10 Years of Special Care for the Spine

10 Years of Special Care for the Spine

Celebrating a Decade of Success When Baylor Scoliosis Center (BSC) first opened its doors, the idea was to deliver advanced, skilled care for spinal deformity in a boutique setting, keeping the patient at the center of everything we do. BSC was built around the patient not his or her condition. By taking this patient-centered approach, over the past 10 years, we have become one of the largest regional deformity centers in the United States. More than 3,000 patients and their families have relied on us for hope and healing. Many of our patients were told by other specialists that nothing could be done for their condition. Then they came to BSC, and their lives were forever changed. Nearly every day we are contacted by prospective patients, as well as spine surgeons from across the country, in need of help managing complex spine issues. As our caseloads grow, so does our experience in treating increasingly difficult spine problems, which only serves to enhance the level of care and service we are able to provide. It also enables us to create evidence-based care protocols and further both the science and practice of spine care. Our expertise and reputation for excellence have helped establish BSC as a leading center for health economics and spinal deformity research. Richard Hostin, MD Medical Director Baylor Scoliosis Center The tremendous strides we have made would not have been possible without our team approach to care. From imaging studies to examination by other specialists to procedure scheduling and follow-up, we strive to provide our patients a level of service and convenience that few other centers in the nation can match. One of the ways we do this is through expert care coordination. BSC patients have the same care coordinator throughout the diagnosis and treatment process. These skilled members of our care team help reduce confusion, delays and duplication, as well as scheduling all the tests and consultations needed prior to major surgery in a matter of days, not weeks. Our approach is all about creating the best experience possible for patients and families, many of whom have traveled great distances to receive care. Jerri Garison President Baylor Scott & White Medical Center Plano Baylor Scoliosis Center has accomplished much over the past decade, for both our patients and the field of spine medicine. We are grateful for the continued support of those we serve and for all our colleagues, as we continue to advance care for the patients of tomorrow.

A History of Compassion Surgical Volumes 2005 184 The Baylor Scoliosis Center (BSC), which opened in February 2005, was the vision of the late Alexis Shelokov, MD, an orthopedic spine surgeon renowned for his expertise in treating complex spinal deformities. Rather than creating a scoliosis program focused solely on driving volumes, Dr. Shelokov sought to create a boutique medical practice for patients with scoliosis, featuring highly personalized care built around convenience for patients and their families. Over its first decade, the BSC has grown from 184 procedures to nearly 400 procedures annually and from one surgeon on the medical staff to three. The scope of the center has also become more robust, treating patients experiencing spinal problems, in addition to increasingly complex cases of spinal deformity. Additionally, BSC has become a leading research center for complex spine problems, creating evidencebased protocols for care and uncovering the best approaches to surgical care for specific conditions. In 2008, BSC opened an outpatient clinic on the Baylor All Saints Medical Center at Fort Worth campus as an added convenience for patients, who now come from all over the world to receive care. A year later, BSC suffered a tremendous loss with the unexpected passing of Dr. Shelokov. While BSC has experienced tremendous growth since 2005, adding additional services and expanding to Baylor Scott & White Medical Center - McKinney, one thing that has not changed is the commitment of the entire Baylor Scoliosis Center team to always put the patient at the center of everything that we do. 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 203 243 264 239 289 306 377 401 396 398 0 100 200 300 400 500 Celebrating Ten Years 3

Darlene Jordan

I m pain free. I go. I do, and nothing slows me down. Darlene Jordan was a junior in high school when she was diagnosed with scoliosis. Within a matter of months, she had her first surgery to try to correct the condition. At the time, the procedure she had was considered revolutionary and involved fusing vertebrae and the insertion of a metal rod along her spine. But any relief she initially felt was short-lived when the rod broke. It was put in in 1972, and I had it taken out in October of 1976, Jordan explains. Over the years, she tried numerous other procedures to deal with pain that only seemed to progress. I had had numerous surgeries, but I wasn t getting any better. Dr. Hostin was able to look at my films and he could tell immediately what needed to be done to help me, explains Jordan. The Baylor Scoliosis Center team performed anterior and posterior spinal fusion surgery to straighten her back. It was a major operation, but the results far exceeded her expectations. She now walks three miles nearly every morning, and she and her husband are able to travel extensively, including taking a dream trip to New Zealand. Jordan s body was in constant pain. It was difficult just standing. She could no longer walk normally, but rather was reduced to shuffling around with baby steps. Whenever she went shopping, she was forced to use a scooter to get around the store. She saw an ad for the Baylor Scoliosis Center in a magazine, and decided to schedule an appointment. It was a life-changing decision. Celebrating Ten Years 5

Patients From All Over the U.S. Choose Us for Great Care From South Florida to the Pacific Northwest, from Hawaii to New England, the Baylor Scoliosis Center has become a national leader in caring for patients with spinal deformity. More than 3,000 patients from across the country and beyond have relied on us for care. BSC has helped more than 3,000 patients from more than 45 states 6 Celebrating Ten Years

A Singular Focus on the Spine Patients from all over the world have turned to the Baylor Scoliosis Center to find the specialized care they need for scoliosis deformities, complex spine surgeries, and revision surgeries after a procedure at another facility. As a result of this focus, BSC is able to offer a greater range of options and personalized care plans for patients of all ages. While the center is proud to feature skilled surgeons on our medical staff and advanced operating room technologies, surgery is never the first option, and there are a number of other therapies and treatments we can recommend. If surgery is recommended to correct a spinal deformity, we can match the patient with a former patient who had a similar type of deformity, so they can learn more about the process from the perspective of someone who has been in their position. Dr. Hostin, medical director, and Dr. O Brien, medical director of research at BSC and on the medical staff of Baylor Scott & White Medical Center - Plano Although we pride ourselves on being a leader in the field of spinal diseases, including pediatric and adult spinal deformity, we treat all conditions of the spine, as well as spinal injury, tumors and infections. Our multi-specialty medical team includes fellowship-trained scoliosis surgeons, cardiac anesthesiologists, implant specialists, a spinal cord monitoring team, and physiatrists on the medical staff all of whom specialize in complex spinal deformities and other conditions of the spine. 7

Getting the Back on Track Scoliosis Deformity Scoliosis/spinal deformity is a sideways curve of the spine that shows up as an S or C shape rather than a straight line down the back. It can occur in children, adolescents and adults. Many people have some degree of curvature of the spine, or scoliosis, yet experience little or no discomfort. Those with more severe scoliosis may experience back pain, disfigurement and nerve compression that can cause numbness, weakness and leg pain, especially upon standing or walking. BSC treats a number of different forms of the disease in both adults and adolescents, including: Type 1/ progressive scoliosis A type of scoliosis that starts out mild or asymptomatic in young adults but worsens with age due to degenerative changes in the spine. Type II/ adult scoliosis Scoliosis that begins in adulthood in response to degenerative disease of the spinal column. This type of scoliosis can progress at a much more rapid pace than in Type I Adult Scoliosis. Adolescent idiopathic scoliosis The most common diagnosis in children, representing nearly 90 percent of cases. Congenital scoliosis Involves spinal bones that did not form properly during fetal development. Neuromuscular scoliosis Caused by abnormalities in neuromuscular function. 8 SCOLISCORE The SCOLISCORE Test is the first genetic test designed to help provide physicians and parents with insight into the possible progression of adolescent idiopathic scoliosis. Using DNA and current curvature angle, the SCOLISCORE Test will allocate a number between 1 and 200 to the probability of curve progression. The SCOLISCORE Test is appropriate for: Children between the ages of 9 and 13 Those with a diagnosis of adolescent idiopathic scoliosis (AIS) Caucasian males and females, including North American, South American, European, Eastern European and Middle Eastern Children with a mild curve of 10 to 25

Spondylolisthesis Spondylolisthesis is when one vertebra of the spine, usually in the lower back, slips out of place onto the vertebra below it potentially pressing on a nerve, causing pain. There are a number of different treatment approaches BSC can take to help patients with the condition depending on the severity and type of spondylolisthesis including medication, physical therapy, bracing, and surgical options such as decompressive laminectomy and spinal fusion. These options can be used to treat: Congenital spondylolisthesis a result of abnormal bone formation, putting vertebrae at greater risk for slipping Isthmic spondylolisthesis small stress fractures in the vertebrae that weaken the bone so much that it slips out of place Degenerative spondylolisthesis the most common form of the disorder, caused by aging discs becoming less spongy and flexible Traumatic spondylolisthesis caused when an injury leads to a spinal fracture or slippage Pathological spondylolisthesis occurs when the spine is weakened by disease such as osteoporosis, infection or tumor Post-surgical spondylolisthesis slippage that occurs or becomes worse after spinal surgery Spinal Stenosis As people age, a natural narrowing of the spinal canal is often normal, changing the size and shape of the spinal canal. This narrowing, called spinal stenosis, can lead to spine problems that need to be addressed in some cases. Lumbar spinal stenosis happens when bone and/or tissue grow into the openings within the spinal bones, thus squeezing and irritating nerves that branch out from the spinal cord. With cervical spinal stenosis, the spinal canal narrows in the neck and can compress the nerve roots where they leave the spinal cord, or it may compress or damage the spinal cord itself. Mild to moderate symptoms associated with lumbar spinal stenosis often can be controlled with over-the-counter pain medicines, exercise and physical therapy. For severe symptoms, BSC can perform decompressive surgery. Since cervical spinal stenosis can potentially cause more serious problems with the nervous system, decompressive surgical intervention may be necessary sooner to avoid complications from stenosis. Disc Herniation Small spongy discs in between the vertebrae act as shock absorbers and help keep the spine flexible. However, these discs can become damaged due to injury or wear and tear. When a disc begins to bulge, break open or slip out of place, it can cause pain, numbness and weakness in the area of the body where the nerve travels. A herniated disc in the lower back is called a lumbar herniation, and can cause pain and numbness in the buttock and down the leg. A herniated disc in the neck or upper spine is called a cervical herniation, and can cause pain, numbness, or weakness in the neck, shoulders, chest, arms and hands. BSC can typically diagnose herniated discs based on a physical exam and symptom history. Most hernias heal without the need for surgery. BSC can recommend a number of options for healing, including lifestyle changes, medication and physical therapy. Should surgery be necessary, the spine surgeons on the BSC medical staff are skilled in the repair of herniated discs. Celebrating Ten Years 9

Hope Is Not Lost Revision Surgery For many patients, to be told that nothing can be done to correct a painful spinal deformity is hard enough to hear. But having a procedure that was supposed to fix the problem, only to have it fail and then be told nothing more can be done, can be even more devastating. Baylor Scoliosis Center offers renewed hope for many of these patients through surgical revisions. Many spine centers won t attempt to correct a failed first procedure. That s because surgical revisions can pose challenges that were not present with the initial procedures, since the normal spine anatomy is altered from the original surgery. For instance, the blood supply to the spine and surrounding tissue may have been compromised, or scar tissue may be present at the surgical site, which can impact functionality even if another procedure does achieve the surgical objective. At Baylor Scoliosis Center, though, these complex revision procedures are virtually routine. Revision surgeries are considered for almost any patient who is healthy, regardless of their age or the reason for the failure of the previous surgery. The center can even help patients who are not candidates for revision surgery, by assessing their circumstance with fresh eyes and presenting options that could help improve their quality of life. Complex Surgery Going the Extra Mile Baylor Scoliosis Center prides itself in caring for patients with complex spinal deformities that are both painful and disabling, and whose conditions were once considered untreatable. Many of these patients can barely walk, yet can t find a physician able to help due to either the condition itself such as an inflammatory condition that can cause some of the vertebrae in the spine to fuse together or because they have another existing condition that complicates their care, such as diabetes or morbid obesity. Baylor Scoliosis Center s experience and capabilities have been highly developed to take care of these difficult cases. The staff collaborates as a team to devise a care plan to help each patient have a quality result. It takes lots of planning, though. Part of the planning process involves a pre-operative evaluation, which can help determine whether a patient is a candidate for surgery. This pre-operative evaluation identifies any barriers to a safe, quality surgery outcome. For example, if a patient is diabetic, Baylor Scoliosis Center works with the patient to get the patient s hemoglobin A1c in control, or if a patient is morbidly obese, a weight loss surgery evaluation may be recommended. So while many centers see these patients complicating factors and simply turn them away, Baylor Scoliosis Center looks as each one as an opportunity to help improve their overall health, and then do whatever is necessary to help improve their complex spine condition as well. 10

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Allie Johnson

The procedure was successful in taking Allie s 81-degree curve to about 10 degrees. After recovery and rehabilitation, she is living pain-free. Growing up in the sun paradise of Hawaii, kids live in swimsuits and beachwear but not Allie Johnson. At age seven, she was diagnosed with adolescent idiopathic scoliosis. I had to wear a hard brace that went from my collarbone all the way down to my pelvic area, explains Johnson. It was a plastic brace that I had to wear for 23 hours a day, which is really hard considering I live in Hawaii and it s 90 degrees half the time. As she grew, her scoliosis progressed and became more noticeable, since it caused her rib cage to stick out. In elementary and middle school, she was often teased about it. Not only was there emotional pain from the teasing, but as her scoliosis worsened, she was in a lot of physical pain as well. On a business trip through DFW, Johnson s father happened to see an ad for the Baylor Scoliosis Center. It stuck with him. Before coming to the Baylor Scoliosis Center, I had visited other doctors and one said he could get it about 50 percent corrected his specific words were you ll always be deformed, and that was really heartbreaking, says Johnson, who was a teen at the time. She didn t think anyone would be able to correct it. But after speaking with a care coordinator at the Baylor Scoliosis Center, she decided to make the several-thousand-mile journey to Plano for another opinion. My first visit with Dr. O Brien, he looked at it and said, oh, I can fix this, very casually, says Johnson. I got really excited, and I know my parents were thrilled to hear good news after all the bad news we were used to getting. The procedure was successful in taking Johnson s 81-degree curve to about 10 degrees. After recovery and rehabilitation, Johnson is so grateful to be living pain-free. While she jokes about now being taller, the biggest change is in her confidence. Prior to surgery, she always wore baggy clothes. I can wear what I want to wear without feeling people are staring at me or my back, she says. Celebrating Ten Years 13

A Guide by Your Side The prospect of major surgery can be daunting for anyone. Add to that all the pre-operative appointments, testing, and then post-operative follow-up care and rehabilitation, and the entire process can seem overwhelming. The Baylor Scoliosis Center features care coordinators who strive to take all the added stress out of the treatment process for patients and their families by acting as each patient s guide through every step of the care plan. Since many Baylor Scoliosis Center patients come from outside of Texas, care coordinators are especially important in helping to ensure that all tests and evaluations by specialists are done in a timely manner. After surgery, care coordinators can locate appropriate rehabilitation facilities near the patient s home and schedule their first rehab session. Care coordinators also serve as advocates for their patients, providing critical information on what to expect at every stage of the care process and getting answers to any questions they may have along the way. The care coordination team takes responsibility for the patient s experience in the clinic, in the hospital, and back at home. A major role coordinators play is being a patient s personal scheduler. This includes: initial consultation all pre-operative work-ups and clearances: cardiac stress test, pulmonary function test, clearance from internal medicine specialists, imaging studies and lab work the date and time of the surgical procedure follow-up appointments and care CARE COORDINATORS Frieda Bone Megan Covert Toni Dunlap Natasha Morton Charlotte Taylor 14

Nurse Navigators The nurse navigator is a single point of contact who guides patients through the continuum of care, helping each patient understand his or her diagnosis and treatment options. The nurse navigator also educates the patient about the resources available to them, including community resources, technologies, hospital services and support services. A nurse navigator serves as an essential link between the patient and his or her health care provider. Care Coordinators Care coordinators help coordinate all aspects of pre- and post-operative surgical care. They provide patients and their families with education and counseling regarding the scoliosis procedure, and if needed assist with housing and travel arrangements. Karen Davenport, nurse navigator Sue Saunders, ACNP-BC Our clinical research coordinator and acute nurse practitioner, Sue Saunders, ACNP- BC, conducts research in accordance with federal, state and institutional guidelines. She supports spine surgery clinical research by extensive chart review, data collection, database management, statistics and analysis. 15

Jasmeet Gill, Chessie Robinson, Elaheh Naseri and Jennifer Fox Research Like everything at the Baylor Scoliosis Center, the approach to research is patient-centered. The primary goal behind most research studies is to help provide patients with spinal deformity the right care for their condition. Consequently, BSC is a recognized leader when it comes to cost-effectiveness as it relates to treatment techniques and outcomes for complex conditions affecting the spine. Spine surgery is difficult and costly, explains Michael O Brien, MD, medical director of research at BSC. We are helping set standards in regard to cost and technique to make sure people will continue to be able to get the help they need. BSC belongs to several national and international study groups on spinal deformity. In collaboration with these groups, the center researches and explores 16 topics to further the field of spine medicine and promote quality care for the patients of today and tomorrow. That s why research and data measurement are fully integrated with the overall patient care experience. The research helps us develop our clinical practice by validating and verifying the things that we do and providing insight into areas for improvement, says Dr. O Brien. Since BSC conducts hundreds of complex spine procedures annually, it has a unique platform to provide data, which can be analyzed both inhouse and by other groups in order to inform best practices in spinal deformity treatment. Annually, the center produces 10 to 15 abstracts and presents at 8 to 10 national conferences. Michael O Brien, MD Medical Director of Research Baylor Scoliosis Center

Publications Analysis of Health Related Quality of Life Improvements among Patients with Adult Spinal Deformity. Michael O Brien, MD, Richard Hostin, MD, Ian McCarthy, PhD, Neil Fleming, PhD, Gerald Ogola, MS, Rustam Kudyakov, MD, MPH, Kathleen Richter, MS, Rajiv Saigal, MD, PhD, Sigurd Berven, MD, Vedat Deviren, MD, Christopher P. Ames, MD. Spine J. 2012 Sep;12(9):S133 Analysis of the Direct Cost of Surgery for Four Diagnostic Categories of Adult Spinal Deformity. McCarthy IM, Hostin RA, O Brien MF, Fleming NS, Ogola G, Kudyakov R, Richter KM, Saigal R, Berven SH, Ames CP; International Spine Study Group. Spine J. 2013 Dec;13(12):1843-8. Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity: A Comparison of Dollars per Quality of Life Improvement across Health Domains. Ian McCarthy, PhD, Richard Hostin, MD, Michael O Brien, MD, Neil Fleming, PhD, Gerald Ogola, PhD, Rustam Kudyakov, MD, MPH, Kathleen Richter, MS, MFA, Rajiv Saigal, MD, Sigurd Berven, MD, Vedat Deviren, MD, Christopher Ames, MD; International Spine Study Group. Spine Deformity. 2013 Jul; 1(4):293-298. Detection of Pseudarthrosis in Adult Spinal Deformity: The use of health-related qualityof-life outcomes to predict pseudarthrosis. Klineberg E, Gupta M, McCarthy I, Hostin R. J Spinal Disord Tech. 2013 Dec 11. Health Economic Analysis of Adult Deformity Surgery. McCarthy I, Hostin R, O Brien M, Saigal R, Ames CP. Neurosurg Clin N Am. 2013 Apr;24(2):293-304. Identification of Decision Criteria for Revision Surgery among Patients with Proximal Junctional Failure following Surgical Treatment for Spinal Deformity. Hart R, McCarthy I, O Brien M, Bess S, Line B, Adjei OB, Burton D, Gupta M, Ames C, Deviren V, Kebaish K, Shaffrey C, Wood K, Hostin R; International Spine Study Group. Spine (Phila Pa 1976). 2013 Jun 17. Incidence, Mode, and Location of Acute Proximal Junctional Failures Following Surgical Treatment for Adult Spinal Deformity. Hostin R, McCarthy I, O Brien M, Bess S, Line B, Boachie-Adjei O, Burton D, Gupta M, Ames C, Deviren V, Kebaish K, Shaffrey C, Wood K, Hart R; International Spine Study Group. Spine (Phila Pa 1976). 2012 Sep 13. Incremental Cost-Effectiveness of Adult Spinal Deformity Surgery: Observed QALYs with Surgery Compared to Predicted QALYs without Surgery. McCarthy I, O Brien M, Ames C, Robinson C, Errico T, Polly DW Jr, Hostin R; International Spine Study Group. JNS Focus. 2014 May. Proximal junctional kyphosis and proximal junctional failure. Hart RA, McCarthy I, Ames CP, Shaffrey CI, Hamilton DK, Hostin R. Neurosurg Clin N Am. 2013 Apr;24(2):213. Retrospective Study of Anterior Interbody Fusion Rates and Patient Outcomes of Using Mineralized Collagen and Bone Marrow Aspirate in Multilevel Adult Spinal Deformity Surgery. Hostin R, O Brien M, McCarthy I, Bess S, Gupta M, Klineberg E; International Spine Study Group, Denver, CO. J Spinal Disord Tech. 2013 Nov 6. Risk Factors for Major Peri-Operative Complications in Adult Spinal Deformity Surgery. Schwab FJ, Hawkinson N, Lafage V, Smith JS, Hart R, Mundis G, Burton DC, Line B, Akbarnia B, Boachie-Adjei O, Hostin R, Shaffrey CI, Arlet V, Wood K, Gupta M, Bess S, Mummaneni PV; International Spine Study Group. Eur Spine J. 2012 Dec;21(12):2603-10. Total Costs of Multilevel Fusion Surgery Including Outpatient Care. Ian McCarthy, PhD, Chessie Robinson, MA, Michael O Brien, MD, Richard Hostin, MD. SpineLine. 2014 May/June 15(3). Total Hospital Costs of Surgical Treatment for Adult Spinal Deformity: An Extended Follow-up Study. McCarthy IM, Hostin RA, Ames CP, Kim HJ, Smith JS, Boachie-Adjei O, Schwab FJ, Klineberg EO, Shaffrey CI, Gupta MC, Polly DW; International Spine Study Group. Spine J. 2014 Jan 24. NON-BAYLOR A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction. Ames CP, Smith JS, Scheer JK, Shaffrey CI, Lafage V, Deviren V, Moal B, Protopsaltis T, Mummaneni PV, Mundis GM Jr, Hostin R, Klineberg E, Burton DC, Hart R, Bess S, Schwab FJ; International Spine Study Group. J Neurosurg Spine. 2013 Jul 5. [Epub ahead of print]. Acute Reciprocal Changes Distant from the Site of Spinal Osteotomies Affect Global Postoperative Alignment. Klineberg E, Schwab F, Ames C, Hostin R, Bess S, Smith JS, Gupta MC, Boachie-Adjei O, Hart RA, Akbarnia BA, Burton DC, Lafage V. Adv Orthop. 2011; 2011:415946. 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 Non-operative Treatment. Smith JS, Klineberg E, Schwab F, Shaffrey CI, Moal B, Ames CP, Hostin R, Fu KM, Burton D, Akbarnia B, Gupta M, Hart R, Bess S, Lafage V; International Spine Study Group. Spine (Phila Pa 1976). 2013 Jun 11. [Epub ahead of print] Changes in Thoracic Kyphosis Negatively Impact Sagittal Alignment After Lumbar Pedicle Subtraction Osteotomy: A Comprehensive Radiographic Analysis. Lafage V, Ames C, Schwab F, Klineberg E, Akbarnia B, Smith J, Boachie-Adjei O, Burton D, Hart R, Hostin R, Shaffrey C, Wood K, Bess S; International Spine Study Group. Spine 2012. Feb 1;37(3):E180-7. Chapter 22: Complications in Surgery for Spinal Deformity. Newton Peter O, O Brien Michael F, eds. Idiopathic Scoliosis: The Harms Study Group Treatment Guide. Thieme. 2010 Clinical improvement through nonoperative treatment of adult spinal deformity: who is likely to benefit? Slobodyanyuk K, Poorman CE, Smith JS, Protopsaltis TS, Hostin R, Bess S, Mundis GM Jr, Schwab FJ, Lafage V; International Spine Study Group. Neurosurg Focus. 2014 May;36(5):E2. doi: 10.3171/2014.3.FOCUS1426. Comparison of Patient and Surgeon Perceptions of Adverse Events Following Adult Spinal Deformity Surgery. Hart RA, Cabalo A, Bess S, Akbarnia BA, Boachie-Adjei O, Burton D, Cunningham ME, Gupta M, Hostin R, Kebaish K, Klineberg E, Mundis G, Shaffrey C, Smith JS, Wood K; International Spine Study Group. Spine (Phila Pa 1976). 2012 Nov 2. [Epub ahead of print] Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I, Mundis G Jr, Shaffrey CI, Kebaish K, Hostin R, Hart R, Gupta MC, Burton D, Ames C, Boachie-Adjei O, Protopsaltis TS, Lafage V; International Spine Study Group. Neurosurg Focus. 2014 May;36(5):E18. doi: 10.3171/2014.2.FOCUS1422. Does vertebral level of Pedicle Subtraction Osteotomy correlate with degree of spino-pelvic parameter correction? Lafage V, Schwab F, Vira S, Hart R, Burton D, Smith JS, Boachie-Adjei O, Shelokov A, Hostin R, Shaffrey CI, Gupta M, Akbarnia BA, Bess S, Farcy JP. J Neurosurg Spine. 2011 Feb;14(2):184-91. Epub 2010 Dec 24. 17

Does recombinant human bone morphogenetic protein-2 use in adult spinal deformity increase complications and are complications associated with location of rhbmp-2 use? A prospective, multicenter study of 279 consecutive patients. Bess S, Line BG, Lafage V, Schwab F, Shaffrey CI, Hart RA, Boachie-Adjei O, Akbarnia BA, Ames CP, Burton DC, Deverin V, Fu KM, Gupta M, Hostin R, Kebaish K, Klineberg E, Mundis G, O Brien M, Shelokov A, Smith JS; International Spine Study Group ISSG. Spine (Phila Pa 1976). 2014 Feb 1;39(3):233-42. doi: 10.1097/ BRS.0000000000000104. Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques. Smith JS, Bess S, Shaffrey CI, Burton DC, Hart RA, Hostin R, Klineberg E; International Spine Study Group. Spine (Phila Pa 1976). 2012 May 1;37(10):845-53 Efficacy of Hemivertebra Resection for Congenital Scoliosis: a multicenter retrospective comparison of three surgical techniques. Yaszay, Burt MD; O Brien, Michael MD; Shufflebarger, Harry L MD; Betz, Randal R MD; Lonner, Baron MD; Shah, Suken A. MD; Boachie-Adjei, Oheneba MD; Crawford, Alvin MD; Letko, Lynn MD; Harms, Jurgen MD; Gupta, Munish C MD; Sponseller, Paul D MD; Abel, Mark F MD; Flynn, John MD; Macagno, Angel MD; Newton, Peter O MD. Spine (Phila Pa 1976). 2011 Nov 15;36(24):2052-60. Impact of age on the likelihood of reaching a minimum clinically important difference in 374 three-column spinal osteotomies: clinical article. Scheer JK, Lafage V, Smith JS, Deviren V, Hostin R, McCarthy IM, Mundis GM, Burton DC, Klineberg E, Gupta MC, Kebaish KM, Shaffrey CI, Bess S, Schwab F, Ames CP; International Spine Study Group. J Neurosurg Spine. 2014 Mar;20(3):306-12. doi: 10.3171/2013.12. SPINE13680. Epub 2014 Jan 3. Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Liu S, Schwab F, Smith JS, Klineberg E, Ames CP, Mundis G, Hostin R, Kebaish K, Deviren V, Gupta M, Boachie-Adjei O, Hart RA, Bess S, Lafage V. Ochsner J. 2014 Spring;14(1):67-77. Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper 18 instrumented vertebra. Scheer JK, Lafage V, Smith JS, Deviren V, Hostin R, McCarthy IM, Mundis GM, Burton DC, Klineberg E, Gupta M, Kebaish K, Shaffrey CI, Bess S, Schwab F, Ames CP; International Spine Study Group (ISSG). Eur Spine J. 2014 Jun 1. [Epub ahead of print] Multicenter validation of a formula predicting postoperative spinopelvic alignment. Lafage V, Bharucha NJ, Schwab F, Hart RA, Burton D, Boachie-Adjei O, Smith JS, Hostin R, Shaffrey C, Gupta M, Akbarnia BA, Bess S. J Neurosurg Spine. 2012 Jan;16(1):15-21. Epub 2011 Sep 23 Outcomes and Complications of Extension of Previous Long Fusion to the Sacro-Pelvis: Does Surgical Approach Make a Difference? Fu KM, Smith JS, Burton DC, Shaffrey CI, Boachie-Adjei O, Carlson B, Schwab FJ, Lafage V, Hostin R, Bess S, Akbarnia BA, Mundis G, Klineberg E, Gupta M; International Spine Study Group. World Neurosurg. 2013 Jan;79(1):177-81. Patients with adult spinal deformity treated operatively report greater baseline pain and disability than patients treated nonoperatively; however, deformities differ between age groups. Fu KM, Bess S, Shaffrey CI, Smith JS, Lafage V, Schwab F, Burton DC, Akbarnia BA, Ames CP, Boachie-Adjei O, Deverin V, Hart RA, Hostin R, Klineberg E, Gupta M, Kebaish K, Mundis G, Mummaneni PV; International Spine Study Group. Spine (Phila Pa 1976). 2014 Aug 1;39(17):1401-7. doi: 10.1097/BRS.0000000000000414. Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Smith JS, Lafage V, Schwab FJ, Shaffrey CI, Protopsaltis T, Klineberg E, Gupta M, Scheer JK, Fu KM, Mundis G, Hostin R, Deviren V, Hart R, Burton DC, Bess S, Ames CP; International Spine Study Group. Spine (Phila Pa 1976). 2014 Aug 1;39(17):E1001-9. doi: 10.1097/BRS.0000000000000432. Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Bess S, Boachie-Adjei O, Burton D, Cunningham M, Shaffrey C, Shelokov A, Hostin R, Schwab F, Wood K, Akbarnia B; International Spine Study Group. Spine (Phila Pa 1976). 2009 Sep 15;34(20):2186-90 Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Scheer JK, Mundis GM Jr, Fu KM, Gupta MC, Hostin R, Deviren V, Kebaish K, Hart R, Burton DC, Line B, Bess S, Ames CP; International Spine Study Group. J Neurosurg Spine. 2014 Dec;21(6):994-1003. doi: 10.3171/2014.9.SPINE131176. Epub 2014 Oct 17. Radiographic Spino-pelvic Parameters and Disability in the Setting of Adult Spinal Deformity: A Prospective Multicenter Analysis. Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V; International Spine Study Group (ISSG). Spine (Phila Pa 1976). 2013 Mar 25. [Epub ahead of print] Reoperation Rates and Impact on Outcome in a Large Prospective Multicenter Adult Spinal Deformity Database. Scheer JK, Tang JA, Smith JS, Klineberg E, Hart RA, Mundis GM Jr, Burton DC, Hostin R, O Brien MF, Bess S, Kebaish KM, Deviren V, Lafage V, Schwab F, Shaffrey CI, Ames CP; International Spine Study Group. J Neurosurg Spine. 2013 Aug 23. [Epub ahead of print] Revision extension to the pelvis versus primary spinopelvic instrumentation in adult deformity: comparison of clinical outcomes and complications. Fu KM, Smith JS, Burton DC, Kebaish KM, Shaffrey CI, Schwab F, Lafage V, Arlet V, Hostin R, Boachie-Adjei O, Akbarnia B, Bess S; International Spine Study Group. World Neurosurg. 2014 Sep-Oct;82(3-4):e547-52. doi: 10.1016/j. wneu.2013.02.059. Epub 2013 Feb 21. Review. Revision Surgery After Three-Column Osteotomy in 335 Adult Spinal Deformity Patients: Inter- Center Variability and Risk Factors. Maier S, Smith JS, Schwab F, Obeid I, Mundis G, Klineberg E, Hostin R, Hart R, Burton D, Boachie-Adjei O, Gupta M, Ames C, Protopsaltis T, Lafage V; International Spine Study Group. Spine (Phila Pa 1976). 2014 Feb 27. [Epub ahead of print] Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough? Schwab FJ, Patel A, Shaffrey CI, Smith JS, Farcy JP, Boachie-Adjei O, Hostin RA, Hart RA, Akbarnia BA, Burton DC, Bess S, Lafage V. J Neurosurg Spine. 2012 Jun;16(6):539-46. Epub 2012 Mar 30. Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity. Lafage V, Smith JS, Bess S, Schwab FJ, Ames CP, Klineberg E, Arlet V, Hostin R, Burton DC, Shaffrey CI; International Spine Study Group. Eur Spine J. 2012 Apr;21(4):698-704. Epub 2011 Aug 12. Spondylolisthesis, Pelvic Incidence, and Spinopelvic Balance. Labelle, Hubert MD;

Roussouly, Pierre MD; Berthonnaud, Éric PhD; Transfeldt, Ensor MD; O Brien, Michael MD; Chopin, Daniel MD; Hresko, Timothy MD; Dimnet, Joannes PhD. Spine (Phila Pa 1976). 2004 Sep 15;29(18):2049-54. 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. Smith JS, Singh M, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Ibrahimi D, Scheer JK, Mundis G Jr, Gupta MC, Hostin R, Deviren V, Kebaish K, Hart R, Burton DC, Bess S, Ames CP; International Spine Study Group. J Neurosurg Spine. 2014 Aug;21(2):160-70. doi: 10.3171/2014.3.SPINE13580. Epub 2014 Apr 25. Surgical Treatment of Lenke 1 Main Thoracic Idiopathic Scoliosis? Results of a Prospective, Multi-Center Study. Newton PO, Marks MC, Bastrom TP, Betz R, Clements D, Lonner B, Crawford A, Shufflebarger H, O Brien M, Yaszay B; Harms Study Group. Spine (Phila Pa 1976). 2013 Feb 15;38(4):328-38. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. Smith JS, Shaffrey CI, Lafage V, Blondel B, Schwab F, Hostin R, Hart R, O Shaughnessy B, Bess S, Hu SS, Deviren V, Ames CP; International Spine Study Group. J Neurosurg Spine. 2012 Oct;17(4):300-7. doi: 10.3171/2012.6.SPINE1250. Epub 2012 Aug 3. T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Ryan DJ, Protopsaltis TS, Ames CP, Hostin R, Klineberg E, Mundis GM, Obeid I, Kebaish K, Smith JS, Boachie-Adjei O, Burton DC, Hart RA, Gupta M, Schwab FJ, Lafage V; International Spine Study Group. Spine (Phila Pa 1976). 2014 Jul 1;39(15):1203-10. doi: 10.1097/ BRS.0000000000000382. The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G, Ryan DJ, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage V; International Spine Study Group. J Bone Joint Surg Am. 2014 Oct 1;96(19):1631-40. doi: 10.2106/JBJS.M.01459. The SRS-Schwab Adult Spinal Deformity Classification: Assessment and Clinical Correlations Based on a Prospective Operative and Nonoperative Cohort. Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP, Fu KM, Burton D, Hostin R, Klineberg E, Gupta M, Deviren V, Mundis G, Hart R, Bess S, Lafage V; International Spine Study Group. Neurosurgery. 2013 Jun 14. [Epub ahead of print] Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis. Kim HJ, Boachie-Adjei O, Shaffrey CI, Schwab F, Lafage V, Bess S, Gupta MC, Smith JS, Deviren V, Akbarnia B, Mundis GM, O Brien M, Hostin R, Ames C; International Spine Study Group. Spine (Phila Pa 1976). 2014 Jun 1;39(13):E795-9. doi: 10.1097/BRS.0000000000000339. ABSTRACT PRESENTATIONS A Preliminary Analysis of Outcomes, and Direct Cost for Four Diagnostic Categories of Adult Spinal Deformity (ASD), 2011 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages Achieves High Fusion Rates in Multilevel Adult Spinal Deformity Surgery, 2011 Identification of Decision Criteria for Revision Surgery among Patients with Acute Proximal Junctional Failure following Surgical Treatment for Spinal Deformity, 2012 Analysis of Health Related Quality of Life Improvements among Patients with Adult Spinal Deformity, 2012 North American Spine Society 27th Annual Meeting 10/24-10/27 Dallas, TX. NASS Best Poster Award The Effect of Complications on Health Outcomes among Patients Undergoing Three- Column Osteotomy Surgery, 2012 The Impact of Restored Global Sagittal Alignment on Outcomes of Three-Column Osteotomy, 2012 Analysis of the Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity, 2012 Cost-Utility Analysis of Surgical Treatment for Adult Spinal Deformity, 2013 Incremental Cost-Effectiveness of Adult Spinal Deformity Surgery: Observed QALYs with Surgery Compared to Predicted QALYs without Surgery, 2013 48th Annual Meeting & Course 09/18-09/21 Lyon, France. SRS Louis A. Goldstein Award for Best Clinical Poster Presentation Quantifying the Role of Baseline Quality-of-Life and Readmissions on the Incremental Cost- Effectiveness of Surgical Treatment for Adult Spinal Deformity (ASD), 2013 Total Hospital Costs of Surgical Treatment for Adult Spinal Deformity: An Extended Follow-up Study, 2013 The Cost of Implants in Surgical Treatment of Adult Spinal Deformity, 2013 Calculating and Defining Minimally Important Clinical Difference (MCID) and Substantial Clinical Benefit (SCB) Values for Adult Spinal Deformity (ASD): A Robust Methodology for Consistent Data Reporting, 2013 North American Spine Society 28th Annual Meeting 10/09-10/12 New Orleans. LANASS Value Abstract Award Comparison of QALYs Predicted from the ODI and QALYs Calculated from the SF-6D Following Surgical Treatment for Adult Spinal Deformity (ASD), 2013 Expectations and Health Outcomes in the Surgical Treatment of Adult Spinal Deformity (ASD), 2013 Incremental Cost-Effectiveness of Adult Spinal Deformity Surgery by Classification of Deformity, 2014 21st International Meeting on Advanced Spine Techniques 07/16-07/19 Valencia, Spain. IMAST Whitecloud Basic Science Award Nominee & Top Scoring Abstract Efficiency in Adult Spinal Deformity Surgery: A Multi-Center Comparison of Resource Use, 2014 North American Spine Society 29th Annual Meeting 11/12-11/15 San Francisco, CA. NASS Value Award Nominee Role of Implant Costs in the Long Term Cost- Effectiveness of Surgical Treatment of Adult Spinal Deformity, 2014, 21st International Meeting on Advanced Spine Techniques 07/16-07/19 Valencia, Spain. IMAST Whitecloud Basic Science Award Nominee & Top Scoring Abstract, Long Term Cost-Effectiveness of Adult Spinal Deformity, 2014 19

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