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Item The Global Spine Care Initiative: methodology, contributors, and disclosures(SPRINGER, 2018-01-01) Johnson, Claire D.; Haldeman, Scott; Nordin, Margareta; Chou, Roger; Cote, Pierre; Hurwitz, Eric L.; Green, Bart N.; Kopansky-Giles, Deborah; Randhawa, Kristi; Cedraschi, Christine; Ameis, Arthur; Acaroglu, Emre; Aartun, Ellen; Adjei-Kwayisi, Afua; Ayhan, Selim; Aziz, Amer; Bas, Teresa; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Brooks, Peter; Camilleri, Connie; Castellote, Juan M.; Clay, Michael B.; Davatchi, Fereydoun; Dudler, Jean; Dunn, Robert; Eberspaecher, Stefan; Emmerich, Juan; Farcy, Jean Pierre; Fisher-Jeffes, Norman; Goertz, Christine; Grevitt, Michael; Griffith, Erin A.; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Kane, Edward J.; Laplante, Julie; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Mmopelwa, Tiro; Modic, Michael; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Rajasekaran, Shanmuganathan; Shearer, Heather; Smuck, Matthew; Sonmez, Erkin; Tavares, Patricia; Taylor-Vaisey, Anne; Torres, Carlos; Torres, Paola; van der Horst, Alexander; Verville, Leslie; Vialle, Emiliano; Kumar, Gomatam Vijay; Vlok, Adriaan; Watters III, William; Wong, Chung Chek; Wong, Jessica J.; Yu, Hainan; Yuksel, SelcenPurpose The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. Methods World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwideItem The Global Spine Care Initiative: model of care and implementation(SPRINGER, 2018-01-01) Johnson, Claire D.; Haldeman, Scott; Chou, Roger; Nordin, Margareta; Green, Bart N.; Cote, Pierre; Hurwitz, Eric L.; Kopansky-Giles, Deborah; Acaroglu, Emre; Cedraschi, Christine; Ameis, Arthur; Randhawa, Kristi; Aartun, Ellen; Adjei-Kwayisi, Afua; Ayhan, Selim; Aziz, Amer; Bas, Teresa; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Brooks, Peter; Camilleri, Connie; Castellote, Juan M.; Clay, Michael B.; Davatchi, Fereydoun; Dudler, Jean; Dunn, Robert; Eberspaecher, Stefan; Emmerich, Juan; Farcy, Jean Pierre; Fisher-Jeffes, Norman; Goertz, Christine; Grevitt, Michael; Griffith, Erin A.; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Kane, Edward J.; Laplante, Julie; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Mmopelwa, Tiro; Modic, Michael; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Rajasekaran, Shanmuganathan; Shearer, Heather; Smuck, Matthew; Sonmez, Erkin; Tavares, Patricia; Taylor-Vaisey, Anne; Torres, Carlos; Torres, Paola; van der Horst, Alexander; Verville, Leslie; Vialle, Emiliano; Kumar, Gomatam Vijay; Vlok, Adriaan; Watters III, William; Wong, Chung Chek; Wong, Jessica J.; Yu, Hainan; Yuksel, SelcenPurpose Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could be applied in global health care settings. The purposes of this paper are to propose: (1) principles to transform the delivery of spine careItem The Global Spine Care Initiative: care pathway for people with spine-related concerns(SPRINGER, 2018-01-01) Haldeman, Scott; Johnson, Claire D.; Chou, Roger; Nordin, Margareta; Cote, Pierre; Hurwitz, Eric L.; Green, Bart N.; Cedraschi, Christine; Acaroglu, Emre; Kopansky-Giles, Deborah; Ameis, Arthur; Adjei-Kwayisi, Afua; Ayhan, Selim; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Brooks, Peter; Camilleri, Connie; Castellote, Juan M.; Clay, Michael B.; Davatchi, Fereydoun; Dunn, Robert; Goertz, Christine; Griffith, Erin A.; Hondras, Maria; Kane, Edward J.; Lemeunier, Nadege; Mayer, John; Mmopelwa, Tiro; Modic, Michael; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Randhawa, Kristi; Shearer, Heather; Sonmez, Erkin; Torres, Carlos; Torres, Paola; Verville, Leslie; Vlok, Adriaan; Watters III, William; Wong, Chung Chek; Yu, HainanPurpose The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. Methods The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. Results After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatmentItem The Global Spine Care Initiative: classification system for spine-related concerns(SPRINGER, 2018-01-01) Haldeman, Scott; Johnson, Claire D.; Chou, Roger; Nordin, Margareta; Cote, Pierre; Hurwitz, Eric L.; Green, Bart N.; Kopansky-Giles, Deborah; Cedraschi, Christine; Aartun, Ellen; Acaroglu, Emre; Ameis, Arthur; Ayhan, Selim; Blyth, Fiona; Borenstein, David; Brady, O'Dane; Davatchi, Fereydoun; Goertz, Christine; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Mmopelwa, Tiro; Modic, Michael; Mullerpatan, Rajani; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Randhawa, Kristi; Sonmez, Erkin; Torres, Carlos; Torres, Paola; Watters III, William; Yu, HainanPurpose The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. Methods Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. Results Thirty-six experts from 15 countries participated. After the second round, there was 95\% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0)Item The Global Spine Care Initiative: resources to implement a spine care program(SPRINGER, 2018-01-01) Kopansky-Giles, Deborah; Johnson, Claire D.; Haldeman, Scott; Chou, Roger; Cote, Pierre; Green, Bart N.; Nordin, Margareta; Acaroglu, Emre; Ameis, Arthur; Cedraschi, Christine; Hurwitz, Eric L.; Ayhan, Selim; Borenstein, David; Brady, O'Dane; Brooks, Peter; Davatchi, Fereydoun; Dunn, Robert; Goertz, Christine; Hajjaj-Hassouni, Najia; Hartvigsen, Jan; Hondras, Maria; Lemeunier, Nadege; Mayer, John; Mior, Silvano; Moss, Jean; Mullerpatan, Rajani; Muteti, Elijah; Mwaniki, Lillian; Ngandeu-Singwe, Madeleine; Outerbridge, Geoff; Randhawa, Kristi; Torres, Carlos; Torres, Paola; Vlok, Adriaan; Wong, Chung ChekPurpose The purpose of this report is to describe the development of a list of resources necessary to implement a model of care for the management of spine-related concerns anywhere in the world, but especially in underserved communities and low- and middle-income countries. Methods Contents from the Global Spine Care Initiative (GSCI) Classification System and GSCI care pathway papers provided a foundation for the resources list. A seed document was developed that included resources for spine care that could be delivered in primary, secondary and tertiary settings, as well as resources needed for self-care and community-based settings for a wide variety of spine concerns (e.g., back and neck pain, deformity, spine injury, neurological conditions, pathology and spinal diseases). An iterative expert consensus process was used using electronic surveys. Results Thirty-five experts completed the process. An iterative consensus process was used through an electronic survey. A consensus was reached after two rounds. The checklist of resources included the following categories: healthcare provider knowledge and skills, materials and equipment, human resources, facilities and infrastructure. The list identifies resources needed to implement a spine care program in any community, which are based upon spine care needs. Conclusion To our knowledge, this is the first international and interprofessional attempt to develop a list of resources needed to deliver care in an evidence-based care pathway for the management of people presenting with spine-related concerns. This resource list needs to be field tested in a variety of communities with different resource capacities to verify its utility.Item The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery(KOREAN SOC SPINE SURGERY, 2022-01-01) Nabi, Vugar; Ayhan, Selim; Yuksel, Selcen; Adhikari, Prashant; Vila-Casademunt, Alba; Pellise, Ferran; Perez-Grueso, Francisco Sanchez; Alanay, Ahmet; Obeid, Ibrahim; Kleinstueck, Frank; Acaroglu, Emre; Grp, European Spine StudyStudy design: Retrospective cohort. Purpose: This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80\%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild {[}11, 64.7\%]Item Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis(AMER ASSOC NEUROLOGICAL SURGEONS, 2018-01-01) Faraj, Sayf S. A.; De Kleuver, Marinus; Vila-Casademunt, Alba; Holewijn, Roderick M.; Obeid, Ibrahim; Acaroglu, Emre; Alanay, Ahmet; Kleinstuck, Frank; Perez-Grueso, Francisco S.; Pellise, Ferran; Grp, European Spine StudyOBJECTIVE Previous studies have demonstrated that among patients with adult spinal deformity (ASD), sagittal plane malalignment is poorly tolerated and correlates with suboptimal patient-reported health-related quality of life (HRQOL). These studies included a broad range of radiographic abnormalities and various types of ASD. However, the clinical and radiographic characteristics of de novo degenerative lumbar scoliosis (DNDLS), a subtype of ASD, may influence previously reported correlation strengths. The aim of this study was to correlate sagittal radiographic parameters with pretreatment HRQOL in patients with symptomatic DNDLS. METHODS In this multicenter retrospective study of prospectively collected data, 74 patients with symptomatic DNDLS were enrolled based on anteroposterior and lateral 36-inch standing radiographs. Measurements included Cobb angle, coronal imbalance, pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis (PI-LL), T1-pelvic angle, and global tilt. HRQOL questionnaires included the Oswestry Disability Index (ODI), Scoliosis Research Society (SRS-22r), 36-item Short-Form Health Survey, and numeric rating scale (NRS) for back and leg pain. Correlations between radiographic parameters and HRQOL were assessed. Finally, HRQOL and increasing severity of sagittal modifiers (SVA, PI-LL, and PT) were evaluated. RESULTS Weak correlations were found between SVA and ODI (r = 0.296, p < 0.05) and PT with NRS back pain and the SRS pain domain (r = -0.260, p < 0.05, and r = 0.282, p < 0.05, respectively). Other sagittal radiographic parameters did not show any significant correlation with HRQOL. No significant differences in HRQOL were found concerning the increasing severity of PT, PI-LL, and SVA. CONCLUSIONS While DNDLS is a severe disabling condition, no noteworthy association between clinical and sagittal radiographic parameters was found through this study, demonstrating that sagittal radiographic parameters should not be considered the unique predictor of pretreatment suboptimal health status in this specific group of patients. Future studies addressing classification and treatment algorithms will have to take into account the existing subgroups of ASD.Item Obeid-Coronal Malalignment Classification Is Age Related and Independently Associated to Personal Reported Outcome Measurement Scores in the Nonfused Spine(KOREAN SPINAL NEUROSURGERY SOC, 2021-01-01) Kieser, David Christopher; Boissiere, Louis; Bourghli, Anouar; Hayashi, Kazunori; Cawley, Derek; Yilgor, Caglar; Alanay, Ahmet; Acaroglu, Emre; Kleinstueck, Frank; Pizones, Javier; Pellise, Ferran; Perez-Grueso, Francisco Javier Sanchez; Obeid, Ibrahim; Grp, European Spine StudyObjective: To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine. Methods: Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle >\_ 20 degrees, pelvic tilt >\_ 25 degrees, sagittal vertical axis >\_ 5 cm, thoracic kyphosis >\_ 60 degrees. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM). Results: Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages. Conclusion: CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD.Item Adult Spinal Deformity Over 70 Years of Age: A 2-Year Follow-Up Study(INT SOC ADVANCEMENT SPINE SURGERY-ISASS, 2019-01-01) Karabulut, Cem; Ayhan, Selim; Yuksel, Selcen; Nabiyev, Vugar; Vila-Casademunt, Alba; Pellise, Ferran; Alanay, Ahmet; Sanchez Perez-Grueso, Francisco Javier; Kleinstuck, Frank; Obeid, Ibrahim; Acaroglu, Emre; Grp, European Spine StudyBackground: Treatment of adult spinal deformity (ASD) in elderly patients remains controversial. The aim of this study was to identify the factors leading to the surgical treatment by comparing the baseline characteristics of operative versus nonoperative patients, to evaluate the safety and efficacy of surgery, and to compare operative and nonoperative management of elderly ASD patients at the end of the 2-year follow-up period. Methods: Retrospective review of a multicenter, prospective ASD database was performed. Patients over 70 years of age with ASD who were scheduled to undergo surgical treatment and who were treated and/or followed without surgical intervention participated in the study. Demographic, clinical, surgical, and radiological characteristics and health-related quality-of-life (HRQOL) (Core Outcome Measures Index {[}COMI], Oswestry Disability Index {[}ODI], Short-Form-36 Mental Component Summary {[}SF-36 MCS], Short-Form-36 Physical Component Summary {[}SF36-PCS], and Scoliosis Research Society-22 {[}SRS-22]) parameters of such group of patients were evaluated pre-and posttreatment. Results: A total 90 patients (females: 71, males: 29Item Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis(AMER ASSOC NEUROLOGICAL SURGEONS, 2017-01-01) Yilgor, Caglar; Sogunmez, Nuray; Yavuz, Yasemin; Abul, Kadir; Boissiere, Louis; Haddad, Sleiman; Obeid, Ibrahim; Kleinstuck, Frank; Sanchez Perez-Grueso, Francisco Javier; Acaroglu, Emre; Mannion, Anne F.; Pellise, Ferran; Alanay, Ahmet; Grp, European Spine StudyOBJECTIVE The subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value. Relative LL (RLL) and the lordosis distribution index (LDI) are PI-based individualized measures. RLL quantifies the magnitude of lordosis relative to the ideal lordosis as defined by the magnitude of PI. LDI defines the magnitude of lower arc lordosis in proportion to total lordosis. The aim of this study was to compare RLL and PI - LL for their ability to predict postoperative complications and their correlations with health-related quality of life (HRQOL) scores. METHODS Inclusion criteria were >= 4 levels of fusion and >= 2 years of follow-up. Mechanical complications were proximal junctional kyphosis/proximal junctional failure, distal junctional kyphosis/distal junctional failure, rod breakage, and implant-related complications. Correlations between PI - LL, RLL, PI, and HRQOL were analyzed using the Pearson correlation coefficient. Mechanical complication rates in PI - LL, RLL, LDI, RLL, and LDI interpreted together, and RLL subgroups for each PI - LL category were compared using chi-square tests and the exact test. Predictive models for mechanical complications with RLL and PI - LL were analyzed using binomial logistic regressions. RESULTS Two hundred twenty-two patients (168 women, 54 men) were included. The mean age was 52.2 +/- 19.3 years (range 18-84 years). The mean follow-up was 28.8 +/- 8.2 months (range 24-62 months). There was a significant correlation between PI - LL and PI (r = 0.441, p < 0.001), threatening the use of PI -LL to quantify spinopelvic mismatch for different PI values. RLL was not correlated with PI (r = -0.093, p > 0.05)