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Seung-Jae Hyun, Ki-Jeong Kim, and Tae-Ahn Jahng

cervical hyperlordosis, posterior pelvic shift, knee flexion, hip extension, and pelvic retroversion. 7 , 8 , 12–16 These compensatory mechanisms resolve reciprocally following thoracolumbar realignment surgery. However, few reports have described how cervical kyphosis correction surgery affects global sagittal alignment (GSA). 17 , 18 A recent study demonstrated that once occiput-trunk (OT) concordance is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize the entire spinal alignment following cervical reconstructive surgery. 18 The

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Frank L. Acosta Jr., John Liu, Nicholas Slimack, David Moller, Richard Fessler, and Tyler Koski

. Nevertheless, precise measurements of changes in segmental, regional, and global sagittal alignment after the lateral transpsoas approach are lacking. Data on the ability of this technique to improve coronal and sagittal plane alignment will be important in determining its overall usefulness as a surgical tool for the correction of spinal imbalance resulting from degenerative lumbar disease. The purpose of this study was to analyze the effect of minimally invasive lumbar interbody fusion via the lateral transpsoas approach utilizing the DLIF technique on segmental, regional

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Yoji Ogura, Yoshio Shinozaki, Yoshiomi Kobayashi, Takahiro Kitagawa, Yoshiro Yonezawa, Yohei Takahashi, Kodai Yoshida, Akimasa Yasuda, and Jun Ogawa

patients with lumbar spinal canal stenosis . J Neurosurg Spine 23 : 49 – 54 , 2015 10.3171/2014.11.SPINE14452 25840041 3 Dohzono S , Toyoda H , Takahashi S , Matsumoto T , Suzuki A , Terai H , : Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis . J Neurosurg Spine 25 : 39 – 45 , 2016 10.3171/2015.12.SPINE15805 26967988 4 Fujii K , Kawamura N , Ikegami M , Niitsuma G , Kunogi J : Radiological improvements in global sagittal alignment

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Ingrid Radovanovic, Jennifer C. Urquhart, Venkat Ganapathy, Fawaz Siddiqi, Kevin R. Gurr, Stewart I. Bailey, and Christopher S. Bailey

, Niitsuma G , Kunogi J : Radiological improvements in global sagittal alignment after lumbar decompression without fusion . Spine (Phila Pa 1976) 40 : 703 – 709 , 2015 25394314 10.1097/BRS.0000000000000708 5 Glassman SD , Berven S , Bridwell K , Horton W , Dimar JR : Correlation of radiographic parameters and clinical symptoms in adult scoliosis . Spine (Phila Pa 1976) 30 : 682 – 688 , 2005 10.1097/01.brs.0000155425.04536.f7 15770185 6 Grevitt M , Khazim R , Webb J , Mulholland R , Shepperd J : The Short Form-36 Health

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Justin K. Scheer, Jessica A. Tang, Justin S. Smith, Frank L. Acosta Jr., Themistocles S. Protopsaltis, Benjamin Blondel, Shay Bess, Christopher I. Shaffrey, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher P. Ames, and the International Spine Study Group

from the centroid of C-2 (or dens) and the posterosuperior aspect of C-7 (C2–7 SVA; Figs. 2 and 3 ) The gravity line measured from the center of gravity of the head has been proposed as an additional method to the C-7 plumb line to assess global sagittal alignment (center of gravity SVA; Fig. 3 left ). 22 , 25 , 62 , 65 , 69 , 93 , 115 This method may also be applied regionally to cervical SVA using a plumb line drawn from the center of gravity of the head instead of C-2 (center of gravity to C-7 SVA). On lateral radiographs, the center of gravity of the head

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Paraspinal muscle size as an independent risk factor for proximal junctional kyphosis in patients undergoing thoracolumbar fusion

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Zach Pennington, Ethan Cottrill, A. Karim Ahmed, Peter Passias, Themistocles Protopsaltis, Brian Neuman, Khaled M. Kebaish, Jeff Ehresman, Erick M. Westbroek, Matthew L. Goodwin, and Daniel M. Sciubba


Proximal junctional kyphosis (PJK) is a structural complication of spinal fusion in 5%–61% of patients treated for adult spinal deformity. In nearly one-third of these cases, PJK is progressive and requires costly surgical revision. Previous studies have suggested that patient body habitus may predict risk for PJK. Here, the authors sought to investigate abdominal girth and paraspinal muscle size as risk factors for PJK.


All patients undergoing thoracolumbosacral fusion greater than 2 levels at a single institution over a 5-year period with ≥ 6 months of radiographic follow-up were considered for inclusion. PJK was defined as kyphosis ≥ 20° between the upper instrumented vertebra (UIV) and two supra-adjacent vertebrae. Operative and radiographic parameters were recorded, including pre- and postoperative sagittal vertical axis (SVA), sacral slope (SS), lumbar lordosis (LL), pelvic tilt, pelvic incidence (PI), and absolute value of the pelvic incidence–lumbar lordosis mismatch (|PI-LL|), as well as changes in LL, |PI-LL|, and SVA. The authors also considered relative abdominal girth and the size of the paraspinal muscles at the UIV.


One hundred sixty-nine patients met inclusion criteria. On univariate analysis, PJK was associated with a larger preoperative SVA (p < 0.001) and |PI-LL| (p = 0.01), and smaller SS (p = 0.004) and LL (p = 0.001). PJK was also associated with more positive postoperative SVA (p = 0.01), ΔSVA (p = 0.01), Δ|PI-LL| (p < 0.001), and ΔLL (p < 0.001); longer construct length (p = 0.005); larger abdominal girth–to-muscle ratio (p = 0.007); and smaller paraspinal muscles at the UIV (p < 0.001). Higher postoperative SVA (OR 1.1 per cm), smaller paraspinal muscles at the UIV (OR 2.11), and more aggressive reduction in |PI-LL| (OR 1.03) were independent predictors of radiographic PJK on multivariate logistic regression.


A more positive postoperative global sagittal alignment and smaller paraspinal musculature at the UIV most strongly predicted PJK following thoracolumbosacral fusion.

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Lawrence G. Lenke

It has become increasingly clear in the past decade that local, regional, and global sagittal alignment of the spinal column is strongly correlated to both quality of life assessments and also the results of spinal surgical interventions. Traditional open spinal reconstructive procedures have emphasized these sagittal parameters recently, correlating to successful radiographic and clinical results. However, the quest for similar type of results when using less invasive surgical techniques has been more challenging. In their article, Manwaring and colleagues

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Alexandria C. Marino, Thomas J. Buell, Rebecca M. Burke, Tony R. Wang, Chun-Po Yen, Christopher I. Shaffrey, and Justin S. Smith

recovery was uneventful. 3:06 Recovery from stage 1 Standing scoliosis films were obtained on postoperative day 3. Global sagittal alignment was 8.5 cm. Pelvic tilt improved from 42° to 30°. Pelvic incidence remained 71°. Lumbar lordosis was improved to 45°. Thoracic kyphosis remained stable at 31°. We felt we achieved enough correction that the stage 2 posterior revision would utilize Smith-Petersen osteotomies without the need for a pedicle subtraction osteotomy. Details of the posterior revision will be described by my colleague Dr. Marino. 3:43 Stage 2 incision and

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surveys than NONOP (p<0.05). OP and NONOP had similar coronal alignment (p<0.05). OP had worse sagittal spinopelvic alignment for all measures than NONOP except cervical lordosis, TK and pelvic incidence (PI). OP had greater percentage of pure sagittal classification (type S; OP=23%, NON=14%; p<0.05). OP had worse grades for all modifier categories: PT (26% vs 16%), PI-lumbar lordosis mismatch (37% vs 21%) and global sagittal alignment (29% vs 9%), OP vs NONOP, respectively (p<0.05). Conclusion: Prospective analysis of OP vs NONOP treated ASD patients demonstrated

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Robert F. Heary and Reza J. Karimi

–3 rt L2–3 bilat cage level(s) NA L3–4, L4–5 NA NA fusion levels L2–S1 L2–5 T11–S1 T11–L4 reference levels for Cobb angle L2–5 L2–3 T12–L4 L1–4 preop coronal curve (Cobb angle in °) 22.3 35 35.9 26.5 postop coronal curve (°) 10.4 2.1 24.7 11.1 coronal curve correction (%) 11.9 (53) 32.9 (94) 11.2 (31) 15.4 (58) preop global sagittal alignment (cm) +4.5 +2.5 +2.5 –2 postop global sagittal alignment (cm) +5 +2 +1.9 –1.8 fusion achieved yes yes yes yes * NA