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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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Michael Y. Wang

Adult spinal deformities (ASD) pose a challenge for the spinal surgeon. Because the spine is often rigid, mobilization of the segments is critical for effective correction, particularly in the sagittal plane. 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 problematic using MIS approaches, including MIS lateral methods. This video illustrates one method for achieving improvement of coronal and sagittal correction without the extensive exposure and soft tissue envelope disruption needed in open surgery, particularly for less severe deformities. By using multi-level TLIFs through a mini-open surgery, curves of less than 60° can be managed with minimal blood loss and within a reasonable surgical timeframe. While feasibility will have to be proven with larger series and improved surgical methods, this technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.

The video can be found here: http://youtu.be/I0rkDSAVas0.

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Ali A. Baaj, Juan S. Uribe, Fernando L. Vale, Mark C. Preul and Neil R. Crawford

. 2–4 A better understanding of ASD, however, has been slowly changing attitudes toward fusion. Hilibrand et al. 17 demonstrated an ASD rate of 2.9%/year, leading to a significant number of reoperations. Similar studies by Katsuura et al. 18 and Goffin et al. 13 reported ASD rates as high as 50 and 36%, respectively. With biomechanical 10 and clinical 13 , 17 , 18 , 30 data demonstrating progression of ASD in the cervical spine after arthrodesis, interest in motion-preserving technology is likely to continue. The goal of this review was to highlight the

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David B. Bumpass, Lawrence G. Lenke, Jeffrey L. Gum, Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames, Shay Bess, Brian J. Neuman, Eric Klineberg, Gregory M. Mundis Jr., Frank Schwab, Virginie Lafage, Han Jo Kim, Douglas C. Burton, Khaled M. Kebaish, Richard Hostin, Renaud Lafage, Michael P. Kelly and for the International Spine Study Group

T he role of sex in adult spinal deformity (ASD) surgery outcomes has not been extensively investigated. In contrast, several studies in the pediatric deformity population have demonstrated that sex does play a role in perioperative outcomes. 11 , 16 , 22 These studies found that male adolescent idiopathic scoliosis (AIS) patients had greater preoperative curve magnitude, less preoperative curve flexibility, and less deformity correction than female patients. Male patients also had greater estimated blood loss (EBL), longer operative duration, and higher

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Eitan M. Kohan, Venu M. Nemani, Stuart Hershman, Daniel G. Kang and Michael P. Kelly

B oth osteoporosis and adult spinal deformity (ASD) are associated with advancing age and often occur concurrently. 14 Osteoporosis is a common disease in the United States, affecting an estimated 53.6 million Americans in 2010. 39 While the exact prevalence of ASD is unknown, estimates range from 2.5% to 25% of the population. 2 , 7 , 13 , 24 , 27 , 31 Preoperative identification and treatment of patients with osteoporosis are important, as accurate measurement of BMD predicts postoperative instability and fracture risk. 17 , 21 However, the most widely

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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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Martin H. Pham, Vivek A. Mehta, Neil N. Patel, Andre M. Jakoi, Patrick C. Hsieh, John C. Liu, Jeffrey C. Wang and Frank L. Acosta

D ynamic stabilization of the spine is a potential alternative to rigid lumbar fusion for lumbar degenerative spinal disease. 34 , 40 , 41 , 51 , 59 Recently, a nonfusion stabilization system with motion preservation (Dynesys system, Zimmer Spine) has been explored as an alternative to fusion in an effort to reduce adjacent-segment disease (ASD) and maintain greater physiological movement and function. 31 , 32 , 47 , 61 Dynesys is a pedicle screw–based dynamic stabilization system that has been used since 1994 and consists of pedicle screws, flexible

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Emily K. Miller, Brian J. Neuman, Amit Jain, Alan H. Daniels, Tamir Ailon, Daniel M. Sciubba, Khaled M. Kebaish, Virginie Lafage, Justin K. Scheer, Justin S. Smith, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group

predict mortality and self-management ability in nonoperatively treated populations, these indices have recently been shown to be better predictors of perioperative adverse events than chronological age alone. 6 , 11 , 12 , 17 Numerous methods for frailty quantification have been developed and validated. 3 , 4 , 7 , 13 , 15–18 Searle et al. proposed and validated a method for creating frailty indices by using large, existing patient databases. This step-by-step method was used to create a frailty index (the adult spinal deformity frailty index [ASD-FI]) in this study

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Pierce D. Nunley, Gregory M. Mundis Jr., Richard G. Fessler, Paul Park, Joseph M. Zavatsky, Juan S. Uribe, Robert K. Eastlack, Dean Chou, Michael Y. Wang, Neel Anand, Kelly A. Frank, Marcus B. Stone, Adam S. Kanter, Christopher I. Shaffrey, Praveen V. Mummaneni and the International Spine Study Group

F or hospitals to continue to provide excellent care for adult spinal deformity (ASD) surgery, they must be able to adequately recover their costs for these procedures. The introduction of Medicare’s Prospective Payment System (PPS) in 1983 led to the development of a fixed payment amount for each patient upon hospital discharge ( https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html ). 1 The fixed payment amount is determined based on the particular diagnosis-related group (DRG) coded at patient discharge and it is intended

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Hazem Mashaly, Erin E. Paschel, Nicolas K. Khattar, Ezequiel Goldschmidt and Peter C. Gerszten

may have undesirable long-term effects on the remainder of the spine, particularly on the immediately adjacent motion segments. 5 , 7 Although instrumented fusion has been demonstrated to have satisfactory clinical results, it has been reported to accelerate degenerative changes at adjacent levels. Adjacent-segment disease (ASD) is a term used to describe any abnormal symptomatic change that can develop in the spinal segment adjacent to a solid fusion level, such as disc herniation, lumbar instability, stenosis, or facet joint arthropathy. 17 Adjacent