T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally.

Study Design: Retrospective review of a multicenter database of consecutive patients undergoing 3-column osteotomy for treatment of adult spinal deformity (ASD).

Objective: To rigorously develop a T1 pelvic angle (TPA) categorization paradigm and use it to assess the surgical management of patients with ASD.

Summary Of Background Data: TPA, the angle between the hips-T1 line and hips-S1 endplate line, is a novel spinopelvic parameter that assesses the combined effect of a loss of lordosis on trunk inclination and pelvic retroversion.

Coronal plane spinal malalignment and Parkinson's disease: prevalence and associations with disease severity.

Background Context: Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system. Patients with PD often present with abnormal posturing.

Purpose: To investigate coronal plane deformities in patients with PD, and to evaluate the correlation between clinical features, coronal parameters related to spine alignment, and disease severity.

Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity.

Study Design: Multicenter, prospective, consecutive case series.

Objective: To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities.

Summary Of Background Data: Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity.

Clinical improvement through nonoperative treatment of adult spinal deformity: who is likely to benefit?

Object: The goal of this study was to determine the outcome and risk factors in patients with adult spinal deformity (ASD) who elected to receive nonoperative care.

Methods: In this retrospective study the authors reviewed a nonoperative branch of the International Spine Study Group database, derived from 10 sites across the US. Specific inclusion criteria included nonoperative treatment for ASD and the availability of Scoliosis Research Society (SRS)-22 scores and radiographic data at baseline (BL) and at 1-year (1Y) follow-up.

Surgical treatment of pathological loss of lumbar lordosis (flatback) in patients with normal sagittal vertical axis achieves similar clinical improvement as surgical treatment of elevated sagittal vertical axis: clinical article.

Object: Increased sagittal vertical axis (SVA) correlates strongly with pain and disability for adults with spinal deformity. A subset of patients with sagittal spinopelvic malalignment (SSM) have flatback deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10°) but remain sagittally compensated with normal SVA. Few data exist for SSM patients with flatback deformity and normal SVA.

Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study.

Background Context: Whereas the costs of primary surgery, revisions, and selected complications for adult spinal deformity (ASD) have been individually reported in the literature, the total costs over several years after surgery have not been assessed. The determinants of such costs are also not well understood in the literature.

Purpose: This study analyzes the total hospital costs and operating room (OR) costs of ASD surgery through extended follow-up.

Complications and intercenter variability of three-column resection osteotomies for spinal deformity surgery: a retrospective review of 423 patients.

Study Type Retrospective review of a prospectively collected multicenter database. Introduction Three-column resection osteotomies (3CO), including pedicle subtraction osteotomies and vertebral column resections are performed for correction of sagittal deformity; however, they have high rates of reported complications. This study examined the incidence and intercenter variability of major intraoperative complications (IOC), postoperative complications (POC), and overall complications (IOC + POC) up to 6 weeks postoperation.

Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy.

Study Design: Narrative review.

Objective: To provide a comprehensive narrative review of cervical alignment parameters, the methods for quantifying cervical alignment, normal cervical alignment values, and how alignment is associated with cervical deformity and myelopathy with discussions of health-related quality of life.

Summary Of Background Data: Indications for surgery to correct cervical alignment are not well-defined and there is no set standard to address the amount of correction to be achieved.

Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

Study Design: Post hoc analysis of prospectively collected data.

Objective: Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM).

Summary Of Background Data: CSM is the leading cause of spinal cord dysfunction.

A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article.

Object: Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies.

Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis.

Study Design: Prospective multicenter study evaluating operative (OP) versus nonoperative (NONOP) treatment for adult spinal deformity (ASD).

Objective: Evaluate correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with ASD.

Summary Of Background Data: Sagittal spinal deformity is commonly defined by an increased sagittal vertical axis (SVA); however, SVA alone may underestimate the severity of the deformity.

Selection of fusion levels in adults with spinal deformity: an update.

Background Context: Adult spinal deformity (ASD) is commonly associated with disability and represents a challenging condition for physicians. Although surgical management has been reported as superior to conservative care, the choice of patient-specific optimal strategy has been poorly defined. A key question remains selection of fusion levels as this implies careful balance of risks and benefits.

Outcome assessment in neuromuscular spinal deformity.

Patient-based outcome measures are important tools quantifying the disease-specific and/or global quality of life (QOL) effects of spinal deformity treatment. In patients with neuromuscular disorders such as cerebral palsy, muscular dystrophy, and myelomeningocele, treatment effects must be differentiated from underlying disease functional impairments. In general, the goals of spinal surgery in these patients are to improve QOL by enhancing sitting balance and posture, improving lung and gastrointestinal function, and reducing pain and deformity.

Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults.

Purpose: Predictors of marked improvement versus failure to improve following surgery for adult scoliosis have not been identified. Our objective was to identify factors that distinguish between patients with the best and worst outcomes following surgery for adult scoliosis.

Methods: This is a secondary analysis of a prospective, multicenter spinal deformity database.

Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity.

Background: Improved understanding of rod fracture (RF) in adult spinal deformity could be valuable for implant design, surgical planning, and patient counseling.

Objective: To evaluate symptomatic RF after posterior instrumented fusion for adult spinal deformity.

Methods: A multicenter, retrospective review of RF in adult spinal deformity was performed.

Outcomes and complications of extension of previous long fusion to the sacro-pelvis: is an anterior approach necessary?

Background: Patients with previous multilevel spinal fusion may require extension of the fusion to the sacro-pelvis. Our objective was to evaluate the outcomes and complications of these patients, stratified based on whether the revision was performed using a posterior-only spinal fusion (PSF) or combined anterior-posterior spinal fusion (APSF).

Methods: A retrospective, multicenter evaluation of adults (>18 years old) with a history of prior spinal fusion for scoliosis (≥4 levels) terminating in the distal lumbar spine requiring extension of fusion to the sacro-pelvis (including iliac fixation in all cases), with minimum 2-year follow-up, was performed.

Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients.

Purpose: Major peri-operative complications for adult spinal deformity (ASD) surgery remain common. However, risk factors have not been clearly defined. Our objective was to identify patient and surgical parameters that correlate with the development of major peri-operative complications with ASD surgery.

Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?: Clinical article.

Object: Pedicle subtraction osteotomy (PSO) is a surgical procedure that is frequently performed on patients with sagittal spinopelvic malalignment. Although it allows for substantial spinopelvic realignment, suboptimal realignment outcomes have been reported in up to 33% of patients. The authors' objective in the present study was to identify differences in radiographic profiles and surgical procedures between patients achieving successful versus failed spinopelvic realignment following PSO.

Patient evaluation and clinical assessment of adult spinal deformity.

The clinical evaluation of adults with spinal deformity can be challenging for both general orthopaedic surgeons and spinal specialists. To properly treat these patients, the physician must be aware of the various types of adult spinal deformity and the basic principles of spinal misalignment. A complete patient assessment must include a thorough history and physical examination.

Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity.

Purpose: Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD).

Methods: Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO.

Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age.

Study Design: Retrospective review of a prospective, multicenter database.

Objective: The purpose of this study was to assess whether elderly patients undergoing scoliosis surgery had an incidence of complications and improvement in outcome measures comparable with younger patients.

Summary Of Background Data: Complications increase with age for adults undergoing scoliosis surgery, but whether this impacts the outcomes of older patients is largely unknown.

Factors affecting distal end & global decompensation in coronal/sagittal planes 2 years after fusion.

Introduction: Decompensation of un-fused vertebrae is a potential complication of spinal instrumentation performed for adolescent idiopathic scoliosis (AIS). This can result in problems requiring revision surgery. The purpose of this study was to compare patients who decompensated in the sagittal/coronal plane and those who do not and to identify risk factors.

Predicting outcome and complications in the surgical treatment of adult scoliosis.

Study Design: prospective, multicenter.

Objective: To determine if models for predicting outcome and complications in the setting of adult deformity surgery can be constructed.

Summary Of Background Data: A classification of adult spinal deformity has been established.

The impact of perioperative complications on clinical outcome in adult deformity surgery.

Study Design: Retrospective case-control series.

Objective: The purpose of this study is to determine whether perioperative complications alter subsequent clinical outcome measures in adult spinal deformity surgery.

Summary Of Background Data: Increasingly, the benefit of surgical intervention is being evaluated based on patient reported outcomes and standardized health related quality of life (HRQOL) measures.