Failure of nonoperative care in adult symptomatic lumbar scoliosis: incidence, timing, and risk factors for conversion from nonoperative to operative treatment.

Objective: The Adult Symptomatic Lumbar Scoliosis (ASLS) study is a prospective multicenter trial with randomized and observational cohorts comparing operative and nonoperative treatment for ASLS. The objective of the present study was to perform a post hoc analysis of the ASLS trial to examine factors related to failure of nonoperative treatment in ASLS.

Methods: Patients from the ASLS trial who initially received at least 6 months of nonoperative treatment were followed for up to 8 years after trial enrollment.

Mechanical complications and patient-reported outcome measures associated with high pelvic incidence and persistent pelvic retroversion: the Roussouly "false type 2" profile.

Objective: The objective of this paper was to report mechanical complications and patient-reported outcome measures (PROMs) for adult spinal deformity (ASD) patients with a Roussouly "false type 2" (FT2) profile.

Methods: ASD patients treated from 2004 to 2014 at a single center were identified. Inclusion criteria were pelvic incidence ≥ 60° and a minimum 2-year follow-up.

Rod fractures in thoracolumbar fusions to the sacrum/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients.

Objective: Previous reports of rod fracture (RF) in adult spinal deformity are limited by heterogeneous cohorts, low follow-up rates, and relatively short follow-up durations. Since the majority of RFs present > 2 years after surgery, true occurrence and revision rates remain unclear. The objectives of this study were to better understand the risk factors for RF and assess its occurrence and revision rates following primary thoracolumbar fusions to the sacrum/pelvis for adult symptomatic lumbar scoliosis (ASLS) in a prospective series with long-term follow-up.

Proximal junctional failure in primary thoracolumbar fusion/fixation to the sacrum/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective multicenter cohort of 160 patients.

Objective: Proximal junctional failure (PJF) is a severe form of proximal junctional kyphosis. Previous reports on PJF have been limited by heterogeneous cohorts and relatively short follow-ups. The authors' objectives herein were to identify risk factors for PJF and to assess its long-term incidence and revision rates in a homogeneous cohort.

Geometric analysis of pedicle subtraction osteotomy (PSO) for Kyphosis correction: anterior lengthening may occur at the osteotomized body as well as at the discs above and below.

Objective: To validate the authors kyphosis correction formula for pedicle subtraction osteotomy (PSO) cases. Additionally, to use the formula to evaluate the safety of PSO by determining if there is anterior lengthening.

Methods: Twenty-two patients with primarily kyphosis corrected by PSO and with clear landmarks on preoperative and postoperative x-rays were selected.

Validation of Adult Spinal Deformity Surgical Outcome Prediction Tools in Adult Symptomatic Lumbar Scoliosis.

Study Design: A post hoc analysis.

Objective: Advances in machine learning (ML) have led to tools offering individualized outcome predictions for adult spinal deformity (ASD). Our objective is to examine the properties of these ASD models in a cohort of adult symptomatic lumbar scoliosis (ASLS) patients.

The impact of lumbar alignment targets on mechanical complications after adult lumbar scoliosis surgery.

Purpose: The purpose of this study was to determine the discriminatory ability of age-adjusted alignment offset and the global alignment and proportion (GAP) score parameters to predict postoperative mechanical complications.

Methods: Surgical patients from the Adult Symptomatic Lumbar Scoliosis cohort were reviewed at 2 year follow up. Age-adjusted alignment offsets and GAP parameters were calculated for each patient.

Individual differences in postoperative recovery trajectories for adult symptomatic lumbar scoliosis.

Objective: The Adult Symptomatic Lumbar Scoliosis-1 (ASLS-1) trial demonstrated the benefit of adult symptomatic lumbar scoliosis (ASLS) surgery. However, the extent to which individuals differ in their postoperative recovery trajectories is unknown. This study's objective was to evaluate variability in and factors moderating recovery trajectories after ASLS surgery.

Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis.

Objective: Adult symptomatic lumbar scoliosis (ASLS) is a widespread and debilitating subset of adult spinal deformity. Although many patients benefit from operative treatment, surgery entails substantial cost and risk for adverse events. Patient-reported outcome measures (PROMs) are patient-centered tools used to evaluate the appropriateness of surgery and to assist in the shared decision-making process.

Orthopedic disease burden in adult patients with symptomatic lumbar scoliosis: results from a prospective multicenter study.

Objective: Although the health impact of adult symptomatic lumbar scoliosis (ASLS) is substantial, these patients often have other orthopedic problems that have not been previously quantified. The objective of this study was to assess disease burden of other orthopedic conditions in patients with ASLS based on a retrospective review of a prospective multicenter cohort.

Methods: The ASLS-1 study is an NIH-sponsored prospective multicenter study designed to assess operative versus nonoperative treatment for ASLS.

Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable?

Objective: The purpose of this study was to identify risk factors for distal adding on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by posterior spinal fusion (PSF) to L3 with a minimum 2-year follow-up.

Methods: AIS patients undergoing PSF to L3 by two senior surgeons from 2000-2010 were analyzed. Distal AO and DJK were deemed poor radiographic results and defined as >3 cm of deviation from L3 to the center sacral vertical line (CSVL), or >10° angle at L3-4 on the posterior anterior- or lateral X-ray at ultimate follow-up.

Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 5-year follow-up: durability of outcomes and impact of treatment-related serious adverse events.

Objective: Although short-term adult symptomatic lumbar scoliosis (ASLS) studies favor operative over nonoperative treatment, longer outcomes are critical for assessment of treatment durability, especially for operative treatment, because the majority of implant failures and nonunions present between 2 and 5 years after surgery. The objectives of this study were to assess the durability of treatment outcomes for operative versus nonoperative treatment of ASLS, to report the rates and types of associated serious adverse events (SAEs), and to determine the potential impact of treatment-related SAEs on outcomes.

Methods: The ASLS-1 (Adult Symptomatic Lumbar Scoliosis-1) trial is an NIH-sponsored multicenter prospective study to assess operative versus nonoperative ASLS treatment.

Evaluation of global alignment and proportion score in an independent database.

Background Context: Sagittal spinopelvic alignment has been associated with patient-reported outcome measures and mechanical complication rates. Recently, it was claimed that linear numerical values of pelvic tilt and lumbar lordosis measurements may be misleading for patients that have different magnitudes of pelvic incidence. The use of "relative" measurements embedded in a weighted scoring of Global Alignment and Proportion (GAP) was proposed.

The Incidence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated by Anterior Spinal Fusion to L3 Was Significantly Higher Than by Posterior Spinal Fusion to L3.

Objective: To compare and identify risk factors for distal adding-on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by anterior- (ASF) and posterior spinal fusion (PSF) to L3.

Methods: AIS patients undergoing ASF versus PSF to L3 from 2000-2010 were analyzed. Distal AO and DJK were deemed poor radiographic results.

The role of the fractional lumbosacral curve in persistent coronal malalignment following adult thoracolumbar deformity surgery: a radiographic analysis.

Study Design: Retrospective cohort.

Objective: Assess radiographically the effect of an all-posterior approach on correction of coronal balance in primary adult thoracolumbar spinal deformities based on Bao's classification of coronal imbalance with a focus on lumbosacral curve correction. Achieving appropriate coronal alignment is difficult in adults with coronal malalignment due to trunk shift ipsilateral to degenerated thoracolumbar scoliosis' apex.

Differences in Functional Treadmill Tests in Patients With Adult Symptomatic Lumbar Scoliosis Treated Operatively and Nonoperatively.

Study Design: Prospective longitudinal cohort.

Objectives: The aim of this study was to determine whether functional treadmill testing (FTT) demonstrates differences between patients treated operatively and nonoperatively for adult symptomatic lumbar scoliosis (ASLS).

Summary Of Background Data: ASLS has become increasingly prevalent as the population ages.

Comprehensive classification system for multirod constructs across three-column osteotomies: a reliability study.

Objective: In this study, the authors' goal was to determine the intra- and interobserver reliability of a new classification system that allows the description of all possible constructs used across three-column osteotomies (3COs) in terms of rod configuration and density.

Methods: Thirty-five patients with multirod constructs (MRCs) across a 3CO were classified by two spinal surgery fellows according to the new system, and then were reclassified 2 weeks later. Constructs were classified as follows: the number of rods across the osteotomy site followed by a letter corresponding to the type of rod configuration: "M" is for a main rod configuration, defined as a single rod spanning the osteotomy.

Thoracolumbar Junction Orientation: A Novel Guide for Sagittal Correction and Proximal Junctional Kyphosis Prediction in Adult Spinal Deformity Patients.

Background: Novel radiographic sagittal parameters of the thoracolumbar junction orientation (TLJO, thoracolumbar slope [TLS] and thoracolumbar tilt [TLT]) have been introduced and correlated with lumbopelvic parameters and thoracic kyphosis.

Objective: To determine a predictive model for reciprocal thoracic kyphosis and proximal junctional kyphosis (PJK) based on the TLJO.

Methods: A total of 127 patients who had fusion from sacrum to T10-L2 from 2004 to 2014 were reviewed.

Rod fractures and nonunions after long fusion to the sacrum for primary presentation adult spinal deformity: a comparison with and without interbody fusion in the distal lumbar spine.

Study Design: Retrospective cohort study.

Objectives: To investigate the prevalence and incidence rate of rod fractures (RF) in patients undergoing surgery for correction of adult spinal deformity (ASD) with or without the use of interbody fusions in the caudal levels of the fusion construct.

Background: Data: Pseudarthrosis and rod fracture after long spinal fusion to the sacrum for correction of ASD remain a concern.

Cost-effectiveness of adult lumbar scoliosis surgery: an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up.

Study Design: Longitudinal comparative cohort.

Objective: The purpose of this study is to report on the cost-effectiveness of surgical versus non-surgical treatment for Adult Symptomatic Lumbar Scoliosis (ASLS) using the as-treated data and provide a comparison to previously reported intent-to-treat (ITT) analysis. Adult spinal deformity is a relatively prevalent condition for which surgical treatment has become increasingly common but concerns surrounding complications, revision rates and cost-effectiveness remain unresolved.

Relationship of the character of rod fractures on outcomes following long thoracolumbar fusion to the sacrum for adult spinal deformity.

Background Context: Rod fractures (RF) and pseudarthrosis are a frequent occurrence after adult spinal deformity (ASD) surgery and may be problematic. However, not all RF signal nonunion and cause clinical concern. An improved understanding of the sequelae after RF occurrence is valuable for further management.

Pedicle Subtraction Osteotomy.

Unlabelled: Pedicle subtraction osteotomy (PSO) was originally performed in cases of ankylosing spondylitis. This procedure was invented because it was safer than trying to lengthen the anterior column via osteoclasis, which risked vascular injury and death. PSO involves the removal of the posterior elements and the use of a vertebral body wedge to shorten the spine posteriorly and achieve sagittal-plane correction.

Effect modifiers for patient-reported outcomes in operatively and nonoperatively treated patients with adult symptomatic lumbar scoliosis: a combined analysis of randomized and observational cohorts.

Objective: Adult symptomatic lumbar scoliosis (ASLS) is a common and disabling condition. The ASLS-1 was a multicenter, dual-arm study (with randomized and observational cohorts) examining operative and nonoperative care on health-related quality of life in ASLS. An aim of ASLS-1 was to determine patient and radiographic factors that modify the effect of operative treatment for ASLS.