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Alexander Tuchman and Patrick C. Hsieh

Adult spinal deformity (ASD) is a rapidly advancing field in terms of understanding the pathophysiology and available surgical treatments. Traditionally, radiographic correction of coronal and sagittal global balance has correlated with improvement in clinical outcomes and is the primary goal in ASD surgery. 6 , 7 Recent clinical outcomes–driven research has revealed that correcting sagittal balance and pelvic tilt significantly improves patient outcomes. 10 , 12 , 13 Meanwhile, coronal imbalance has a considerably lesser effect on functional disability

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Christopher I. Shaffrey and Justin S. Smith

spinal disorders have demonstrated substantial variability in decisions regarding nonoperative management, when to operate, who to operate on, when to perform a fusion, and what the appropriate indications are for the various types of spinal implants. The surgical management of adult spinal deformity (ASD) is rapidly growing despite the high costs and frequent complications associated with these procedures. From 2002 to 2007, the rate of complex fusion procedures in the Medicare population increased 15-fold and was accompanied by a 5.6% incidence of life

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Michael P. Kelly, Lawrence G. Lenke, Christopher I. Shaffrey, Christopher P. Ames, Leah Y. Carreon, Virginie Lafage, Justin S. Smith and Adam L. Shimer

A dult spinal deformity is associated with relatively high rates of perioperative complications, with a concordant increased risk of a new neurological deficit. 6 , 7 , 10–12 , 15 The combination of an aging population and the increasing number of spine fusion procedures results in an increasing number of patients with adult spinal deformities (ASDs), as well as an increasingly complex revision burden. 13 , 14 With the rising revision burden, the diagnosis of fixed sagittal malalignment is increasingly common. 20 Numerous centers have reported their

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Ian McCarthy, Michael O'Brien, Christopher Ames, Chessie Robinson, Thomas Errico, David W. Polly Jr. and Richard Hostin

B ased on the Nationwide Inpatient Sample, the total number of adult spinal deformity (ASD) surgeries more than doubled over the past decade, from 9400 in 2000 to more than 20,600 in 2010 ( http://hcupus.ahrq.gov/nisoverview.jsp ). This compares to just a 20% increase in the frequency of all other spine primary diagnosis codes over the same time period (from 675,500 in 2000 to 813,800 in 2010; http://hcup-us.ahrq.gov/nisoverview.jsp ). Adult spinal deformity surgery is likely to increase in frequency with as much as 32% of the adult population suffering

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Michael Y. Wang, Praveen V. Mummaneni, Kai-Ming G. Fu, Neel Anand, David O. Okonkwo, Adam S. Kanter, Frank La Marca, Richard Fessler, Juan Uribe, Christopher I. Shaffrey, Virginie Lafage, Raqeeb M. Haque, Vedat Deviren and Gregory M. Mundis Jr.

S urgery for adult spinal deformity (ASD) remains a challenging proposition. Several factors contribute to create a high likelihood of intraoperative and postoperative complication rates. Medical comorbidities, patient deconditioning due to pain and immobility, associated osteoporosis, a rigid skeletal deformity, and abnormal spinal anatomy all increase the likelihood of a complication from ASD surgery. 6 , 9 Furthermore, the surgical enterprise needed to destabilize, realign, and fuse the spine over multiple segments is painful and debilitating

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Shinya Okuda, Takenori Oda, Ryoji Yamasaki, Takafumi Maeno and Motoki Iwasaki

W hereas posterior lumbar interbody fusion (PLIF) with pedicle screw fixation has shown satisfactory clinical results, 4–6 solid fusion has been reported as one of the risk factors for adjacent-segment degeneration (ASD). Adjacent-segment degeneration after PLIF is one of the most important sequelae affecting long-term results. Although several reports have described the occurrence rate and risk factors for ASD, 1 , 3 , 7 , 8 there have been no reports of repeated ASD. A patient who developed ASD three times after repeated PLIFs is described. Patients

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Matthew D. Alvin, Jacob A. Miller, Daniel Lubelski, Benjamin P. Rosenbaum, Kalil G. Abdullah, Robert G. Whitmore, Edward C. Benzel and Thomas E. Mroz

Kingdom. TABLE 3: Cost analyses of lumbar spine surgery (1976–2014) * Authors & Year Study Design No. of Patients Follow-Up (mos) Indication Intervention Perspective CCM Discount Rate (%) DC ($) IC ($) LR Adogwa et al., 20123 RC 50 24 ASD revision fusion societal Medicare NR 30,216 20,979 2 Adogwa et al., 20122 RC 42 24 spinal stenosis revision fusion societal Medicare NR 32,965 19,927 2 Glassman et al., 2012 PC 80 60 DDD posterolateral

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Sanjay S. Dhall, Tanvir F. Choudhri, Jason C. Eck, Michael W. Groff, Zoher Ghogawala, William C. Watters III, Andrew T. Dailey, Daniel K. Resnick, Alok Sharan, Praveen V. Mummaneni, Jeffrey C. Wang and Michael G. Kaiser

III Cohort of 193 pts (data collected from 3 trials) w/ heterogeneous diagnoses: spondylolisthesis, instability, DDD, ASD, nonunion; all underwent instrumented PLF. Used CT scans instead of radiographs, ODI, medical outcomes study (MOS), SF-36. No loss to follow-up reported. Compared outcomes in pts w/ & w/ o fusion; SF-36 & VAS (back & leg) scores did not show significant btwn-groups difference at 2 yrs. But 65% of pts w/ fusion achieved MCID on ODI vs 32% of pts w/ o fusion (p = 0.004) & similar for SCB on ODI. 67% vs 50% reached SF-36 MCID (p = 0.152) & 63% vs

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Owoicho Adogwa, Terence Verla, Paul Thompson, Anirudh Penumaka, Katherine Kudyba, Kwame Johnson, Erin Fulchiero, Timothy Miller Jr., Kimberly B. Hoang, Joseph Cheng and Carlos A. Bagley

L ow -back pain (LBP) is a leading cause of disability among elderly patients. Adjacent-segment disease (ASD), pseudarthrosis, and lumbar spinal stenosis are well-defined causes of disability in the elderly and have been increasingly recognized as causes of LBP and claudication. Although surgical treatment has been traditionally contraindicated in patients of advanced age, there is increasing debate regarding the need for surgical intervention in these patients. 6 , 11 , 15 , 16 , 29 , 33 However, surgical repair of the degenerated lumbar spine in an aging

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Christopher I. Shaffrey and Justin S. Smith

revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis”) is a study that provides some interesting perspectives on the surgical management of more complex disorders of the lumbar spine in older patients. 3 This study evaluated factors affecting clinical outcomes in 69 patients undergoing revision neural decompression and instrumented fusion for adjacent-segment disease (ASD), pseudarthrosis, or same-level recurrent stenosis. 3 An important aspect of this study was the inclusion of the Zung self