Operative

A. Multicenter, prospective, nonrandomized analysis of operatively treated complex ASD patients meeting the following Inclusion Criteria~1. 18 years of age or greater at the time of treatment~2. Diagnosis of adult congenital, degenerative, idiopathic or iatrogenic spinal deformity~3. Full body EOS radiographic assessment (sagittal and coronal visualization from skull to foot)~4. Complex patients are defined as and meeting any one of the subsequent criteria:~ a. Radiographic criteria: i. PI-LL ≥ 25 degrees ii. TPA ≥ 30 degrees iii. SVA\>15cm iv. Thoracic scoliosis ≥ 70 degrees v. Thoracolumbar/lumbar scoliosis ≥ 50 degrees vi. Global coronal malalignment \>7cm b. Procedural criteria: i. Posterior spinal fusion \> 12 levels ii. 3 column osteotomy or ACR c. Geriatric criteria: i. Age \>65 years and minimum 7 levels of spinal instrumentation during surgery