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Item AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care(SAGE PUBLICATIONS LTD, 2022-01-01) Naresh-Babu, J.; Kwan, Kenny Yat Hong; Wu, Yabin; Yilgor, Caglar; Alanay, Ahmet; Cheung, Kenneth M. C.; Polly Jr., David W.; Park, Jong-Beom; Ito, Manabu; Lenke, Lawrence G.; van Hooff, Miranda L.; de Kleuver, Marinus; Deformity, A.O. Spine Knowledge ForumStudy Design: Modified Delphi study. Objective: Adult spinal deformity (ASD) is an increasingly recognized condition, comprising a spectrum of pathologies considerably impacting patients' health and functional status. Patients present with a combination of pain, disability, comorbidities and radiological deformity. The study aims to propose a systematic approach of gathering information on the factors that drive decision-making by developing a patient profile. Methods: The present study comprises of 3 parts. Part 1: Development of prototype of patient profile: The data from the Core Outcome Study on SCOlisis (COSSCO) by Scoliosis Research Society (SRS) was categorized into a conceptual framework. Part 2: Modified Delphi study: Items reaching >70\% agreement were included in a 4 round iterative process with 51 panellists across the globe. Part 3: Pilot testing-feasibility: Content validity and usability were evaluated quantitatively. Results: The profile consisted of 4 domains. 1. General health with demographics and comorbidities, 2.Spine-specific health with spine related health and neurological status, 3. Imaging with radiographic and MRI parameters and 4. Deformity type. Each domain consisted of 1 or 2 components with various factors and their measuring instruments. Profile was found to have an excellent content validity (1-CVIr 0.78-1.00Item 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 Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity(SPRINGER, 2022-01-01) Ignasiak, Dominika; Behm, Pascal; Mannion, Anne F.; Galbusera, Fabio; Kleinstuck, Frank; Fekete, Tamas F.; Haschtmann, Daniel; Jeszenszky, Dezso; Zimmermann, Laura; Richner-Wunderlin, Sarah; Vila-Casademunt, Alba; Pellise, Ferran; Obeid, Ibrahim; Pizones, Javier; Sanchez Perez-Grueso, Francisco J.; Karaman, Muhammed Ilkay; Alanay, Ahmet; Yilgor, Caglar; Ferguson, Stephen J.; Loibl, MarkusPurposeSagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. MethodsA previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. ResultsWeak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43Item Analysis of factors affecting baseline SF-36 Mental Component Summary in Adult Spinal Deformity and its impact on surgical outcomes(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2018-01-01) Mmopelwa, Tiro; Ayhan, Selim; Yuksel, Selcen; Nabiyev, Vugar; Niyazi, Asli; Pellise, Ferran; Alanay, Ahmet; Perez Grueso, Francisco Javier Sanchez; Kleinstuck, Frank; Obeid, Ibrahim; Acaroglu, Emre; Grp, European Spine StudyObjectives: To identify the factors that affect SF-36 mental component summary (MCS) in patients with adult spinal deformity (ASD) at the time of presentation, and to analyse the effect of SF-36 MCS on clinical outcomes in surgically treated patients. Methods: Prospectively collected data from a multicentric ASD database was analysed for baseline parameters. Then, the same database for surgically treated patients with a minimum of 1-year follow-up was analysed to see the effect of baseline SF-36 MCS on treatment results. A clinically useful SF-36 MCS was determined by ROC Curve analysis. Results: A total of 229 patients with the baseline parameters were analysed. A strong correlation between SF-36 MCS and SRS-22, ODI, gender, and diagnosis were found (p < 0.05). For the second part of the study, a total of 186 surgically treated patients were analysed. Only for SF-36 PCS, the un-improved cohort based on minimum clinically important differences had significantly lower mean baseline SF-36 MCS (p < 0.001). SF-36 MCS was found to have an odds ratio of 0.914 in improving SF-36 PCS score (unit by unit) (p < 0.001). A cut-off point of 43.97 for SF-36 MCS was found to be predictive of SF-36 PCS (AUC = 0.631Item Adult Congenital Spine Deformity: Clinical Features and Motivations for Surgical Treatment(INT SOC ADVANCEMENT SPINE SURGERY-ISASS, 2021-01-01) Pizones, Javier; Moreno-Manzanaro, Lucia; Vila-Casademunt, Alba; Fernandez-Baillo, Nicomedes; Sanchez-Marquez, Jose; Talavera, Gloria; Obeid, Ibrahim; Alanay, Ahmet; Kleinstuck, Frank; Pellise, Ferran; Sanchez Perez-Grueso, Francisco Javier; ESSGBackground: There is scarce information available about adult congenital spine deformity (ACSD) in the literature, especially its impact after the pediatric age. The aim was to define ACSD characteristics and to establish the drivers for surgical intervention. Methods: Cross-sectional study of data collected in an adult deformity multicenter database. Only ACSD patients were included. Demographic and radiographic data, as well as patient-reported outcome measures, were assessed. Conservatively (C) vs surgically (S) treated patients were compared using Student t test, chi(2), and Mann-Whitney U test. Results: Fifty-two patients were included. They were young adults (x = 37.7 years), mostly female (71\%). Among them. 60\% had single hemivertebrae (HV), 35\% had multiple HV, and 5\% had segmentation defects. Also. 75\% had mainly corona' deformity (Cobb 625 degrees +/- 29.6) and 25\% had sagittal deformity. Mean Oswestry Disability Index (ODI) was 29.6\% +/- 17 and mean Scoliosis Research Society 22-item survey (SRS-22) total score was 3.2 +/- 0.8. Of note, mean SRS-22 self-image score was 2.8 +/- 0.9 and 36-item Short Form Health Survey (SF-36) physical function score was 40.9 +/- 11. Thirty patients were treated conservatively (C), whereas 22 patients underwent surgery (S). No differences were found regarding age, type or location of the deformity, comorbidities, or radiographic parameters. Operated patients had worse Core Outcome Measurement Index (COMI) back scores (C: 3.8 +/- 2.4 vs S: 6.7 +/- 2.4Item The Influence of Diagnosis, Age, and Gender on Surgical Outcomes in Patients With Adult Spinal Deformity(SAGE PUBLICATIONS LTD, 2018-01-01) Ayhan, Selim; Yuksel, Selcen; Nabiyev, Vugar; Adhikari, Prashant; Villa-Casademunt, Alba; Pellise, Ferran; Sanchez Perez-Grueso, Francisco; Alanay, Ahmet; Obeid, Ibrahim; Kleinstueck, Frank; Acaroglu, Emre; Grp, European Spine StudyStudy Design: Retrospective review of prospectively collected data from a multicentric database. Objectives: To determine the clinical impact of diagnosis, age, and gender on treatment outcomes in surgically treated adult spinal deformity (ASD) patients. Methods: A total of 199 surgical patients with a minimum follow-up of 1 year were included and analyzed for baseline characteristics. Patients were separated into 2 groups based on improvement in health-related quality of life (HRQOL) parameters by minimum clinically important difference. Statistics were used to analyze the effect of diagnosis, age, and gender on outcome measurements followed by a multivariate binary logistic regression model for these results with statistical significance. Results: Age was found to affect SF-36 PCS (Short From-36 Physical Component Summary) score significantly, with an odds ratio of 1.017 (unit by unit) of improving SF-36 PCS score on multivariate analysis (P < .05). The breaking point in age for this effect was 37.5 years (AUC = 58.0, P = .05). A diagnosis of idiopathic deformity would increase the probability of improvement in Oswestry Disability Index (ODI) by a factor of 0.219 and in SF-36 PCS by 0.581 times (P < .05). Gender was found not to have a significant effect on any of the HRQOL scores. Conclusions: Age, along with a diagnosis of degenerative deformity, may have positive effects on the likelihood of improvement in SF-36 PCS (for age) and ODI (for diagnosis) in surgically treated patients with ASD and the breaking point of this effect may be earlier than generally anticipated. Gender does not seem to affect results. These may be important in patient counseling for the anticipated outcomes of surgery.Item The Transverse Process Trajectory Technique: An Alternative for Thoracic Pedicle Screw Implantation-Radiographic and Biomechanical Analysis(INT SOC ADVANCEMENT SPINE SURGERY-ISASS, 2021-01-01) Lonner, Baron; Verma, Kushagra; Roonprapunt, Chanland; Ren, Yuan; Slattery, Casey A.; Alanay, Ahmet; Kassin, Gabrielle; Castillo, Andrea; Bazerbashi, Mohamad; Buehler, Mark A.; Kodigudla, Manoj K.; Kelkar V, Amey; Serhan, Hassan; Goel, VijayBackground: This study evaluates the accuracy, biomechanical profile, and learning curve of the transverse process trajectory technique (TPT) compared to the straightforward (SF) and in-out-in (IOI) techniques. SF and IOI have been used for fixation in the thoracic spine. Although widely used, there are associated learning curves and symptomatic pedicular breaches. We have found the transverse process to be a reproducible pathway into the pedicle. Methods: Three surgeons with varying experience (experienced {[}E] with 20 years in practice, surgeon {[}S] with less than 10 years in practice, and senior resident trainee {[}T] with no experience with TPT) operated on 8 cadavers. In phase 1, each surgeon instrumented 2 cadavers, alternating between TPT and SF from T1 to T12 (n = 48 total levels). In phase 2, the E and T surgeons instrumented 1 cadaver each, alternating between TPT and IOI. Computed tomography scans were analyzed for accuracy of screw placement, defined as the percentage of placements without critical breaches. Axial pullout and derotational force testing were performed. Statistical analyses include paired t test and analysis of variance with Tukey correction. Results: Overall accuracy of screw placement was comparable between techniques (TPT: 92.7\%Item Treatment of thoracolumbar burst fractures using combined pedicle screw-laminar hook fixation(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2014-01-01) Kaymaz, Burak; Demirkiran, Gokhan; Ayvaz, Mehmet; Akel, Ibrahim; Acaroglu, Emre; Alanay, AhmetObjective: The aim of this study was to evaluate the mid-term outcome of pedicle screw-laminar hook (PS-LH) fixation in the surgical treatment of thoracolumbar burst fractures. Methods: Nineteen patients (12 male, 7 femaleItem A Review on Cutaneous and Musculoskeletal Manifestations of CLOVES Syndrome(DOVE MEDICAL PRESS LTD, 2022-01-01) Durmaz, Emel Ozturk; Demircioglu, Deniz; Dikmen, Pinar Yalinay; Alanay, Yasemin; Alanay, Ahmet; Demirkesen, Cuyan; Tokat, Fatma; Karaarslan, ErcanCLOVES syndrome is a novel sporadic mosaic segmental overgrowth syndrome, currently categorized under the canopy of PROS (PIK3CA-related overgrowth spectrum) disorders. All PROS disorders harbor heterozygous postzygotic activating somatic mutations involving the PIK3CA gene. As an upstream regulator of the PI3K/AKT/mTOR signal transduction pathway, activating mutations of PIK3CA gene commence in uncontrolled growth of cutaneous, vascular (capillaries, veins, and lymphatics), adipose, neural, and musculoskeletal tissues. The excessive growth is segmental, patchy, asymmetric, and confined to body parts affected by the mutation. The term `CLOVES' is an acronym denoting congenital lipomatous overgrowth, vascular malformations, epidermal nevi and spinal (scoliosis) and/ or skeletal anomalies. The syndrome is characterized by an admixture of overgrown tissues, derived mainly from mesoderm and neuroectoderm. Among PROS disorders, CLOVES syndrome represents the extreme end of the spectrum with massive affection of almost the entire body. The syndrome might judiciously be treated with medications hampering with the PI3K/AKT/mTOR signal transduction pathway. This article aims at reviewing the cutaneous and musculoskeletal manifestations of CLOVES syndrome, as the paradigm for PROS disorders. CLOVES syndrome and other PROS disorders are still misdiagnosed, underdiagnosed, underreported, and undertreated by the dermatology community.