{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:54:56Z","timestamp":1786125296790,"version":"build-2736575974"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T00:00:00Z","timestamp":1623283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Operative treatment of adult spinal deformity (ASD) can be very challenging with high complication rates. It is well established that patients benefit from such treatment; however, the surgical outcomes for patients with severe sagittal deformity have not been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To report the outcomes of patients undergoing surgical correction for severe sagittal deformity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Retrospective review of a prospective, multicenter ASD database. Inclusion criteria: operative patients age\u00a0\u226518, sagittal vertical axis (SVA)\u00a0\u226515 cm, mismatch between pelvic incidence and lumbar lordosis (PI-LL)\u00a0\u226530\u00b0, and\/or lumbar kyphosis\u00a0\u22655\u00b0 with minimum 2 yr follow-up. Health-related quality of life (HRQOL) scores including minimal clinically important difference (MCID)\/substantial clinical benefit (SCB), sagittal and coronal radiographic values, demographic, frailty, surgical, and complication data were collected. Comparisons between 2 yr postoperative and baseline HRQOL\/radiographic data were made.\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.05 was significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 138 patients were included from 502 operative patients (54.3% Female, Average (Avg) age 63.3\u00a0\u00b1\u00a011.5 yr). Avg operating room (OR) time 386.2\u00a0\u00b1\u00a0136.5 min, estimated blood loss (EBL) 1829.8\u00a0\u00b1\u00a01474.6 cc. A total of 71(51.4%) had prior fusion. A total of 89.9% were posterior fusion only. Mean posterior levels fused 11.5\u00a0\u00b1\u00a04.1. A total of 44.9% had a 3-column osteotomy. All 2 yr postoperative radiographic parameters were significantly improved compared to baseline (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001 for all). All 2yr HRQOL measures were significantly improved compared to baseline (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.004 for all). A total of 46.6% to 73.8% of patients met either MCID\/SCB for all HRQOL. A total of 74.6% of patients had at least 1 complication, 11.6% had 4 or more complications, 33.3% had minimum 1 major complication, and 42(30.4%) had a postop revision.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Patients with severe sagittal malalignment benefit from surgical correction at 2 yr postoperative both radiographically and clinically despite having a high complication rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opab153","type":"journal-article","created":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T20:28:38Z","timestamp":1623356918000},"page":"94-103","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of Surgical Treatment for 138 Patients With Severe Sagittal Deformity at a Minimum 2-Year Follow-up: A Case Series"],"prefix":"10.1227","volume":"21","author":[{"given":"Justin K","family":"Scheer","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence G","family":"Lenke","sequence":"additional","affiliation":[{"name":"The Och Spine Hospital at New York-Presbyterian, Columbia University Department of Orthopaedic Surgery, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Presbyterian St. Lukes Medical Center, Denver, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles S","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric O","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Davis, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of The International Spine Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,9]]},"reference":[{"issue":"20","key":"bib1-20250822","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1097\/BRS.0b013e3181b05146","article-title":"Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients","volume":"34","author":"Bess","year":"2009","journal-title":"Spine"},{"issue":"1","key":"bib2-20250822","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/01.brs.0000251022.18847.77","article-title":"The selection of operative versus nonoperative treatment in patients with adult scoliosis","volume":"32","author":"Glassman","year":"2007","journal-title":"Spine"},{"issue":"4","key":"bib3-20250822","doi-asserted-by":"crossref","first-page":"326","DOI":"10.3171\/SPI.2008.9.10.326","article-title":"Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management","volume":"9","author":"Smith","year":"2008","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib4-20250822","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1227\/01.NEU.0000347005.35282.6C","article-title":"Improvement of back pain with operative and nonoperative treatment in adults with scoliosis","volume":"65","author":"Smith","year":"2009","journal-title":"Neurosurgery"},{"issue":"16","key":"bib5-20250822","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1097\/BRS.0b013e3181ac5fcd","article-title":"Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up","volume":"34","author":"Smith","year":"2009","journal-title":"Spine"},{"issue":"8","key":"bib6-20250822","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/BRS.0b013e31822ff5c1","article-title":"Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients","volume":"37","author":"Charosky","year":"2012","journal-title":"Spine"},{"issue":"5","key":"bib7-20250822","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/BRS.0b013e31821f0126","article-title":"Comparative analysis of clinical outcome and complications in primary versus revision adult scoliosis surgery","volume":"37","author":"Cho","year":"2012","journal-title":"Spine"},{"issue":"12","key":"bib8-20250822","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1097\/BRS.0b013e3181eabb26","article-title":"Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee","volume":"36","author":"Smith","year":"2011","journal-title":"Spine"},{"key":"bib9-20250822","doi-asserted-by":"crossref","DOI":"10.1186\/1748-7161-3-9","article-title":"Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature","author":"Weiss","year":"2008","journal-title":"Scoliosis"},{"issue":"3","key":"bib10-20250822","doi-asserted-by":"crossref","first-page":"E3","DOI":"10.3171\/2009.12.FOCUS09254","article-title":"Adult scoliosis surgery outcomes: a systematic review","volume":"28","author":"Yadla","year":"2010","journal-title":"Neurosurg Focus"},{"issue":"20","key":"bib11-20250822","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1097\/BRS.0b013e3181efa06a","article-title":"Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up","volume":"35","author":"Bridwell","year":"2010","journal-title":"Spine"},{"issue":"1","key":"bib12-20250822","first-page":"67","article-title":"Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment","volume":"14","author":"Liu","year":"2014","journal-title":"Ochsner J"},{"issue":"5","key":"bib13-20250822","doi-asserted-by":"crossref","first-page":"540","DOI":"10.3171\/2014.10.SPINE14475","article-title":"Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction","volume":"22","author":"Scheer","year":"2015","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib14-20250822","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jspd.2012.04.011","article-title":"Outcomes, expectations, and complications overview for the surgical treatment of adult and pediatric spinal deformity","volume":"1","author":"Smith","year":"2012","journal-title":"Spine Deform"},{"issue":"19","key":"bib15-20250822","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1097\/BRS.0b013e31829ec563","article-title":"Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment","volume":"38","author":"Smith","year":"2013","journal-title":"Spine"},{"issue":"16","key":"bib16-20250822","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1097\/BRS.0b013e3181ac5fcd","article-title":"Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up","volume":"34","author":"Smith","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"issue":"10","key":"bib17-20250822","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1097\/BRS.0b013e3181e21783","article-title":"Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age","volume":"36","author":"Smith","year":"2011","journal-title":"Spine"},{"issue":"2","key":"bib18-20250822","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s00586-012-2547-x","article-title":"Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults","volume":"22","author":"Smith","year":"2013","journal-title":"Eur Spine J"},{"issue":"5","key":"bib19-20250822","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/BRS.0000000000001626","article-title":"Operative management of adult spinal deformity results in significant increases in QALYs gained compared to nonoperative management: analysis of 479 patients with minimum 2-year follow-up","volume":"43","author":"Scheer","year":"2018","journal-title":"Spine"},{"issue":"10","key":"bib20-20250822","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1016\/j.spinee.2017.04.013","article-title":"Importance of patient-reported individualized goals when assessing outcomes for adult spinal deformity (ASD): initial experience with a patient generated index (PGI)","volume":"17","author":"Scheer","year":"2017","journal-title":"Spine J"},{"issue":"6","key":"bib21-20250822","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1227\/NEU.0000000000001116","article-title":"Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up","volume":"78","author":"Smith","year":"2016","journal-title":"Neurosurgery"},{"issue":"3","key":"bib22-20250822","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3171\/2014.12.SPINE14777","article-title":"Comparison of best versus worst clinical outcomes for adult spinal deformity surgery: a retrospective review of a prospectively collected, multicenter database with 2-year follow-up","volume":"23","author":"Smith","year":"2015","journal-title":"J Neurosurg Spine"},{"issue":"2","key":"bib23-20250822","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3171\/2014.3.SPINE13580","article-title":"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","volume":"21","author":"Smith","year":"2014","journal-title":"J Neurosurg Spine"},{"issue":"6","key":"bib24-20250822","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1097\/01.brs.0000155425.04536.f7","article-title":"Correlation of radiographic parameters and clinical symptoms in adult scoliosis","volume":"30","author":"Glassman","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"issue":"18","key":"bib25-20250822","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1097\/01.brs.0000179086.30449.96","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005","journal-title":"Spine"},{"issue":"4","key":"bib26-20250822","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jspd.2015.12.009","article-title":"Adult spinal deformity: epidemiology, health impact, evaluation, and management","volume":"4","author":"Ames","year":"2016","journal-title":"Spine Deform"},{"issue":"17","key":"bib27-20250822","doi-asserted-by":"crossref","first-page":"E599","DOI":"10.1097\/BRS.0b013e3181aad219","article-title":"Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity","volume":"34","author":"Lafage","year":"2009","journal-title":"Spine"},{"issue":"20","key":"bib28-20250822","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1097\/BRS.0b013e3181a8fdc8","article-title":"Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study","volume":"34","author":"Bridwell","year":"2009","journal-title":"Spine"},{"issue":"4","key":"bib29-20250822","doi-asserted-by":"crossref","first-page":"E203","DOI":"10.1097\/BRS.0000000000003228","article-title":"Pelvic compensation in sagittal malalignment: how much retroversion can the pelvis accommodate?","volume":"45","author":"Beyer","year":"2020","journal-title":"Spine"},{"issue":"11","key":"bib30-20250822","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/0895-4356(94)90129-5","article-title":"Validation of a combined comorbidity index","volume":"47","author":"Charlson","year":"1994","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"bib31-20250822","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1093\/neuros\/nyx303","article-title":"Development and validation of a novel adult spinal deformity surgical invasiveness score: analysis of 464 patients","volume":"82","author":"Neuman","year":"2018","journal-title":"Neurosurgery"},{"issue":"6","key":"bib32-20250822","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1007\/s00586-005-0927-1","article-title":"Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies","volume":"15","author":"Champain","year":"2006","journal-title":"Eur Spine J"},{"issue":"3","key":"bib34-20250822","first-page":"218","article-title":"Validation of a tool to measure pelvic and spinal parameters of sagittal balance","volume":"89","author":"Rillardon","year":"2003","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"issue":"12","key":"bib35-20250822","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/BRS.0b013e31823e15e2","article-title":"Scoliosis Research Society-Schwab Adult Spinal Deformity Classification: a validation study","volume":"37","author":"Schwab","year":"2012","journal-title":"Spine"},{"issue":"20","key":"bib36-20250822","first-page":"1426","article-title":"External validation of the adult spinal deformity (ASD) frailty index (ASD-FI)","volume":"43","author":"Miller","year":"2018","journal-title":"Eur Spine J"},{"issue":"9","key":"bib37-20250822","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1007\/s00586-018-5575-3","article-title":"External validation of the adult spinal deformity (ASD) frailty index (ASD-FI)","volume":"27","author":"Miller","year":"2018","journal-title":"Eur Spine J"},{"issue":"9","key":"bib38-20250822","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.2106\/JBJS.G.01095","article-title":"Defining substantial clinical benefit following lumbar spine arthrodesis","volume":"90","author":"Glassman","year":"2008","journal-title":"J Bone Joint Surg Am"},{"issue":"23","key":"bib39-20250822","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1097\/BRS.0b013e3181c61fd7","article-title":"The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis","volume":"35","author":"Carreon","year":"2010","journal-title":"Spine"},{"issue":"6","key":"bib40-20250822","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.spinee.2007.11.006","article-title":"Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry disability index, Medical Outcomes Study questionnaire Short Form 36, and pain scales","volume":"8","author":"Copay","year":"2008","journal-title":"Spine J"},{"issue":"3","key":"bib41-20250822","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/BRS.0000000000001202","article-title":"The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases","volume":"41","author":"Bess","year":"2016","journal-title":"Spine"},{"issue":"6","key":"bib42-20250822","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jspd.2015.04.005","article-title":"A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent","volume":"3","author":"Sciubba","year":"2015","journal-title":"Spine Deform"},{"issue":"3","key":"bib43-20250822","doi-asserted-by":"crossref","first-page":"340","DOI":"10.3171\/2014.12.SPINE141031","article-title":"The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients","volume":"23","author":"Fakurnejad","year":"2015","journal-title":"J Neurosurg Spine"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/21\/3\/94\/39655456\/opab153.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:53:21Z","timestamp":1786121601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,10]]},"references-count":42,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab153","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,10]]},"assertion":[{"value":"2020-10-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}