Primary Drivers of Adult Cervical Deformity: Prevalence, Variations in Presentation, and Effect of Surgical Treatment Strategies on Early Postoperative Alignment.

Background: Primary drivers (PDs) of adult cervical deformity (ACD) have not been described in relation to pre- and early postoperative alignment or degree of correction.

Objective: To define the PDs of ACD to understand the impact of driver region on global postoperative compensatory mechanisms.

Methods: Primary cervical deformity driver/vertebral apex level were determined: CS = cervical; CTJ = cervicothoracic junction; TH = thoracic; SP = spinopelvic.

Adult Spinal Deformity: National Trends in the Presentation, Treatment, and Perioperative Outcomes From 2003 to 2010.

Study Design: Retrospective review of a prospective database.

Objectives: To investigate adult spinal deformity (ASD) surgery outcome trends on a nationwide scale using the Nationwide Inpatient Sample (NIS) from 2003 to 2010.

Methods: ASD patients ≥25 years from 2003 to 2010 in the NIS undergoing anterior, posterior, or combined surgical approaches were included.

A novel index for quantifying the risk of early complications for patients undergoing cervical spine surgeries.

OBJECTIVE It is becoming increasingly necessary for surgeons to provide evidence supporting cost-effectiveness of surgical treatment for cervical spine pathology. Anticipating surgical risk is critical in accurately evaluating the risk/benefit balance of such treatment. Determining the risk and cost-effectiveness of surgery, complications, revision procedures, and mortality rates are the most significant limitations.

A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan.

Purpose: Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP).

Methods: Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified.

Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients.

OBJECTIVE Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of follow-up (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366).

Diabetes as an Independent Predictor for Extended Length of Hospital Stay and Increased Adverse Post-Operative Events in Patients Treated Surgically for Cervical Spondylotic Myelopathy.

Background: Diabetes as an independent driver of peri-operative outcomes, and whether its severity impacts indications is conflicted in the research. The purpose of this study is to evaluate diabetes as a predictor for postoperative outcomes in cervical spondylotic myelopathy (CSM) patients.

Methods: A retrospective review was performed of patients treated surgically for CSM (ICD-9 721.

The Lumbar Pelvic Angle, the Lumbar Component of the T1 Pelvic Angle, Correlates With HRQOL, PI-LL Mismatch, and it Predicts Global Alignment.

Study Design: Prospective multicenter analysis of adult spinal deformity (ASD) patients.

Objective: The aim of this study was to introduce the lumbar pelvic angle (LPA), a novel parameter of spinopelvic alignment.

Summary Of Background Data: The T1 pelvic angle (TPA), a measure of global spinopelvic alignment, correlates with health-related quality of life (HRQOL), but it may not be measureable on all intraoperative x-rays.

Comparative Analysis of Perioperative Outcomes Using Nationally Derived Hospital Discharge Data Relative to a Prospective Multicenter Surgical Database of Adult Spinal Deformity Surgery.

Study Design: Retrospective analysis of three prospectively collected databases.

Objective: To compare perioperative outcomes in Adult Spinal Deformity (ASD) surgeries in a surgeon-run (SR-ASD) and two national databases: the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP).

Summary Of Background Data: Much has been learned on the treatment of ASD in the last decade with prospective multicenter collaborative research focusing on this specific condition.

The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion.

Objective: To report the outcome of adult spinal deformity (ASD) in patients with rod fracture (RF) after thoracolumbar fusion.

Methods: Retrospective review of prospective, multicenter database. Operative patients with ASD ≥18 years old with RF after ASD surgery and with a minimum 6-month follow-up after RF were included.

Patient profiling can identify patients with adult spinal deformity (ASD) at risk for conversion from nonoperative to surgical treatment: initial steps to reduce ineffective ASD management.

Background Context: Non-operative management is a common initial treatment for patients with adult spinal deformity (ASD) despite reported superiority of surgery with regard to outcomes. Ineffective medical care is a large source of resource drain on the health system. Characterization of patients with ASD likely to elect for operative treatment from non-operative management may allow for more efficient patient counseling and cost savings.

The Adult Deformity Surgery Complexity Index (ADSCI): a valid tool to quantify the complexity of posterior adult spinal deformity surgery and predict postoperative complications.

Background Context: In 2008, Mirza et al. designed and validated the first and only index capable of quantifying the complexity of spine surgery. However, this index is not fully applicable to adult spinal deformity (ASD) surgery as it does not include the surgical techniques most commonly used and most strongly associated with perioperative complications in patients with ASD.

Novel Angular Measures of Cervical Deformity Account for Upper Cervical Compensation and Sagittal Alignment.

Study Design: This is a retrospective review of a prospective multicenter database.

Objective: This study introduces 2 new cervical alignment measures accounting for both cervical deformity (CD) and upper cervical compensation.

Summary Of Background Data: Current descriptions of CD like the C2-C7 sagittal vertical axis (cSVA) do not account for compensatory mechanisms such as C0-C2 lordosis and pelvic tilt, which makes surgical planning difficult.

Cell Saver for Adult Spinal Deformity Surgery Reduces Cost.

Study Design: Retrospective cohort.

Objectives: To determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery.

Summary Of Background Data: Recent studies have questioned the clinical value of cell saver during spine procedures.

Tridimensional Analysis of Rotatory Subluxation and Sagittal Spinopelvic Alignment in the Setting of Adult Spinal Deformity.

Study Design: Retrospective single-center.

Objective: To investigate rotatory subluxation (RS) in adult spinal deformity (ASD) with three-dimensional (3D) stereoradiographic images and analyze relationships between RS, transverse plane parameters, spinopelvic parameters, and clinical outcomes.

Background: Recent research has demonstrated that sagittal plane malalignment and listhesis correlate with ASD patient-reported outcomes.

Results of the 2015 Scoliosis Research Society Survey on Single Versus Dual Attending Surgeon Approach for Adult Spinal Deformity Surgery.

Study Design: An electronic survey administered to Scoliosis Research Society (SRS) membership.

Objective: To characterize surgeon practices and views regarding the use of two attending surgeons for adult spinal deformity (ASD) surgery.

Summary Of Background Data: The use of two experienced attending surgeons can decrease the operative time, estimated blood loss, and perioperative complication rates.

Three types of sagittal alignment regarding compensation in asymptomatic adults: the contribution of the spine and lower limbs.

Purpose: A comprehensive understanding of normative sagittal profile is necessary for adult spinal deformity. Roussouly described four sagittal alignment types based on sacral slope, lumbar lordosis, and location of lumbar apex. However, the lower limb, a newly described component of spinal malalignment compensation, is missing from this classification.

Characterizing Adult Cervical Deformity and Disability Based on Existing Cervical and Adult Deformity Classification Schemes at Presentation and Following Correction.

Background: Adult cervical deformity (ACD) classifications have not been implemented in a prospective ACD population and in conjunction with adult spinal deformity (ASD) classifications.

Objective: To characterize cervical deformity type and malalignment with 2 classifications (Ames-ACD and Schwab-ASD).

Methods: Retrospective review of a prospective multicenter ACD database.

Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity.

Objective: Anterior column realignment (ACR) is a minimally invasive surgical technique used for the correction of adult sagittal plane deformity. ACR is performed via a minimally invasive lateral transpsoas approach with anterior longitudinal ligament release and hyperlordotic cage placement. The objective of this study was to compare radiographic outcomes and complications in patients treated by ACR or Pedicle subtraction osteotomy (PSO).

A Novel Tool for Deformity Surgery Planning: Determining the Magnitude of Lordotic Correction Required to Achieve a Desired Sagittal Vertical Axis.

Objective: We sought to create a model capable of predicting the magnitude of pelvic incidence-lumbar lordosis (PI-LL) correction necessary to achieve a desired change in sagittal vertical axis (SVA).

Methods: A retrospective review was conducted of a prospectively maintained multicenter adult spinal deformity database collected by the International Spine Study Group between 2009 and 2014. The independent variable of interest was the degree of correction achieved in the PI-LL mismatch 6 weeks after surgery.

Comparative analysis of perioperative complications between a multicenter prospective cervical deformity database and the Nationwide Inpatient Sample database.

Background Context: Complication rates for adult cervical deformity are poorly characterized given the complexity and heterogeneity of cases.

Purpose: To compare perioperative complication rates following adult cervical deformity corrective surgery between a prospective multicenter database for patients with cervical deformity (PCD) and the Nationwide Inpatient Sample (NIS).

Study Design/setting: Retrospective review of prospective databases.

Radiological lumbar stenosis severity predicts worsening sagittal malalignment on full-body standing stereoradiographs.

Background Context: Patients with degenerative lumbar stenosis (DLS) adopt a forward flexed posture in an attempt to decompress neural elements. The relationship between sagittal alignment and severity of lumbar stenosis has not previously been studied.

Purpose: We hypothesized that patients with increasing radiological severity of lumbar stenosis will exhibit worsening sagittal alignment.

Cervical spondylotic myelopathy: National trends in the treatment and peri-operative outcomes over 10years.

Background: Recent studies show increases in cervical spine surgery prevalence and cervical spondylotic myelopathy (CSM) diagnoses in the US. However, few studies have examined outcomes for CSM surgical management, particularly on a nationwide scale.

Objective: Evaluate national trends from 2001 to 2010 for CSM patient surgical approach, postoperative outcomes, and hospital characteristics.

Effect of liberal blood transfusion on clinical outcomes and cost in spine surgery patients.

Background Context: Blood transfusions in spine surgery are shown to be associated with increased patient morbidity. The association between transfusion performed using a liberal hemoglobin (Hb) trigger-defined as an intraoperative Hb level of ≥10 g/dL, a postoperative level of ≥8 g/dL, or a whole hospital nadir between 8 and 10 g/dL-and perioperative morbidity and cost in spine surgery patients is unknown and thus was investigated in this study.

Purpose: This study aimed to describe the perioperative outcomes and economic cost associated with liberal Hb trigger transfusion among spine surgery patients.

Orientation of the Upper-most Instrumented Segment Influences Proximal Junctional Disease Following Adult Spinal Deformity Surgery.

Study Design: Retrospective review of a prospective database.

Objective: The aim of this study was to define the role of sagittal orientation of the construct at the upper instrumented levels in the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) patients.

Summary Of Background Data: PJK following ASD surgery remains challenging.