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Kazunori Hayashi, Hiromitsu Toyoda, Hidetomi Terai, Akinobu Suzuki, Masatoshi Hoshino, Koji Tamai, Shoichiro Ohyama, and Hiroaki Nakamura

cervical parameters, such as the cervical lordotic angle (CLA), in patients with AIS is not clearly elucidated because of the lack of reports on reciprocal changes outside of the fused segments after posterior corrective spinal fusion. 8 , 9 , 12 , 18 There are only a few radiographic and clinical studies that evaluate both preoperative and postoperative courses of patients with cervical hyperkyphosis. Some studies have identified risk factors for postoperative cervical hyperkyphosis after AIS surgery. However, none of the previous studies performed multivariate

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

researchers reported that a subsequent significant change in thoracolumbar alignment was observed in head-balanced patients and those with cervical spinal balance (sagittal vertical axis [SVA] C2–7 < 40 mm). However, a major limitation of the study was that they did not investigate changes in lower-extremity alignment or associations with patient-reported health-related quality of life (HRQOL). With advancements in whole-body stereoradiography (EOS imaging), the reciprocal changes in both cervical and lower-extremity compensatory mechanisms in patients with a

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Taemin Oh, Justin K. Scheer, Robert Eastlack, Justin S. Smith, Virginie Lafage, Themistocles S. Protopsaltis, Eric Klineberg, Peter G. Passias, Vedat Deviren, Richard Hostin, Munish Gupta, Shay Bess, Frank Schwab, Christopher I. Shaffrey, and Christopher P. Ames

can demonstrate dynamic changes postoperatively, a phenomenon referred to as “reciprocal change.” Reciprocal changes in neighboring unfused segments have been described following instrumentation and fusion, and these relationships carry compelling implications for patient management. At times, reciprocal changes have been shown to improve patient outcomes, as evidenced by spontaneous correction of increased CL following lumbar pedicle subtraction osteotomy (PSO). 25 Occasionally, however, the converse has been observed. In a study conducted by Lafage et al., for

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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Benjamin Blondel, Frank Schwab, Richard Hostin, Robert Hart, Brian O'Shaughnessy, Shay Bess, Serena S. Hu, Vedat Deviren, Christopher P. Ames, and International Spine Study Group

-related quality of life measures. 8 , 31 Although most improvement in sagittal alignment after spinal deformity surgery occurs within the instrumented and fused spinal segments, there is increasing appreciation of the changes in spinopelvic alignment that occur outside the fused spinal segments. These alignment changes have been termed “reciprocal changes” and have been reported for the thoracic and lumbar regions, as well as the pelvis. Klineberg et al. 15 recently reported that a thoracic osteotomy with limited fusion for correction of kyphosis results in a spontaneous

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Liang Xu, Benlong Shi, Yong Qiu, Zhonghui Chen, Xi Chen, Song Li, Changzhi Du, Qingshuang Zhou, Zezhang Zhu, and Xu Sun

.43 3.5 ± 0.39 0.558   Latest FU 4.1 ± 0.51 4.3 ± 0.48 0.337  Satisfaction   Latest FU 4.4 ± 0.44 4.3 ± 0.39 0.562 Values are presented as the mean ± SD. Discussion This study retrospectively reviewed 59 SK patients (including 35 patients in the T-SK group and 24 patients in the TL-SK) who underwent posterior-only correction via multilevel Ponte osteotomies. Our results demonstrated that preoperative CL in the T-SK group was significantly greater compared to the TL-SK group. After surgery, reciprocal changes were noted in the two groups, with CL significantly

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M. Burhan Janjua, Jared C. Tishelman, Dennis Vasquez-Montes, Max Vaynrub, Thomas J. Errico, Aaron J. Buckland, and Themistocles Protopsaltis

imaging such as MRI or CT can be an adjunct. A recent study has demonstrated the utility of advanced supine imaging to assess the flexibility of the lumbar spine as a part of surgical planning. 1 However, postoperative alignment changes in unfused adjacent segments are often overlooked. The concept of reciprocal changes in unfused segments proximal to the instrumentation and deformity correction has been well described in the literature. 16 The greater incidence of kyphosis progression reported among patients undergoing shorter segment fusions following lower thoracic

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

< 0.001). There were also reciprocal changes to the distal spine: TK (54.4° vs 46.4°, p < 0.001), LL (49.9° vs 45.8°, p = 0.003), and TLS (13.9° vs 11.1°, p = 0.009). Cervical, thoracolumbar, and spinopelvic parameters were compared in three distinct cohorts: all patients, patients who underwent high-grade osteotomies, and patients who underwent low-grade osteotomies. When considering patients who underwent 3CO, significant improvement was observed in all cervical measurements: cSVA (6.5 vs 3.8 cm, p < 0.001), CL (2.3° [kyphosis] vs −6.7° [lordosis], p < 0.001), CS

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Peter G. Passias, Haddy Alas, Sara Naessig, Han Jo Kim, Renaud Lafage, Christopher Ames, Eric Klineberg, Katherine Pierce, Waleed Ahmad, Douglas Burton, Bassel Diebo, Shay Bess, D. Kojo Hamilton, Munish Gupta, Paul Park, Breton Line, Christopher I. Shaffrey, Justin S. Smith, Frank Schwab, Virginie Lafage, and the International Spine Study Group

proximal junctional kyphosis (PJK), a common concern among surgeons performing long-construct thoracolumbar (TL) fusions. PJK has an incidence rate previously reported to be between 11% and 41% in comparative studies, although recent studies have found rates exceeding 60% with long-term follow-up. 8–10 Reciprocal changes in neighboring spinal regions have been well described following ASD surgery, including thoracic hyperkyphosis following lumbar osteotomy and loss of lumbar lordosis (LL) following thoracic osteotomy. 11–13 Smith et al. demonstrated that patients with

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. You may not sell, republish, or systematically distribute any published materials without written permission from JNSPG. 2015 Introduction: Patients (pts) with thoracolumbar deformity employ compensatory mechanisms to maintain horizontal gaze, which may result in cervical mal-alignment. However, the effects of these reciprocal changes on regional cervical disability have not been well studied in this pt population. The objective of the present study is two-fold: a) to report baseline regional neck disability in adult spinal deformity (ASD) and b) to

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there was a significant increase of lumbar lordosis (24° vs. 42°, p<0.001) and T5-T12 kyphosis (30° vs. 53°, p<0.001). Though there was a trend toward decrease in the mean PT following index procedure, this did not reached statistical significance. There was no relation between absolute PJK angle and revision surgery for and a higher angle did not portrayed requirement of revision surgery. Conclusion: The susceptibility to PJK may relate to development of an exaggerated reciprocal change in thoracic kyphosis to offset a significant increase in lumbar lordosis