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Item The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM (vol 31, pg 980, 2022)(2021-01-01) Negrini, Stefano; Aulisa, Angelo Gabriele; Cerny, Pavel; de Mauroy, Jean Claude; McAviney, Jeb; Mills, Andrew; Donzelli, Sabrina; Grivas, Theodoros B.; Hresko, M. Timothy; Kotwicki, Tomasz; Labelle, Hubert; Marcotte, Louise; Matthews, Martin; O'Brien, Joe; Parent, Eric C.; Price, Nigel; Manuel, Rigo; Stikeleather, Luke; Vitale, Michael G.; Wong, Man Sang; Wood, Grant; Wynne, James; Zaina, Fabio; Bruno, Marco Brayda; Wursching, Suncica Bulat; Yilgor, Caglar; Cahill, Patrick; Dema, Eugenio; Knott, Patrick; Lebel, Andrea; Lein, Grigorii; Newton, Peter O.; Smith, Brian G.Item Spinal deformity surgery is accompanied by serious complications: report from the Morbidity and Mortality Database of the Scoliosis Research Society from 2013 to 2020(SPRINGER, 2022-01-01) Bivona, Louis J.; France, John; Daly-Seiler, Conor S.; Burton, Douglas C.; Dolan, Lori A.; Seale, J. Justin; de Kleuver, Marinus; Ferrero, Emmanuelle; Gurd, David P.; Konya, Deniz; Lavelle, William F.; Sarwahi, Vishal; Suratwala, Sanjeev J.; Yilgor, Caglar; Li, YingPurpose The Morbidity and Mortality (M\&M) report of the Scoliosis Research Society (SRS) has been collected since 1965 and since 1968 submission of complications has been required of all members. Since 2009, the SRS has collected information on death, blindness, and neurological deficit, with acute infection being added in 2012 and unintentional return to the operating room (OR) being added in 2017. In this report, we use the most recent data submitted to the SRS M\&M database to determine the rate of neurological deficit, blindness, acute infection, unintentional return to the OR, and death, while also comparing this information to previous reports. Methods The SRS M\&M database was queried for all cases from 2013 to 2020. The rates of death, vision loss, neurological deficit, acute infection, and unintentional return to the OR were then calculated and analyzed. The rates were compared to previously published data if available. Differences in complication rates between years were analyzed with Poisson regression with significance set at alpha = 0.05. Results The total number of cases submitted per year varied with a maximum of 49,615 in 2018 and a minimum of 40,464 in 2020. The overall reported complication rate from 2013 to 2020 was 2.86\%. The overall mortality rate ranged from 0.09\% in 2018 to 0.14\% in 2015. The number of patients with visual impairment ranged from 4 to 13 between 2013 and 2015 (no data on visual impairment were collected after 2015). The overall infection rate varied from 0.95 in 2020 to 1.30\% in 2015. When the infection rate was analyzed based on spinal deformity group, the neuromuscular scoliosis group consistently had the highest infection rate ranging from 3.24 to 3.94\%. The overall neurological deficit rate ranged from 0.74 to 0.94\%, with the congenital kyphosis and dysplastic spondylolisthesis groups having the highest rates. The rates of unintentional return to the OR ranged from 1.60 to 1.79\%. Multiple groups showed a statistically significant decreasing trend for infection, return to the operating room, neurologic deficit, and death. Conclusions Neuromuscular scoliosis had the highest infection rate among all spinal deformity groups. Congenital kyphosis and dysplastic spondylolisthesis had the highest rate of neurological deficit postoperatively. This is similar to previously published data. Contrary to previous reports, neuromuscular scoliosis did not have the highest annual death rate. Multiple groups showed a statistically significant decreasing trend in complication rates during the reporting period, with only mortality in degenerative spondylolisthesis significantly trending upwards.Item Development and Validation of a Multidomain Surgical Complication Classification System for Adult Spinal Deformity(LIPPINCOTT WILLIAMS \& WILKINS, 2021-01-01) Klineberg, Eric O.; Wick, Joseph B.; Lafage, Renaud; Lafage, Virginie; Pellise, Ferran; Haddad, Sleiman; Yilgor, Caglar; Nunez-Pereira, Susana; Gupta, Munish; Smith, Justin S.; Shaffrey, Christopher; Schwab, Frank; Ames, Christopher; Bess, Shay; Lewis, Stephen; Lenke, Lawrence G.; Berven, Sigurd; Grp, Int Spine StudyStudy Design. Prospective analysis of example cases Objective. The aim of this study was to analyze the accuracy and repeatability of a new comprehensive classification system for capturing complications data in adult spinal deformity. Summary of Background Data. Complications are common in adult spinal deformity surgery. However, no consensus exists on the definition or classification of complications in adult spinal deformity surgery. The lack of consensus significantly limits understanding of complications' effects on outcomes in surgery for adult spinal deformity. Methods. Using a Delphi method, members of the International Spine Study Group, AO Spine, and the European Spine Study Group collaborated to develop an adult spinal deformity classification system. The multidomain classification system accounts for medical complications (cancer, cardiopulmonary, central nervous system, gastrointestinal, infectious, musculoskeletal, renal) and surgical complications (implant complications, radiographic complications, neurologic events, intraoperative events, and wound complications). Seventeen individuals ({''}event readers{''}), including spine surgeons, trainees, and research coordinators, used the new classification system two separate times to analyze complications in ten example cases. The accuracy and repeatability of the classification system were subsequently calculated based on the providers' responses for the example cases. Results. The 10 example cases included 22 complications. Nearly 95\% of complications were captured by >95\% of the event readers. The system demonstrated good repeatability of 86.9\% between the first and second set of responses provided by event readers. Conclusion. The ISSG-AO Multi-Domain Spinal Deformity Complication Classification System for Adult Spinal Deformity demonstrated good accuracy and repeatability among both surgeons and research coordinators in capturing complications in adult spinal deformity surgery. The ISSG-AO system may be applied to help better understand the impact of complications on outcomes and costs in adult spinal deformity surgery.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 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 Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity(OXFORD UNIV PRESS INC, 2021-01-01) Kwan, Kenny Yat Hong; Naresh-Babu, J.; Jacobs, Wilco; de Kleuver, Marinus; Polly, David W.; Yilgor, Caglar; Wu, Yabin; Park, Jong-Beom; Ito, Manabu; van Hooff, Miranda L.; Deformity, A.O. Spine Knowledge ForumBACKGROUND: Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE: To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS: Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION:This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.Item 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 = - 0.43