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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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Morsi Khashan, Micheal Raad, Mostafa H. El Dafrawy, Varun Puvanesarajah and Khaled M. Kebaish

KH , Sehn JK , Milby AH , Bumpass D , : Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures . Spine (Phila Pa 1976) 37 : 1198 – 1210 , 2012 10.1097/BRS.0b013e31824fffde 22366971 2 Bridwell KH , Lenke LG , Baldus C , Blanke K : Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution . Spine (Phila Pa 1976) 23 : 324 – 331 , 1998 10.1097/00007632-199802010-00008 9507620 3 Charlson ME , Pompei

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Darryl Lau, Andrew K. Chan, Vedat Deverin and Christopher P. Ames

(inability to complete activities of daily living and instrumental activities of daily living). 9 In addition, patients with ASD present with poor self-esteem and personal dissatisfaction. 8 , 10 , 14 , 19 , 22 The surgical correction of spinal imbalance can be effective in addressing the aforementioned problems in well-selected patients. 13 , 18 , 20 In patients with fixed, immobile thoracolumbar spinal deformities, 3-column osteotomies and long construct instrumented fusion are often warranted to achieve optimal correction and spinal balance. 21 The morbidity

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Emmanuelle Ferrero, Barthelemy Liabaud, Jensen K. Henry, Christopher P. Ames, Khaled Kebaish, Gregory M. Mundis, Richard Hostin, Munish C. Gupta, Oheneba Boachie-Adjei, Justin S. Smith, Robert A. Hart, Ibrahim Obeid, Bassel G. Diebo, Frank J. Schwab and Virginie Lafage

alignment to reset the compensatory mechanisms and improve the patient’s functional status. The Scoliosis Research Society–Schwab deformity classification established key radiographic sagittal parameters with ideal thresholds for realignment in terms of sagittal vertical axis (SVA), pelvic incidence (PI) minus LL (i.e., PI-LL mismatch), and pelvic tilt (PT). 13 , 22 , 39 The 3-column osteotomy (3CO) is a powerful method to correct fixed spinal deformity. 2 , 4 , 9 , 12 , 27 , 30 , 37 , 40 , 42 , 43 Several studies have emphasized the importance of preoperative planning

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Darryl Lau, Alexander F. Haddad, Vedat Deviren and Christopher P. Ames

, individual sagittal plane deformities can vary significantly, and understanding the underlying cause of sagittal imbalance and spinopelvic mismatch is one of the most important components to proper surgical management of ASD patients. Deciding at which level to perform a 3-column osteotomy (3CO) is dependent on a variety of factors, such as the presence of apical deformity, Roussouly sagittal alignment type, and/or type of spinopelvic imbalance. 4 Building on previous work investigating sagittal alignment, there is an accumulation of research supporting the importance of

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Shayan Fakurnejad, Justin K. Scheer, Virginie Lafage, Justin S. Smith, Vedat Deviren, Richard Hostin, Gregory M. Mundis Jr., Douglas C. Burton, Eric Klineberg, Munish Gupta, Khaled Kebaish, Christopher I. Shaffrey, Shay Bess, Frank Schwab, Christopher P. Ames and The International Spine Study Group

R igid adult spinal deformity (ASD) may be surgically corrected with 3-column osteotomy (3CO) techniques such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). 4 , 5 , 8 , 17 , 35 , 38 These techniques allow for significant correction of severe rigid spinal deformity in the sagittal, coronal, and axial planes simultaneously through a posterior-only approach. 1 , 4 , 8 , 17 , 18 , 35 , 36 , 38 Both 3CO procedures are technically challenging and are associated with significant morbidity rates, but have resulted in significant

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Darryl Lau, Vedat Deviren and Christopher P. Ames

for 3-column osteotomy (3CO) for ASD can be prolonged, 6 and published data regarding the learning curve for 3CO specifically are presently limited to consecutive series of 34–102 patients. 6 , 10 , 24 Therefore, the learning curve for thoracolumbar 3CO in patients with ASD is not well defined, and it is unclear how perioperative results are affected by the surgeon’s experience. In this study, we examine a single surgeon’s consecutive 13-year experience in thoracolumbar 3CO for ASD and evaluate how experience affects perioperative results. Methods This study was

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Darryl Lau, Vedat Deviren, Rushikesh S. Joshi and Christopher P. Ames

, especially in cases with rigid and fused deformities that require release via spinal osteotomies. A number of different surgical strategies exist for cervical deformity correction, including anterior-only, posterior-only, and combined anterior-posterior approaches. However, the optimal surgical approach depends on a number of anatomical and deformity-specific considerations. Osteotomy types that can be performed in the cervicothoracic region include anterior column osteotomy, Smith-Petersen osteotomy (SPO), and posterior-based 3-column osteotomy (3CO) via pedicle

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Justin S. Smith, Christopher I. Shaffrey, Eric Klineberg, Virginie Lafage, Frank Schwab, Renaud Lafage, Han Jo Kim, Richard Hostin, Gregory M. Mundis Jr., Munish Gupta, Barthelemy Liabaud, Justin K. Scheer, Bassel G. Diebo, Themistocles S. Protopsaltis, Michael P. Kelly, Vedat Deviren, Robert Hart, Doug Burton, Shay Bess and Christopher P. Ames

A lthough multiple studies have shown the potential for significant improvement in pain and disability with surgery for adult spinal deformity (ASD), 11 , 12 , 53 , 56 , 59–61 these procedures are associated with high rates of complications. 47 , 53 , 54 , 57 , 61 , 63 Correction of ASD often relies upon the use of osteotomies that range from simple facet releases to 3-column osteotomies (3COs), which include pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). 13 , 14 , 49 Use of 3CO is typically reserved for the most severe and often

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Darryl Lau, Joseph A. Osorio, Vedat Deviren and Christopher P. Ames

osteotomies. Several spinal osteotomy techniques have been described throughout the literature, and more recently thoracolumbar osteotomies were classified based on extent of bony resection and anatomical location. 37 In cases in which substantial corrections are needed, 3-column osteotomies such as pedicle subtraction osteotomy (PSO; grade 4 osteotomy) or vertebral column resection (VCR; grade 5 and 6 osteotomy) are used to maximize destabilizing potential to achieve maximal spinal mobility and correction. Three-column osteotomies have proven to be powerful techniques; a