Munish Gupta

Munish Gupta
Washington University in St. Louis | WUSTL , Wash U · Department of Orthopaedic Surgery

Doctor of Medicine

About

516
Publications
31,573
Reads
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7,182
Citations
Citations since 2017
284 Research Items
5364 Citations
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Introduction
Dr. Munish C. Gupta specializes in spinal reconstructive surgery for both adults and children who need repair of spinal deformities resulting from scoliosis, kyphosis, spondylolisthesis and flatback syndrome. He has helped many patients to start living normally again, by correcting their spinal problems to regain lost mobility and to relieve pain and numbness. Gupta received his medical degree from Northwestern University in 1986 after completing a combined BA/MD honors program in medical education. After finishing an internship and residency at Northwestern, he completed a fellowship in spinal surgery in 1992 at the Norton Leatherman Spine Center, affiliated with the University of Louisville.
Education
August 1991 - July 1992
University of Louisville
Field of study
  • Spine Surgery Fellowship-Kenton D. Leatherman Spine Center
May 1986 - May 1997
Northwestern University
Field of study
  • Orthopaedic Internship and Residency
August 1982 - May 1986
Northwestern University
Field of study
  • Medical

Publications

Publications (516)
Article
Study design: Retrospective review of prospective database. Objectives: Vertebral pelvic angles (VPAs) account for complexity in spine shape by assessing the relative position of each vertebra with regard to the pelvis. This study uses VPAs to investigate the shape of the fused spine after T10-pelvis fusion, in patients with adult spinal deformi...
Article
PurposeLittle is known about the perioperative characteristics associated with a posterior spinal fusion (PSF) in adolescent idiopathic scoliosis patients previously treated with vertebral body tethering (VBT). We aimed to determine if operative time, estimated blood loss, postoperative length of stay, instrumentation type, and implant density diff...
Article
Background: Rapid growth in smartphone use has expanded opportunities to use mobile health (mHealth) technology to collect real-time patient-reported and objective biometric data. These data may have important implication for personalized treatments of degenerative spine disease. However, no large-scale study has examined the feasibility and accep...
Article
Objective: Proximal junctional failure (PJF) is a severe form of proximal junctional kyphosis. Previous reports on PJF have been limited by heterogeneous cohorts and relatively short follow-ups. The authors' objectives herein were to identify risk factors for PJF and to assess its long-term incidence and revision rates in a homogeneous cohort. Me...
Article
OBJECTIVE The purpose of this study was to validate the Global Alignment and Proportion (GAP) score as a predictor of health-related quality of life (HRQOL) outcomes for patients undergoing adult spinal deformity (ASD) surgery. METHODS This was a retrospective cohort study of patients with ASD undergoing long-segment spine fusions (≥ 5 vertebrae f...
Article
Purpose: To determine the proportions of patients returning to work at various points after adult spinal deformity (ASD) surgery and the associations between surgical invasiveness and time to return to work. Methods: Using a multicenter database of patients treated surgically for ASD from 2008 to 2015, we identified 188 patients (mean age 51 ± 1...
Article
Study design: Retrospective cohort. Objective: To assess whether patient outcomes and cost effectiveness of adult spinal deformity (ASD) surgery have improved over the past decade. Background: Surgery for ASD is an effective intervention, but one that is also associated with large initial healthcare expenditures. Changes in the cost profile fo...
Article
Full-text available
A targeted injury to the mouse intervertebral disc (IVD) is often used to recapitulate the degenerative cascade of the human pathology. Since injuries can vary in magnitude and localization, it is critical to examine the effects of different injuries on IVD degeneration. We thus evaluated the degenerative progression resulting from either a partial...
Article
Purpose: Despite adequate correction, the pelvis may fail to readjust, deemed pelvic non-response. To assess alignment outcomes(pelvic non-response[PNR], PJK, postoperative cervical deformity[CD]) following ASD surgery utilizing different realignment strategies. Methods: ASD patients with 2-year(2Y) data were included. PNR defined as undercorrec...
Article
BACKGROUND CONTEXT Adult spinal deformity (ASD) refers to multiple types of spinal deformity. This study used a prospective multicenter database of patients with "complex" surgical ASD to derive a data-driven classification of different deformity patterns, and assessed if such patterns have distinct clinical outcomes. PURPOSE Use an AI-based unsup...
Article
BACKGROUND CONTEXT Both cervical and thoracolumbar deformity surgeries are often complex and invasive, with a fairly comorbid patient population. However, few studies have assessed the mortality rates, frailty, and invasiveness between the two populations. PURPOSE The aim of this study was to determine the incidence density of all-cause mortality...
Article
BACKGROUND CONTEXT Evidence on long-term surgical recovery in adult spinal deformity (ASD) patients who are both frail and have an invasive procedure is limited. PURPOSE This study aims to evaluate frail and invasive patients with 5-year recovery kinetics. We hypothesize that patients who are both frail and have invasive surgeries will have advers...
Article
BACKGROUND CONTEXT Adult spinal deformity (ASD) patients maintain upright posture by compensating through their spine, pelvis and lower extremities. Little data exist quantifying the contribution of lower extremity compensation through the hips, knees, and ankles to maintain upright posture. PURPOSE Evaluate the effect of the lower limb compensati...
Article
BACKGROUND CONTEXT Malalignment following adult spinal deformity (ASD) surgery can negatively impact clinical outcomes and increase risk of mechanical complications. Despite improved definition of ideal alignment for ASD surgery and increasingly sophisticated preoperative alignment planning tools, it remains unclear whether the preoperative goals f...
Article
BACKGROUND CONTEXT Previous reports indicate postoperative complications have minimal impact on long-term outcomes after ASD surgery. Little data has evaluated the impact of complications on specific heath domains during postoperative period. PURPOSE To evaluate the impact of specific complications on patient reported health domains compared to pa...
Article
BACKGROUND CONTEXT Preoperative risk stratification is critical to determining which adult spinal deformity (ASD) patients may develop postop complications and to maximize surgical success. Currently it is unknown if a preoperative inflammatory state results in a higher risk for postop complications. This information can be used in risk stratificat...
Article
BACKGROUND CONTEXT Adult cervical deformity (ACD) can have profound impact on health-related quality of life (HRQL). Operative treatment for ACD is associated with high complication rates due to the complexity of surgery and the frailty of the patients affected. Very few studies have focused on outcomes of operative ACD treatment. PURPOSE To asses...
Article
BACKGROUND CONTEXT While past research has shown racial disparities exist in the outcomes and utilization of spine surgery, those studies were often performed on nondisease-specific national databases, which may capture different patient populations and complication rates compared to prospective multicenter databases. PURPOSE Purpose: 1) Assess ra...
Article
BACKGROUND CONTEXT Adult spinal deformity (ASD) is a complex pathology associated with high complication rates. Although complication rates have been previously reported, the interplay between timing and type of complications has not been fully analyzed. PURPOSE Provide benchmarks for the rates of complications by type and timing. STUDY DESIGN/SE...
Article
BACKGROUND CONTEXT Prophylaxis usage has been established in literature as an important component of minimizing the risk of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) development. However, literature is scarce on the effects of prophylaxis in patients who have achieved adequate postoperative alignment and those who mai...
Article
BACKGROUND CONTEXT Numerous studies have reported the interplay between spinal deformity and pelvis compensatory mechanisms, but little data exist evaluating the contribution of lower extremity compensation (LE) to maintain upright posture. We hypothesis that hip, knee and ankle compensation is proportional to the severity of the spinal deformity a...
Article
BACKGROUND CONTEXT Loss of lumbar curvature is often expressed as an angular regional loss. Previous work comparing adult spinal deformity (ASD) lumbar alignment to their age-and-PI adjusted normative value demonstrated that, contrary to general belief, a large proportion of the curvature is lost proximally (L1-L4). This study is a follow-up lookin...
Article
BACKGROUND CONTEXT Identifying the components needed for an optimal adult spinal deformity (ASD) surgical outcome could help inform surgeons and improve ASD treatment. However, defining the components that create an optimal outcome for ASD surgery is challenging because outcome metrics depend on multiple perspectives. A patient may receive a techni...
Article
BACKGROUND CONTEXT The durability of adult spinal deformity (ASD) surgery is key for cost-effective treatment. Malalignment is one of the main reasons for revision surgery. PURPOSE To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery. STUDY DESIGN/SETTING Retrospective cohort study of a pro...
Article
BACKGROUND CONTEXT Sacralization of L5 is a condition that affects 15% of the population. Because of the increased L5 articulations to the sacrum, it is unclear how pelvic incidence and spinopelvic parameters should be measured. PURPOSE Determine whether patients with L5 sacralization should be radiographically measured with relation to the L5 or...
Article
BACKGROUND CONTEXT Proximal junctional kyphosis (PJK) is a common adverse event in adult spinal deformity (ASD) surgery. Proximal junctional failure (PJF) is a severe form of PJK that often warrants revision surgery. Previous reports on PJK/PJF have been limited by heterogeneous patient populations and relatively short follow-up. PURPOSE The objec...
Article
BACKGROUND CONTEXT Evidence on long-term maintenance of health status in adult spinal deformity (ASD) patients who improve above MCID threshold (MCID+) at 2 years following surgery is limited. PURPOSE This study aims to: (1) evaluate whether patients who reached MCID+ status at two years postoperatively will maintain MCID+ status at 5 years, (2) i...
Article
BACKGROUND CONTEXT Adult spinal deformity (ASD) patients undergoing surgery risk neurological decline following surgery. However, surgery may be the key in improving outcomes in patients starting with lower extremity motor deficits at baseline (BL). We aim to analyze the improvement in neurological outcomes of ASD patients undergoing spinal reconst...
Article
BACKGROUND CONTEXT Tranexamic acid (TXA) is commonly used to lower blood loss in ASD surgery. Despite widespread use of TXA in ASD surgery, there is a lack of consensus regarding the optimal dosing intraoperatively. PURPOSE This study aims to assess differences in blood loss and complications between high-dose, medium-dose, and low-dose TXA regime...
Article
BACKGROUND CONTEXT As adult spinal deformity (ASD) prevalence increases in our ever-aging population there is a concomitant increase in poor bone quality. ASD surgery is expensive and carries a high complication profile. It is important to optimize modifiable preoperative risk factors, such as osteopenia or osteoporosis. Additional diagnostic modal...
Article
BACKGROUND CONTEXT Despite studies reporting the efficacy of BMP to promote surgical spinal fusion, hospital systems and third-party payors continue to deny use of BMP, claiming high cost and lack of long term follow up. PURPOSE Perform a propensity score matched analysis of complications and cost-effectiveness for surgically treated adult spinal...
Article
BACKGROUND CONTEXT The relationship of sagittal malalignment to outcomes has been emphasized in adult spinal deformity (ASD) surgery and it is known that sagittal parameters have some correlation to HRQOL measures overall. However, the specific relationship of HRQOL to postop sagittal alignment and changes in the strength of the relationship from p...
Article
BACKGROUND CONTEXT Several studies have suggested that Hounsfield units (HU) in the spine are associated with increased complications for adult spinal deformity (ASD) patients. PURPOSE The aim of this study is to assess whether there exists a threshold for HU that is associated with increased blood loss following ASD surgery. We hypothesize that H...
Article
BACKGROUND CONTEXT While reimbursement is centered on 90-day outcomes, some patients persevere through these short-term, transient complications and manage to still achieve optimal, long-term outcomes. PURPOSE Assess whether achieving optimal alignment suffering similar perioperative complications compared to suboptimally-aligned peers are inhibit...
Article
BACKGROUND CONTEXT Prior reports have focused on grading fusion status after adult spinal deformity (ASD) surgery; however, few focused on fusion status after 4-years postop. PURPOSE To identify risk factors for nonunion in a prospective cohort of ASD patients with long-term follow-up (=4 years). STUDY DESIGN/SETTING Prospective multicenter obser...
Article
BACKGROUND CONTEXT Prior studies assessed the association between underlying neurological condition and worse outcomes following spinal surgery with recent emphasis of self-reported loss of balance (Imbalance) by Uribe et al. PURPOSE To investigate if patients with self-reported loss of balance have poorer outcomes following adult spinal deformity...
Article
OBJECTIVE Previous reports of rod fracture (RF) in adult spinal deformity are limited by heterogeneous cohorts, low follow-up rates, and relatively short follow-up durations. Since the majority of RFs present > 2 years after surgery, true occurrence and revision rates remain unclear. The objectives of this study were to better understand the risk f...
Article
Objective: Revision surgery is often necessary for adult spinal deformity (ASD) patients. Satisfaction with management is an important component of health-related quality of life. The authors hypothesized that patients who underwent multiple revision surgeries following ASD correction would exhibit lower self-reported satisfaction scores. Methods...
Article
Background: Three-column osteotomies (3COs), usually in the form of pedicle subtraction or vertebral column resection, have become common in adult spinal deformity surgery. Although a powerful tool for deformity correction, 3COs can increase the risks of perioperative morbidity. Methods: Operative patients with adult spinal deformity (Cobb angle...
Article
Purpose: Traditionally, 2-year follow-up data have been the established standard for reporting clinical outcomes following spinal deformity surgery. However, previous studies indicate that 2-year follow-up does not represent long-term outcomes. Currently, there is no clear data that demonstrate a difference in outcomes between the 1 and 2 years po...
Article
Objective: Adult cervical deformity (ACD) has high complication rates due to surgical complexity and patient frailty. Very few studies have focused on longer-term outcomes of operative ACD treatment. The objective of this study was to assess minimum 2-year outcomes and complications of ACD surgery. Methods: A multicenter, prospective observation...
Article
Summary of background data: The influence of frailty on economic burden following corrective surgery for adult cervical deformity (CD) is understudied and may provide valuable insights for pre-operative planning. Objective: To assess the influence of baseline frailty status on the economic burden of CD surgery. Study design: Retrospective coho...
Article
Purpose: Given the challenges associated with managing progressive scoliosis in patients with cerebral palsy (CP), the purpose of this study was to evaluate deformity correction and HRQOL 5 years post-spinal fusion in CP patients who were skeletally immature at the time of surgical correction. Methods: CP patients who underwent definitive fusion...
Article
Objective: Hyperextension of C0-2 is a debilitating compensatory mechanism used to maintain horizontal gaze, analogous to high pelvic tilt in the lumbopelvic complex to maintain an upright posture. This study aims to investigate the impact of cervical deformity (CD) correction on this hyperextension. The authors hypothesize that correction of cerv...
Article
Full-text available
Background Surgeons often rely on their intuition, experience and published data for surgical decision making and informed consent. Literature provides average values that do not allow for individualized assessments. Accurate validated machine learning (ML) risk calculators for adult spinal deformity (ASD) patients, based on 10 year multicentric pr...
Article
Objective: The current literature has primarily focused on the 2-year outcomes of operative adult spinal deformity (ASD) treatment. Longer term durability is important given the invasiveness, complications, and costs of these procedures. The aim of this study was to assess minimum 3-year outcomes and complications of ASD surgery. Methods: Operat...
Article
Background: Accurate reporting of long-term complications of surgical treatment of adolescent idiopathic scoliosis (AIS) is critical, but incomplete. This study aimed to report on the rate of complications following surgical treatment of AIS among patients with at least 10 years of follow-up. Methods: This was a retrospective review of prospecti...
Article
Study design: Retrospective study of a multicenter Adult Spinal Deformity (ASD) Database. Objective: To investigate the change in Pelvic tilt (PT) imparted by regional changes in lumbar lordosis at 2-year minimum follow up. Summary of background data: The distribution of lumbar lordosis between L1-4 and L4-S1 is known to vary based on pelvic i...
Article
Study design: Retrospective cohort study. Objective: To investigate the evolution of PJK rate over 10-year enrollment period within a prospective database. Summary of background data: Proximal junctional kyphosis (PJK) is a common complication following adult spinal deformity (ASD) surgery and has been intensively studied over the last decade....
Article
Purpose: Prior work identified optimal outcomes at 2 years following selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS) but it is unclear whether these published predictors represent what is required to achieve an optimal outcome with further time and potential growth. The purpose of this study was to determine the preoperat...
Article
Study design: Prospective multicenter international observational study. Objective: To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction. Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studie...
Article
Purpose: To expand on previously described intraoperative aids by developing consensus-based best practice guidelines to optimize the approach to intraoperative neuromonitoring (IONM) events associated with "high-risk" spinal deformity surgery. Methods: Consensus was established among a group of experienced spinal deformity surgeons by way of th...
Article
Study design: This was a retrospective review of a prospectively collected database. Objective: The aim of this study was to delineate radiographic parameters that distinguish severe cervical spine deformity (CSD). Summary of background data: Our objective was to define parameters that distinguish severe CSD using a consensus approach combined...
Article
Purpose: To establish expert consensus on various parameters that constitute elevated risk during spinal deformity surgery and potential preventative strategies that may minimize the risk of intraoperative neuromonitoring (IONM) events and postoperative neurological deficits. Methods: Through a series of surveys and a final virtual consensus mee...
Preprint
Study Design Preclinical animal study Objective Evaluation of the degenerative progression resulting from either a partial- or full-width injury to the mouse lumbar intervertebral disc (IVD) using contrast-enhanced micro-computed tomography and histological analyses. We utilized a lateral-retroperitoneal surgical approach to access the lumbar IVD,...
Article
Study design: Retrospective review of prospectively collected multicenter registry data. Objective: The aim of this study was to determine whether surgical variables and complications as graded by treatment severity impact postoperative hospital length of stay (LOS). Summary of background data: Surgical treatment can substantially improve qual...
Article
Study design: Retrospective cohort study. Objective: Determine whether screws per level and rod material/diameter are associated with incidence of proximal junctional kyphosis (PJF). Summary of background data: PJF is a common and particularly adverse complication of adult spinal deformity (ASD) surgery. There is evidence that the rigidity of...
Article
Case: We report a rare case of a right-sided L4-5 facet osteoid osteoma in a 11-year-old female who presented with lower extremity pain, contractures, and gait disturbance in the setting of failed radiofrequency ablation. After open excision and single-level posterolateral fusion with instrumentation, her symptoms resolved and her spinopelvic para...
Article
Objective: The aim was to determine whether applying Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles for external fixation of long bone fracture to patients with a 3-column osteotomy (3CO) would be associated with reduced rod fracture (RF) rates. Summary of background data: AO dictate principles to follow when fixating long bone frac...
Article
Objective: Adult spinal deformity is a complex pathology that benefits greatly from surgical treatment. Despite continuous innovation, little is known regarding continuous changes in surgical techniques and the complications rate. The objective of the current study was to investigate the evolution of the patient profiles and surgical complications...
Article
Full-text available
Background Preoperative opioid is associated with poor postoperative outcomes for several surgical specialties, including neurosurgical, orthopedic, and general surgery. Patients with symptomatic adult spinal deformity (SASD) are among the highest patient populations reporting opioid use prior to surgery. Surgery for SASD has been demonstrated to i...
Article
Background Context : Previous research on rates of spinal detection showed a low frequency of patients (5%) experienced delays and additional screening going through airport security. With continuous technology advances in screenings and the rise in cobalt chrome implantation, updated data on patient experiences was needed. Purpose : 1) Assess the...
Article
Study design: Retrospective review of prospectively collected multicenter registry data. Objective: To identify rates and timing of postoperative complications in adult spinal deformity (ASD) patients, the impact of complication type and timing on health related quality of life (HRQoL) outcomes, and the impact of complication timing on readmissi...
Article
Full-text available
Study design: Retrospective cohort study of a prospectively collected database. Objective: To compare clinical utility of two common classification systems for ASD and determine whether both should be considered in surgical planning to improve patient outcomes. Summary of background data: Surgical restoration of appropriate Roussouly classific...
Article
Objective: Cervical deformity (CD) is a complex condition with a clear impact on patient quality of life, which can be improved with surgical treatment. Previous study following thoracolumbar surgery demonstrated a spontaneous and maintained improvement in cervical alignment following lumbar pedicle subtraction osteotomy (PSO). In this study the a...
Article
Study design: Retrospective cohort study. Objective: We hypothesized that adult spinal deformity (ASD) surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism. Summary of background data: ASD patients experience markedly decreased health-related quality of life along many dimen...
Article
Full-text available
Objectives: Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothesis was that surgical strategies will differ based...
Article
BACKGROUND Few reports focus on adults with severe scoliosis. OBJECTIVE To report surgical outcomes and complications for adults with severe scoliosis. METHODS A multicenter, retrospective review was performed on operatively treated adults with severe scoliosis (minimum coronal Cobb: thoracic [TH] ≥ 75°, thoracolumbar [TL] ≥ 50°, lumbar [L] ≥ 50°...
Article
Objective: Circumferential minimally invasive spine surgery (cMIS) for adult scoliosis has become more advanced and powerful, but direct comparison with traditional open correction using prospectively collected data is limited. The authors performed a retrospective review of prospectively collected, multicenter adult spinal deformity data. The aut...
Article
PurposeTypically, selection of lowest instrumented vertebra (LIV) in Adolescent Idiopathic Scoliosis (AIS) is based on the coronal radiograph; however, increasing evidence suggests that fusions proximal to the stable sagittal vertebrae (SSV) on the lateral radiograph can result in distal junctional kyphosis (DJK). The purpose of this study is to co...
Article
BACKGROUND Lateral (ie, coronal) vertebral listhesis may contribute to disability in adult scoliosis patients. OBJECTIVE To assess for a correlation between lateral listhesis and disability among patients with adult scoliosis. METHODS This was a retrospective multi-center analysis of prospectively collected data. Patients eligible for a minimum o...
Article
Objective: The authors' objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery. Methods: A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preopera...
Article
BACKGROUND CONTEXT Few guidelines exist regarding appropriate upper instrumented vertebra (UIV) selection for adult spinal deformity (ASD) patients undergoing long fusion to the pelvis. Fusion to upper thoracic (UT) spine may provide greater deformity correction and reduce proximal junctional failure (PJF) rates compared to fusions terminating at t...
Article
BACKGROUND CONTEXT Few studies investigate segmental lordosis restoration after long fusion with anterior (ALIF) vs transforaminal lumbar interbody fusion (TLIF) for adults with flatback deformity. PURPOSE Our objective was to compare segmental lordosis restoration, health-related quality-of-life (HRQL), and complications associated with L4-S1 ALI...
Article
BACKGROUND CONTEXT Both frailty and surgical invasiveness are correlated with increased risk of complications following ASD surgery, yet there is no accepted risk-stratification system combining these factors. PURPOSE The aim of this study is to ascertain data-driven categories defining the risk for 90-day complications following ASD surgery based...
Article
BACKGROUND CONTEXT Proximal junctional kyphosis (PJK) is one of the most common complications following adult spinal deformity (ASD) surgery and has been intensively studied over the last decade. PURPOSE This study aims to investigate the evolution of PJK rate over a 10-year enrollment period within a prospective database of ASD patients. The hypo...
Article
BACKGROUND CONTEXT Reoperations following adult spinal deformity (ASD) surgery place a significant burden on patient quality of life and overall health care costs. Despite the common knowledge of frequently occurring complications following ASD surgery that require reoperation, little is known on the cost and timing of these complications. Attempts...
Article
BACKGROUND CONTEXT Corrective surgery for adult spinal deformity (ASD) is known to carry a high likelihood of complications including surgical site infection, mechanical failure and loss of correction. It is currently unclear what category of complications that has the greatest impact on outcomes following ASD surgery. PURPOSE To investigate what...
Article
BACKGROUND CONTEXT ASD surgery is associated with postoperative improvements in patient pain and function but is also associated with high complication rates and long recovery. Accordingly, if given a choice, patients may indicate they would not undergo surgery again. PURPOSE At minimum two years postop, evaluate 1) surgically treated ASD patients...
Article
BACKGROUND CONTEXT Proximal junctional kyphosis (PJK) is a common cause of revision surgery for ASD patients. Surgeons may elect to perform a proximal extension of the fusion, or, also correct the source of the lumbo-pelvic mismatch. The goal was to determine if there is clinical benefit in addressing the root cause of PJK. PURPOSE To investigate...
Article
BACKGROUND CONTEXT The distribution of lumbar lordosis (LL) between L1-4 and L4-S1 is known to vary based on pelvic incidence (PI). However, the extent to which regional changes effect pelvic tilt (PT) is not clearly elucidated. This information can be useful for adult spinal deformity (ASD) surgical planning. PURPOSE To investigate the change in...
Article
BACKGROUND CONTEXT In asymptomatic individuals, two-thirds of the lordosis comes from the L4-S1 level. It is commonly believed that the majority of loss of lordosis in adult spinal deformity (ASD) is attributable to the distal (L4-S1) levels. PURPOSE This study aims to investigate the location of loss of lordosis in a cohort of ASD patients prior...
Article
BACKGROUND CONTEXT Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are two of the most challenging complications in adult spinal deformity (ASD) surgery. Bone quality has been identified as an important factor in outcomes of ASD patients. The association between Hounsfield units (HU) on CT scan at UIV and L1, and PJK occurr...