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1. 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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3. 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

4. Critical Analysis of Radiographic and Patient-Reported Outcomes Following Anterior/Posterior Staged Versus Same-Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity

Author

Passias, Peter G., Ahmad, Waleed, Tretiakov, Peter S., Lafage, Renaud, Lafage, Virginie, Schoenfeld, Andrew J., Line, Breton, Daniels, Alan, Mir, Jamshaid M., Gupta, Munish, Mundis, Gregory, Eastlack, Robert, Nunley, Pierce, Hamilton, D. Kojo, Hostin, Richard, Hart, Robert, Burton, Douglas C., Shaffrey, Christopher, Schwab, Frank, Ames, Christopher, Smith, Justin S., Bess, Shay, and Klineberg, Eric O.

Published
2024
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6. Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes.

Author

Passias, Peter Gust, Alas, Haddy, Kummer, Nicholas, Tretiakov, Peter, Diebo, Bassel G, Lafage, Renaud, Ames, Christopher P, Line, Breton, Klineberg, Eric O, Burton, Douglas C, Uribe, Juan S, Kim, Han Jo, Daniels, Alan H, Bess, Shay, Protopsaltis, Themistocles, Mundis, Gregory M, Shaffrey, Christopher I, Schwab, Frank J, Smith, Justin S, Lafage, Virginie, and International Spine Study Group

Subjects
Cervical deformity, cervical lordosis, hyperlordosis, spine surgery, Clinical Research, Patient Safety, Clinical Sciences, Neurosciences
Abstract

BackgroundPatients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL).ObjectiveThe objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes.Materials and methodsOperative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2-C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (-6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (

Published
2022

10. The Evolution of Enhanced Recovery After Surgery: Assessing the Clinical Benefits of Developments Within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery

Author

Passias, Peter G., Tretiakov, Peter S., Onafowokan, Oluwatobi O., Galetta, Matthew, Lorentz, Nathan, Mir, Jamshaid M., Das, Ankita, Dave, Pooja, Lafage, Renaud, Yee, Timothy, Diebo, Bassel, Vira, Shaleen, Jankowski, Pawel P., Hockley, Aaron, Daniels, Alan, Schoenfeld, Andrew J., Mummaneni, Praveen, Paulino, Carl B., and Lafage, Virginie

Published
2024
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11. Assessing the Economic Benefits of Enhanced Recovery After Surgery (ERAS) Protocols in Adult Cervical Deformity Patients: Is the Initial Additive Cost of Protocols Offset by Clinical Gains?

Author

Tretiakov, Peter S., Onafowokan, Oluwatobi O., Lorentz, Nathan, Galetta, Matthew, Mir, Jamshaid M., Das, Ankita, Dave, Pooja, Yee, Timothy, Buell, Thomas J., Jankowski, Pawel P., Eastlack, Robert, Hockley, Aaron, Schoenfeld, Andrew J., and Passias, Peter G.

Published
2024
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13. The Impact of Lumbopelvic Realignment Versus Prevention Strategies at the Upper-instrumented Vertebra on the Rates of Junctional Failure Following Adult Spinal Deformity Surgery

Author

Passias, Peter G., Williamson, Tyler K., Joujon-Roche, Rachel, Krol, Oscar, Tretiakov, Peter, Imbo, Bailey, Schoenfeld, Andrew J., Owusu-Sarpong, Stephane, Lebovic, Jordan, Mir, Jamshaid, Dave, Pooja, McFarland, Kimberly, Vira, Shaleen, Diebo, Bassel G., Park, Paul, Chou, Dean, Smith, Justin S., Lafage, Renaud, and Lafage, Virginie

Published
2024
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14. The impact of postoperative neurologic complications on recovery kinetics in cervical deformity surgery.

Author

Passias, Peter Gust, Brown, Avery E, Alas, Haddy, Pierce, Katherine E, Bortz, Cole A, Diebo, Bassel, Lafage, Renaud, Lafage, Virginie, Burton, Douglas C, Hart, Robert, Kim, Han Jo, Bess, Shay, Moattari, Kevin, Joujon-Roche, Rachel, Krol, Oscar, Williamson, Tyler, Tretiakov, Peter, Imbo, Bailey, Protopsaltis, Themistocles S, Shaffrey, Christopher, Schwab, Frank, Eastlack, Robert, Line, Breton, Klineberg, Eric, Smith, Justin, Ames, Christopher, and International Spine Study Group

Subjects
International Spine Study Group, Cervical deformity surgery, health-related quality of life, neurologic complications, outcomes, recovery kinetics, Clinical Research, Neurosciences, Patient Safety, Neurodegenerative, Physical Injury - Accidents and Adverse Effects, Rehabilitation, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Clinical Sciences
Abstract

ObjectiveThe objective of the study is to investigate which neurologic complications affect clinical outcomes the most following cervical deformity (CD) surgery.MethodsCD patients (C2-C7 Cobb >10°, CL >10°, cSVA >4 cm or chin-brow vertical angle >25°) >18 years with follow-up surgical and health-related quality of life (HRQL) data were included. Descriptive analyses assessed demographics. Neurologic complications assessed were C5 motor deficit, central neurodeficit, nerve root motor deficits, nerve sensory deficits, radiculopathy, and spinal cord deficits. Neurologic complications were classified as major or minor, then: intraoperative, before discharge, before 30 days, before 90 days, and after 90 days. HRQL outcomes were assessed at 3 months, 6 months, and 1 year. Integrated health state (IHS) for the neck disability index (NDI), EQ5D, and modified Japanese Orthopaedic Association (mJOA) were assessed using all follow-up time points. A subanalysis assessed IHS outcomes for patients with 2Y follow-up.Results153 operative CD patients were included. Baseline characteristics: 61 years old, 63% female, body mass index 29.7, operative time 531.6 ± 275.5, estimated blood loss 924.2 ± 729.5, 49% posterior approach, 18% anterior approach, 33% combined. 18% of patients experienced a total of 28 neurologic complications in the postoperative period (15 major). There were 7 radiculopathy, 6 motor deficits, 6 sensory deficits, 5 C5 motor deficits, 2 central neurodeficits, and 2 spinal cord deficits. 11.2% of patients experienced neurologic complications before 30 days (7 major) and 15% before 90 days (12 major). 12% of neurocomplication patients went on to have revision surgery within 6 months and 18% within 2 years. Neurologic complication patients had worse mJOA IHS scores at 1Y but no significant differences between NDI and EQ5D (0.003 vs. 0.873, 0.458). When assessing individual complications, central neurologic deficits and spinal cord deficit patients had the worst outcomes at 1Y (2.6 and 1.8 times worse NDI scores, P = 0.04, no improvement in EQ5D, 8% decrease in EQ5D). Patients with sensory deficits had the best NDI and EQ5D outcomes at 1Y (31% decrease in NDI, 8% increase in EQ5D). In a subanalysis, neurologic patients trended toward worse NDI and mJOA IHS outcomes (P = 0.263, 0.163).Conclusions18% of patients undergoing CD surgery experienced a neurologic complication, with 15% within 3 months. Patients who experienced any neurologic complication had worse mJOA recovery kinetics by 1 year and trended toward worse recovery at 2 years. Of the neurologic complications, central neurologic deficits and spinal cord deficits were the most detrimental.

Published
2021

15. Risk of spinal surgery among individuals who have been re-vascularized for coronary artery disease

Author

Passias, Peter G., Ahmad, Waleed, Kapadia, Bhaveen H., Krol, Oscar, Bell, Joshua, Kamalapathy, Pramod, Imbo, Bailey, Tretiakov, Peter, Williamson, Tyler, Onafowokan, Oluwatobi O., Das, Ankita, Joujon-Roche, Rachel, Moattari, Kevin, Passfall, Lara, Kummer, Nicholas, Vira, Shaleen, Lafage, Virginie, Diebo, Bassel, Schoenfeld, Andrew J., and Hassanzadeh, Hamid

Published
2024
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19. The Importance of Incorporating Proportional Alignment in Adult Cervical Deformity Corrections Relative to Regional and Global Alignment: Steps Toward Development of a Cervical-Specific Score

Author

Passias, Peter G., Williamson, Tyler K., Pierce, Katherine E., Schoenfeld, Andrew J., Krol, Oscar, Imbo, Bailey, Joujon-Roche, Rachel, Tretiakov, Peter, Ahmad, Salman, Bennett-Caso, Claudia, Mir, Jamshaid, Dave, Pooja, McFarland, Kimberly, Owusu-Sarpong, Stephane, Lebovic, Jordan A., Janjua, Muhammad Burhan, de la Garza-Ramos, Rafael, Vira, Shaleen, Diebo, Bassel, Koller, Heiko, Protopsaltis, Themistocles S., Lafage, Renaud, and Lafage, Virginie

Published
2024
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20. Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis

Author

Passias, Peter G., Passfall, Lara, Moattari, Kevin, Krol, Oscar, Kummer, Nicholas A., Tretiakov, Peter, Williamson, Tyler, Joujon-Roche, Rachel, Imbo, Bailey, Burhan Janjua, Muhammad, Jankowski, Pawel, Paulino, Carl, Schwab, Frank J., Owusu-Sarpong, Stephane, Singh, Vivek, Ahmad, Salman, Onafowokan, Tobi, Lebovic, Jordan, Tariq, Muhammad, Saleh, Hesham, Vira, Shaleen, Smith, Justin S., Diebo, Bassel, and Schoenfeld, Andrew J.

Published
2024
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25. Impact of Frailty on the Development of Proximal Junctional Failure: Does Frailty Supersede Achieving Optimal Realignment?

Author

Krol, Oscar, McFarland, Kimberly, Owusu-Sarpong, Stephane, Sagoo, Navraj, Williamson, Tyler, Joujon-Roche, Rachel, Tretiakov, Peter, Imbo, Bailey, Dave, Pooja, Mir, Jamshaid, Lebovic, Jordan, Onafowokan, Oluwatobi O., Schoenfeld, Andrew J., De la Garza Ramos, Rafael, Janjua, Muhammad Burhan, Sciubba, Daniel M., Diebo, Bassel G., Vira, Shaleen, Smith, Justin S., Lafage, Virginie, Lafage, Renaud, and Passias, Peter G.

Published
2023
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26. “Reverse roussouly”: cervicothoracic curvature ratios define characteristic shapes in adult cervical deformity

Author

Passias, Peter G., Pierce, Katherine E., Williamson, Tyler, Vira, Shaleen, Owusu-Sarpong, Stephane, Singh, Ravinderjit, Krol, Oscar, Passfall, Lara, Kummer, Nicholas, Imbo, Bailey, Joujon-Roche, Rachel, Tretiakov, Peter, Moattari, Kevin, Abola, Matthew V., Ahmad, Waleed, Naessig, Sara, Ahmad, Salman, Singh, Vivek, Diebo, Bassel, and Lafage, Virginie

Published
2022
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27. The Impact of Lumbopelvic Realignment versus Prevention Strategies at the Upper-Instrumented Vertebra on Rates of Junctional Failure following Adult Spinal Deformity Surgery

Author

Passias, Peter G., Williamson, Tyler K., Joujon-Roche, Rachel, Krol, Oscar, Tretiakov, Peter, Imbo, Bailey, Schoenfeld, Andrew J., Owusu-Sarpong, Stephane, Lebovic, Jordan, Mir, Jamshaid, Dave, Pooja, McFarland, Kimberly, Vira, Shaleen, Diebo, Bassel G., Park, Paul, Chou, Dean, Smith, Justin S., Lafage, Renaud, and Lafage, Virginie

Published
2023
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28. Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis

Author

Passias, Peter G., Passfall, Lara, Moattari, Kevin, Krol, Oscar, Kummer, Nicholas A., Tretiakov, Peter, Williamson, Tyler, Joujon-Roche, Rachel, Imbo, Bailey, Burhan Janjua, Muhammad, Jankowski, Pawel, Paulino, Carl, Schwab, Frank J., Owusu-Sarpong, Stephane, Singh, Vivek, Ahmad, Salman, Onafowokan, Tobi, Lebovic, Jordan, Tariq, Muhammad, Saleh, Hesham, Vira, Shaleen, Smith, Justin S., Diebo, Bassel, and Schoenfeld, Andrew J.

Published
2023
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29. Long-term Morbidity in Patients After Surgical Correction of Adult Spinal Deformity: Results From a Cohort With Minimum 5-year Follow-up

Author

Imbo, Bailey, Williamson, Tyler, Joujon-Roche, Rachel, Krol, Oscar, Tretiakov, Peter, Ahmad, Salman, Bennett-Caso, Claudia, Schoenfeld, Andrew J., Dinizo, Michael, De La Garza-Ramos, Rafael, Janjua, M. Burhan, Vira, Shaleen, Ihejirika-Lomedico, Rivka, Raman, Tina, O’Connell, Brooke, Maglaras, Constance, Paulino, Carl, Diebo, Bassel, Lafage, Renaud, Lafage, Virginie, and Passias, Peter G.

Published
2023
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30. Health-related quality of life measures in adult spinal deformity: can we replace the SRS-22 with PROMIS?

Author

Passias, Peter G., Pierce, Katherine E., Krol, Oscar, Williamson, Tyler, Naessig, Sara, Ahmad, Waleed, Passfall, Lara, Tretiakov, Peter, Imbo, Bailey, Joujon-Roche, Rachel, Lebovic, Jordan, Owusu-Sarpong, Stephane, Moattari, Kevin, Kummer, Nicholas A., Maglaras, Constance, O’Connell, Brooke K., Diebo, Bassel G., Vira, Shaleen, Lafage, Renaud, Lafage, Virginie, Buckland, Aaron J., and Protopsaltis, Themistocles

Published
2022
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35. 371 The Impact of Thoracolumbar Inflection Point on Outcomes and Complications in Adult Spinal Deformity

Author

Mir, Jamshaid M., primary, Passias, Peter G., additional, Lewis, Stephen, additional, Tretiakov, Peter S., additional, Dave, Pooja, additional, Lafage, Renaud, additional, Smith, Justin S., additional, Line, Breton G., additional, Diebo, Bassel G., additional, Daniels, Alan H., additional, Gum, Jeffrey Lynn, additional, and Protopsalt, Themistocles, additional

Published
2024
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36. 326 Factors Associated With the Maintenance of Cost-Effectiveness at 5 Years in Adult Spinal Deformity Corrective Surgery

Author

Passias, Peter G., primary, Mir, Jamshaid M., additional, Dave, Pooja, additional, Tretiakov, Peter S., additional, Smith, Justin S., additional, Lafage, Renaud, additional, Gum, Jeffrey Lynn, additional, Line, Breton G., additional, Diebo, Bassel G., additional, Daniels, Alan H., additional, Protopsaltis, Themistocles, additional, and Hamilton, D. Kojo, additional

Published
2024
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39. Crossing the Bridge from Degeneration to Deformity: When Does Sagittal Correction Impact Outcomes in Adult Spinal Deformity Surgery?

Author

Williamson, Tyler K, Krol, Oscar, Tretiakov, Peter, Joujon-Roche, Rachel, Imbo, Bailey, Ahmad, Salman, Owusu-Sarpong, Stephane, Lebovic, Jordan, Ihejirika-Lomedico, Rivka, Dinizo, Michael, Vira, Shaleen, Dhillon, Ekamjeet, O’Connell, Brooke, Maglaras, Constance, Schoenfeld, Andrew J, Janjua, M. Burhan, Alan, Nima, Diebo, Bassel, Paulino, Carl, Smith, Justin S., Raman, Tina, Lafage, Renaud, Protopsaltis, Themistocles, Lafage, Virginie, and Passias, Peter G.

Published
2022
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40. Assessing the Impact of Radiographic Realignment on Adult Spinal Deformity Patients with Sacroiliac Joint Pain at Presentation.

Author

Onafowokan, Oluwatobi O., Tretiakov, Peter, Lorentz, Nathan, Galetta, Matthew, Das, Ankita, Mir, Jamshaid, Roberts, Timothy, and Passias, Peter G.

Subjects
*SACROILIAC joint, *JOINT pain, *SPINE abnormalities, *ADULTS, *REGRESSION analysis
Abstract

Background: Adult spinal deformity (ASD) patients with concurrent sacroiliac joint (SIJ) pain are susceptible to worse postoperative outcomes. There is scarce literature on the impact of ASD realignment surgery on SIJ pain. Methods: Patients undergoing ASD realignment surgery were included and stratified by the presence of SIJ pain at the baseline (SIJP+) or SIJ pain absence (SIJP−). Mean comparison tests via ANOVA were used to assess baseline differences between both cohorts. Multivariable regression analyses analyzed factors associated with SIJ pain resolution/persistence, factoring in BMI, frailty, disability, and deformity. Results: A total of 464 patients were included, with 30.8% forming the SIJP+ cohort. At the baseline (BL), SIJP+ had worse disability scores, more severe deformity, higher BMI, higher frailty scores, and an increased magnitude of lower limb compensation. SIJP+ patients had higher mechanical complication (14.7 vs. 8.2%, p = 0.024) and reoperation rates (32.4 vs. 20.2%, p = 0.011) at 2 years. SIJP+ patients who subsequently underwent SI fusion achieved disability score outcomes similar to those of their SIJ− counterparts. Multivariable regression analysis revealed that SIJP+ patients who were aligned in the GAP lordosis distribution index were more likely to report symptom resolution at six weeks (OR 1.56, 95% CI: 1.02–2.37, p = 0.039), 1 year (OR 3.21, 2.49–5.33), and 2 years (OR 3.43, 2.41–7.12). SIJP− patients who did not report symptom resolution by 1 year and 2 years were more likely to demonstrate PI-LL > 5° (OR 1.36, 1.07–2.39, p = 0.045) and SVA > 20 mm (OR 1.62, 1.24–1.71 p = 0.017). Conclusions: SIJ pain in ASD patients may result in worsened pain and disability at presentation. Symptom resolution may be achieved in affected patients by adequate postoperative lumbar lordosis restoration. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Comparison of multilevel low-grade techniques versus three-column osteotomies in adult spinal deformity surgery: does harmonious correction matter?

Author

Passias, Peter G., Williamson, Tyler K., Mir, Jamshaid M., Lebovic, Jordan A., Dave, Pooja, Tretiakov, Peter S., Joujon-Roche, Rachel, Imbo, Bailey, Krol, Oscar, Owusu-Sarpong, Stephane, Vira, Shaleen, Schoenfeld, Andrew J., Daniels, Alan H., Diebo, Bassel G., Lafage, Renaud, and Lafage, Virginie

Published
2024
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42. The Clinical Impact of Failing to Achieve Ideal Proportional Realignment in Adult Spinal Deformity Patients

Author

Passias, Peter G., Passfall, Lara, Williamson, Tyler K., Schoenfeld, Andrew J., Owusu-Sarpong, Stephane, Dhillon, Ekamjeet, Krol, Oscar, Kummer, Nicholas A., Tretiakov, Peter, Imbo, Bailey, Joujon-Roche, Rachel, Moattari, Kevin, Lebovic, Jordan, Vira, Shaleen, Diebo, Bassel, Smith, Justin S., Park, Paul, Mummaneni, Praveen, Shabani, Saman, Chou, Dean, Lafage, Renaud, and Lafage, Virginie

Published
2022
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43. Impact of congestive heart failure on patients undergoing lumbar spine fusion for adult spine deformity

Author

Onafowokan, Oluwatobi O., primary, Ahmad, Waleed, additional, McFarland, Kimberly, additional, Williamson, Tyler K., additional, Tretiakov, Peter, additional, Mir, Jamshaid M., additional, Das, Ankita, additional, Bell, Joshua, additional, Naessig, Sara, additional, Vira, Shaleen, additional, Lafage, Virginie, additional, Paulino, Carl, additional, Diebo, Bassel, additional, Schoenfeld, Andrew, additional, Hassanzadeh, Hamid, additional, Jankowski, Pawel P., additional, Hockley, Aaron, additional, and Passias, Peter Gust, additional

Published
2024
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44. The Predictive Potential of Nutritional and Metabolic Burden: Development of a Novel Validated Metric Predicting Increased Postoperative Complications in Adult Spinal Deformity Surgery.

Author

Tretiakov, Peter S., Thomas, Zach, Krol, Oscar, Joujon-Roche, Rachel, Williamson, Tyler, Imbo, Bailey, Dave, Pooja, McFarland, Kimberly, Mir, Jamshaid, Vira, Shaleen, Diebo, Bassel, Schoenfeld, Andrew J., and Passias, Peter G.

Subjects
*SURGICAL complications, *SPINAL surgery, *SPINE abnormalities, *ADULTS, *PERIPHERAL vascular diseases
Abstract

Study Design: A retrospective cohort review. Objective: To develop a scoring system for predicting increased risk of postoperative complications in adult spinal deformity (ASD) surgery based on baseline nutritional and metabolic factors. Background: Endocrine and metabolic conditions have been shown to adversely influence patient outcomes and may increase the likelihood of postoperative complications. The impact of these conditions has not been effectively evaluated in patients undergoing ASD surgery. Materials and Methods: ASD patients 18 years or above with baseline and two-year data were included. An internally crossvalidated weighted equation using preoperative laboratory and comorbidity data correlating to increased perioperative complications was developed via Poisson regression. Body mass index (BMI) categorization (normal, over/underweight, and obese) and diabetes classification (normal, prediabetic, and diabetic) were used per the Centers for Disease Control and Prevention and the American Diabetes Associates parameters. A novel ASD-specific nutritional and metabolic burden score (ASD-NMBS) was calculated via Beta-Sullivan adjustment, and Conditional Inference Tree determined the score threshold for experiencing ≥ 1 complication. Cohorts were stratified into low-risk and high-risk groups for comparison. Logistic regression assessed correlations between increasing burden score and complications. Results: Two hundred one ASD patients were included (mean age: 58.60±15.4, sex: 48% female, BMI: 29.95±14.31, Charlson Comorbidity Index: 3.75±2.40). Significant factors were determined to be age (+1/yr), hypertension (+18), peripheral vascular disease (+37), smoking status (+21), anemia (+1), VitD hydroxyl (+1/ ng/mL), BMI (+13/cat), and diabetes (+4/cat) (model: P<0.001, area under the curve: 92.9%). Conditional Inference Tree determined scores above 175 correlated with ≥1 post-op complication (P<0.001). Furthermore, HIGH patients reported higher rates of postoperative cardiac complications (P=0.045) and were more likely to require reoperation (P=0.024) compared with low patients. Conclusions: The development of a validated novel nutritional and metabolic burden score (ASD-NMBS) demonstrated that patients with higher scores are at greater risk of increased postoperative complications and course. As such, surgeons should consider the reduction of nutritional and metabolic burden preoperatively to enhance outcomes and reduce complications in ASD patients. [ABSTRACT FROM AUTHOR]

Published
2024
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45. An Economic Analysis of Early and Late Complications After Adult Spinal Deformity Correction.

Author

Williamson, Tyler K., Owusu-Sarpong, Stephane, Imbo, Bailey, Krol, Oscar, Tretiakov, Peter, Joujon-Roche, Rachel, Ahmad, Salman, Bennett-Caso, Claudia, Schoenfeld, Andrew J., Lebovic, Jordan, Vira, Shaleen, Diebo, Bassel, Lafage, Renaud, Lafage, Virginie, and Passias, Peter G.

Subjects
SPINE abnormalities, ADULTS, SPINAL surgery, ECONOMIC impact, REOPERATION, MECHANICAL failures
Abstract

Study design/setting: Retrospective cohort. Objective: Adult spinal deformity (ASD) corrective surgery is often a highly invasive procedure portending patients to both immediate and long-term complications. Therefore, we sought to compare the economic impact of certain complications before and after 2 years. Methods: ASD patients with minimum 3-year data included. Complication groups were defined as follows: any complication, major, medical, mechanical, radiographic, and reoperation. Complications stratified by occurrence before or after 2 years postoperatively. Published methods converted ODI to SF-6D to QALYs. Cost was calculated using CMS.gov definitions. Marginalized means for utility gained and cost-per-QALY were calculated via ANCOVA controlling for significant confounders. Results: 244 patients included. Before 2Y, complication rates: 76% ≥1 complication, 18% major, 26% required reoperation. After 2Y, complication rates: 32% ≥1 complication, 4% major, 2.5% required reoperation. Major complications after 2 years had worse cost-utility (.320 vs.441, P =.1). Patients suffering mechanical complications accrued the highest overall cost ($130,482.22), followed by infection and PJF for complications before 2 years. Patients suffering a mechanical complication after 2 years had lower cost-utility ($109,197.71 vs $130,482.22, P =.041). Patients developing PJF after 2 years accrued a better cost-utility ($77,227.84 vs $96,873.57; P =.038), compared to PJF before 2 years. Conclusion: Mechanical complications had the single greatest impact on cost-utility after adult spinal deformity surgery, but less so after 2 years. Understanding the cost-utility of specific interventions at certain timepoints may mitigate economic burden and prophylactic efforts should strategically be made against early mechanical complications. [ABSTRACT FROM AUTHOR]

Published
2024
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46. Predictors of pelvic tilt normalization: a multicenter study on the impact of regional and lower-extremity compensation on pelvic alignment after complex adult spinal deformity surgery.

Author

Dave, Pooja, Lafage, Renaud, Smith, Justin S., Line, Breton G., Tretiakov, Peter S., Mir, Jamshaid, Diebo, Bassel, Daniels, Alan H., Gum, Jeffrey L., Hamilton, D. Kojo, Buell, Thomas, Than, Khoi D., Kai-Ming Fu, Scheer, Justin K., Eastlack, Robert, Mullin, Jeffrey P., Mundis Jr., Gregory, Naobumi Hosogane, Mitsuru Yagi, and Nunley, Pierce

Published
2024
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48. Outcomes and survival analysis of adult cervical deformity patients with ten-year follow-up

Author

Passias, Peter G., primary, Tretiakov, Peter S., additional, Das, Ankita, additional, Thomas, Zach, additional, Krol, Oscar, additional, Joujon-Roche, Rachel, additional, Williamson, Tyler, additional, Imbo, Bailey, additional, Owusu-Sarpong, Stephane, additional, Lebovic, Jordan, additional, Diebo, Bassel, additional, Vira, Shaleen, additional, Lafage, Virginie, additional, and Schoenfeld, Andrew J., additional

Published
2023
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49. 5. Sustenance of substantial clinical benefit in adult spinal deformity corrective surgery patients: a minimum 5-year outcomes analysis

Author

Mir, Jamshaid, primary, Tretiakov, Peter, additional, Das, Ankita, additional, Onafowokan, Oluwatobi, additional, Lorentz, Nathan, additional, Galetta, Matthew, additional, Lebovic, Jordan, additional, Dave, Pooja, additional, Owusu-Sarpong, Stephane, additional, Janjua, Muhammad, additional, and Passias, Peter, additional

Published
2023
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