Despite a Multifactorial Etiology, Rates of Distal Junctional Kyphosis After Adult Cervical Deformity Corrective Surgery Can be Dramatically Diminished by Optimizing Age Specific Radiographic Improvement.

Study Design: Retrospective cohort study of a prospectively collected single-center database.

Objective: Distal Junctional Kyphosis (DJK) is one of the most common complications in adult cervical deformity (ACD) correction. The utility of radiographic alignment alone in predicting and minimizing DJK occurrence warrants further study.

Determining the utility of three-column osteotomies in revision surgery compared with primary surgeries in the thoracolumbar spine: a retrospective cohort study in the United States.

Study Design: Retrospective cohort study.

Purpose: To determine the incidence and success of three-column osteotomies (3COs) performed in primary and revision adult spine deformity (ASD) corrective surgeries.

Overview Of Literature: 3COs are often required to correct severe, rigid ASD presentations.

Durability of substantial clinical benefit leading to optimal outcomes in adult spinal deformity corrective surgery: a minimum 5-year analysis.

Objective: The objective was to evaluate factors associated with the long-term durability of outcomes in adult spinal deformity (ASD) patients.

Methods: Operative ASD patients fused from at least L1 to the sacrum with baseline (BL) to 5-year (5Y) follow-up were included. Substantial clinical benefit (SCB) in Oswestry Disability Index (ODI), numeric rating scale (NRS)-back, NRS-leg, and Scoliosis Research Society (SRS)-22r scores and physical component score were assessed on the basis of previously published values.

Is It Possible for Patients with Early Distal Junctional Kyphosis following Adult Cervical Deformity Corrective Surgery to Achieve Similar Outcomes to Their Unaffected Counterparts? An Analysis of Recovery Kinetics.

Distal junctional kyphosis (DJK) is a concerning complication for surgeons performing cervical deformity (CD) surgery. Patients sustaining such complications may demonstrate worse recovery profiles compared to their unaffected peers. DJK was defined as a >10° change in kyphosis between LIV and LIV-2, and a >10° index angle.

The Incremental Clinical Benefit of Adding Layers of Complexity to the Planning and Execution of Adult Spinal Deformity Corrective Surgery.

Background And Objectives: For patients with surgical adult spinal deformity (ASD), our understanding of alignment has evolved, especially in the last 20 years. Determination of optimal restoration of alignment and spinal shape has been increasingly studied, yet the assessment of how these alignment schematics have incrementally added benefit to outcomes remains to be evaluated.

Methods: Patients with ASD with baseline and 2-year were included, classified by 4 alignment measures: Scoliosis Research Society (SRS)-Schwab, Age-Adjusted, Roussouly, and Global Alignment and Proportion (GAP).

The Impact of Peri-operative Enhanced Recovery After Surgery Protocols on Outcomes Following Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort study.

Objectives: To assess the impact of Enhanced recovery after surgery (ERAS) protocols on peri-operative course in adult cervical deformity (ACD) corrective surgery.

Methods: Patients ≥18 yrs with complete pre-(BL) and up to 2-year (2Y) radiographic and clinical outcome data were stratified by enrollment in an ERAS protocol that commenced in 2020.

Impact of congestive heart failure on patients undergoing lumbar spine fusion for adult spine deformity.

Background: With the increasing amount of elective spine fusion patients presenting with cardiac disease and congestive heart failure, it is becoming difficult to assess when it is safe to proceed with surgery. Assessing the severity of heart failure (HF) through ejection fraction may provide insight into patients' short- and long-term risks.

Purpose: The purpose of this study was to assess the severity of HF on perioperative outcomes of spine fusion surgery patients.

Assessing the Economic Benefits of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Cervical Deformity Patients: Is the Initial Additive Cost of Protocols Offset by Clinical Gains?

Objective: To assess the financial impact of Enhanced Recovery After Surgery (ERAS) protocols and cost-effectiveness in cervical deformity corrective surgery.

Study Design: Retrospective review of prospective CD database.

Background: Enhanced Recovery After Surgery (ERAS) can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care.

The Evolution of Enhanced Recovery After Surgery: Assessing the Clinical Benefits of Developments Within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort.

Objective: To investigate the impact of evolving Enhanced Recovery After Surgery (ERAS) protocols on outcomes after cervical deformity (CD) surgery.

Background: ERAS can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care.

Comparison of multilevel low-grade techniques versus three-column osteotomies in adult spinal deformity surgery: does harmonious correction matter?

Objective: Recent debate has arisen between whether to use a three-column osteotomy (3CO) or multilevel low-grade (MLG) techniques to treat severe sagittal malalignment in adult spinal deformity (ASD) surgery. The goal of this study was to compare the outcomes of 3CO and MLG techniques performed in corrective surgeries for ASD.

Methods: ASD patients who had a baseline PI-LL > 30° and 2-year follow-up data were included.

Factors Associated With the Maintenance of Cost-effectiveness at Five Years in Adult Spinal Deformity Corrective Surgery.

Study Design: Retrospective cohort.

Objective: To evaluate factors associated with the long-term durability of cost-effectiveness (CE) in ASD patients.

Background: A substantial increase in costs associated with the surgical treatment for adult spinal deformity (ASD) has given precedence to scrutinize the value and utility it provides.

Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool.

Purpose: To develop a simplified, modified frailty index for adult spinal deformity (ASD) patients dependent on objective clinical factors.

Methods: ASD patients with baseline (BL) and 2-year (2Y) follow-up were included. Factors with the largest R value derived from multivariate forward stepwise regression were including in the modified ASD-FI (clin-ASD-FI).

Predictors of reoperation for spinal disorders in Chiari malformation patients with prior surgical decompression.

Background: Chiari malformation (CM) is a cluster of related developmental anomalies of the posterior fossa ranging from asymptomatic to fatal. Cranial and spinal decompression can help alleviate symptoms of increased cerebrospinal fluid pressure and correct spinal deformity. As surgical intervention for CM increases in frequency, understanding predictors of reoperation may help optimize neurosurgical planning.

Persistent Lower Extremity Compensation for Sagittal Imbalance After Surgical Correction of Complex Adult Spinal Deformity: A Radiographic Analysis of Early Impact.

Background And Objectives: Achieving spinopelvic realignment during adult spinal deformity (ASD) surgery does not always produce ideal outcomes. Little is known whether compensation in lower extremities (LEs) plays a role in this disassociation. The objective is to analyze lower extremity compensation after complex ASD surgery, its effect on outcomes, and whether correction can alleviate these mechanisms.

Current concepts in adult cervical spine deformity surgery.

Cervical spine deformity surgery has significantly evolved over recent decades. There has been substantial work performed, which has furthered the true understanding of alignment and advancements in surgical technique and instrumentation. Concomitantly, understanding of cervical spine pathology and the contributing drivers have also improved, which have influenced the development of classification systems for cervical spine deformity and the development of treatment-guiding algorithms.

Achievement and Maintenance of Optimal Alignment After Adult Spinal Deformity Corrective Surgery: A 5-Year Outcome Analysis.

Objective: We sought to assess factors contributing to optimal radiographic outcomes.

Methods: Operative adult spinal deformity (ASD) patients with baseline and 5-year (5Y) data were included. Optimal alignment (O) was defined as improving in at least 1 Scoliosis Research Society-Schwab modifier without worsening in any Scoliosis Research Society-Schwab modifier.

Should realignment goals vary based on patient frailty status in adult spinal deformity?

Objective: The objective of this study was to adjust the sagittal age-adjusted score (SAAS) to accommodate frailty in alignment considerations and thereby increase the predictability of clinical outcomes and junctional failure.

Methods: Surgical adult spinal deformity (ASD) patients with 2-year data were included. Frailty was assessed with the continuous ASD modified frailty index (ASD-mFI).

Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery.

Background: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications.

Objective: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers.

Study Design/setting: Retrospective cohort study of a prospectively collected multicenter database.

Can Baseline Disability Predict Outcomes in Adult Spinal Deformity Surgery?

Study Design: Retrospective Cohort Study.

Objective: To assess if there is a threshold of baseline disability beyond which the patient-reported outcomes after surgical correction of adult spinal deformity (ASD) are adversely impacted.

Background: Patient-reported outcomes vary after correction of adult spinal deformity, even when patients are optimally realigned.

Critical Analysis of Radiographic and Patient-Reported Outcomes Following Anterior/Posterior Staged Versus Same-Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity.

Study Design: A retrospective cohort study of a prospectively collected multicenter adult spinal deformity (ASD) database.

Objective: The aim of this study was to compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for the treatment of ASD.

Background: Surgical intervention for ASD is an invasive and complex procedure that surgeons often elect to perform on different days (staging).

Natural history of adult spinal deformity: how do patients with suboptimal surgical outcomes fare relative to nonoperative counterparts?

Objective: Management of adult spinal deformity (ASD) has increasingly favored operative intervention; however, the incidence of complications and reoperations is high, and patients may fail to achieve idealized postsurgical results. This study compared health-related quality of life (HRQOL) metrics between patients with suboptimal surgical outcomes and those who underwent nonoperative management as a proxy for the natural history (NH) of ASD.

Methods: ASD patients with 2-year data were included.