Publications (53) View all
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Article: Use of Surgimap Spine in Sagittal Plane Analysis, Osteotomy Planning, and Correction Calculation.
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ABSTRACT: Over the past 3 decades the sagittal plane has received increasing attention from the scientific community and spine surgeons alike. There remains a lack of clear and concise methods for incorporating surgical techniques and radiographic parameters to achieve the best possible outcome on a patient-specific level. This article proposes a new method for a treatment approach to sagittal malalignment by incorporating new digital tools for surgical planning. This technique offers a consistent approach to adult spinal deformity with sagittal-plane components, and can permit optimization in consistently achieving proper postoperative spinopelvic alignment.Neurosurgery Clinics of North America 04/2013; 24:163-172. · 1.76 Impact Factor -
Article: Clinical and radiographic evaluation of the adult spinal deformity patient.
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ABSTRACT: Among the prevalent forms of adult spinal deformity are residual adolescent idiopathic and degenerative scoliosis, kyphotic deformity, and spondylolisthesis. Clinical evaluation should include a thorough history, discussion of concerns, and a review of comorbidities. Physical examination should include assessment of the deformity and a neurologic examination. Imaging studies should include full-length standing posteroanterior and lateral spine radiographs, and measurement of pelvic parameters. Advanced imaging studies are frequently indicated to assess for neurologic compromise and for surgical planning. This article focuses on clinical and radiographic evaluation of spinal deformity in the adult population, particularly scoliosis and kyphotic deformities.Neurosurgery clinics of North America 04/2013; 24(2):143-56. · 1.73 Impact Factor -
Article: Sagittal spinal pelvic alignment.
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ABSTRACT: The goal of any ambulatory patient is to maintain a horizontal gaze with the least amount of energy expenditure. With progressive deformity, and in particular sagittal malalignment, significant compensatory mechanisms must be used to achieve this goal. Each pelvis dictates the amount of lumbar lordosis required through its morphometric parameter pelvic incidence. The pelvis may compensate for decreasing lumbar lordosis (eg, age, flat back deformity) by retroverting and increasing pelvic tilt and decreasing the sacral slope. Underappreciation for these spinopelvic compensatory mechanisms leads to surgical under-correction, iatrogenic flat back and poor clinical outcomes.Neurosurgery clinics of North America 04/2013; 24(2):157-62. · 1.73 Impact Factor -
Article: Classifications for adult spinal deformity and use of the scoliosis research society-schwab adult spinal deformity classification.
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ABSTRACT: Adult spinal deformity (ASD) is a complex disease state that pathologically alters standing upright posture and is associated with substantial pain and disability. This article provides an overview of classification systems for spinal deformity, clarifies the need to differentiate between pediatric and adult classifications, and provides an explanation on the use of the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification (SRS-Schwab ASD Classification). This information allows surgeons, researchers, and health care providers to (1) identify sources of pain and disability in patients with ASD and (2) accurately use the SRSeSchwab ASD Classification to evaluate patients with ASD.Neurosurgery clinics of North America 04/2013; 24(2):185-93. · 1.73 Impact Factor -
Article: Radiographic Spino-pelvic Parameters and Disability in the Setting of Adult Spinal Deformity: A Prospective Multicenter Analysis.
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ABSTRACT: : Study Design: Prospective multi-center study evaluating operative (OP) vs. nonoperative (NON) treatment for adult spinal deformity (ASD).Objective: Evaluate correlations between spino-pelvic parameters and health related quality of life (HRQL) scores in ASD patients.Summary of Background Data: Sagittal spinal deformity is commonly defined by an increased sagittal vertical axis (SVA), however SVA alone may underestimate the severity of the deformity. Spino-pelvic parameters provide a more complete assessment of the sagittal plane but only limited data are available that correlate spino-pelvic parameters with disability.Methods: Baseline demographic, radiographic, and HRQOL data were obtained for all patients enrolled in a multicenter consecutive database. Inclusion criteria were: age >18 years and radiographic diagnosis of ASD. Radiographic evaluation was conducted on the frontal and lateral planes and HRQOL questionnaires (ODI, SRS-22r and SF-12) were completed. Radiographic parameters demonstrating highest correlation with HRQOL values were evaluated to determine thresholds predictive of ODI>40.Results: 492 consecutive ASD patients (mean age 51.9 years) were enrolled. Patients from the OP group (n = 178) were older (55 vs. 50.1 years, p<0.05), had greater SVA (5.5 vs. 1.7cm, p<0.05), greater pelvic tilt (PT; 22° vs. 11°, p<0.05) and greater pelvic incidence/ lumbar lordosis mismatch (PI-LL; 12.2 vs. 4.3; p<0.05) than NON group (n = 314). OP group demonstrated greater disability on all HRQOL measures compared to NON group (ODI = 41.4 vs. 23.9, p<0.05; SRS total = 2.9 vs. 3.5, p<0.05). Pearson analysis demonstrated that among all parameters, PT, SVA, and PI-LL correlated most strongly with disability for both OP and NON groups (p<0.001). Linear regression models demonstrated threshold radiographic spino-pelvic parameters for ODI>40 to be: PT≥22° (r = 0.38), SVA ≥47 mm (r = 0.47), PI-LL≥11 (r = 0.45).Conclusion: ASD is a disabling condition. Prospective analysis of consecutively enrolled ASD patients demonstrated that PT and PI-LL combined with SVA can predict patient disability and provide a guide for patient assessment for appropriate therapeutic decision-making. Threshold values for severe disability (ODI>40) included: PT≥22°, SVA ≥47mm, and PI-LL≥11°.Spine 03/2013; · 2.08 Impact Factor
