https://sam.ensam.eu:443 The DSpace digital repository system captures, stores, indexes, preserves, and distributes digital research material. Wed, 11 Mar 2026 09:45:00 GMT 2026-03-11T09:45:00Z http://hdl.handle.net/10985/18100 Clinical Improvement Through Surgery for Adult Spinal Deformity: What Can Be Expected and Who Is Likely to Benefit Most ? MOAL, Bertrand; LAFAGE, Virginie; SMITH, Justin.S; AMES, Christopher P.; MUNDIS, Gregory; TERRAN, Jamie S.; KLINEBERG, Eric; HART, Robert; BOACHIE-ADJEI, Oheneba; SHAY, Bess; SKALLI, Wafa; SCHWAB, Frank Study Design: Multicenter, prospective, nonconsecutive, surgical case series from the International Spine Study Group. Objectives: To evaluate the extent of clinical improvement after surgery for adult spinal deformity (ASD) based on minimal clinically important difference (MCID) and baseline measures. Summary of Background Data: For ASD, evaluation of surgical treatment success using clinical scores should take into account baseline disability and pain and the improvement defined relative to the MCID. Methods: Inclusion criteria included operative patients (age O18 years) with baseline and 2-year SRS-22 scores. Normative values for the SRS scores were included and improvement for patients was expressed in number of MCIDs. At baseline, patients were classified by differences in activity and pain scores from normative values in four groups: ‘‘worst,’’ ‘‘severe,’’ ‘‘poor,’’ and, ‘‘moderate.’’ At 2 years after surgery, patients were classified into four groups based on their change in SRS score as follows: ‘‘no improvement or deterioration,’’ ‘‘mediocre,’’ ‘‘satisfactory,’’ or ‘‘optimal.’’ Distinction among curve types was also performed based on the SRS-Schwab ASD classification. Results: A total of 223 patients (age 5 55 15 years) were included. At baseline, for 77% of the patients, the worst scores were in Activity or Pain. At baseline, the distribution was 36%‘‘worst,’’ 28%‘‘severe,’’ 19% ‘‘poor,’’ and 17% ‘‘moderate.’’ Patients with sagittal malalignment only were more likely to be in the ‘‘worst’’ state (54%). The overall distribution of improvement was as follows: 24% no improvement or deterioration, 17% mediocre, 25%satisfactory, and 33%optimal. Forty-one percent of baseline ‘‘moderate’’ patients achieved no improvement. Of the baseline ‘‘worst’’ patients, 20% achieved no improvement, and 36% and 19% achieved ‘‘satisfactory’’ and ‘‘optimal’’ improvement, respectively. Conclusion: Overall, 24% of patients did not experience improvement after surgery. Patients with baseline severe disability were more likely to perceive improvement than patients with less disability. Thu, 01 Jan 2015 00:00:00 GMT http://hdl.handle.net/10985/18100 2015-01-01T00:00:00Z MOAL, Bertrand LAFAGE, Virginie SMITH, Justin.S AMES, Christopher P. MUNDIS, Gregory TERRAN, Jamie S. KLINEBERG, Eric HART, Robert BOACHIE-ADJEI, Oheneba SHAY, Bess SKALLI, Wafa SCHWAB, Frank Study Design: Multicenter, prospective, nonconsecutive, surgical case series from the International Spine Study Group. Objectives: To evaluate the extent of clinical improvement after surgery for adult spinal deformity (ASD) based on minimal clinically important difference (MCID) and baseline measures. Summary of Background Data: For ASD, evaluation of surgical treatment success using clinical scores should take into account baseline disability and pain and the improvement defined relative to the MCID. Methods: Inclusion criteria included operative patients (age O18 years) with baseline and 2-year SRS-22 scores. Normative values for the SRS scores were included and improvement for patients was expressed in number of MCIDs. At baseline, patients were classified by differences in activity and pain scores from normative values in four groups: ‘‘worst,’’ ‘‘severe,’’ ‘‘poor,’’ and, ‘‘moderate.’’ At 2 years after surgery, patients were classified into four groups based on their change in SRS score as follows: ‘‘no improvement or deterioration,’’ ‘‘mediocre,’’ ‘‘satisfactory,’’ or ‘‘optimal.’’ Distinction among curve types was also performed based on the SRS-Schwab ASD classification. Results: A total of 223 patients (age 5 55 15 years) were included. At baseline, for 77% of the patients, the worst scores were in Activity or Pain. At baseline, the distribution was 36%‘‘worst,’’ 28%‘‘severe,’’ 19% ‘‘poor,’’ and 17% ‘‘moderate.’’ Patients with sagittal malalignment only were more likely to be in the ‘‘worst’’ state (54%). The overall distribution of improvement was as follows: 24% no improvement or deterioration, 17% mediocre, 25%satisfactory, and 33%optimal. Forty-one percent of baseline ‘‘moderate’’ patients achieved no improvement. Of the baseline ‘‘worst’’ patients, 20% achieved no improvement, and 36% and 19% achieved ‘‘satisfactory’’ and ‘‘optimal’’ improvement, respectively. Conclusion: Overall, 24% of patients did not experience improvement after surgery. Patients with baseline severe disability were more likely to perceive improvement than patients with less disability. http://hdl.handle.net/10985/8975 Radiographic Outcomes of Adult Spinal Deformity Correction : A Critical Analysis of Variability and Failures Across Deformity Patterns MOAL, Bertrand; SCHWAB, Franck; AMES, Christopher P.; SMITH, Justin; RYAN, Devon; PRAVEEN, Mummaneni; TERRAN, Jamie; KLINEBERG, Eric; HART, Robert; OHENEBA, Boachie-Adjei; SHAFFREY, Christopher; SKALLI, Wafa; LAFAGE, Virginie Study Design: Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. Objectives: To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. Summary of Background Data: Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment. Methods: Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30 , GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10 , and PT greater than 20 . According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes. Wed, 01 Jan 2014 00:00:00 GMT http://hdl.handle.net/10985/8975 2014-01-01T00:00:00Z MOAL, Bertrand SCHWAB, Franck AMES, Christopher P. SMITH, Justin RYAN, Devon PRAVEEN, Mummaneni TERRAN, Jamie KLINEBERG, Eric HART, Robert OHENEBA, Boachie-Adjei SHAFFREY, Christopher SKALLI, Wafa LAFAGE, Virginie Study Design: Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. Objectives: To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. Summary of Background Data: Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment. Methods: Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30 , GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10 , and PT greater than 20 . According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes. http://hdl.handle.net/10985/26163 Assessing Abnormal Proximal Junctional Angles in Adult Spinal Deformity KHALIFÉ, Marc; LAFAGE, Renaud; DANIELS, Alan H.; DIEBO, Bassel G.; ELYSEE, Jonathan; AMES, Christopher P.; BESS, Shay R.; BURTON, Douglas C.; EASTLACK, Robert K.; GUPTA, Munish C.; HOSTIN, Richard; KEBAISH, Khaled; KIM, Han-Jo; KLINEBERG, Eric; MUNDIS, Gregory; OKONKWO, David O.; GUIGUI, Pierre; FERRERO, Emmanuelle; SKALLI, Wafa; ASSI, Ayman; VERGARI, Claudio; SHAFFREY, Christopher; SMITH, Justin S.; SCHWAB, Frank J.; LAFAGE, Virginie; HOSTIN, Richard Study design: Multicentric retrospective study of prospectively collected data. Objective: Based on normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate. Summary of Background Data: Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account. Methods: This study included 721 healthy volunteers and 824 ASD surgery patients with 2-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2 standard deviations. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes’ and Lovecchio’s definitions for PJK in the ASD population at two years. Results: Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P<0.001). There was 46.2% of PJK according to Glattes’ versus 8.7% according to Lovecchio’s and 22.9% of kyphotic PJA compared to normative values (P<0.001). Conclusion: This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK. Level of evidence: II Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/10985/26163 2025-01-01T00:00:00Z KHALIFÉ, Marc LAFAGE, Renaud DANIELS, Alan H. DIEBO, Bassel G. ELYSEE, Jonathan AMES, Christopher P. BESS, Shay R. BURTON, Douglas C. EASTLACK, Robert K. GUPTA, Munish C. HOSTIN, Richard KEBAISH, Khaled KIM, Han-Jo KLINEBERG, Eric MUNDIS, Gregory OKONKWO, David O. GUIGUI, Pierre FERRERO, Emmanuelle SKALLI, Wafa ASSI, Ayman VERGARI, Claudio SHAFFREY, Christopher SMITH, Justin S. SCHWAB, Frank J. LAFAGE, Virginie HOSTIN, Richard Study design: Multicentric retrospective study of prospectively collected data. Objective: Based on normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate. Summary of Background Data: Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account. Methods: This study included 721 healthy volunteers and 824 ASD surgery patients with 2-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2 standard deviations. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes’ and Lovecchio’s definitions for PJK in the ASD population at two years. Results: Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P<0.001). There was 46.2% of PJK according to Glattes’ versus 8.7% according to Lovecchio’s and 22.9% of kyphotic PJA compared to normative values (P<0.001). Conclusion: This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK. Level of evidence: II