Traynelis, Bobby Tay, Domagoj Coric and Praveen V. Mummaneni

encouraging at this point, great care must be taken when assessing the true significance of this result. TABLE 9: Summary of combined results Item Favor NDI not significant SF-36 MCS not significant SF-36 PCS not significant neck pain frequency score not significant neck pain intensity score not significant arm pain frequency score not significant arm pain intensity score not significant neurological success arthroplasty, significantly all secondary op arthroplasty, significantly op for ASD

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Juan S. Uribe, William D. Smith, Luiz Pimenta, Roger Härtl, Elias Dakwar, Urvij M. Modhia, Glen A. Pollock, Vamsi Nagineni, Ryan Smith, Ginger Christian, Leonardo Oliveira, Luis Marchi and Vedat Deviren

— — — — — — — — — — — — — — — — — —  Machino et al., 2010 ant 8 — — — — 13.0 — — — — — — — — — — — 13.0 0.0  Ayhan et al., 2010 ant 27 11.1 — — 7.4 — — — — — 7.4 — — — 11.1 — 3.7/ASD 40.7 —  Rosenthal & Dickman, 1999 ant 18 — — — — 6.0 — 50.0 — — 50.0 — — — — — — 111.0 5.0  Johnson et al., 2000 ant 8 — — — — — — 50.0 — — 25.0 — 13.0 — — 13.0 — 150.0 —  Regan et al., 1998 ant 10 — — — — — — — 10

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Scott L. Parker, David N. Shau, Stephen K. Mendenhall and Matthew J. McGirt

pathology have increased by at least 220% over the past 2 decades. 9 Approximately 10%–40% of patients who undergo lumbosacral surgery experience persistent and recurrent back or radicular pain postoperatively. 23 Some patients presenting with chronic and debilitating pain following lumbar spine surgery develop FBSS, a condition that is economically costly and challenging for health care providers. 24 , 26 Depending on the etiology, FBSS patients may require subsequent revision surgery, especially those in whom pseudarthrosis, ASD, or same-level stenosis develops

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Frank J. Schwab, Ashish Patel, Christopher I. Shaffrey, Justin S. Smith, Jean-Pierre Farcy, Oheneba Boachie-Adjei, Richard A. Hostin, Robert A. Hart, Behrooz A. Akbarnia, Douglas C. Burton, Shay Bess and Virginie Lafage

A dult spinal deformity is a complex musculoskeletal pathology with varied clinical presentations. Recent reports have demonstrated that pain and disability resulting from ASD are strongly associated with sagittal spinopelvic malalignment. 13 , 21 , 29 Common etiologies for sagittal spinopelvic malalignment include degenerative conditions, iatrogenic or postoperative flatback, and posttraumatic conditions. 3 , 10 , 27 , 30 Surgery for spinopelvic malalignment can provide a more ergonomic standing posture, resulting in improved function and reduced pain

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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Benjamin Blondel, Frank Schwab, Richard Hostin, Robert Hart, Brian O'Shaughnessy, Shay Bess, Serena S. Hu, Vedat Deviren, Christopher P. Ames and International Spine Study Group

P ositive sagittal malalignment (defined as anterior deviation of the C-7 plumb line >5 cm from the posterior superior corner of S-1) is recognized as a cause of pain and disability in cases of ASD. 8 , 20 , 28 , 30 , 31 Poor sagittal alignment has been shown to require increased energy expenditure, and multiple compensatory measures have been described, including knee flexion, pelvic retroversion, and thoracic hypokyphosis. 20 , 30 , 31 Surgical correction of positive sagittal malalignment has been correlated with significant improvement in health

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spinal deformity (ASD) remains a challenge for the spinal surgeon. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained elusive using MIS an approach. This report describes the evolution of an MIS method for treating ASD with attention to sagittal correction. Methods: Over an 18 month period 25 patients with thoracolumbar scoliosis were treated surgically. The mean patient age was 72 years, with 68% females. Patients were treated with

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Michael Y. Wang

S urgery for ASD remains a challenging proposition. A combination of factors acts in concert to create the milieu for high intraoperative and postoperative complication rates. These factors include more medical comorbidities, patient de-conditioning due to pain and immobility, associated osteoporosis, a rigid skeletal deformity, and abnormal spinal anatomy. 7 , 13 In addition, the surgical intervention necessary to treat these patients is typically a long-segment fusion with fixation and osteotomies, often in conjunction with interbody fusion or anterior