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251. Development of a Modified Cervical Deformity Frailty Index

Author

Passias, Peter G., primary, Bortz, Cole A., additional, Segreto, Frank A., additional, Horn, Samantha R., additional, Lafage, Renaud, additional, Lafage, Virginie, additional, Smith, Justin S., additional, Line, Breton, additional, Kim, Han Jo, additional, Eastlack, Robert, additional, Hamilton, David Kojo, additional, Protopsaltis, Themistocles, additional, Hostin, Richard A., additional, Klineberg, Eric O., additional, Burton, Douglas C., additional, Hart, Robert A., additional, Schwab, Frank J., additional, Bess, Shay, additional, Shaffrey, Christopher I., additional, and Ames, Christopher P., additional

Published
2019
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253. Development of a validated computer-based preoperative predictive model for pseudarthrosis with 91% accuracy in 336 adult spinal deformity patients

Author

Scheer, Justin K., primary, Oh, Taemin, additional, Smith, Justin S., additional, Shaffrey, Christopher I., additional, Daniels, Alan H., additional, Sciubba, Daniel M., additional, Hamilton, D. Kojo, additional, Protopsaltis, Themistocles S., additional, Passias, Peter G., additional, Hart, Robert A., additional, Burton, Douglas C., additional, Bess, Shay, additional, Lafage, Renaud, additional, Lafage, Virginie, additional, Schwab, Frank, additional, Klineberg, Eric O., additional, Ames, Christopher P., additional, and _, _, additional

Published
2018
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254. Recovery Kinetics of Radiographic and Implant-Related Revision Patients Following Adult Spinal Deformity Surgery

Author

Passias, Peter G, primary, Jalai, Cyrus M, additional, Lafage, Virginie, additional, Poorman, Gregory W, additional, Vira, Shaleen, additional, Horn, Samantha R, additional, Scheer, Justin K, additional, Hamilton, D Kojo, additional, Line, Breton G, additional, Bess, Shay, additional, Schwab, Frank J, additional, Ames, Christopher P, additional, Burton, Douglas C, additional, Hart, Robert A, additional, and Klineberg, Eric O, additional

Published
2018
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256. 208. Improvements in outcomes and cost after adult spinal deformity corrective surgery between 2008 and 2019

Author

Passias, Peter G., Kummer, Nicholas, Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Line, Breton, Diebo, Bassel G., Gum, Jeffrey L., Daniels, Alan H., Klineberg, Eric O., Gupta, Munish C., Kebaish, Khaled M., Jain, Amit, Neuman, Brian J., Chou, Dean, Carreon, Leah Y., Kelly, Michael P., Hart, Robert A., Burton, Douglas C., Shaffrey, Christopher I., Ames, Christopher P., Schwab, Frank J., Hostin, Richard A., Jr., Bess, Shay, and International Spine Study Group

Published
2021
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257. 236. Rod failures continue to plague the surgical treatment of adult spinal deformity (ASD)

Author

Gupta, Munish C., Lafage, Renaud, Gupta, Sachin, Daniels, Alan H., Soroceanu, Alexandra, Eastlack, Robert K., Kebaish, Khaled M., Shaffrey, Christopher I., Kim, Han Jo, Klineberg, Eric O., Lafage, Virginie, Protopsaltis, Themistocles S., Passias, Peter G., Mundis, Gregory M., Jr., Kojo Hamilton, D., Kelly, Michael P., Burton, Douglas C., Hostin, Richard A., Jr., Hart, Robert A., Schwab, Frank J., Bess, Shay, Ames, Christopher P., Smith, Justin S., and International Spine Study Group

Published
2021
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259. 207. Cost benefit of implementation of risk stratification models for adult spinal deformity surgery

Author

Kummer, Nicholas, Passias, Peter G., Pellise, Ferran, Lafage, Virginie, Lafage, Renaud, Serra-Burriel, Miquel, Smith, Justin S., Line, Breton, Gum, Jeffrey L., Haddad, Sleiman, Perez-Grueso, Francisco J., Daniels, Alan H., Klineberg, Eric O., Gupta, Munish C., Kebaish, Khaled M., Kelly, Michael P., Hart, Robert A., Burton, Douglas C., Kleinstuck, Frank, Obeid, Ibrahim, Shaffrey, Christopher I., Alanay, Ahmet, Ames, Christopher P., Schwab, Frank J., Hostin, Richard A., Jr., Bess, Shay, and International Spine Study Group

Published
2021
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260. 206. Comparison of patient factors (frailty) vs surgical factors (invasiveness) for optimization of 2-year cost utility: We should focus on the patient factors

Author

Gum, Jeffrey L., Yeramaneni, Samrat, Wang, Kevin, Hostin, Richard A., Jr., Kebaish, Khaled M., Neuman, Brian J., Jain, Amit, Kelly, Michael P., Burton, Douglas C., Ames, Christopher P., Shaffrey, Christopher I., Klineberg, Eric O., Kim, Han Jo, Protopsaltis, Themistocles S., Passias, Peter G., Mundis, Gregory M., Jr., Eastlack, Robert K., Schwab, Frank J., Hart, Robert A., Gupta, Munish C., Daniels, Alan H., Smith, Justin S., Lafage, Virginie, Line, Breton, Bess, Shay, and International Spine Study Group

Published
2021
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261. 213. Adult spinal deformity surgery is associated with increased productivity and decreased absenteeism from work and school

Author

Durand, Wesley M., Babu, Jacob, Kojo Hamilton, D., Passias, Peter G., Kim, Han Jo, Protopsaltis, Themistocles S., Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Shaffrey, Christopher I., Gupta, Munish C., Kelly, Michael P., Klineberg, Eric O., Schwab, Frank J., Gum, Jeffrey L., Mundis, Gregory M., Jr., Eastlack, Robert K., Kebaish, Khaled M., Soroceanu, Alexandra, Hostin, Richard A., Jr., Burton, Douglas C., Bess, Shay, Ames, Christopher P., Hart, Robert A., Daniels, Alan H., and International Spine Study Group

Published
2021
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262. 212. Matched analysis demonstrates acute rehabilitation or skilled nursing facility care does not reduce readmissions, return to surgery or improve outcomes compared to home discharge following adult spine deformity surgery

Author

Bess, Shay, Line, Breton, Lafage, Renaud, Nunley, Pierce D., Ames, Christopher P., Eastlack, Robert K., Mundis, Gregory M., Jr., Lafage, Virginie, Klineberg, Eric O., Gupta, Munish C., Kelly, Michael P., Hart, Robert A., Passias, Peter G., Protopsaltis, Themistocles S., Burton, Douglas C., Kebaish, Khaled M., Kim, Han Jo, Schwab, Frank J., Shaffrey, Christopher I., Smith, Justin S., and International Spine Study Group

Published
2021
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263. 195. Are we getting better at 3-column osteotomy in terms of achieving optimal realignment and minimizing complications in adult spinal deformity surgery?

Author

Passias, Peter G., Krol, Oscar, Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Line, Breton, Vira, Shaleen N., Daniels, Alan H., Diebo, Bassel G., Gum, Jeffrey L., Kebaish, Khaled M., Than, Khoi D., Kim, Han Jo, Hostin, Richard A., Jr., Gupta, Munish C., Eastlack, Robert K., Anand, Neel, Ames, Christopher P., Hart, Robert A., Burton, Douglas C., Schwab, Frank J., Shaffrey, Christopher I., Klineberg, Eric O., Bess, Shay, and International Spine Study Group

Published
2021
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265. 188. Prospective analysis of adult spinal deformity patients demonstrates radically different preop demographic, radiographic and quality of life parameters for primary vs revision patients

Author

Cerpa, Meghan, Lenke, Lawrence G., Zuckerman, Scott L., Kelly, Michael P., Line, Breton, Smith, Justin S., Shaffrey, Christopher I., Kebaish, Khaled M., Klineberg, Eric O., Kim, Han Jo, Schwab, Frank J., Gupta, Munish C., Protopsaltis, Themistocles S., Passias, Peter G., Daniels, Alan H., Lafage, Virginie, Lafage, Renaud, Burton, Douglas C., Bess, Shay, and International Spine Study Group

Published
2021
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266. P110. Improvements in cost effectiveness of adult cervical deformity corrective surgery over time: Analysis of a prospective adult cervical deformity database

Author

Passias, Peter G., Kummer, Nicholas, Krol, Oscar, Lafage, Virginie, Lafage, Renaud, Kim, Han Jo, Daniels, Alan H., Diebo, Bassel G., Lebovic, Jordan, Mundis, Gregory M., Jr., Eastlack, Robert K., Soroceanu, Alexandra, Scheer, Justin K., Hamilton, D. Kojo, Klineberg, Eric O., Line, Breton, Schoenfeld, Andrew J., Hart, Robert A., Burton, Douglas C., Schwab, Frank J., Shaffrey, Christopher I., Bess, Shay, Smith, Justin S., Ames, Christopher P., and International Spine Study Group

Published
2021
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267. P89. Utilization of Hounsfield units (HU) at L1 for bone quality assessment in ASD surgery is reliable and correlates with a history of osteoporosis

Author

Gum, Jeffrey L., Soroceanu, Alexandra, Lafage, Renaud, Mundis, Gregory M., Jr., Yeramaneni, Samrat, Wang, Kevin, Hostin, Richard A., Jr., Kebaish, Khaled M., Neuman, Brian J., Jain, Amit, Kelly, Michael P., Burton, Douglas C., Ames, Christopher P., Shaffrey, Christopher I., Klineberg, Eric O., Kim, Han Jo, Protopsaltis, Themistocles S., Passias, Peter G., Eastlack, Robert K., Schwab, Frank J., Hart, Robert A., Gupta, Munish C., Daniels, Alan H., Smith, Justin S., Lafage, Virginie, Line, Breton, Bess, Shay, and International Spine Study Group

Published
2021
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268. P94. Preoperative opioid use poorly correlates with mental health in adult spinal deformity: Time to rethink foregone conclusions

Author

Kelly, Michael P., Lenke, Lawrence G., Line, Breton, Smith, Justin S., Shaffrey, Christopher I., Kebaish, Khaled M., Klineberg, Eric O., Kim, Han Jo, Schwab, Frank J., Gupta, Munish C., Lafage, Virginie, Lafage, Renaud, Daniels, Alan H., Passias, Peter G., Protopsaltis, Themistocles S., Burton, Douglas C., Bess, Shay, and International Spine Study Group

Published
2021
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269. P86. Impact of reoperations on cost of care in adult spinal deformity surgery

Author

Yeramaneni, Samrat, Wang, Kevin, Line, Breton, Jain, Amit, Neuman, Brian J., Kebaish, Khaled M., Harris, Andrew B., Gum, Jeffrey L., Kelly, Michael P., Burton, Douglas C., Ames, Christopher P., Shaffrey, Christopher I., Klineberg, Eric O., Protopsaltis, Themistocles S., Passias, Peter G., Mundis, Gregory M., Jr., Eastlack, Robert K., Schwab, Frank J., Hart, Robert A., Gupta, Munish C., Daniels, Alan H., Smith, Justin S., Lafage, Virginie, Bess, Shay, Hostin, Richard A., Jr., and International Spine Study Group

Published
2021
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270. P83. Fractional curve correction using TLIF vs ALIF in adult scoliosis

Author

Buell, Thomas, Shaffrey, Christopher I., Bess, Shay, Kim, Han Jo, Klineberg, Eric O., Lafage, Virginie, Lafage, Renaud, Protopsaltis, Themistocles S., Passias, Peter G., Mundis, Gregory M., Jr., Eastlack, Robert K., Deviren, Vedat, Kelly, Michael P., Daniels, Alan H., Gum, Jeffrey L., Soroceanu, Alexandra, Hamilton, D. Kojo, Gupta, Munish C., Burton, Douglas C., Hostin, Richard A., Jr., Kebaish, Khaled M., Hart, Robert A., Schwab, Frank J., Ames, Christopher P., Smith, Justin S., and International Spine Study Group

Published
2021
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271. P84. Which components of the global alignment proportionality score have the greatest impact on outcomes in adult spinal deformity corrective surgery?

Author

Krol, Oscar, Passias, Peter G., Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Line, Breton, Diebo, Bassel G., Daniels, Alan H., Protopsaltis, Themistocles S., Vira, Shaleen N., Klineberg, Eric O., Hostin, Richard A., Jr., Eastlack, Robert K., Mundis, Gregory M., Jr., Kebaish, Khaled M., Gum, Jeffrey L., Yagi, Mitsuru, Hart, Robert A., Burton, Douglas C., Ames, Christopher P., Shaffrey, Christopher I., Bess, Shay, Gupta, Munish C., Schwab, Frank J., and International Spine Study Group

Published
2021
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272. 172. Matched analysis demonstrates fusion to upper thoracic spine does not improve correction or outcomes compared to thoracolumbar upper instrumented vertebra (UIV) for select adult spinal deformities

Author

Bess, Shay, Line, Breton, Lafage, Renaud, Ames, Christopher P., Eastlack, Robert K., Mundis, Gregory M., Jr., Lafage, Virginie, Klineberg, Eric O., Gupta, Munish C., Kelly, Michael P., Passias, Peter G., Protopsaltis, Themistocles S., Burton, Douglas C., Kebaish, Khaled M., Kim, Han Jo, Schwab, Frank J., Shaffrey, Christopher I., Smith, Justin S., and International Spine Study Group

Published
2021
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273. 177. Would you do it again? Discrepancies between patient and surgeon willingness for adult spine deformity surgery

Author

Bess, Shay, Line, Breton, Lafage, Renaud, Ames, Christopher P., Eastlack, Robert K., Mundis, Gregory M., Jr., Lafage, Virginie, Klineberg, Eric O., Daniels, Alan H., Gupta, Munish C., Kelly, Michael P., Lenke, Lawrence G., Passias, Peter G., Protopsaltis, Themistocles S., Burton, Douglas C., Kebaish, Khaled M., Kim, Han Jo, Schwab, Frank J., Shaffrey, Christopher I., Smith, Justin S., and International Spine Study Group

Published
2021
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274. 139. Segmental lordosis restoration using ALIF vs TLIF in adults with flatback deformity

Author

Buell, Thomas, Shaffrey, Christopher I., Bess, Shay, Kim, Han Jo, Klineberg, Eric O., Lafage, Virginie, Lafage, Renaud, Protopsaltis, Themistocles S., Passias, Peter G., Mundis, Gregory M., Jr., Eastlack, Robert K., Deviren, Vedat, Kelly, Michael P., Daniels, Alan H., Gum, Jeffrey L., Soroceanu, Alexandra, Hamilton, D. Kojo, Gupta, Munish C., Burton, Douglas C., Hostin, Richard A., Jr., Kebaish, Khaled M., Hart, Robert A., Schwab, Frank J., Ames, Christopher P., Smith, Justin S., and International Spine Study Group

Published
2021
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275. 138. Radiographic malalignment has a far greater impact on clinical outcomes than perioperative and postoperative complications in ASD surgery

Author

Krol, Oscar, Passias, Peter G., Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Line, Breton, Vira, Shaleen N., Daniels, Alan H., Diebo, Bassel G., Gum, Jeffrey L., Kebaish, Khaled M., Park, Paul, Mundis, Gregory M., Jr., Hostin, Richard A., Jr., Gupta, Munish C., Eastlack, Robert K., Anand, Neel, Ames, Christopher P., Hart, Robert A., Burton, Douglas C., Schwab, Frank J., Shaffrey, Christopher I., Klineberg, Eric O., Bess, Shay, and International Spine Study Group

Published
2021
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276. 128. Evolution of adult cervical deformity surgery clinical and radiographic outcomes based on a multicenter prospective study: Are behaviors and outcomes changing with experience?

Author

Passias, Peter G., Krol, Oscar, Lafage, Virginie, Lafage, Renaud, Kim, Han Jo, Daniels, Alan H., Diebo, Bassel G., Protopsaltis, Themistocles S., Mundis, Gregory M., Jr., Kebaish, Khaled M., Soroceanu, Alexandra, Scheer, Justin K., Hamilton, D. Kojo, Klineberg, Eric O., Line, Breton, Hart, Robert A., Burton, Douglas C., Schwab, Frank J., Shaffrey, Christopher I., Bess, Shay, Smith, Justin S., Ames, Christopher P., and International Spine Study Group

Published
2021
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278. 105. Global coronal decompensation after adult spinal deformity surgery: comparison of upper vs lower thoracic proximal fixation

Author

Buell, Thomas, Shaffrey, Christopher I., Kim, Han Jo, Klineberg, Eric O., Lafage, Virginie, Lafage, Renaud, Protopsaltis, Themistocles S., Passias, Peter G., Mundis, Gregory M., Jr., Eastlack, Robert K., Deviren, Vedat, Kelly, Michael P., Daniels, Alan H., Gum, Jeffrey L., Soroceanu, Alexandra, Hamilton, D. Kojo, Gupta, Munish C., Burton, Douglas C., Hostin, Richard A., Jr., Kebaish, Khaled M., Hart, Robert A., Schwab, Frank J., Bess, Shay, Ames, Christopher P., Smith, Justin S., and International Spine Study Group

Published
2021
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280. 51. Upper thoracic fusion does not impact physical function greater for younger vs older ASD patients undergoing long fusion to the pelvis

Author

Bess, Shay, Line, Breton, Lafage, Renaud, Ames, Christopher P., Eastlack, Robert K., Mundis, Gregory M., Jr., Lafage, Virginie, Klineberg, Eric O., Gupta, Munish C., Kelly, Michael P., Passias, Peter G., Protopsaltis, Themistocles S., Burton, Douglas C., Kebaish, Khaled M., Kim, Han Jo, Schwab, Frank J., Shaffrey, Christopher I., Smith, Justin S., and Study Group, International Spine

Published
2021
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281. 35. The clinical benefit of addressing the malalignment in revision surgery for proximal junctional kyphosis following ASD surgery

Author

Passias, Peter G., Krol, Oscar, Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Line, Breton, Lipa, Shaina A., Protopsaltis, Themistocles S., Daniels, Alan H., Diebo, Bassel G., Vira, Shaleen N., Eastlack, Robert K., Mundis, Gregory M., Jr., Hostin, Richard A., Jr., Gupta, Munish C., Anand, Neel, Ames, Christopher P., Hart, Robert A., Burton, Douglas C., Schwab, Frank J., Shaffrey, Christopher I., Klineberg, Eric O., Kim, Han Jo, Bess, Shay, and Group, International Spine Study

Published
2021
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282. 31. Evolution of proximal junctional kyphosis and proximal junctional failure rates over 10 years of enrollment in a prospective multicenter adult spinal deformity database

Author

Alshabab, Basel Sheikh, Lafage, Renaud, Smith, Justin S., Kim, Han Jo, Mundis, Gregory M., Jr., Klineberg, Eric O., Shaffrey, Christopher I., Daniels, Alan H., Ames, Christopher P., Gupta, Munish C., Burton, Douglas C., Hostin, Richard A., Jr., Bess, Shay, Schwab, Frank J., Lafage, Virginie, and Group, International Spine Study

Published
2021
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284. Outcomes of Surgical Treatment for 138 Patients With Severe Sagittal Deformity at a Minimum 2-Year Follow-up: A Case Series.

Author

Scheer, Justin K, Lenke, Lawrence G, Smith, Justin S, Lau, Darryl, Passias, Peter G, Kim, Han Jo, Bess, Shay, Protopsaltis, Themistocles S, Burton, Douglas C, Klineberg, Eric O, Lafage, Virginie, Schwab, Frank, Shaffrey, Christopher I, and Ames, Christopher P

Abstract

Operative treatment of adult spinal deformity (ASD) can be very challenging with high complication rates. It is well established that patients benefit from such treatment; however, the surgical outcomes for patients with severe sagittal deformity have not been reported.

Published
2021
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287. The ISSG-AO Complication Intervention Score, but Not Major/Minor Designation, is Correlated With Length of Stay Following Adult Spinal Deformity Surgery

Author

Wick, Joseph B., Blandino, Andrew, Smith, Justin S., Line, Breton G., Lafage, Virginie, Lafage, Renaud, Kim, Han Jo, Passias, Peter G., Gum, Jeffrey L., Kebaish, Khaled M., Eastlack, Robert K., Daniels, Alan, Mundis, Gregory, Hostin, Richard, Protopsaltis, Themistocles, Hamilton, D. Kojo, Kelly, Michael P., Gupta, Munish, Hart, Robert A., Schwab, Frank J., Burton, Douglas C., Ames, Christopher P., Lenke, Lawrence G., Shaffrey, Christopher I., Bess, Shay, and Klineberg, Eric

Abstract

Study Design Retrospective review.Objectives The International Spine Study Group-AO (ISSG-AO) Adult Spinal Deformity (ASD) Complication Classification System was developed to improve classification, reporting, and study of complications among patients undergoing ASD surgery. The ISSG-AO system classifies interventions to address complications by level of invasiveness: grade zero (none); grade 1, mild (e.g., medication change); grade 2, moderate (e.g., ICU admission); grade 3, severe (e.g., reoperation related to surgery of interest). To evaluate the efficacy of the ISSG-AO ASD Complication Classification System, we aimed to compare correlations between postoperative length of stay (LOS) and complication severity as classified by the ISSG-AO ASD and traditional major/minor complication classification systems.Methods Patients age ≥18 in a multicenter ASD database who sustained in-hospital complications were identified. Complications were classified with the major/minor and ISSG-AO systems and correlated with LOS using an ensemble-based machine learning algorithm (conditional random forest) and a generalized linear mixed model.Results 490 patients at 19 sites were included. 64.9% of complications were major, and 35.1% were minor. By ISSG-AO classification, 20.4%, 66.1%, 6.7%, and 6.7% were grades 0-3, respectively. ISSG-AO complication grading demonstrated significant correlation with LOS, whereas major/minor complication classification demonstrated inverse correlation with LOS. In conditional random forest analysis, ISSG-AO classification had the greatest relative importance when assessing correlations across multiple variables with LOS.Conclusions The ISSG-AO system may help identify specific complications associated with prolonged LOS. Targeted interventions to avoid or reduce these complications may improve ASD surgical quality and resource utilization.

Published
2024
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288. Cost Benefit of Implementation of Risk Stratification Models for Adult Spinal Deformity Surgery

Author

Passias, Peter G., Williamson, Tyler K., Kummer, Nicholas A., Pellisé, Ferran, Lafage, Virginie, Lafage, Renaud, Serra-Burriel, Miguel, Smith, Justin S., Line, Breton, Vira, Shaleen, Gum, Jeffrey L., Haddad, Sleiman, Sánchez Pérez-Grueso, Francisco Javier, Schoenfeld, Andrew J., Daniels, Alan H., Chou, Dean, Klineberg, Eric O., Gupta, Munish C., Kebaish, Khaled M., Kelly, Michael P., Hart, Robert A., Burton, Douglas C., Kleinstück, Frank, Obeid, Ibrahim, Shaffrey, Christopher I., Alanay, Ahmet, Ames, Christopher P., Schwab, Frank J., Hostin, Richard A., and Bess, Shay

Abstract

Study Design/Setting Retrospective cohort study.Objective Assess the extent to which defined risk factors of adverse events are drivers of cost-utility in spinal deformity (ASD) surgery.Methods ASD patients with 2-year (2Y) data were included. Tertiles were used to define high degrees of frailty, sagittal deformity, blood loss, and surgical time. Cost was calculated using the Pearl Diver registry and cost-utility at 2Y was compared between cohorts based on the number of risk factors present. Statistically significant differences in cost-utility by number of baseline risk factors were determined using ANOVA, followed by a generalized linear model, adjusting for clinical site and surgeon, to assess the effects of increasing risk score on overall cost-utility.Results By 2 years, 31% experienced a major complication and 23% underwent reoperation. Patients with ≤2 risk factors had significantly less major complications. Patients with 2 risk factors improved the most from baseline to 2Y in ODI. Average cost increased by $8234 per risk factor (R2= .981). Cost-per-QALY at 2Y increased by $122,650 per risk factor (R2= .794). Adjusted generalized linear model demonstrated a significant trend between increasing risk score and increasing cost-utility (r2= .408, P< .001).Conclusions The number of defined patient-specific and surgical risk factors, especially those with greater than two, were associated with increased index surgical costs and diminished cost-utility. Efforts to optimize patient physiology and minimize surgical risk would likely reduce healthcare expenditures and improve the overall cost-utility profile for ASD interventions. Level of evidence:III

Published
2024
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289. Revision Strategy for Proximal Junctional Failure: Combined Effect of Proximal Extension and Focal Correction

Author

Lafage, Renaud, Kim, Han-Jo, Eastlack, Robert K., Daniels, Alan H., Diebo, Bassel G., Mundis, Greg, Khalifé, Marc, Smith, Justin S., Bess, Shay R., Shaffrey, Christopher I., Ames, Christopher P., Burton, Douglas C., Gupta, Munish C., Klineberg, Eric O., Schwab, Frank J., and Lafage, Virginie

Abstract

Study design Retrospective review of a prospectively-collected multicenter database.Objectives The objective of this study was to determine optimal strategies in terms of focal angular correction and length of proximal extension during revision for PJF.Methods 134 patients requiring proximal extension for PJF were analyzed in this study. The correlation between amount of proximal junctional angle (PJA) reduction and recurrence of proximal junctional kyphosis (PJK) and/or PJF was investigated. Following stratification by the degree of PJK correction and the numbers of levels extended proximally, rates of radiographic PJK (PJA >28° & ΔPJA >22°), and recurrent surgery for PJF were reported.Results Before revision, mean PJA was 27.6° ± 14.6°. Mean number of levels extended was 6.0 ± 3.3. Average PJA reduction was 18.8° ± 18.9°. A correlation between the degree of PJA reduction and rate of recurrent PJK was observed (r = −.222). Recurrent radiographic PJK (0%) and clinical PJF (4.5%) were rare in patients undergoing extension ≥8 levels, regardless of angular correction. Patients with small reductions (<5°) and small extensions (<4 levels) experienced moderate rates of recurrent PJK (19.1%) and PJF (9.5%). Patients with large reductions (>30°) and extensions <8 levels had the highest rate of recurrent PJK (31.8%) and PJF (16.0%).Conclusion While the degree of focal PJK correction must be determined by the treating surgeon based upon clinical goals, recurrent PJK may be minimized by limiting reduction to <30°. If larger PJA correction is required, more extensive proximal fusion constructs may mitigate recurrent PJK/PJF rates.

Published
2024
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290. Utilization of Predictive Modeling to Determine Episode of Care Costs and to Accurately Identify Catastrophic Cost Nonwarranty Outlier Patients in Adult Spinal Deformity Surgery: A Step Toward Bundled Payments and Risk Sharing.

Author

Ames, Christopher P., Smith, Justin S., Gum, Jeffrey L., Kelly, Michael, Vila-Casademunt, Alba, Burton, Douglas C., Hostin, Richard, Yeramaneni, Samrat, Lafage, Virginie, Schwab, Frank J., Shaffrey, Christopher I., Bess, Shay, Pellisé, Ferran, Serra-Burriel, Miquel, and European Spine Study Group and International Spine Study Group

Published
2020
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291. Fatty infiltration of the cervical extensor musculature, cervical sagittal balance, and clinical outcomes: An analysis of operative adult cervical deformity patients.

Author

Passias, Peter G., Segreto, Frank A., Horn, Samantha R., Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Naessig, Sara, Bortz, Cole, Klineberg, Eric O., Diebo, Bassel G., Sciubba, Daniel M., Neuman, Brian J., Hamilton, D. Kojo, Burton, Douglas C., Hart, Robert A., Schwab, Frank J., Bess, Shay, Shaffrey, Christopher I., Nunley, Pierce, and Ames, Christopher P.

Abstract

• Lordotic curvature correlated with C2-C7 fatty infiltration. • Residual postop TS-CL and cSVA malalignment associated with greater apex fatty-infiltration. • Deformity correction and sagittal balance influence cervical muscle tone. To assess preliminary associations between fatty-infiltration (FI) of cervical spine extensor musculature, cervical sagittal balance, and clinical outcomes in cervical deformity (CD) patients. Operative CD patients (C2-C7 Cobb > 10°, CL > 10°, cSVA > 4 cm, or CBVA > 25°) with pre-operative (BL) MRIs and 1-year (1Y) post-operative MRIs or CTs were assessed for fatty-infiltration of cervical extensor musculature, using dedicated imaging software at each C2-C7 intervertebral level and the apex of deformity (apex). FI was gauged as a ratio of fat-free-muscle-cross-sectional-area (FCSA) over total-muscle-CSA (TCSA), with lower ratio values indicating greater FI. BL-1Y associations between FI, sagittal alignment, and clinical outcomes were assessed using appropriate parametric and non-parametric tests. 22 patients were included (Age 59.22, 71.4%F, BMI 29.2, CCI:0.75, Frailty: 0.43). BL deformity presentation: TS-CL: 29.0°, C2-C7 Sagittal Cobb:-1.6°, cSVA:30.4 mm. No correlations were observed between BL fatty-infiltration, sagittal alignment, frailty, or clinical outcomes (p > 0.05). Following surgical correction, C2-C7 (BL: 0.59 vs 1Y:0.67, p = 0.005) and apex (BL: 0.59 vs. 1Y: 0.66, p = 0.33) fatty-infiltration decreased. Achievement of lordotic curvature correlated with C2-C7 fatty infiltration reduction (R s : 0.495, p < 0.05), and patients with residual postoperative TS-CL and cSVA malalignment were associated with greater apex fatty-infiltration (R s : −0.565, −0.561; p < 0.05). C2-C7 FI improvement was associated with NRS back pain reduction (R s : −0.630, p < 0.05), and greater apex fatty-infiltration at BL was associated with minor perioperative complication occurrence (R s : 0.551, p = 0.014). Deformity correction and sagittal balance appear to influence the reestablishment of cervical muscle tone from C2-C7 and reduction of back pain for severely frail CD patients. This analysis helps to understand cervical extensor musculature's role amongst CD patients. [ABSTRACT FROM AUTHOR]

Published
2020
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293. The Importance of C2 Slope, a Singular Marker of Cervical Deformity, Correlates With Patient-reported Outcomes.

Author

Protopsaltis, Themistocles S., Ramchandran, Subaraman, Tishelman, Jared C., Smith, Justin S., Neuman, Brian J., Mundis Jr, Gregory M., Lafage, Renaud, Klineberg, Eric O., Hamilton, D. Kojo, LaFage, Virginie, Gupta, Munish C., Hart, Robert A., Schwab, Frank J., Burton, Douglas C., Bess, Shay, Shaffrey, Christopher I., Ames, Christopher P., Mundis, Gregory M Jr, International Spine Study Group, and Jr, Gregory M Mundis

Published
2020
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294. Development of a Novel Cervical Deformity Surgical Invasiveness Index.

Author

Passias, Peter G., Horn, Samantha R., Soroceanu, Alexandra, Oh, Cheongeun, Ailon, Tamir, Neuman, Brian J., Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Line, Breton, Bortz, Cole A., Segreto, Frank A., Brown, Avery, Alas, Haddy, Pierce, Katherine E., Eastlack, Robert K., Sciubba, Daniel M., Protopsaltis, Themistocles S., Klineberg, Eric O., and Burton, Douglas C.

Published
2020
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295. Predicting extended operative time and length of inpatient stay in cervical deformity corrective surgery.

Author

Horn, Samantha R., Passias, Peter G., Bortz, Cole A., Pierce, Katherine E., Lafage, Virginie, Lafage, Renaud, Brown, Avery E., Alas, Haddy, Smith, Justin S, Line, Breton, Deviren, Vedat, Mundis, Gregory M., Kelly, Michael P., Kim, Han Jo, Protopsaltis, Themistocles, Daniels, Alan H., Klineberg, Eric O., Burton, Douglas C., Hart, Robert A., and Schwab, Frank J.

Abstract

• Identification of predictors of extended op-time and length of stay in CD patients. • Levels fused, surgical approach, BMI and osteotomy predicted op-time and LOS. • Baseline cSVA and C0 slope predicted increased LOS and op-time. • Patient care, hospital efficiency, and resource allocation can be optimized. It's increasingly common for surgeons to operate on more challenging cases and higher risk patients, resulting in longer op-time and inpatient LOS. Factors predicting extended op-time and LOS for cervical deformity (CD) patients are understudied. This study identified predictors of extended op-time and length of stay (LOS) after CD-corrective surgery. CD patients with baseline (BL) radiographic data were included. Patients were stratified by extended LOS (ELOS; >75th percentile) and normal LOS (N-LOS; <75th percentile). Op-time analysis excluded staged cases, cases >12 h. A Conditional Variable Importance Table used non-replacement sampling set of Conditional Inference trees to identify influential factors. Mean comparison tests compared LOS and op-time for top factors. 142 surgical CD patients (61 yrs, 62%F, 8.2 levels fused). Op-time and LOS were 358 min and 7.2 days; 30% of patients experienced E-LOS (14 ± 13 days). Overlapping predictors of E-LOS and op-time included levels fused (>7 increased LOS 2.7 days; >5 increased op-time 96 min, P < 0.001), approach (anterior reduced LOS 3.0 days; combined increased op-time 69 min, P < 0.01), BMI (>38 kg/m2 increased LOS 8.1 days; >39 kg/m2 increased op-time 17 min), and osteotomy (LOS 2.0 days, op-time 62 min, P < 0.005). BL cervical parameters increased LOS and op-time: cSVA (>42 mm increased LOS; >50 mm increased op-time, P < 0.030), C0 slope (>@−0.9° increased LOS, >0.3° increased op-time, P < 0.003.) Additional op-time predictors: prior cervical surgery (p = 0.004) and comorbidities (P = 0.015). Other predictors of E-LOS: EBL (P < 0.001), change in mental status (P = 0.001). Baseline cervical malalignment, levels fused, and osteotomy predicted both increased op-time and LOS. These results can be used to better optimize patient care, hospital efficiency, and resource allocation. [ABSTRACT FROM AUTHOR]

Published
2019
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296. Recovery Kinetics: Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology

Author

Segreto, Frank A, primary, Lafage, Virginie, additional, Lafage, Renaud, additional, Smith, Justin S, additional, Line, Breton G, additional, Eastlack, Robert K, additional, Scheer, Justin K, additional, Chou, Dean, additional, Frangella, Nicholas J, additional, Horn, Samantha R, additional, Bortz, Cole A, additional, Diebo, Bassel G, additional, Neuman, Brian J, additional, Protopsaltis, Themistocles S, additional, Kim, Han Jo, additional, Klineberg, Eric O, additional, Burton, Douglas C, additional, Hart, Robert A, additional, Schwab, Frank J, additional, Bess, Shay, additional, Shaffrey, Christopher I, additional, Ames, Christopher P, additional, and Passias, Peter G, additional

Published
2018
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297. 113 Cost-Utility of Revisions for Cervical Deformity Correction Warrants Minimization of Reoperations

Author

Horn, Samantha R, primary, Passias, Peter G, additional, Lafage, Renaud, additional, Lafage, Virginie, additional, Smith, Justin S, additional, Line, Breton G, additional, Mundis, Gregory M, additional, Kelly, Michael P, additional, Protopsaltis, Themistocles, additional, Kim, Han Jo, additional, Bortz, Cole, additional, Segreto, Frank, additional, Janjua, Muhammad B, additional, Daniels, Alan H, additional, Klineberg, Eric, additional, Burton, Douglas C, additional, Hart, Robert, additional, Schwab, Frank, additional, Bess, Shay, additional, Shaffrey, Christopher I, additional, Hostin, Richard A, additional, and Ames, Christopher P, additional

Published
2018
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298. 165 Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction

Author

Passias, Peter G, primary, Bortz, Cole, additional, Lafage, Virginie, additional, Lafage, Renaud, additional, Smith, Justin S, additional, Line, Breton G, additional, Eastlack, Robert, additional, Gupta, Munish C, additional, Hostin, Richard A, additional, Horn, Samantha R, additional, Sciubba, Daniel M, additional, Gum, Jeffrey L, additional, Kebaish, Khaled, additional, Klineberg, Eric, additional, Burton, Douglas C, additional, Schwab, Frank, additional, Shaffrey, Christopher I, additional, Ames, Christopher P, additional, and Janjua, Muhammad Burhan Ud Din, additional

Published
2018
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299. Radiographic Fusion Grade Does Not Impact Health-Related Quality of Life in the Absence of Instrumentation Failure for Patients Undergoing Posterior Instrumented Fusion for Adult Spinal Deformity

Author

Ailon, Tamir, primary, Hamilton, D. Koho, additional, Klineberg, Erik, additional, Daniels, Alan H., additional, Lafage, Virginie, additional, Bess, Shay, additional, Burton, Douglas C., additional, Gupta, Munish, additional, Schwab, Frank, additional, Ames, Christopher P., additional, Smith, Justin S., additional, Shaffrey, Christopher I., additional, and Hart, Robert A., additional

Published
2018
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300. Development of a Preoperative Predictive Model for Reaching the Oswestry Disability Index Minimal Clinically Important Difference for Adult Spinal Deformity Patients

Author

Scheer, Justin K., primary, Osorio, Joseph A., additional, Smith, Justin S., additional, Schwab, Frank, additional, Hart, Robert A., additional, Hostin, Richard, additional, Lafage, Virginie, additional, Jain, Amit, additional, Burton, Douglas C., additional, Bess, Shay, additional, Ailon, Tamir, additional, Protopsaltis, Themistocles S., additional, Klineberg, Eric O., additional, Shaffrey, Christopher I., additional, and Ames, Christopher P., additional

Published
2018
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