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Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management

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Abstract

Spinal deformity in the adult is a common medical disorder with a significant and measurable impact on health-related quality of life. The ability to measure and quantify patient self-reported health status with disease-specific and general health status measures, and to correlate health status with radiographic and clinical measures of spinal deformity, has enabled significant advances in the assessment of the impact of deformity on our population, and in the evaluation and management of spinal deformity using an evidence-based approach. There has been a significant paradigm shift in the evaluation and management of patients with adult deformity. The paradigm shift includes development of validated, disease-specific measures of health status, recognition of deformity in the sagittal plane as a primary determinant of health status, and information on results of operative and medical/interventional management strategies for adults with spinal deformity. Since its inception in 1966, the Scoliosis Research Society (SRS) has been an international catalyst for improving the research and care for patients of all ages with spinal deformity. The SRS Adult Spinal Deformity Committee serves the mission of developing and defining an evidence-based approach to the evaluation and management of adult spinal deformity. The purpose of this overview from the SRS Adult Deformity Committee is to provide current information on the epidemiology and impact of adult deformity, and to provide patients, physicians, and policy makers a guide to the evidence-based evaluation and management of patients with adult deformity.

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References

  1. Dykes PC, Samal L, Donahue M, et al. A patient-centered longitudinal care plan: vision versus reality. J Am Med Inform Assoc 2014;21:1082–90.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gillick MR. The critical role of caregivers in achieving patient-centered care. JAMA 2013;310:575–6.

    Article  CAS  PubMed  Google Scholar 

  3. Kupfer JM, Bond EU. Patient satisfaction and patient-centered care: necessary but not equal. JAMA 2012;308:139–40.

    Article  CAS  PubMed  Google Scholar 

  4. Allen H, Nobel JJ, Burton WN. Making health care reform work: where physician and employer interests converge. JAMA 2012;308:2465–6.

    Article  CAS  PubMed  Google Scholar 

  5. Rosenbaum S. The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public Health Rep 2011;126:130–5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ames CP, Smith JS, Scheer JK, et al. Impact of spinopelvic alignment on decision making in deformity surgery in adults: a review. J Neurosurg Spine 2012;16:547–64.

    Article  PubMed  Google Scholar 

  7. Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 2009;34:1828–33.

    Article  Google Scholar 

  8. Schwab F, Patel A, Ungar B, et al. Adult spinal deformity—postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 2010;35:2224–31.

    Article  Google Scholar 

  9. Grubb SA, Lipscomb HJ, Coonrad RW. Degenerative adult onset scoliosis. Spine (Phila Pa 1976) 1988;13:241–5.

    Article  CAS  Google Scholar 

  10. Lu DC, Chou D. Flatback syndrome. Neurosurg Clin N Am 2007;18:289–94.

    Article  CAS  PubMed  Google Scholar 

  11. Potter BK, Lenke LG, Kuklo TR. Prevention and management of iatrogenic flatback deformity. J Bone Joint Surg Am 2004;86–A:1793–808.

    Article  Google Scholar 

  12. Bernhardt M, Bridwell KH. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976) 1989;14:717–21.

    Article  CAS  Google Scholar 

  13. Schwab FJ, Smith VA, Biserni M, et al. Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 2002;27:387–92.

    Article  Google Scholar 

  14. Smith JS, Singh M, Klineberg E, et al. Surgical treatment of pathological loss of lumbar lordosis (flatback) in patients with normal sagittal vertical axis achieves similar clinical improvement as surgical treatment of elevated sagittal vertical axis: clinical article. J Neurosurg Spine 2014;21:160–70.

    Article  PubMed  Google Scholar 

  15. Takemitsu Y, Harada Y, Iwahara T, et al. Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine (Phila Pa 1976) 1988;13:1317–26.

    Article  CAS  Google Scholar 

  16. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005;30:2024–9.

    Article  Google Scholar 

  17. Schwab F, Bess S, Blondel B, et al. Combined assessment of pelvic tilt, pelvic incidence/lumbar lordosis mismatch and sagittal vertical axis predicts disability in adult spinal deformity: a prospective analysis. Spine J 2011;11:S158–9.

    Article  Google Scholar 

  18. Schwab FJ, Blondel B, Bess S, et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 2013;38:E803–12.

    Article  Google Scholar 

  19. Smith JS, Shaffrey CI, Fu KM, et al. Clinical and radiographic evaluation of the adult spinal deformity patient. Neurosurg Clin N Am 2013;24:143–56.

    Article  PubMed  Google Scholar 

  20. Carter OD, Haynes SG. Prevalence rates for scoliosis in US adults: results from the first National Health and Nutrition Examination Survey. Int J Epidemiol 1987;16:537–44.

    Article  CAS  PubMed  Google Scholar 

  21. Francis RS. Scoliosis screening of 3,000 college-aged women. The Utah Study—phase 2. Phys Ther 1988;68:1513–6.

    CAS  PubMed  Google Scholar 

  22. Kostuik JP, Bentivoglio J. The incidence of low-back pain in adult scoliosis. Spine (Phila Pa 1976) 1981;6:268–73.

    Article  CAS  Google Scholar 

  23. Perennou D, Marcelli C, Herisson C, et al. Adult lumbar scoliosis. Epidemiologic aspects in a low-back pain population. Spine (Phila Pa 1976) 1994;19:123–8.

    Article  CAS  Google Scholar 

  24. Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976) 2005;30:1082–5.

    Article  Google Scholar 

  25. United States Census Bureau.2012 US Census Bureau. Available at: http://www.census.gov/population/projections/data/national/2012.html. Accessed August 27, 2014.

  26. Jacobs LA, Kent M, Lee M, et al. America’s aging population. Popul Bull 2011;66:2–16.

    Google Scholar 

  27. Grayson VK, Velkoff VA. The next four decades, the older population in the United States: 2010 to 2050. In: Current Population Reports. Washington, DC: United States Census Bureau; 2010:P25–1138.

    Google Scholar 

  28. Healthcare Costs, Utilization Project. U.S. Department of Health and Human Services. Available at: http://hcupnet.ahrq.gov; 2013. Accessed November 1, 2013.

  29. Dall TM, Gallo PD, Chakrabarti R, et al. An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Aff (Millwood) 2013;32:2013–20.

    Article  Google Scholar 

  30. Acosta Jr FL, McClendon Jr J, O’Shaughnessy BA, et al. Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine 2011;15:667–74.

    Article  PubMed  Google Scholar 

  31. Utilization of wedge Osteotomies. U.S. Department of Health and Human Services. Available at: http://hcupnet.ahrq.gov; 2013. Accessed November 1, 2013.

  32. Bess S, Boachie-Adjei O, Burton D, et al. Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Spine (Phila Pa 1976) 2009;34:2186–90.

    Article  Google Scholar 

  33. Glassman SD, Schwab FJ, Bridwell KH, et al. The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine (Phila Pa 1976) 2007;32:93–7.

    Article  Google Scholar 

  34. Smith JS, Fu KM, Urban P, et al. Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 2008;9:326–31.

    Article  PubMed  Google Scholar 

  35. Smith JS, Shaffrey CI, Berven S, et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976) 2009;34:1693–8.

    Article  Google Scholar 

  36. Smith JS, Shaffrey CI, Berven S, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 2009;65:86–93; discussion 94.

    Article  PubMed  Google Scholar 

  37. Smith JS, Shaffrey CI, Glassman SD, et al. Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J 2013;22:402–10.

    Article  PubMed  Google Scholar 

  38. McCormick JD, Werner BC, Shimer AL. Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 2013;21:99–107.

    Article  PubMed  Google Scholar 

  39. Baldus C, Bridwell KH, Harrast J, et al. Age-gender matched comparison of SRS instrument scores between adult deformity and normal adults: are all SRS domains disease specific? Spine (Phila Pa 1976) 2008;33:2214–8.

    Article  Google Scholar 

  40. Bridwell KH, Cats-Baril W, Harrast J, et al. The validity of the SRS-22 instrument in an adult spinal deformity population compared with the Oswestry and SF-12: a study of response distribution, concurrent validity, internal consistency, and reliability. Spine (Phila Pa 1976) 2005;30:455–61.

    Article  Google Scholar 

  41. Carreon LY, Sanders JO, Diab M, et al. The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, and Pain domains after surgical correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:2079–83.

    Article  Google Scholar 

  42. Copay AG, Glassman SD, Subach BR, et al. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 2008;8:968–74.

    Article  PubMed  Google Scholar 

  43. Glassman SD, Copay AG, Berven SH, et al. Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am 2008;90:1839–47.

    Article  PubMed  Google Scholar 

  44. Berven S, Deviren V, Demir-Deviren S, et al. Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine (Phila Pa 1976) 2003;28:2164–9; discussion 2169.

    Article  Google Scholar 

  45. Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 2009;34:E599–606.

    Article  Google Scholar 

  46. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 2005;30:682–8.

    Article  Google Scholar 

  47. Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine 2012;37:1077–82.

    Article  PubMed  Google Scholar 

  48. Smith JS, Klineberg E, Schwab F, et al. Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spine (Phila Pa 1976) 2013;38:1663–71.

    Article  Google Scholar 

  49. Terran J, Schwab F, Shaffrey CI, et al. The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 2013;73:559–68.

    Article  PubMed  Google Scholar 

  50. Bess S, Line B, Fu KM, et al. The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases, Spine (Phila Pa 1976) 2016;41:224–33.

    Article  Google Scholar 

  51. Everett CR, Patel RK. A systematic literature review of nonsurgical treatment in adult scoliosis. Spine (Phila Pa 1976) 2007;32:S130–4.

    Article  Google Scholar 

  52. Youssef JA, Orndorff DO, Patty CA, et al. Current status of adult spinal deformity. Global Spine J 2013;3:51–62.

    Article  CAS  PubMed  Google Scholar 

  53. Glassman SD, Berven S, Kostuik J, et al. Nonsurgical resource utilization in adult spinal deformity. Spine 2006;31:941–7.

    Article  PubMed  Google Scholar 

  54. Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated with the use of morphine and opiates. J Intern Med 2006;260:76–87.

    Article  CAS  PubMed  Google Scholar 

  55. Cooper G, Lutz GE, Boachie-Adjei O, et al. Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy. Pain Physician 2004;7:311–7.

    PubMed  Google Scholar 

  56. Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014;371:11–21.

    Article  PubMed  CAS  Google Scholar 

  57. Glassman SD, Carreon LY, Shaffrey CI, et al. The costs and benefits of nonoperative management for adult scoliosis. Spine (Phila Pa 1976) 2010;35:578–82.

    Article  Google Scholar 

  58. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008;299:656–64.

    Article  CAS  PubMed  Google Scholar 

  59. Fu KM, Bess S, Shaffrey CI, et al. Patients with adult spinal deformity treated operatively report greater baseline pain and disability than patients treated nonoperatively; however, deformities differ between age groups. Spine (Phila Pa 1976) 2014;39:1401–7.

    Article  Google Scholar 

  60. Fu KM, Smith JS, Sansur CA, et al. Standardized measures of health status and disability and the decision to pursue operative treatment in elderly patients with degenerative scoliosis. Neurosurgery 2010;66:42–7; discussion 47.

    Article  PubMed  Google Scholar 

  61. Liu S, Schwab F, Smith JS, et al. Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Ochsner J 2014;14:67–77.

    PubMed  PubMed Central  Google Scholar 

  62. Bridwell KH. Surgical treatment of idiopathic adolescent scoliosis. Spine (Phila Pa 1976) 1999;24:2607–16.

    Article  CAS  Google Scholar 

  63. Kling JM, Clarke BL, Sandhu NP. Osteoporosis prevention, screening, and treatment: a review. J Womens Health (Larchmt) 2014;23:563–72.

    Article  Google Scholar 

  64. Bridwell KH, Glassman S, Horton W, et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976) 2009;34:2171–8.

    Article  Google Scholar 

  65. Bridwell KH, Baldus C, Berven S, et al. Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up. Spine (Phila Pa 1976) 2010;35:1849–54.

    Article  Google Scholar 

  66. Blondel B, Schwab F, Ungar B, et al. Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up. Neurosurgery 2012;71:341–8; discussion 348.

    Article  PubMed  Google Scholar 

  67. Smith JS, Lafage V, Shaffrey CI, et al. Outcomes of operative and non-operative treatment for adult spinal deformity: a prospective, multicenter matched and unmatched cohort assessment with minimum two-year follow up. Paper presented at: North American Spine Society 29th Annual Meeting, San Francisco, CA. 2014.

  68. Smith JS, Shaffrey CI, Glassman SD, et al. Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976) 2011;36:817–24.

    Article  Google Scholar 

  69. Daubs MD, Lenke LG, Cheh G, et al. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 2007;32:2238–44.

    Article  Google Scholar 

  70. Li G, Passias P, Kozanek M, et al. Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine (Phila Pa 1976) 2009;34:2165–70.

    Article  Google Scholar 

  71. Cho SK, Bridwell KH, Lenke LG, et al. Comparative analysis of clinical outcome and complications in primary versus revision adult scoliosis surgery. Spine (Phila Pa 1976) 2012;37:393–401.

    Article  Google Scholar 

  72. Charosky S, Guigui P, Blamoutier A, et al. Study Group on Scoliosis. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976) 2012;37:693–700.

    Article  Google Scholar 

  73. Zimmerman RM, Mohamed AS, Skolasky RL, et al. Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older: a prospective study with minimum two-year follow-up. Spine (Phila Pa 1976) 2010;35:1861–6.

    Article  Google Scholar 

  74. Yadla S, Maltenfort MG, Ratliff JK, et al. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus 2010;28:E3.

    Article  PubMed  Google Scholar 

  75. Weiss HR, Goodall D. Rate of complications in scoliosis surgery—a systematic review of the Pub Med literature. Scoliosis 2008;3:9.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Bridwell KH, Lewis SJ, Edwards C, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976) 2003;28:2093–101.

    Article  Google Scholar 

  77. Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 2007;32:2189–97.

    Article  Google Scholar 

  78. Norton RP, Bianco K, Lafage V, et al; International Spine Study Group F. Complications and intercenter variability of three-column resection osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Evid Based Spine Care J 2013;4:157–9.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Yang BP, Ondra SL, Chen LA, et al. Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine 2006;5:9–17.

    Article  PubMed  Google Scholar 

  80. Zhang HQ, Huang J, Guo CF, et al. Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis. Eur Spine J 2014;23:234–41.

    Article  PubMed  Google Scholar 

  81. Hassanzadeh H, Jain A, El Dafrawy MH, et al. Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications. Spine (Phila Pa 1976) 2013;38:726–31.

    Article  Google Scholar 

  82. Smith JS, Sansur CA, Donaldson 3rd WF, et al. Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 2011;36:958–64.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California, San Francisco, Medical Center, 400 Parnassus Avenue, A850, San Francisco, CA, 94143, USA

    Christopher P. Ames MD

  2. School of Medicine, University of California, San Diego, 9500 Gilman Dr. La Jolla, San Diego, CA, 92093, USA

    Justin K. Scheer BS

  3. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 333 E 38th St., New York, NY, 10016, USA

    Virginie Lafage PhD

  4. Department of Neurosurgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA

    Justin S. Smith MD, PhD

  5. Rocky Mountain Hospital for Children, 2001 N. High Street, Denver, CO, 80205, USA

    Shay Bess MD

  6. Department of Orthopaedic Surgery, University of California, San Francisco, 400 Parnassus Ave., Third Floor, San Francisco, CA, 94143, USA

    Sigurd H. Berven MD

  7. San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300 La Jolla, San Diego, CA, 92037, USA

    Gregory M. Mundis MD

  8. Virginia Mason Medical Center, University of Washington, 125 16th Avenue East, CSB-3 Neurosurgery, Seattle, WA, 98112, USA

    Rajiv K. Sethi MD

  9. Department of Orthopaedic Surgery, University of Alabama, Birmingham, 619 19th St S, AL, 35233, USA

    Donald A. Deinlein MD

  10. Silicon Valley Spine Institute, 21 E Hacienda Ave Suite A Campbell, Los Gatos, CA, 95008, USA

    Jeffrey D. Coe MD

  11. Hey Clinic, 3404 Wake Forest Rd #203, Raleigh, NC, 27609, USA

    Lloyd A. Hey MD

  12. School of Medicine, University of Nevada, 1707 West Charleston Boulevard, Las Vegas, NV, 89102, USA

    Michael D. Daubs MD

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  1. Christopher P. Ames MD
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  2. Justin K. Scheer BS
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  4. Justin S. Smith MD, PhD
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  5. Shay Bess MD
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  6. Sigurd H. Berven MD
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  9. Donald A. Deinlein MD
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Correspondence to Christopher P. Ames MD.

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CPA (personal fees from DePuy, personal fees from Medtronic, personal fees from Stryker, personal fees from Biomet Spine, personal fees from Styker, personal fees from Doctors Research Group, personal fees from UCSF, outside the submitted work; in addition, CPA has a patent with Fish & Richardson, P.C. issued), JKS (none), VL (grants from SRS, grants from NIH, grants from DePuy Spine Synthesis, other from Nemaris INC, personal fees from DePuy, personal fees from Medicrea, personal fees from Neamris INC, personal fees from MSD, outside the submitted work), JSS (personal fees and other from Biomet, personal fees from NuVasive, grants and personal fees from DePuy, personal fees from K2M, personal fees from Cerapedics, personal fees from Medtronic, outside the submitted work), SB (grants and personal fees from K2 Medical, grants and personal fees from NuVasive, grants and personal fees from Innovasis, personal fees from Allosource, grants from Stryker, grants from Medtronic, personal fees from Pioneer, outside the submitted work), SHB (honoraria: Medtronic, Stryker Spine, RTI, Globus; royalties: Medtronic; ownership/shareholder: Globus medical, Providence Medical, Simpirica, Gensano), GMM (personal fees from NuVasive, personal fees from Misonix, personal fees from Medicrea, personal fees from K2M, outside the submitted work; in addition, GMM has a patent with K2M with royalties paid, a patent with NuVasive with royalties paid, and SOLAS Board), RKS (none), DAD (none), JDC (other from Alphatec Spine, grants, personal fees and other from Benvenue, grants and personal fees from Medtronic, grants and personal fees from NuVasive, grants, personal fees and other from SI Bone, grants and personal fees from SI Bone, outside the submitted work), LAH (none), MDD (consulting fees and royalties from DePuy Synthes, outside the submitted work).

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Ames, C.P., Scheer, J.K., Lafage, V. et al. Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management. Spine Deform 4, 310–322 (2016). https://doi.org/10.1016/j.jspd.2015.12.009

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