The impact of Roussouly sagittal profile changes on postoperative outcomes.

Objective: The aim of this retrospective study was to investigate the relationship between postoperative Roussouly sagittal profile changes and patient outcomes.

Methods: From a prospectively collected, single-center database, the authors reviewed the records of patients with adult spinal deformity (ASD) who had clinical and radiographic data from baseline to 2 years after surgery. The patients were stratified by their Roussouly curve type (current sacral slope-based and "theoretical" pelvic incidence-based types).

Are we Getting Better at Achieving Optimal Lumbar Segmental Sagittal Alignment in Complex Adult Spine Deformity Surgery?

Study Design: Retrospective Multi-Center Study.

Objective: To investigate how advances in spine realignment have impacted lumbar segmental alignment.

Summary Of Background Data: The understanding of spine alignment and Adult Spinal Deformity (ASD) management continues to advance.

Assessing the impact of high-risk committees in adult cervical deformity corrective surgery: a retrospective review of outcomes, complications, and frequency of procedures receiving preoperative multidisciplinary evaluation.

Objective: The objective was to assess the frequency, outcomes, and impact of high-risk procedures receiving preoperative multidisciplinary review in adult cervical deformity (ACD) patients.

Methods: ACD patients were stratified by whether they underwent high-risk review (HRR). High-risk patients were defined as meeting ≥ 1 of the following criteria: anterior-posterior cervical deformity fusion ≥ 3 levels; planned 3-column osteotomy, vertebral column resection, and/or anterior column refinement; deformity correction with severe baseline neurological deficit; severe baseline myelopathy (modified Japanese Orthopaedic Association score < 11); and severe osteoporosis with fusion ≥ 4 levels.

Impact of thoracolumbar inflection point on outcomes and complications in adult spinal deformity.

Objective: Existing literature on the impact of alignment parameters relative to the thoracolumbar inflection point remains sparse. The authors aimed to investigate the influence of the inflection point, lumbar lordosis apex (LLA), and other alignment parameters on complications, reoperations, and clinical outcomes.

Methods: Patients with adult spinal deformity who underwent fusion of the lower thoracic spine (T7-12) to pelvis, for whom 2-year data were available, were included.

When Does the Construct Need to Extend further Into the Thoracic Spine in Patients Undergoing Correction for Cervical Deformity?

Study Design: Retrospective cohort study of prospectively enrolled cervical deformity patients.

Objective: To investigate patients in whom fusion to the thoracic spine was warranted.

Summary Of Background Data: Thoracolumbar malalignment is often seen in patients presenting with cervical deformities.

An analysis of the usage and limitations of the T1 pelvic angle.

Aims: The T1 pelvic angle (T1PA) provides a consistent global measure of sagittal alignment independent of compensatory mechanisms and positional changes. However, it may not explicitly reflect alignment goals that correlate with a lower risk of complications. This study assessed the value of T1PA in achieving sagittal alignment goals in patients with an adult spinal deformity (ASD).

Impact of Enhanced Recovery After Surgery Protocols on Outcomes Up to Two Years After Adult Structural Spine Disorder Surgery.

Study Design: Retrospective cohort study of prospectively enrolled database.

Objective: We analyze the recovery pattern of patients with adult structural spine disorder (ASD) who underwent corrective surgery with enhanced recovery after surgery (ERAS+) protocol, including physical and psychological prehabilitation components, compared with a non-ERAS protocol (ERAS-) up to 2 years (2Y) after surgery.

Background: Spine surgery for ASD is often highly invasive, which can contribute to prolonged recovery.

Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine.

Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine. Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included.

Single-Position Prone Lateral Interbody Fusion is Associated with Improved Radiographic and Clinical Outcomes at One Year compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.

Background: Recent studies highlight the increasing adoption of single-position prone lateral(SP-PL) and single-position lateral decubitus(SP-LD) in Minimally Invasive Spine Surgery(MISS) to reduce operative time, enhance patient safety, and improve surgical accessibility.

Objective: To assess the differences between SP-PL and SP-LD achievement of optimal postoperative outcomes and post-operative complication rates.

Study Design: Retrospective review of prospectively collected MIS database.

The 'Quartered Head Technique': a simple, reliable way of maintaining leg length and offset during total hip arthroplasty.

Introduction: Various techniques have been described for restoring leg length and offset during total hip arthroplasty (THA). We herein describe a novel "Quartered Head Technique" (QHT) involving a series of femoral osteotomies.

Methods: 124 hips were included in the analysis.

Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time?

Background And Objectives: The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.

When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions.

Objective: The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery.

Methods: Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts.

Frail patients require Longer Fusions for Success following Adult Cervical Deformity Surgery.

Background: Adult cervical deformity (ACD) surgery is more frequently being performed in frail patients. Although surgical outcomes are largely successful, there remains significant risk of poor outcomes. The ideal length of fusion constructs in these patients remains debatable.

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 DesignRetrospective cohort study of a prospectively collected single-center database.ObjectiveDistal 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.

Treatment of adult spine deformity: A retrospective comparison of bone morphogenic protein and bone marrow aspirate with bone allograft.

Unlabelled: BACKGROUND  : The use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow aspirate, cancellous bone chips and i-Factor.

Methods: This was a retrospective cohort study.

Which components of the global alignment proportionality score have the greatest impact on outcomes in adult spinal deformity corrective surgery?

Purpose: To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.

Methods: Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.

Frail patients require instrumentation of a more proximal vertebra for a successful outcome after surgery for adult spine deformity.

Aims: The aim of this study was to investigate the impact of the level of upper instrumented vertebra (UIV) in frail patients undergoing surgery for adult spine deformity (ASD).

Methods: Patients with adult spinal deformity who had undergone T9-to-pelvis fusion were stratified using the ASD-Modified Frailty Index into not frail, frail, and severely frail categories. ASD was defined as at least one of: scoliosis ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, or pelvic tilt ≥ 25°.

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.

Should pelvic incidence influence realignment strategy? A detailed analysis in adult spinal deformity.

Objective: The purpose of this study was to assess how various realignment strategies affect mechanical failure and clinical outcomes in pelvic incidence (PI)-stratified cohorts following adult spinal deformity (ASD) surgery.

Methods: Median and interquartile range statistics were calculated for demographics and surgical details. Further statistical analysis was used to define subsets within PI generating significantly different rates of mechanical failure.

The more the better? Integration of vertebral pelvic angles (VPA) PJK thresholds to existing alignment schemas for prevention of mechanical complications after adult spinal deformity surgery.

Purpose: While existing adult spinal deformity (ASD) alignment schemas acknowledge the dynamic relationship between the pelvis and spine, consideration of vertebral pelvic angles (VPA) thresholds for PJK may provide further insight into the relationship of each individual vertebra to the pelvis, which may allow for greater individualization of operative targets. Herein, we examine VPA's utility in preventing mechanical complications and its possible unification with prevalent scoring systems.

Methods: In a retrospective cohort study of a prospectively collected database, operative ASD patients ≥ 18 years with complete baseline (BL) and two-year (Y) operative, radiographic, and health-related quality of life data were included.

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.