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Tatsuya Yasuda, Tomohiko Hasegawa, Yu Yamato, Daisuke Togawa, Sho Kobayashi, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe and Yukihiro Matsuyama

R ecent studies have shown that sagittal spinopelvic alignment, including pelvic position, plays a critical role in the health-related quality of life of patients with adult spinal deformity (ASD). 4 , 7 , 12 , 13 Therefore, the goal of corrective surgery for ASD is to achieve and maintain optimal spinopelvic alignment. Lumbar lordosis (LL) is one of the important parameters for optimal sagittal alignment. The achievement of adequate LL is necessary for good results in corrective surgeries in spinal fusion. Additionally, LL is one of the main parameters that

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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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Rafael De la Garza-Ramos, Amit Jain, Khaled M. Kebaish, Ali Bydon, Peter G. Passias and Daniel M. Sciubba

1 Charosky S , Guigui P , Blamoutier A , Roussouly P , Chopin D : Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients . Spine (Phila Pa 1976) 37 : 693 – 700 , 2012 2 Cram P : Assessing hospital productivity . Health Aff (Millwood) 34 : 1069 , 2015 3 Daubs MD , Lenke LG , Cheh G , Stobbs G , Bridwell KH : Adult spinal deformity surgery: complications and outcomes in patients over age 60 . Spine (Phila Pa 1976) 32 : 2238 – 2244 , 2007 4 Diebo BG , Passias PG

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Alex Soroceanu, Douglas C. Burton, Bassel Georges Diebo, Justin S. Smith, Richard Hostin, Christopher I. Shaffrey, Oheneba Boachie-Adjei, Gregory M. Mundis Jr., Christopher Ames, Thomas J. Errico, Shay Bess, Munish C. Gupta, Robert A. Hart, Frank J. Schwab, Virginie Lafage and International Spine Study Group

number is expected to increase. Adult spinal deformity (ASD) is common, and its incidence increases with age. The prevalence of ASD in the elderly population has been investigated, with Schwab et al. 56 reporting rates of ASD up to 68% in patients over the age of 65 years. Regarding ASD treatment, multiple reports have documented the superiority of surgical intervention and its potential ability to improve pain and disability, the 2 primary presenting complaints of patients with ASD. 5 , 23 , 61 , 62 However, several authors have identified high complication

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Junseok Bae, Alexander A. Theologis, Russell Strom, Bobby Tay, Shane Burch, Sigurd Berven, Praveen V. Mummaneni, Dean Chou, Christopher P. Ames and Vedat Deviren

T reatment options for adult spinal deformity (ASD) are varied according to the patient’s baseline condition. Patients with minimal pain and mild thoracolumbar coronal deformity might benefit from conservative treatment. 18 The goal of surgical treatment for patients with ASD is to achieve sagittal and coronal balance, relieve axial and radiating pain, and achieve fusion. The surgical treatment of ASD is an effective endeavor that can be accomplished using a variety of surgical strategies. Interbody fusion has been advocated as an important surgical option in

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Justin K. Scheer, Justin S. Smith, Frank Schwab, Virginie Lafage, Christopher I. Shaffrey, Shay Bess, Alan H. Daniels, Robert A. Hart, Themistocles S. Protopsaltis, Gregory M. Mundis Jr., Daniel M. Sciubba, Tamir Ailon, Douglas C. Burton, Eric Klineberg, Christopher P. Ames and The International Spine Study Group

T he surgical management of adult spinal deformity (ASD) can provide significant improvements in pain, disability, and health-related quality of life (HRQOL). 6 , 7 , 28 , 34 , 36–38 , 40–45 However, these procedures are technically demanding and are associated with a high complication rate. The patient population suitable for these complicated surgeries continues to increase, including patients of advanced age. 2 , 16 , 17 , 27 The reported complication rates in the literature are varied and range from 14% to 71%. 11 , 13 , 39 , 47 , 48 It has been

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Juan S. Uribe, Armen R. Deukmedjian, Praveen V. Mummaneni, Kai-Ming G. Fu, Gregory M. Mundis Jr., David O. Okonkwo, Adam S. Kanter, Robert Eastlack, Michael Y. Wang, Neel Anand, Richard G. Fessler, Frank La Marca, Paul Park, Virginie Lafage, Vedat Deviren, Shay Bess and Christopher I. Shaffrey

O ver the past several decades, surgical treatment options for adult spinal deformity (ASD) have expanded, including both minimally invasive and open techniques. 3 , 12 , 14 , 18 , 27 Determining the most suitable approach in patients should take into account the risks and benefits of each surgical technique. Unfortunately, studies comparing the different operative techniques are lacking. Moreover, outcomes and complications of ASD are largely reported in terms of patient characteristics following traditional open techniques with little published data

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Max S. Riley, Keith H. Bridwell, Lawrence G. Lenke, Jonathan Dalton and Michael P. Kelly

10.1097/01.brs.0000201331.50597.ea 3 Auerbach JD , Lenke LG , Bridwell 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 4 Bridwell KH , Baldus C , Berven S , Edwards C II , Glassman S , Hamill C , : Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to

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Russell G. Strom, Junseok Bae, Jun Mizutani, Frank Valone III, Christopher P. Ames and Vedat Deviren

L oss of sagittal balance is associated with pain and disability, and its restoration is the primary goal of adult spinal deformity (ASD) surgery. 13 , 16 Facet osteotomies often provide limited sagittal correction because stiff, collapsed disc spaces impair posterior shortening. Moderate to severe ASD generally requires anterior disc space augmentation and/or posterior 3-column osteotomy. 6 Anterior lumbar interbody fusion (ALIF) and pedicle subtraction osteotomy (PSO) each carry significant risks. 5 , 11 , 17 , 29 , 33 , 34 Lateral lumbar interbody

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Varun Puvanesarajah, Sandesh S. Rao, Hamid Hassanzadeh and Khaled M. Kebaish

S urgery for adult spinal deformity (ASD) is associated with substantial blood loss because of the extensive soft-tissue dissection and osteotomies required. 17 This increased risk of blood loss leads to a greater need for intravascular volume replacement. From 2000 to 2009, the number of allogeneic blood transfusions performed during spinal arthrodesis increased. 34 However, allogeneic transfusions in surgical patients are associated with increased rates of wound complications, postoperative infections, and pulmonary complications, although the causal