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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 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)Item 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 +/- 2.4