Virginie Lafage

• PhD
• AVP Orthopedic Clinical Research at Lenox Hill Hospital

BACKGROUND AND OBJECTIVES The concept of upper cervical ( C0-C2) extension reserve (ER) capacity, ER relaxation, and their impact on outcomes following surgical correction of adult cervical deformity (ACD) has not been extensively studied. We aimed to evaluate the impact of upper cervical ER on postoperative disability and outcomes. METHODS Patien...

OBJECTIVE Existing literature on the impact of alignment parameters relative to the thoracolumbar inflection point remains sparse. The authors aimed to investigate the influence of the inflection point, lumbar lordosis apex (LLA), and other alignment parameters on complications, reoperations, and clinical outcomes. METHODS Patients with adult spin...

Background context Spinopelvic alignment assessment needs to account for pelvic incidence (PI). Purpose This study aimed at providing normative values for commonly used parameters in whole-body alignment analysis based on PI. Design Multicentric prospective study. Patient sample This study included healthy volunteers with full-body biplanar radi...

Study Design Retrospective matched cohort study. Objective Understanding biological aging in adult spinal deformity (ASD) across different populations offers insights into its impact on aging and potential interventions. Summary of Background Data ASD significantly impacts physiological health and may accelerate biological aging. Understanding bi...

Study Design Retrospective cohort study of prospectively enrolled cervical deformity patients. Objective To investigate patients in whom fusion to the thoracic spine was warranted. Summary of background data Thoracolumbar malalignment is often seen in patients presenting with cervical deformities. For cervical deformity (CD) patients, it is not a...

BACKGROUND AND OBJECTIVES To investigate the cost-effectiveness and impact of prophylactic techniques on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in the context of postoperative alignment. METHODS Adult spinal deformity patients with fusion to pelvis and 2-year data were included. Patients receivi...

Importance Long-term follow-up studies of operative and nonoperative treatment of adult symptomatic lumbar scoliosis (ASLS) are needed to assess benefits and durability. Objective To assess the durability of treatment outcomes for operative vs nonoperative treatment of ASLS. Design, Setting, and Participants The Adult Symptomatic Lumbar Scoliosis...

INTRODUCTION Proximal junctional kyphosis(PJK) is prevalent after adult spinal deformity(ASD) surgery. METHODS ASD patients fused from at least 5 levels from sacrum with 2Y data were included. Radiographic PJK (radPJK) was defined by Lafage et al. criteria. RadPJK and reoperation for PJK (reopPJK) were evaluated by summation of the Sagittal Age-Ad...

INTRODUCTION Hyperextension of the upper cervical spine is a prominent compensatory mechanism to maintain horizontal gaze and balance in adult cervical deformity (ACD). Relaxation of ER and its impact on postoperative outcomes is not well understood. METHODS ACD patients undergoing subaxial cervical fusion with 2Y data were included. Upper cervica...

Study Design A retrospective Cohort Study. Objective The aim of this study is to investigate the associations between posterior muscle health characteristics and disk geometry parameters between L1 and S1. Summary of Background Data Paralumbar muscle changes have been associated with clinical outcomes. However, the relationship between disk geome...

Purpose To determine if iatrogenic posterior translation (UIV SPi) at the upper instrumented vertebrae (UIV) is associated with increased mechanical complications and secondarily to generate and validate a UIV SPi threshold for increased complications. Methods Two patient databases were utilized: one for generating a UIV SPi threshold and another...

Background Early-term complications may not predict long-term success after adult cervical deformity (ACD) correction. Objective Evaluate whether optimal realignment results in similar rates of perioperative complications but achieves longer-term cost-utility. Study Design Retrospective cohort study. Methods ACD patients with 2-year data include...

OBJECTIVE Malalignment following cervical spine deformity (CSD) surgery can negatively impact outcomes and increase complications. Despite the growing ability to plan alignment, it remains unclear whether preoperative goals are achieved with surgery. The objective of this study was to assess how good surgeons are at achieving their preoperative goa...

Study Design Retrospective analysis of prospectively-collected data Objective This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery. Background Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE). Methods Adults...

Study Design Cross-sectional study. Objective To assess the potential role of degenerative myelopathy as a risk factor for major fragility fractures in older patients. Background Degenerative cervical myelopathy (DCM) stands as the foremost spinal disorder affecting adults, significantly impacting patients’ quality of life. However, it is often u...

OBJECTIVE The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery. METHODS Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surge...

OBJECTIVE The goal of this study was to assess the impact of fractional curve (FC) severity on curve progression and postoperative outcomes in patients undergoing adult idiopathic scoliosis (AdIS) correction. METHODS Patients with AdIS who had preoperative coronal plane deformity and who had undergone thoracolumbar fusion with a lowermost instrume...

Background The use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow asp...

Study Design Retrospective analysis of prospectively collected data Objective This study evaluates the impact of knee osteoarthritis (OA) and knee arthroplasty on alignments and patient-reported outcomes measures (PROMS) of patients undergoing adult spinal deformity (ASD) corrective surgery. Background The relationship between knee OA and spinal...

Purpose To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery. Methods Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinop...

BACKGROUND AND OBJECTIVES The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine tempo...

Aims The aim of this study was to investigate the impact of the level of upper instrumented vertebra (UIV) in frail patients undergoing surgery for adult spine deformity (ASD). Methods Patients with adult spinal deformity who had undergone T9-to-pelvis fusion were stratified using the ASD-Modified Frailty Index into not frail, frail, and severely...

Purpose Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients. Methods ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of fai...

Study Design Retrospective cohort study. Objectives To evaluate whether different radiographic clusters of adult spinal deformity identified using artificial intelligence-based clustering are associated with distinct surgical outcomes. Methods Patients were classified based on the results of a previously conducted analysis that examined clusters...

Study Design: Retrospective cohort study.Purpose: To determine the incidence and success of three-column osteotomies (3COs) performed in primary and revision adult spine deformity (ASD) corrective surgeries.Overview of Literature: 3COs are often required to correct severe, rigid ASD presentations. However, controversy remains on the utility of 3COs...

Study design Retrospective study of a multicentric prospective database. Objective This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbo-sacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications f...

Study Design Secondary data analysis of the NIH-sponsored study on adult symptomatic lumbar scoliosis (ASLS). Objectives The purpose of this study is to perform a cost-effectiveness analysis comparing operative (Op) versus non-operative (Non-Op) care for ASLS 8 years after enrollment. Background A prior cost-effectiveness analysis of the current...

Background: Recent studies assessing the importance of various preoperative factors on postoperative outcomes following spine surgery have uncovered several important variables that influence subjective and objective outcomes following cervical spine surgery, but it is still unclear which patients are most likely to benefit from operative manageme...

Background Tranexamic acid (TXA) is commonly utilized to reduce blood loss in adult spinal deformity (ASD) surgery. Despite its widespread use, there is a lack of consensus regarding the optimal dosing regimen. The aim of this study was to assess differences in blood loss and complications between high, medium, and low-dose TXA regimens among patie...

Study design Multicentric retrospective study of prospectively collected data. Objective Based on normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate. Summary of Backgro...

of Background Data Yilgor et al developed the lumbar Lordosis Distribution Index to individualize the pelvic mismatch to each patient’s pelvic incidence. The cervical lordosis distribution in relation to its apex has not been characterized. Objective Tailor correction of cervical deformity by incorporating the cervical apex into a distribution ind...

Retrospective cohort study. The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following long segment fusion is underreported. This study evaluates the impact of MS on two-year (2Y) postoperative complications and revisions following ≥ 4-level fusion for adult spinal deformity (ASD). Patients undergoing ≥ 4-level fusi...

Background Our understanding of the relationship between sagittal alignment and mechanical complications is evolving. In normal spines, the L1-pelvic angle (L1PA) accounts for the magnitude and distribution of lordosis and is strongly associated with pelvic incidence (PI), and the T4-pelvic angle (T4PA) is within 4° of the L1PA. We aimed to examine...

Study Design Case-based survey. Objectives This study aims to investigate what a group of surgeons learned from their own revisions, and what they would do differently today. Methods A multi-center database of ASD surgical patients was queried to identify those with at least 2 surgical procedures performed by the same surgeon between 2009 and 201...

OBJECTIVE Correction of mild flexible cervical deformity (CD) via the posterior approach has been described with and without the use of posterior osteotomies (POs), despite a lack of clarity regarding their necessity or risks. The purpose of this study was to determine whether the use of POs when correcting mild flexible CD leads to improved clinic...

To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS). Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included. Intraoperative intravenous (IV...

OBJECTIVE The purpose of this study was to assess how various realignment strategies affect mechanical failure and clinical outcomes in pelvic incidence (PI)–stratified cohorts following adult spinal deformity (ASD) surgery. METHODS Median and interquartile range statistics were calculated for demographics and surgical details. Further statistical...

Study Design Retrospective study of a multicentric prospective database. Objective This study aimed at describing the relative contribution of vertebral bodies versus discs to lumbar lordosis, and its variation with age and pelvic incidence. Summary of Background Data While studies sought to determine the physiological magnitude and distribution...

Study Design Retrospective Cohort Study. Objectives Length of Stay (LOS) and resource utilization are of primary importance for hospital administration. This study aimed to understand the incremental effect of having a specific complication on LOS among ASD patients. Methods A retrospective examination of prospective multicenter data utilized pat...

Purpose While existing adult spinal deformity (ASD) alignment schemas acknowledge the dynamic relationship between the pelvis and spine, consideration of vertebral pelvic angles (VPA) thresholds for PJK may provide further insight into the relationship of each individual vertebra to the pelvis, which may allow for greater individualization of opera...

OBJECTIVE The objective was to evaluate factors associated with the long-term durability of outcomes in adult spinal deformity (ASD) patients. METHODS Operative ASD patients fused from at least L1 to the sacrum with baseline (BL) to 5-year (5Y) follow-up were included. Substantial clinical benefit (SCB) in Oswestry Disability Index (ODI), numeric...

Study Design Retrospective analysis of prospectively collected data. Objective Evaluate the impact of prior cervical constructs on upper instrumented vertebrae (UIV) selection and postoperative outcomes among patients undergoing thoracolumbar deformity correction. Background Surgical planning for adult spinal deformity (ASD) patients involves con...

Recombinant human bone morphogenetic protein-2 (rhBMP-2) has not shown superior benefit overall in cost-effectiveness during adult spinal deformity (ASD) surgery. Retrospective Generate a risk score for pseudarthrosis to inform the utilization of rhBMP-2, balancing costs against quality of life and complications. ASD patients with 3-year data were...

Adult spinal deformity (ASD) patients with sagittal plane deformity (N) or structural lumbar/thoraco-lumbar (TL) curves can be treated with fusions stopping at the TL junction or extending to the upper thoracic (UT) spine. This study evaluates the impact on cost/cumulative quality-adjusted life year (QALY) in patients treated with TL vs UT fusion....

To assess impact of baseline disability on HRQL outcomes. CD patients with baseline (BL) and 2 year (2Y) data included, and ranked into quartiles by baseline NDI, from lowest/best score (Q1) to highest/worst score (Q4). Means comparison tests analyzed differences between quartiles. ANCOVA and logistic regressions assessed differences in outcomes wh...

Purpose Previous work comparing ASD to a normative population demonstrated that a large proportion of lumbar lordosis is lost proximally (L1-L4). The current study expands on these findings by collectively investigating regional angles and spinal contours. Methods 119 asymptomatic volunteers with full-body free-standing radiographs were used to id...