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1. How Good Are Surgeons at Achieving Their Preoperative Goal Sagittal Alignment Following Adult Deformity Surgery?

Author

Smith, Justin, Elias, Elias, Sursal, Tolga, Line, Breton, Lafage, Virginie, Lafage, Renaud, Klineberg, Eric, Kim, Han, Passias, Peter, Nasser, Zeina, Gum, Jeffrey, Eastlack, Robert, Daniels, Alan, Mundis, Gregory, Hostin, Richard, Protopsaltis, Themistocles, Soroceanu, Alex, Hamilton, David, Kelly, Michael, Lewis, Stephen, Gupta, Munish, Schwab, Frank, Burton, Douglas, Ames, Christopher, Lenke, Lawrence, Shaffrey, Christopher, and Bess, Shay

Subjects
adult spinal deformity, alignment prediction, kyphosis, sagittal alignment, scoliosis, surgery
Abstract

STUDY DESIGN: Multicenter, prospective cohort. OBJECTIVES: Malalignment following adult spine deformity (ASD) surgery can impact outcomes and increase mechanical complications. We assess whether preoperative goals for sagittal alignment following ASD surgery are achieved. METHODS: ASD patients were prospectively enrolled based on 3 criteria: deformity severity (PI-LL ≥25°, TPA ≥30°, SVA ≥15 cm, TCobb≥70° or TLCobb≥50°), procedure complexity (≥12 levels fused, 3-CO or ACR) and/or age (>65 and ≥7 levels fused). The surgeon documented sagittal alignment goals prior to surgery. Goals were compared with achieved alignment on first follow-up standing radiographs. RESULTS: The 266 enrolled patients had a mean age of 61.0 years (SD = 14.6) and 68% were women. Mean instrumented levels was 13.6 (SD = 3.8), and 23.2% had a 3-CO. Mean (SD) offsets (achieved-goal) were: SVA = -8.5 mm (45.6 mm), PI-LL = -4.6° (14.6°), TK = 7.2° (14.7°), reflecting tendencies to undercorrect SVA and PI-LL and increase TK. Goals were achieved for SVA, PI-LL, and TK in 74.4%, 71.4%, and 68.8% of patients, respectively, and was achieved for all 3 parameters in 37.2% of patients. Three factors were independently associated with achievement of all 3 alignment goals: use of PACs/equivalent for surgical planning (P < .001), lower baseline GCA (P = .009), and surgery not including a 3-CO (P = .037). CONCLUSIONS: Surgeons failed to achieve goal alignment of each sagittal parameter in ∼25-30% of ASD patients. Goal alignment for all 3 parameters was only achieved in 37.2% of patients. Those at greatest risk were patients with more severe deformity. Advancements are needed to enable more consistent translation of preoperative alignment goals to the operating room.

Published
2024

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

Author

Onafowokan, Oluwatobi O., Krol, Oscar, Lafage, Virginie, Lafage, Renaud, Smith, Justin S., Line, Breton, Vira, Shaleen, Daniels, Alan H., Diebo, Bassel, Schoenfeld, Andrew J., Gum, Jeffrey, Kebaish, Khaled, Than, Khoi, Kim, Han Jo, Hostin, Richard, Gupta, Munish, Eastlack, Robert, Burton, Douglas, Schwab, Frank J., Shaffrey, Christopher, Klineberg, Eric O., Bess, Shay, and Passias, Peter G.

Published
2025
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3. Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes

Author

Cetik, Riza M., Gum, Jeffrey L., Lafage, Renaud, Smith, Justin S., Bess, Shay, Mullin, Jeffrey P., Kelly, Michael P., Diebo, Bassel G., Buell, Thomas J., Scheer, Justin K., Line, Breton G., Lafage, Virginie, Klineberg, Eric O., Kim, Han Jo, Passias, Peter G., Kebaish, Khaled M., Eastlack, Robert K., Daniels, Alan H., Soroceanu, Alex, Mundis, Gregory M., Hostin, Richard A., Protopsaltis, Themistocles S., Hamilton, D. Kojo, Hart, Robert A., Gupta, Munish C., Lewis, Stephen J., Schwab, Frank J., Lenke, Lawrence G., Shaffrey, Christopher I., Ames, Christopher P., and Burton, Douglas C.

Published
2025
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4. Defining modern iatrogenic flatback syndrome: examination of segmental lordosis in short lumbar fusion patients undergoing thoracolumbar deformity correction

Author

Diebo, Bassel G., Singh, Manjot, Balmaceno-Criss, Mariah, Daher, Mohammad, Lenke, Lawrence G., Ames, Christopher P., Burton, Douglas C., Lewis, Stephen M., Klineberg, Eric O., Lafage, Renaud, Eastlack, Robert K., Gupta, Munish C., Mundis, Gregory M., Gum, Jeffrey L., Hamilton, Kojo D., Hostin, Richard, Passias, Peter G., Protopsaltis, Themistocles S., Kebaish, Khaled M., Kim, Han Jo, Shaffrey, Christopher I., Line, Breton G., Mummaneni, Praveen V., Nunley, Pierce D., Smith, Justin S., Turner, Jay, Schwab, Frank J., Uribe, Juan S., Bess, Shay, Lafage, Virginie, and Daniels, Alan H.

Published
2024
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5. Opioid Use Prior to Adult Spine Deformity Correction Surgery is Associated With Worse Pre- and Postoperative Back Pain and Prolonged Opioid Demands.

Author

Sardi, Juan, Smith, Justin, Gum, Jeffrey, Rocos, Brett, Charalampidis, Anastasios, Lenke, Lawrence, Shaffrey, Christopher, Cheung, Kenneth, Qiu, Yong, Matsuyama, Yukihiro, Pellisé, Ferran, Polly, David, Sembrano, Jonathan, Dahl, Benny, Kelly, Michael, de Kleuver, Marinus, Spruit, Maarten, Alanay, Ahmet, Berven, Sigurd, and Lewis, Stephen

Subjects
adult spinal deformity, opioid use, pain management, pain measurement, spinal instrumentation, spine surgery
Abstract

STUDY DESIGN: Prospective multicenter database post-hoc analysis. OBJECTIVES: Opioids are frequently prescribed for painful spinal conditions to provide pain relief and to allow for functional improvement, both before and after spine surgery. Amidst a current opioid epidemic, it is important for providers to understand the impact of opioid use and its relationship with patient-reported outcomes. The purpose of this study was to evaluate pre-/postoperative opioid consumption surrounding ASD and assess patient-reported pain outcomes in older patients undergoing surgery for spinal deformity. METHODS: Patients ≥60 years of age from 12 international centers undergoing spinal fusion of at least 5 levels and a minimum 2-year follow-up were included. Patient-reported outcome scores were collected using the Numeric Rating Scale for back and leg pain (NRS-B; NRS-L) at baseline and at 2 years following surgery. Opioid use, defined based on a specific question on case report forms and question 11 from the SRS-22r questionnaire, was assessed at baseline and at 2-year follow-up. RESULT: Of the 219 patients who met inclusion criteria, 179 (81.7%) had 2-year data on opioid use. The percentages of patients reporting opioid use at baseline (n = 75, 34.2%) and 2 years after surgery (n = 55, 30.7%) were similar (P = .23). However, at last follow-up 39% of baseline opioid users (Opi) were no longer taking opioids, while 14% of initial non-users (No-Opi) reported opioid use. Regional pre- and postoperative opioid use was 5.8% and 7.7% in the Asian population, 58.3% and 53.1% in the European, and 50.5% and 40.2% in North American patients, respectively. Baseline opioid users reported more preoperative back pain than the No-Opi group (7.0 vs 5.7, P = .001), while NRS-Leg pain scores were comparable (4.8 vs 4, P = .159). Similarly, at last follow-up, patients in the Opi group had greater NRS-B scores than Non-Opi patients (3.2 vs 2.3, P = .012), but no differences in NRS-Leg pain scores (2.2 vs 2.4, P = .632) were observed. CONCLUSIONS: In this study, almost one-third of surgical ASD patients were consuming opioids both pre- and postoperatively world-wide. There were marked international variations, with patients from Asia having a much lower usage rate, suggesting a cultural influence. Despite both opioid users and nonusers benefitting from surgery, preoperative opioid use was strongly associated with significantly more back pain at baseline that persisted at 2-year follow up, as well as persistent postoperative opioid needs.

Published
2024

6. Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions

Author

Kim, Andrew H., Hostin, Richard A., Yeramaneni, Samrat, Gum, Jeffrey L., Nayak, Pratibha, Line, Breton G., Bess, Shay, Passias, Peter G., Hamilton, D. Kojo, Gupta, Munish C., Smith, Justin S., Lafage, Renaud, Diebo, Bassel G., Lafage, Virginie, Klineberg, Eric O., Daniels, Alan H., Protopsaltis, Themistocles S., Schwab, Frank J., Shaffrey, Christopher I., Ames, Christopher P., Burton, Douglas C., and Kebaish, Khaled M.

Published
2024
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7. Contemporary utilization of three-column osteotomy techniques in a prospective complex spinal deformity multicenter database: implications on full-body alignment and perioperative course

Author

Williamson, Tyler K., Mir, Jamshaid M., Smith, Justin S., Lafage, Virginie, Lafage, Renaud, Line, Breton, Diebo, Bassel G., Daniels, Alan H., Gum, Jeffrey L., Hamilton, D. Kojo, Scheer, Justin K., Eastlack, Robert, Demetriades, Andreas K., Kebaish, Khaled M., Lewis, Stephen, Lenke, Lawrence G., Hostin Jr, Richard A., Gupta, Munish C., Kim, Han Jo, Ames, Christopher P., Burton, Douglas C., Shaffrey, Christopher I., Klineberg, Eric O., Bess, Shay, and Passias, Peter G.

Published
2024
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8. Expectations of clinical improvement following corrective surgery for adult cervical deformity based on functional disability at presentation

Author

Passias, Peter G., Onafowokan, Oluwatobi O., Joujon-Roche, Rachel, Smith, Justin, Tretiakov, Peter, Buell, Thomas, Diebo, Bassel G., Daniels, Alan H., Gum, Jeffrey L., Hamiltion, D. Kojo, Soroceanu, Alex, Scheer, Justin, Eastlack, Robert K., Fessler, Richard G., Klineberg, Eric O., Kim, Han Jo, Burton, Douglas C., Schwab, Frank J., Bess, Shay, Lafage, Virginie, Shaffrey, Christopher I., and Ames, Christopher

Published
2024
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9. Impact of Self-Reported Loss of Balance and Gait Disturbance on Outcomes following Adult Spinal Deformity Surgery.

Author

Diebo, Bassel, Alsoof, Daniel, Lafage, Renaud, Daher, Mohammad, Balmaceno-Criss, Mariah, Passias, Peter, Ames, Christopher, Shaffrey, Christopher, Burton, Douglas, Deviren, Vedat, Line, Breton, Soroceanu, Alex, Hamilton, David, Klineberg, Eric, Mundis, Gregory, Kim, Han, Gum, Jeffrey, Smith, Justin, Uribe, Juan, Kebaish, Khaled, Gupta, Munish, Nunley, Pierce, Eastlack, Robert, Hostin, Richard, Protopsaltis, Themistocles, Lenke, Lawrence, Hart, Robert, Schwab, Frank, Bess, Shay, Lafage, Virginie, and Daniels, Alan

Subjects
adult spinal deformity, balance, radiological outcomes
Abstract

Background: The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. Methods: ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to whether they answered yes or no to a recent history of pre-operative loss of balance. The groups were propensity-matched by age, pelvic incidence-lumbar lordosis (PI-LL), and surgical invasiveness score. Results: In total, 212 patients were examined (106 in each group). Patients with gait imbalance had worse baseline PROM measures, including Oswestry disability index (45.2 vs. 36.6), SF-36 mental component score (44 vs. 51.8), and SF-36 physical component score (p < 0.001 for all). After 2 years, patients with gait imbalance had less pelvic tilt correction (-1.2 vs. -3.6°, p = 0.039) for a comparable PI-LL correction (-11.9 vs. -15.1°, p = 0.144). Gait imbalance patients had higher rates of radiographic proximal junctional kyphosis (PJK) (26.4% vs. 14.2%) and implant-related complications (47.2% vs. 34.0%). After controlling for age, baseline sagittal parameters, PI-LL correction, and comorbidities, patients with imbalance had 2.2-times-increased odds of PJK after 2 years. Conclusions: Patients with a self-reported loss of balance/unsteady gait have significantly worse PROMs and higher risk of PJK.

Published
2024

11. High-Dose TXA Is Associated with Less Blood Loss Than Low-Dose TXA without Increased Complications in Patients with Complex Adult Spinal Deformity

Author

Kim, Andrew H., Mo, Kevin C., Harris, Andrew B., Lafage, Renaud, Neuman, Brian J., Hostin, Richard A., Soroceanu, Alexandra, Kim, Han Jo, Klineberg, Eric O., Gum, Jeffrey L., Gupta, Munish C., Hamilton, D. Kojo, Schwab, Frank, Burton, Doug, Daniels, Alan, Passias, Peter G., Hart, Robert A., Line, Breton G., Ames, Christopher, Lafage, Virginie, Shaffrey, Christopher I., Smith, Justin S., Bess, Shay, Lenke, Lawrence, Kebaish, Khaled M., Akbarnia, Behrooz, Ames, Christopher, Anand, Neel, Bess, Shay, Boachie-Adjei, Oheneba, Bridwell, Keith, Burton, Douglas, Chou, Dean, Cunningham, Matthew E., Daniels, Alan, Deviren, Vedat, Eastlack, Robert, Fessler, Richard, Glassman, Steven, Gum, Jeffrey, Gupta, Munish, Hamilton, D. Kojo, Hart, Robert, Hosogane, Naobumi, Hostin, Richard, Javidan, Yashar, Fu, Kai Ming, Kanter, Adam, Kebaish, Khaled, Kelly, Michael, Kim, Han Jo, Klineberg, Eric, Lafage, Renaud, Lafage, Virginie, Lenke, Lawrence, Line, Breton, Mummaneni, Praveen, Mundis, Gregory, Neuman, Brian, Nunley, Pierce, Okonkwo, David, Park, Paul, Passias, Peter, Protopsaltis, Themistocles, Scheer, Justin, Schwab, Frank, Sciubba, Daniel, Shaffrey, Christopher, Smith, Justin S., Soroceanu, Alexandra, Ailon, Tamir, Than, Khoi, Uribe, Juan, Wang, Michael, Yagi, Mitsuru, and Yeramaneni, Samrat

Published
2024
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12. Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery.

Author

Passias, Peter, Williamson, Tyler, Mir, Jamshaid, Smith, Justin, Lafage, Virginie, Lafage, Renaud, Line, Breton, Daniels, Alan, Gum, Jeffrey, Schoenfeld, Andrew, Hamilton, David, Soroceanu, Alex, Scheer, Justin, Eastlack, Robert, Mundis, Gregory, Diebo, Bassel, Kebaish, Khaled, Hostin, Richard, Gupta, Munish, Kim, Han, Klineberg, Eric, Ames, Christopher, Hart, Robert, Burton, Douglas, Schwab, Frank, Shaffrey, Christopher, and Bess, Shay

Subjects
Medicare, adult spinal deformity, clinical improvement, complex realignment, complications, cost-utility
Abstract

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. METHODS: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. RESULTS: A total of 930 patients were considered. Following PSM, 253 optimal (O) and 253 not optimal (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. CONCLUSIONS: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success.

Published
2023

13. Identifying Subsets of Patients With Adult Spinal Deformity Who Maintained a Positive Response to Nonoperative Management.

Author

Passias, Peter, Ahmad, Waleed, Tretiakov, Peter, Krol, Oscar, Segreto, Frank, Lafage, Renaud, Lafage, Virginie, Soroceanu, Alex, Daniels, Alan, Gum, Jeffrey, Line, Breton, Schoenfeld, Andrew, Vira, Shaleen, Hart, Robert, Burton, Douglas, Smith, Justin, Shaffrey, Christopher, Schwab, Frank, Bess, Shay, and Ames, Christopher

Subjects
Humans, Adult, Aged, Treatment Outcome, Retrospective Studies, Frailty, Quality of Life, Pain
Abstract

BACKGROUND: Adult spinal deformity (ASD) represents a major cause of disability in the elderly population in the United States. Surgical intervention has been shown to reduce disability and pain in properly indicated patients. However, there is a small subset of patients in whom nonoperative treatment is also able to durably maintain or improve symptoms. OBJECTIVE: To examine the factors associated with successful nonoperative management in patients with ASD. METHODS: We retrospectively evaluated a cohort of 207 patients with nonoperative ASD, stratified into 3 groups: (1) success, (2) no change, and (3) failure. Success was defined as a gain in minimal clinically importance difference in both Oswestry Disability Index and Scoliosis Research Society-Pain. Logistic regression model and conditional inference decision trees established cutoffs for success according to baseline (BL) frailty and sagittal vertical axis. RESULTS: In our cohort, 44.9% of patients experienced successful nonoperative treatment, 22.7% exhibited no change, and 32.4% failed. Successful nonoperative patients at BL were significantly younger, had a lower body mass index, decreased Charlson Comorbidity Index, lower frailty scores, lower rates of hypertension, obesity, depression, and neurological dysfunction (all P < .05) and significantly higher rates of grade 0 deformity for all Schwab modifiers (all P < .05). Conditional inference decision tree analysis determined that patients with a BL ASD-frailty index ≤ 1.579 (odds ratio: 8.3 [4.0-17.5], P < .001) were significantly more likely to achieve nonoperative success. CONCLUSION: Success of nonoperative treatment was more frequent among younger patients and those with less severe deformity and frailty at BL, with BL frailty the most important determinant factor. The factors presented here may be useful in informing preoperative discussion and clinical decision-making regarding treatment strategies.

Published
2023

15. Impact of Prior Cervical Fusion on Patients Undergoing Thoracolumbar Deformity Correction

Author

Singh, Manjot, Balmaceno-Criss, Mariah, Daher, Mohammad, Lafage, Renaud, Eastlack, Robert K., Gupta, Munish C., Mundis, Gregory M., Gum, Jeffrey L., Hamilton, Kojo D., Hostin, Richard, Passias, Peter G., Protopsaltis, Themistocles S., Kebaish, Khaled M., Lenke, Lawrence G., Ames, Christopher P., Burton, Douglas C., Lewis, Stephen M., Klineberg, Eric O., Kim, Han Jo, Schwab, Frank J., Shaffrey, Christopher I., Smith, Justin S., Line, Breton G., Bess, Shay, Lafage, Virginie, Diebo, Bassel G., and Daniels, Alan H.

Published
2025
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16. The T4-L1-Hip Axis: Sagittal Spinal Realignment Targets in Long-Construct Adult Spinal Deformity Surgery: Early Impact

Author

Hills, Jeffrey, Mundis, Gregory M., Klineberg, Eric O., Smith, Justin S., Line, Breton, Gum, Jeffrey L., Protopsaltis, Themistocles S., Hamilton, D. Kojo, Soroceanu, Alex, Eastlack, Robert, Nunley, Pierce, Kebaish, Khaled M., Lenke, Lawrence G., Hostin, Richard A., Jr., Gupta, Munish C., Kim, Han Jo, Ames, Christopher P., Burton, Douglas C., Shaffrey, Christopher I., Schwab, Frank J., Lafage, Virginie, Lafage, Renaud, Bess, Shay, and Kelly, Michael P.

Published
2024
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17. Impact of Knee Osteoarthritis and Arthroplasty on Full Body Sagittal Alignment in Adult Spinal Deformity Patients

Author

Daher, Mohammad, Daniels, Alan H, Knebel, Ashley, Balmaceno-Criss, Mariah, Lafage, Renaud, Lenke, Lawrence G, Ames, Chrisotpher P, Burton, Douglas, Lewis, Stephen M, Klineberg, Eric O, Eastlack, Robert K, Gupta, Munish C., Mundis, Gregory M., Gum, Jeffrey L., Hamilton, Kojo D., Hostin, Richard, Passias, Peter G., Protopsaltis, Themistocles S., Kebaish, Khaled M., Kim, Han Jo, Schwab, Frank, Shaffrey, Christopher I., Smith, Justin S., Line, Breton, Bess, Shay, Lafage, Virginie, and Diebo, Bassel G

Published
2024
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18. Accuracy of Rod Contouring to Desired Angles With and Without a Template: Implications for Achieving Desired Spinal Alignment and Outcomes

Author

Sardi, Juan Pablo, Ames, Christopher P, Coffey, Skye, Good, Christopher, Dahl, Benny, Kraemer, Paul, Gum, Jeffrey, Devito, Dennis, Brayda-Bruno, Marco, Lee, Robert, Bell, Christopher P, Bess, Shay, and Smith, Justin S

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Neurodegenerative, biomechanics, proximal junctional kyphosis, rod bending, sagittal alignment, spinal alignment, spinal instrumentation, spine surgery, Clinical sciences
Abstract

Study designBiomechanical Study.ObjectiveThe search for optimal spinal alignment has led to the development of sophisticated formulas and software for preoperative planning. However, preoperative plans are not always appropriately executed since rod contouring during surgery is often subjective and estimated by the surgeon. We aimed to assess whether rods contoured to specific angles with a French rod bender using a template guide will be more accurate than rods contoured without a template.MethodsTen experienced spine surgeons were requested to contour two 125 × 5.5 mm Ti64 rods to 40°, 60° and 80° without templates and then 2 more rods using 2D metallic templates with the same angles. Rod angles were then measured for accuracy and compared.ResultsAverage angles for rods bent without a template to 40°, 60° and 80° were 60.2°, 78.9° and 97.5°, respectively. Without a template, rods were overbent by a mean of 18.9°. When using templates of 40°, 60° and 80°, mean bend angles were 41.5°, 59.1° and 78.7°, respectively, with an average underbend of 0.2°. Differences between the template and non-template groups for each target angle were all significant (p < 0.001).ConclusionsWithout the template, surgeons tend to overbend rods compared to the desired angle, while surgeons improved markedly with a template guide. This tendency to overbend could have significant impact on patient outcomes and risk of proximal junctional failure and warrants further research to better enable surgeons to more accurately execute preoperative alignment plans.

Published
2023

21. Comparison of clinical and radiological outcomes of three-column lumbar osteotomies with and without interbody cages for adult spinal deformity

Author

Mullin, Jeffrey P., Quiceno, Esteban, Soliman, Mohamed A.R, Daniels, Alan H., Smith, Justin S., Kelly, Michael P., Ames, Christopher P., Bess, Shay, Burton, Douglas, Diebo, Bassel, Eastlack, Robert K., Hostin, Richard, Kebaish, Khaled, Kim, Han Jo, Klineberg, Eric, Lafage, Virginie, Lenke, Lawrence G., Lewis, Stephen J., Mundis, Gregory, Jr., Passias, Peter G., Protopsaltis, Themistocles S., Schwab, Frank J., Gum, Jeffrey L., Buell, Thomas J., Shaffrey, Christopher I., and Gupta, Munish C.

Published
2025
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25. Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile

Author

Singh, Manjot, Balmaceno-Criss, Mariah, Daher, Mohammad, Lafage, Renaud, Hamilton, D. Kojo, Smith, Justin S., Eastlack, Robert K., Fessler, Richard G., Gum, Jeffrey L., Gupta, Munish C., Hostin, Richard, Kebaish, Khaled M., Klineberg, Eric O., Lewis, Stephen J., Line, Breton G., Nunley, Pierce D., Mundis, Gregory M., Passias, Peter G., Protopsaltis, Themistocles S., Buell, Thomas, Ames, Christopher P., Mullin, Jeffrey P., Soroceanu, Alex, Scheer, Justin K., Lenke, Lawrence G., Bess, Shay, Shaffrey, Christopher I., Schwab, Frank J., Lafage, Virginie, Burton, Douglas C., Diebo, Bassel G., and Daniels, Alan H.

Published
2024
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26. Opioid use prior to surgery is associated with worse preoperative and postoperative patient reported quality of life and decreased surgical cost effectiveness for symptomatic adult spine deformity; A matched cohort analysis

Author

Line, Breton, Bess, Shay, Gum, Jeffrey L, Hostin, Richard, Kebaish, Khaled, Ames, Christopher, Burton, Douglas, Mundis, Gregory, Eastlack, Robert, Gupta, Munish, Klineberg, Eric, Lafage, Virgine, Lafage, Renaud, Schwab, Frank, Shaffrey, Christopher, Smith, Justin S, and Group, International Spine Study

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Comparative Effectiveness Research, Brain Disorders, Clinical Research, Chronic Pain, Cost Effectiveness Research, Pain Research, Neurosciences, Behavioral and Social Science, Patient Safety, Management of diseases and conditions, 7.1 Individual care needs, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Good Health and Well Being, International Spine Study Group, Adult spinal deformity, Cost effectiveness, Opioid, Patient reported outcome measures, Quality adjusted life years
Abstract

BackgroundPreoperative opioid is associated with poor postoperative outcomes for several surgical specialties, including neurosurgical, orthopedic, and general surgery. Patients with symptomatic adult spinal deformity (SASD) are among the highest patient populations reporting opioid use prior to surgery. Surgery for SASD has been demonstrated to improve patient reported quality of life, however, little medical economic data exists evaluating impact of preoperative opioid use upon surgical cost-effectiveness for SASD. The purpose of this study was to evaluate the impact that preoperative opioid use has upon SASD surgery including duration of intensive care unit (ICU) and hospital stay, postoperative complications, patient reported outcome measures (PROMs), and surgical cost-effectiveness using a propensity score matched analysis model.MethodsSurgically treated SASD patients enrolled into a prospective multi-center SASD study were assessed for preoperative opioid use, and divided into two cohorts; preoperative opioid users (OPIOID) and preoperative opioid non-users (NON). Propensity score matching (PSM) was used to control for patient age, medical comorbidities, spine deformity type and magnitude, and surgical procedures for OPIOID vs NON. Preoperative and minimum 2-year postoperative PROMs, duration of ICU and hospital stay, postoperative complications, and opioid use at one and two years postoperative were compared for OPIOID vs NON. Preoperative, one year, and minimum two-year postoperative SF6D values were calculated, and one- and two-year postoperative QALYs were calculated using SF6D change from baseline. Hospital costs at the time of index surgery were calculated and cost/QALY compared at one and two years postop for OPIOID vs NON.Results261/357 patients (mean follow-up 3.3 years) eligible for study were evaluated. Following the PSM control, OPIOID (n=97) had similar preoperative demographics, smoking and depression history, spine deformity magnitude, and surgery performed as NON (n=164; p>0.05). Preoperatively, OPIOID reported greater NRS back pain (7.7 vs 6.7) and leg pain (5.2 vs 3.9), worse ODI (50.8 vs 36.9), worse SF-36 PCS (28.8 vs 35.6), and worse SRS-22r self-image (2.3 vs 2.5) than NON, respectively (p

Published
2022

28. Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity

Author

Balmaceno-Criss, Mariah, Lafage, Renaud, Alsoof, Daniel, Daher, Mohammad, Hamilton, David Kojo, Smith, Justin S., Eastlack, Robert K., Fessler, Richard G., Gum, Jeffrey L., Gupta, Munish C., Hostin, Richard, Kebaish, Khaled M., Klineberg, Eric O., Lewis, Stephen J., Line, Breton G., Nunley, Pierce D., Mundis, Gregory M., Passias, Peter G., Protopsaltis, Themistocles S., Buell, Thomas, Scheer, Justin K., Mullin, Jeffrey P., Soroceanu, Alex, Ames, Christopher P., Lenke, Lawrence G., Bess, Shay, Shaffrey, Christopher I., Schwab, Frank J., Lafage, Virginie, Burton, Douglas C., Diebo, Bassel G., and Daniels, Alan H.

Published
2024
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29. Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes

Author

Diebo, Bassel G., Alsoof, Daniel, Balmaceno-Criss, Mariah, Daher, Mohammad, Lafage, Renaud, Passias, Peter G., Ames, Christopher P., Shaffrey, Christopher I., Burton, Douglas C., Deviren, Vedat, Line, Breton G., Soroceanu, Alex, Hamilton, D. Kojo, Klineberg, Eric O., Mundis, Gregory M., Kim, Han Jo, Gum, Jeffrey L., Smith, Justin S., Uribe, Juan S., Kebaish, Khaled M., Gupta, Munish C., Nunley, Pierce D., Eastlack, Robert K., Hostin, Richard, Protopsaltis, Themistocles S., Lenke, Lawrence G., Hart, Robert A., Schwab, Frank J., Bess, Shay, Lafage, Virginie, Daniels, Alan H., and International Spine Study Group

Published
2024
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31. Prioritization of Realignment Associated With Superior Clinical Outcomes for Cervical Deformity Patients.

Author

Pierce, Katherine E, Passias, Peter G, Brown, Avery E, Bortz, Cole A, Alas, Haddy, Passfall, Lara, Krol, Oscar, Kummer, Nicholas, Lafage, Renaud, Chou, Dean, Burton, Douglas C, Line, Breton, Klineberg, Eric, Hart, Robert, Gum, Jeffrey, Daniels, Alan, Hamilton, Kojo, Bess, Shay, Protopsaltis, Themistocles, Shaffrey, Christopher, Schwab, Frank A, Smith, Justin S, Lafage, Virginie, Ames, Christopher, and International Spine Study Group (ISSG)

Subjects
International Spine Study Group, Alignment, Cervical deformity, Spine
Abstract

ObjectiveTo prioritize the cervical parameter targets for alignment.MethodsIncluded: cervical deformity (CD) patients (C2-7 Cobb angle > 10°, cervical lordosis > 10°, cervical sagittal vertical axis [cSVA] > 4 cm, or chin-brow vertical angle > 25°) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical [C] or cervicothoracic [CT] Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA ( < 4 cm) and T1 slope minus cervical lordosis (TS-CL) ( < 15°) were excluded. Patients assessed: meeting minimum clinically important differences (MCID) for NDI ( < -15 ΔNDI). Ratios of correction were found for regional parameters categorized by primary Ames driver (C or CT). Decision tree analysis assessed cutoffs for differences associated with meeting NDI MCID at 1Y.ResultsSeventy-seven CD patients (mean age, 62.1 years; 64% female; body mass index, 28.8 kg/m2). Forty-one point six percent of patients met MCID for NDI. A backwards linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R2 of 0.820 (p = 0.032) included TS-CL, cSVA, McGregor's slope (MGS), C2 sacral slope, C2-T3 angle, C2-T3 SVA, cervical lordosis. By primary Ames driver, 67.5% of patients were C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and CT were not significant between the 2 groups (p > 0.050). Decision tree analysis determined cutoffs for radiographic change, prioritizing in the following order: ≥ 42.5° C2-T3 angle, > 35.4° cervical lordosis, < -31.76° C2 slope, < -11.57-mm cSVA, < -2.16° MGS, > -30.8-mm C2-T3 SVA, and ≤ -33.6° TS-CL.ConclusionCertain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient-reported outcomes for patients undergoing CD surgery.

Published
2021

33. Cause and effect of revisions in adult spinal deformity surgery: a multicenter study on outcomes based on etiology

Author

Passias, Peter G., Dave, Pooja, Smith, Justin S., Lafage, Renaud, Onafowokan, Oluwatobi O., Tretiakov, Peter, Mir, Jamshaid, Line, Breton, Diebo, Bassel, Daniels, Alan H., Gum, Jeffrey L., Eastlack, Robert, Hamilton, D. Kojo, Chou, Dean, Klineberg, Eric O., Kebaish, Khaled M., Lewis, Stephen, Gupta, Munish C., Kim, Han Jo, Lenke, Lawrence G., Ames, Christopher P., Shaffrey, Christopher I., Schwab, Frank J., Lafage, Virginie, Bess, Shay, Hostin, Robert, and Burton, Douglas C.

Published
2024
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37. Evolving concepts in pelvic fixation in adult spinal deformity surgery

Author

Turner, Jay D., Schupper, Alexander J., Mummaneni, Praveen V., Uribe, Juan S., Eastlack, Robert K., Mundis, Gregory M., Jr., Passias, Peter G., DiDomenico, Joseph D., Harrison Farber, S., Soliman, Mohammed A.R., Shaffrey, Christopher I., Klineberg, Eric O., Daniels, Alan H., Buell, Thomas J., Burton, Douglas C., Gum, Jeffrey L., Lenke, Lawrence G., Bess, Shay, and Mullin, Jeffrey P.

Published
2023
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40. Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patients

Author

Pierce, Katherine E, Passias, Peter Gust, Brown, Avery E, Bortz, Cole A, Alas, Haddy, Lafage, Renaud, Krol, Oscar, Chou, Dean, Burton, Douglas C, Line, Breton, Klineberg, Eric, Hart, Robert, Gum, Jeffrey, Daniels, Alan, Hamilton, Kojo, Bess, Shay, Protopsaltis, Themistocles, Shaffrey, Christopher, Schwab, Frank A, Smith, Justin S, Lafage, Virginie, and Ames, Christopher

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Good Health and Well Being, Cervical deformity, prioritization, realignment, International Spine Study Group, Neurosciences, Clinical sciences
Abstract

BackgroundTo optimize quality of life in patients with cervical deformity (CD), there may be alignment targets to be prioritized.ObjectiveTo prioritize the cervical parameter targets for alignment.MethodsIncluded: CD patients (C2-C7 Cobb >10°°, C2-C7 lordosis [CL] >10°°, cSVA > 4 cm, or chin-brow vertical angle >25°°) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical (C) or cervicothoracic (CT) Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA ( 0.050). Decision tree analysis determined cut-offs for radiographic change, prioritizing in the following order: ≥42.5° C2-T3 angle, >35.4° CL, -30.8 mm C2-T3 SVA, and ≤-33.6° TS-CL.ConclusionsCertain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient-reported outcomes for patients undergoing CD surgery.

Published
2021

43. Patient-specific Cervical Deformity Corrections With Consideration of Associated Risk: Establishment of Risk Benefit Thresholds for Invasiveness Based on Deformity and Frailty Severity

Author

Passias, Peter G., Pierce, Katherine E., Williamson, Tyler K., Lebovic, Jordan, Schoenfeld, Andrew J., Lafage, Renaud, Lafage, Virginie, Gum, Jeffrey L., Eastlack, Robert, Kim, Han Jo, Klineberg, Eric O., Daniels, Alan H., Protopsaltis, Themistocles S., Mundis, Gregory M., Scheer, Justin K., Park, Paul, Chou, Dean, Line, Breton, Hart, Robert A., Burton, Douglas C., Bess, Shay, Schwab, Frank J., Shaffrey, Christopher I., Smith, Justin S., and Ames, Christopher P.

Published
2024
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46. Diagnosis-Related Group–Based Payments for Adult Spine Deformity Surgery Significantly Vary across Centers: Results from a Multicenter Prospective Cohort Study

Author

Yeramaneni, Samrat, Wang, Kevin, Gum, Jeffrey, Line, Breton, Jain, Amit, Kebaish, Khaled, Shaffrey, Christopher, Smith, Justin S., Lafage, Virginie, Schwab, Frank, Passias, Peter, Hamilton, D. Kojo, Klineberg, Eric, Ames, Christopher, Burton, Douglas, Bess, Shay, and Hostin, Richard

Published
2023
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49. Height Gain Following Correction of Adult Spinal Deformity

Author

Diebo, Bassel G., Tataryn, Zachary, Alsoof, Daniel, Lafage, Renaud, Hart, Robert A., Passias, Peter G., Ames, Christopher P., Scheer, Justin K., Lewis, Stephen J., Shaffrey, Christopher I., Burton, Douglas C., Deviren, Vedat, Line, Breton G., Soroceanu, Alex, Hamilton, D. Kojo, Klineberg, Eric O., Mundis, Gregory M., Kim, Han Jo, Gum, Jeffrey L., Smith, Justin S., Uribe, Juan S., Kelly, Michael P., Kebaish, Khaled M., Gupta, Munish C., Nunley, Pierce D., Eastlack, Robert K., Hostin, Richard, Protopsaltis, Themistocles S., Lenke, Lawrence G., Schwab, Frank J., Bess, Shay, Lafage, Virginie, and Daniels, Alan H.

Published
2023
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50. When Not to Operate in Spinal Deformity: Identifying Subsets of Patients with Simultaneous Clinical Deterioration, Major Complications, and Reoperation

Author

Passias, Peter G., Pierce, Katherine E., Dave, Pooja, Lafage, Renaud, Lafage, Virginie, Schoenfeld, Andrew J, Line, Breton, Uribe, Juan, Hostin, Richard, Daniels, Alan, Hart, Robert, Burton, Douglas, Kim, Han Jo, Mundis, Gregory M., Eastlack, Robert, Diebo, Bassel G., Gum, Jeffrey L., Shaffrey, Christopher, Schwab, Frank, Ames, Christopher P., Smith, Justin S., Bess, Shay, Klineberg, Eric, Gupta, Munish C., and Hamilton, D. Kojo

Published
2023
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