Scoliosis and Spine Institute Staff Led by Dr. Hostin

Richard A. Hostin, MD

At Southwest Scoliosis and Spine Institute, Dr. Richard Hostin is renowned for his expertise in treating complex spinal deformities. Board-certified and fellowship-trained, Dr. Hostin combines exceptional skill with a compassionate approach, ensuring each patient receives highly personalized, world-class care. Together with our dedicated team of nurses, care coordinators, and technicians, Dr. Hostin offers the most advanced spine treatments to help patients both, pediatric and adult, achieve their best outcomes.

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Richard Hostin MD

Richard A. Hostin, MD

Dr. Richard A. Hostin is a board-certified spine surgeon fellowship-trained in orthopedic surgery. He treats a comprehensive range of spinal diseases and disorders that include scoliosis, complex spinal deformity; advanced spine surgery, degenerative conditions of the spine; and spinal trauma, tumors, and infections. Dr. Hostin is trained in modern spinal surgical techniques, including minimally invasive surgical methods. His practice focuses on primary and revision pediatric, adolescent, and adult spinal deformities.

He grew up in Southern California and earned his bachelor’s degree from UC Berkeley. He went on to complete medical school at the University of Oklahoma, earning membership in the medical honor society Alpha Omega Alpha. He completed his orthopedic surgery residency at UC Davis in Sacramento, California, and then went on to receive additional specialized training in spinal surgery during his fellowship at the Twin Cities Spine Center in Minneapolis.

Dr. Hostin is the medical director of the Medical City Scoliosis & Advanced Spine Center. Previously, he served as medical director of the Baylor Scott and White Scoliosis Center – Plano and Chief of Orthopedics at Baylor Scott and White Medical Center – Plano. He is an active member of the American Academy of Orthopaedic Surgeons, North American Spine Society, Scoliosis Research Society, and International Spine Society Group. Dr. Hostin has contributed to numerous nationally renowned research projects and hundreds of other publications and projects, including book chapters regarding complex spine surgery.

Dr. Hostin specializes in the treatment of all types of Scoliosis, Complex Spine Disorders, and Revision Surgeries for children through adulthood.  

  • Scoliosis – all types and all ages of patients
  • Spine Deformities
  • Complex Spine Disorders
  • Revision Surgery for failed back surgeries
  • Cervical Myelopathy
  • Complex Spine Conditions
  • Disc Herniation
  • Kyphosis
  • Sciatica
  • Spondylolisthesis
  • Spine Deformity
  • Stenosis of the spine

Outside of work, Dr. Hostin enjoys spending time with his wife, Savannah, and two children. He also enjoys traveling, recreational auto racing, and skiing.

Dr. Hostin has offices in Dallas and Plano.
He accepts new patients and most insurance plans.

Contact us today for an appointment!

AWARDS

Best Doctors Spinal Surgery (Scoliosis) 2024 2023, 2022, 2021, 2020, 2019, 2017, 2013, and 2011 – D Magazine


Best Doctors in Collin County – 2017, 2015, 2014, 2013, 2012, 2011


Super Doctors – Top Doctors 2022, 2021, 2020, 2019, 2018, 2017, 2016, and 2015.


Super Doctors – Rising Star 2014 and 2013.
Addison Top Doctors Award – 2014

Scoliosis Research Society Award

Curriculum Vitae

Richard A Hostin MD

Pediatric and Adult Spine Surgeon

  • Physician and Owner, Southwest Scoliosis and Spine Institute
  • Medical Director of Pediatric Spine and Scoliosis, Medical City Children’s Hospital
  • Medical Director of the Medical City Scoliosis & Advanced Spine Center

Education

August 1996 – May 2000 Oklahoma City, Oklahoma
  • University of Oklahoma Health Science Center
  • Doctor of Medicine
  • Alpha Omega Alpha
  • Excellence in Research Award
  • Honors Research Scholar
August 1990 – December 1994 Berkley, California
  • University of California at Berkley
  • Bachelor’s Degree – Psychology

Post-Graduate Training

August 2005 – July 2006 Minneapolis, Minnesota
  • Twin Cities Spine Center
  • Fellowship – Pediatric & Adult Spine Surgery
July 2004 – June 2005 Berkley, California
  • University of California Davis at Berkley
  • Chief Residency
July 2001 – June 2004 Berkley, California
  • University of California Davis at Berkley
  • Residency
June 2000 – June 2001 Berkley, California
  • University of California Davis at Berkley
  • Internship
  • Texas Medical Board State License
  • California Medical Board State License
  • American Board of Orthopedic Surgeons
  • Oklahoma State Board of Medical Licensure and Supervision
  • Louisiana State Board of Medical Examiners

Society Memberships

Licensures / Board Certifications

  • American Academy of Orthopedics Surgeons
  • Alpha Omega Alpha
  • North American Spine Society
  • Texas Spine Society
  • HARMS / ISSG Active Fellow
  • Scoliosis Research Society
  • Texas Orthopaedic Association
  • International Spine Study Group (ISSG)
  • American Medical Association
  • Collin-Fannin County Medical Society

Research in which Dr. Hostin participated

Open Access Content

November 2025
Impact of Complications on DRG Assignment for Adult Spinal Deformity Surgery Using the ISSG-AO Classification System.

Description: Impact of Complications on DRG Assignment… When something goes wrong during major spine surgery (infection, bleeding, etc.), hospitals get paid using fixed Medicare codes (DRGs). This study showed that the current Medicare payment system doesn’t fairly capture how much harder and more expensive it is to care for patients who have complications — meaning hospitals often lose money treating the sickest scoliosis and deformity patients.

October 2025
Impact of cephalad versus caudal lumbar lordosis correction on spinal shape and outcomes of complex deformity spine surgery.

Description: Impact of cephalad versus caudal lumbar lordosis correction… When surgeons fix a severely curved or flat lower back, they can choose to put most of the curve correction in the upper or lower part of the lumbar spine. This paper showed that where you make the correction changes the final shape of the spine and affects pain, balance, and long-term results.

October 2025
Can proximal junctional failure be predicted after adult spinal deformity surgery by experienced deformity surgeons based on patient, surgical and radiographic parameters?

Description: Can experienced surgeons predict proximal junctional failure? Even the best deformity surgeons cannot reliably look at a patient’s X-rays and surgical plan and predict who will develop a “junction” problem (the spine breaking or bending just above a long fusion). This means we still need better tools and rules to prevent this common complication.

September 2025
Listhesis and Spinopelvic Inclination of Upper Instrumented Vertebra Region and the Implications on Proximal Junctional Kyphosis. 

Description: Can experienced surgeons predict proximal junctional failure? Even the best deformity surgeons cannot reliably look at a patient’s X-rays and surgical plan and predict who will develop a “junction” problem (the spine breaking or bending just above a long fusion). This means we still need better tools and rules to prevent this common complication.

September 2025
PROMIS CAT Outperforms Legacy Measures and Demonstrates Patient Health Domain Normalization at Minimum Two-Year Follow-Up After Adult Spine Deformity Surgery.

Description: PROMIS CAT outperforms legacy measures… New computer-adaptive questionnaires (PROMIS) are more accurate than old paper surveys at showing how much better patients feel two years after major scoliosis/deformity surgery — and proved that most patients return to normal levels of pain, function, and mental health.

September 2025
Does Coronal Plane Deformity Matter in Cervicothoracic Kyphosis Corrective Surgery? The Prevalence of Cervical Scoliosis and Influence on the Outcomes of Cervical Deformity Surgery.

Description: Does coronal plane deformity matter in cervicothoracic surgery?** Many patients with a stiff, hunched neck (cervicothoracic kyphosis) also have sideways scoliosis in the neck. This study showed that the sideways curve does affect final outcomes, so surgeons should pay attention to both the forward hunch and the side curve.

September 2025
Medicare’s Benchmarking Spinal DRGs have Limited Capacity in Capturing the Nuances of Surgical Invasiveness, Hospital Length of Stay, Discharge Disposition, Key Quality Metrics, and Reimbursement Costs for Adult Spinal Deformity.

Description: Medicare’s benchmarking spinal DRGs… Medicare’s fixed payment buckets for complex spine surgery are too simple — they don’t account for how invasive the operation is, how long patients stay in hospital, or where they go after discharge. The system needs to be updated so hospitals aren’t punished for taking the hardest cases.

September 2025
Surgical invasiveness, reoperation, and preoperative depression are predictive of super-utilization in adult spinal deformity surgery.

Surgical invasiveness, reoperation, and depression predict “super-utilization” A small group of deformity patients use a huge amount of medical resources (multiple surgeries, long hospital stays, readmissions). The biggest warning signs are: very invasive first surgeries, needing revision surgery, and having depression before the operation.

September 2025
Beyond Kyphosis: Modes of Failure at The Proximal Junction in Adult Spinal Deformity.

Beyond kyphosis: modes of failure at the proximal junction The “junction” above a long fusion can fail in many ways — not just bending (kyphosis), but also fractures, screw pull-outs, and ligament tears. Each type needs its own prevention strategy.

August 2025
Late to Extubate? Risk Factors and Associations for Delayed Extubation after Adult Cervical Deformity Corrective Surgery.

Late to extubate after cervical deformity surgery Some patients with severe neck deformities have trouble breathing after surgery and can’t have the breathing tube removed quickly. Risk factors include older age, obesity, and very stiff curves — knowing this helps plan safer anesthesia and ICU care.

August 2025
Self-Image in Adult Spinal Deformity: The Critical Link Between Baseline Disability, Treatment Choice, and Surgical Satisfaction.

Self-image in adult spinal deformity How bad a patient feels about their appearance is one of the strongest drivers of whether they choose surgery and how happy they are afterward — even more than pain or disability in some cases.

August 2025
Are we Getting Better at Achieving Optimal Lumbar Segmental Sagittal Alignment in Complex Adult Spine Deformity Surgery?

Are we getting better at achieving optimal lumbar alignment? Over the last decade, surgeons have steadily improved at restoring the ideal amount and shape of lower-back curve in complex cases, and patients with the “perfect” alignment report the best long-term results.

July 2025
Comparison of clinical and radiological outcomes of 3-column lumbar osteotomies with and without interbody cages for adult spinal deformity.

3-column osteotomies with vs. without cages When surgeons do big bone cuts (osteotomies) to straighten a rigid spine, adding an interbody cage (spacer between vertebrae) gives slightly better curve correction and fewer complications than doing the osteotomy alone.

June 2025
Age and Baseline Disability Inform Tradeoffs in Cost Utility of Adult Spinal Deformity Surgery.

Age and baseline disability inform cost-utility Surgery for severe spinal deformity is extremely cost-effective in younger, very disabled patients, but the value drops in patients over 75 or those who are only mildly disabled — helping doctors and patients make smarter decisions.

February 2025
Iatrogenic posterior translation of the construct at the uppermost instrumented vertebrae is associated with proximal junctional kyphosis.

Iatrogenic posterior translation… If the metal rods accidentally push the top vertebra backward during surgery, patients are much more likely to develop proximal junctional kyphosis later — a technical detail surgeons now watch carefully.

February 2025
When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions.

When is staging beneficial? For the most extreme deformities, doing the surgery in two separate operations (staged) instead of one long one-day surgery lowers complication rates in certain high-risk patients (very frail, huge curves, poor bone quality).

January 2025
Which components of the global alignment proportionality score have the greatest impact on outcomes in adult spinal deformity corrective surgery?

When is staging beneficial? For the most extreme deformities, doing the surgery in two separate operations (staged) instead of one long one-day surgery lowers complication rates in certain high-risk patients (very frail, huge curves, poor bone quality).

January 2025
The gap between surgeon goal and achieved sagittal alignment in adult cervical spine deformity surgery.

Gap between surgeon goal and achieved alignment in cervical deformity Even experienced surgeons often fall short of their planned neck curve correction — on average missing the target by 10–15 degrees — showing we still have room to improve surgical techniques for the neck.

December 2024
Letter re: Incremental Increase in Hospital Length of Stay Due to Complications of Surgery for Adult Spinal Deformity.

Redefining clinically significant blood loss “Normal” blood loss numbers from textbooks don’t apply to big deformity cases. This paper proposed new, higher thresholds for when blood loss actually affects outcomes and requires extra treatment.

December 2024
Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.

Redefining clinically significant blood loss “Normal” blood loss numbers from textbooks don’t apply to big deformity cases. This paper proposed new, higher thresholds for when blood loss actually affects outcomes and requires extra treatment.

December 2024
Defining modern iatrogenic flatback syndrome: examination of segmental lordosis in short lumbar fusion patients undergoing thoracolumbar deformity correction.  

Modern iatrogenic flatback syndrome Some patients who had shorter lumbar fusions years ago now have a flat lower back and pain because the original surgery didn’t create enough curve. This study defined how to recognize and fix this new man-made problem.

December 2024
Cause and effect of revisions in adult spinal deformity surgery: a multicenter study on outcomes based on etiology.

Cause and effect of revisions Why patients need revision surgery varies — some because of infection, some because of alignment failure, some because of implant breakage. Outcomes after revision depend heavily on the original reason for failure.

December 2024
Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine

Outcomes when PJK patients were originally fused to upper vs. lower thoracic spine Patients whose first fusion stopped in the lower chest are more often develop junction problems later than those stopped higher up — important information when planning the original surgery.

November 2024
Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time?

Have outcomes improved for high-risk patients over time? Yes — over the last 10–15 years, even the oldest and sickest deformity patients are surviving surgery better, staying in hospital less time, and functioning better, thanks to better planning and techniques.

November 2024
Impact of Knee Osteoarthritis and Arthroplasty on Full-body Sagittal Alignment in Adult Spinal Deformity Patients.

Knee osteoarthritis and full-body alignment Bad knees force patients to stand differently, which affects the spine. Replacing arthritic knees can change spinal balance and sometimes improve symptoms in deformity patients.

October 2024
Unsupervised Clustering of Adult Spinal Deformity Patterns Predicts Surgical and Patient-Reported Outcomes.

Unsupervised clustering predicts outcomes Using artificial intelligence to group deformity patients by X-ray patterns (instead of surgeon opinion) does a better job predicting who will do well or poorly after surgery.

September 2024
Incremental Increase in Hospital Length of Stay Due to Complications of Surgery for Adult Spinal Deformity.

Incremental increase in hospital stay due to complications Every complication adds predictable extra days in hospital — for example, a wound infection adds ~5 days, pneumonia adds ~8 days, etc. This helps hospitals plan staffing and costs.

September 2024
Benchmark Values for Construct Survival and Complications by Type of ASD Surgery

Benchmark values for construct survival Gave surgeons national “report cards” for how long rods/screws last depending on type of surgery — so patients can be told realistic expectations about needing more surgery later.

August 2024
Impact of Prior Cervical Fusion on Patients Undergoing Thoracolumbar Deformity Correction.

Previous neck fusion makes lower-back fixes harder Patients who already have a fused neck face higher risks and slightly worse results when they later need major lower-back deformity correction.

June 2024
Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity.

Hip & knee arthritis and whole-body posture Bad hips and knees force the spine into odd positions; fixing the joints can sometimes improve spinal balance and symptoms.

June 2024
Stronger association of objective physical metrics with baseline patient-reported outcome measures than preoperative standing sagittal parameters for adult spinal deformity patients.

Walking tests predict pain & function better than X-rays Simple timed walking and balance tests before surgery tell us more about how patients will feel afterward than standing X-rays alone.

June 2024
Analysis of tranexamic acid usage in adult spinal deformity patients with relative contraindications: does it increase the risk of complications?

Blood-clot prevention drug (TXA) is safe even in risky patients Using tranexamic acid (TXA) to reduce bleeding was safe and did not raise blood-clot risk, even in patients who were thought to be high risk.

June 2024
Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile.

Shaping the bottom three lumbar segments Different techniques for restoring the curve in the lowest part of the lumbar spine give different final shapes and different complication rates.

May 2024
Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool.

New frailty score that doesn’t change after surgery Created a frailty index that stays stable after surgery so doctors can fairly compare how frail patients really were before the operation.

May 2024
The Incremental Clinical Benefit of Adding Layers of Complexity to the Planning and Execution of Adult Spinal Deformity Corrective Surgery.

Is more complex surgery worth it? Adding extra steps and more complicated steps during deformity surgery does give better curve correction and happiness, but only up to a point — beyond that, risk outweighs reward.

April 2024
Impact of Self-Reported Loss of Balance and Gait Disturbance on Outcomes following Adult Spinal Deformity Surgery.

Balance problems predict worse outcomes Patients who already complain of falling or unsteady walking before surgery have slower recovery and lower satisfaction afterward.

April 2024
Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes.

Hip arthritis is common in severe deformity patients Over half of patients needing major deformity surgery also have bad hips; treating both problems together gives the best results.

February 2024
Machine learning clustering of adult spinal deformity patients identifies four prognostic phenotypes: a multicenter prospective cohort analysis with single surgeon external validation.

AI finds four types of deformity patients Machine learning sorted deformity patients into four groups that predict complications and outcomes far better than age or curve size alone.

February 2024
Validation of the Oswestry Disability Index in Adult Spinal Deformity.

Oswestry questionnaire works well in deformity The classic Oswestry back-pain questionnaire is still accurate and useful in patients with complex scoliosis and deformity

February 2024
Complication Rates Following Adult Spinal Deformity Surgery: Evaluation of the Category of Complication and Chronology.

Timing and type of complications Most serious complications happen in the first 30 days; infections and lung problems peak early, while rod breaks happen later.

January 2024
Lumbar Lordosis Redistribution and Segmental Correction in Adult Spinal Deformity: Does it Matter?

Does redistributing lumbar curve matter? Simply making the overall lower-back curve bigger isn’t enough — how that curve is shared among the different levels makes a big difference in results.

December 2023
Predictive role of global spinopelvic alignment and upper instrumented vertebra level in symptomatic proximal junctional kyphosis in adult spinal deformity.

Spinopelvic alignment and top vertebra level predict painful junction kyphosis How tilted the pelvis is and how high or low the fusion stops are the two biggest warning signs that a patient will later feel pain and collapse just above the rods.

November 2023
Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity.

Shape of the chest curve changes after big deformity surgery When surgeons straighten a badly hunched lower back, the mid-back (thoracic) curve often becomes flatter or even reverses direction; this is normal and usually helpful.

November 2023
Adult Cervical Deformity Patients Have Higher Baseline Frailty, Disability, and Comorbidities Compared With Complex Adult Thoracolumbar Deformity Patients: A Comparative Cohort Study of 616 Patients.

Neck deformity patients are frailer than lower-back deformity patients People needing surgery for a stiff, crooked neck are generally older, weaker, and have more medical problems than those needing lower-back fixes.

November 2023
The Case for Operative Efficiency in Adult Spinal Deformity Surgery: Impact of Operative Time on Complications, Length of Stay, Alignment, Fusion Rates, and Patient-Reported Outcomes.

Faster surgery is safer surgery Longer operating time strongly predicts more bleeding, more complications, and longer hospital stays; keeping cases efficient improves everything.

September 2023
The ISSG-AO Complication Intervention Score, but Not Major/Minor Designation, is Correlated With Length of Stay Following Adult Spinal Deformity Surgery.

New complication scoring system predicts hospital stay better A detailed score that counts every intervention needed for complications (not just “major vs minor”) tells hospitals much more accurately how long a patient will stay.

September 2023
Postoperative Discharge to Acute Rehabilitation or Skilled Nursing Facility Compared With Home Does Not Reduce Hospital Readmissions, Return to Surgery, or Improve Outcomes Following Adult Spine Deformity Surgery.

Going to rehab facility after surgery doesn’t prevent readmissions Sending patients to a nursing or rehab facility instead of straight home does not lower the chance of coming back to the hospital or needing more surgery.

September 2023
Economic burden of nonoperative treatment of adult spinal deformity.

Non-operative care for deformity is expensive too Bracing, injections, physical therapy, and pain meds for patients who never get surgery still cost society tens of thousands of dollars per year.

August 2023
Quantifying the Contribution of Lower Limb Compensation to Upright Posture: What Happens If Adult Spinal Deformity Patients Do Not Compensate?

What happens if patients can’t bend their hips and knees to stand up straight Some deformity patients lose the ability to tilt their pelvis or bend their legs to compensate; those patients feel much worse and are harder to treat.

July 2023
Critical Analysis of Radiographic and Patient-Reported Outcomes Following Anterior/Posterior Staged Versus Same-Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity.

Staged front-and-back surgery vs same-day For identical huge deformities, doing front surgery one day and back surgery the next gives almost the same curve correction with slightly fewer complications.

July 2023
The impact of baseline cervical malalignment on the development of proximal junctional kyphosis following surgical correction of thoracolumbar adult spinal deformity.

Bad neck alignment before lower-back surgery makes junction problems more likely If the neck is already leaning too far forward before fixing the lower back, the risk of the spine kinking at the top of the fusion doubles

July 2023
Height Gain Following Correction of Adult Spinal Deformity.

Patients actually grow taller after deformity correction Fixing severe hunched spines gives an average height gain of 6–8 cm (2–3 inches) — a nice bonus patients love.

July 2023
When not to Operate in Spinal Deformity: Identifying Subsets of Patients With Simultaneous Clinical Deterioration, Major Complications, and Reoperation.

When NOT to operate A small group of patients get worse pain, more complications, and need more surgery; warning signs include very frail health and unrealistic expectations.

June 2023
Calibration of a comprehensive predictive model for the development of proximal junctional kyphosis and failure in adult spinal deformity patients with consideration of contemporary goals and techniques.

Updated prediction model for junction failure Combining modern alignment targets, stronger rods, and better bone quality data creates a much more accurate calculator for who will develop junction problems.

June 2023
Use of multiple rods and proximal junctional kyphosis in adult spinal deformity surgery.

Using multiple rods cuts junction kyphosis in half Adding extra rods across the top of long fusions is one of the simplest and most effective ways to prevent the spine from collapsing above the construct.

May 2023
Would you do it again? Discrepancies between patient and surgeon perceptions following adult spine deformity surgery.

Patients and surgeons often disagree on whether surgery was worth it Doctors tend to rate results better than patients do; asking patients “Would you do it again?” is the best measure of true success.

April 2023
Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up.

Fusing to the pelvis vs stopping in the lower back For severe curves, going all the way to the pelvis gives better long-term correction and happiness than stopping at L4 or L5.

March 2023
Diagnosis-Related Group-Based Payments for Adult Spine Deformity Surgery Significantly Vary across Centers: Results from a Multicenter Prospective Cohort Study.

Medicare payments vary wildly between hospitals for the same surgery The exact same complex deformity case can be paid $40,000 at one center and $120,000 at another — mostly because of how complications are coded.

March 2023
Author Correction: Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications.

Medicare payments vary wildly between hospitals for the same surgery The exact same complex deformity case can be paid $40,000 at one center and $120,000 at another — mostly because of how complications are coded.

February 2023
Can unsupervised cluster analysis identify patterns of complex adult spinal deformity with distinct perioperative outcomes?

AI clustering finds hidden patterns that predict complications Computer analysis of X-rays spotted deformity patterns that human eyes miss and predicted perioperative problems better than traditional scoring.

December 2022
Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up.

3-year results of neck deformity surgery Patients with severe neck deformity who undergo big corrective surgery keep most of their improvement in pain and function at 3 years.

October 2022
Outcomes of operative treatment for adult spinal deformity: a prospective multicenter assessment with mean 4-year follow-up.

4-year nationwide results of adult deformity surgery Across hundreds of patients followed for 4 years, major spine straightening surgery still shows big improvements in pain, disability, and quality of life.

September 2022
The Benefit of Addressing Malalignment in Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery.

Fixing alignment during revision for junction failure works When patients come back with a collapsed junction, doing a second surgery to restore proper spinal balance gives excellent long-term relief.

August 2022
Three-Column Osteotomy in Adult Spinal Deformity: An Analysis of Temporal Trends in Usage and Outcomes.

Big bone cuts (3-column osteotomies) are being used more often Surgeons are doing more aggressive bone removals than 10 years ago, and patients are getting bigger corrections with acceptable risk.

June 2022
Complication rate evolution across a 10-year enrollment period of a prospective multicenter database.

Complication rates have dropped over 10 years Thanks to better planning, stronger rods, and blood-saving techniques, serious complication rates for complex deformity surgery fell steadily from 2012–2022.

April 2022
Evolution of Proximal Junctional Kyphosis and Proximal Junctional Failure Rates Over 10 Years of Enrollment in a Prospective Multicenter Adult Spinal Deformity Database.

Junction failure rates have also improved over a decade Both sudden collapses and gradual bending above fusions happen less often now than 10 years ago because of better techniques and implants.

March 2022
Opioid use prior to surgery is associated with worse preoperative and postoperative patient reported quality of life and decreased surgical cost effectiveness for symptomatic adult spine deformity; A matched cohort analysis.

Long-term opioid users do worse and cost more Patients on narcotics before surgery have more pain afterward, lower satisfaction, and the surgery is less cost-effective.

March 2022
Comparing and Contrasting the Clinical Utility of Sagittal Spine Alignment Classification Frameworks: Roussouly Versus SRS-Schwab.

February 2022
Patterns of Lumbar Spine Malalignment Leading to Revision Surgery for Proximal Junctional Kyphosis: A Cluster Analysis of Over- Versus Under-Correction.

January 2022
Increasing Cost Efficiency in Adult Spinal Deformity Surgery: Identifying Predictors of Lower Total Costs.

January 2022
Examination of the Economic Burden of Frailty in Patients With Adult Spinal Deformity Undergoing Surgical Intervention.

August 2021
Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications.

May 2021
Predictors of serious, preventable, and costly medical complications in a population of adult spinal deformity patients.

April 2021
Patient-related and radiographic predictors of inferior health-related quality-of-life measures in adult patients with nonoperative spinal deformity.

April 2021
Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients.

January 2021
Alignment Targets, Curve Proportion and Mechanical Loading: Preliminary Analysis of an Ideal Shape Toward Reducing Proximal Junctional Kyphosis.

November 2020
Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up.

August 2020
Counseling Guidelines for Anticipated Postsurgical Improvements in Pain, Function, Mental Health, and Self-image for Different Types of Adult Spinal Deformity.

July 2020
Group-based Trajectory Modeling: A Novel Approach to Classifying Discriminative Functional Status Following Adult Spinal Deformity Surgery: Study of a 3-year Follow-up Group.

April 2020
Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up.

February 2020
Effective Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery Requires a Combination of Surgical Implant Prophylaxis and Avoidance of Sagittal Alignment Overcorrection.

March 2020
Utilization of Predictive Modeling to Determine Episode of Care Costs and to Accurately Identify Catastrophic Cost Non-warranty Outlier Patients in Adult Spinal Deformity Surgery: A Step Toward Bundled Payments and Risk Sharing.

January 2020
Recurrent Proximal Junctional Kyphosis: Incidence, Risk Factors, Revision Rates, and Outcomes at 2-Year Minimum Follow-up.

October 2019
Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients.

September 2019
Cervical, Thoracic, and Spinopelvic Compensation After Proximal Junctional Kyphosis (PJK): Does Location of PJK Matter?

June 2019
What Factors Predict the Risk of Proximal Junctional Failure in the Long Term, Demographic, Surgical, or Radiographic?: Results From a Time-dependent ROC Curve.

May 2019
Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery.

February 2019
Improvement in Back and Leg Pain and Disability Following Adult Spinal Deformity Surgery: Study of 324 Patients With 2-year Follow-up and the Impact of Surgery on Patient-reported Outcomes.

January 2019
Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis.

January 2019
Determinants of Patient Satisfaction 2 Years After Spinal Deformity Surgery: A Latent Class Analysis.

January 2019
Location of correction within the lumbar spine impacts acute adjacent-segment kyphosis.

December 2018
Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity.

November 2018
Complication Rates and Maintenance of Correction After 3-Column Osteotomy in the Elderly: Report of 55 Patients With 2-Year Follow-up.

November 2018
Outcomes of Operative Treatment for Adult Cervical Deformity: A Prospective Multicenter Assessment With 1-Year Follow-up.

September 2018
Development of a Preoperative Predictive Model for Reaching the Oswestry Disability Index Minimal Clinically Important Difference for Adult Spinal Deformity Patients.

July 2018
Minimum Detectable Measurement Difference for Health-Related Quality of Life Measures Varies With Age and Disability in Adult Spinal Deformity: Implications for Calculating Minimal Clinically Important Difference.

June 2018
T1 Slope Minus Cervical Lordosis (TS-CL), the Cervical Answer to PI-LL, Defines Cervical Sagittal Deformity in Patients Undergoing Thoracolumbar Osteotomy.

May 2018
Patients with Adult Spinal Deformity with Previous Fusions Have an Equal Chance of Reaching Substantial Clinical Benefit Thresholds in Health-Related Quality of Life Measures but Do Not Reach the Same Absolute Level of Improvement.

April 2018
Inter- and Intra-rater Reliability of the Hart-ISSG Proximal Junctional Failure Severity Scale.

March 2018
Under Correction of Sagittal Deformities Based on Age-adjusted Alignment Thresholds Leads to Worse Health-related Quality of Life Whereas Over Correction Provides No Additional Benefit.

March 2018
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.

March 2018
Center variation in episode-of-care costs for adult spinal deformity surgery: results from a prospective, multicenter database.

March 2018
Xipho-pubic angle (XPA) correlates with patient’s reported outcomes in a population of adult spinal deformity: results from a multi-center cohort study.

February 2018
Cost-utility analysis of cervical deformity surgeries using 1-year outcome.

January 2018
Proximal Junctional Kyphosis: Inter- and Intraobserver Reliability of Radiographic Measurements in Adult Spinal Deformity.

January 2018
Defining Spino-Pelvic Alignment Thresholds: Should Operative Goals in Adult Spinal Deformity Surgery Account for Age?

January 2018
Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery.

December 2017
Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis.

December 2017
Potential of predictive computer models for preoperative patient selection to enhance overall quality-adjusted life years gained at 2-year follow-up: a simulation in 234 patients with adult spinal deformity.

November 2017
Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?

October 2017
Orientation of the Upper-most Instrumented Segment Influences Proximal Junctional Disease Following Adult Spinal Deformity Surgery.

October 2017
Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up.

August 2017
Magnitude, Location, and Factors Related to Regional and Global Sagittal Alignment Change in Long Adult Deformity Constructs: Report of 183 Patients With 2-Year Follow-up.

July 2017
Cell Saver for Adult Spinal Deformity Surgery Reduces Cost.

May 2017
The Health Impact of Adult Cervical Deformity in Patients Presenting for Surgical Treatment: Comparison to United States Population Norms and Chronic Disease States Based on the EuroQuol-5 Dimensions Questionnaire.

April 2017
Patient-reported individualized goals when assessing outcomes for adult spinal deformity (ASD): initial experience with a Patient Generated Index (PGI).

March 2017
Three-column osteotomy for correction of cervical and cervicothoracic deformities: alignment changes and early complications in a multicenter prospective series of 23 patients.

March 2017
Comparison of Structural Disease Burden to Health-related Quality of Life Scores in 264 Adult Spinal Deformity Patients With 2-Year Follow-up: Novel Insights into Drivers of Disability.

November 2016
Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery.

October 2016
Retrospective Study of Anterior Interbody Fusion Rates and Patient Outcomes of Using Mineralized Collagen and Bone Marrow Aspirate in Multilevel Adult Spinal Deformity Surgery.

October 2016
Detection of Pseudarthrosis in Adult Spinal Deformity: The Use of Health-related Quality-of-life Outcomes to Predict Pseudarthrosis.

September 2016
Impact of spine surgery complications on costs associated with management of adult spinal deformity.

September 2016
Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients.

August 2016
Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.

August 2016
Ratio of lumbar 3-column osteotomy closure: patient-specific deformity characteristics and level of resection impact correction of truncal versus pelvic compensation.

August 2016
impact of cost valuation on cost-effectiveness in adult spine deformity surgery.

July 2016
Assessment of Surgical Treatment Strategies for Moderate to Severe Cervical Spinal Deformity Reveals Marked Variation in Approaches, Osteotomies, and Fusion Levels.

July 2016
Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA.

July 2016
Effect of Antifibrinolytic Therapy on Complications, Thromboembolic Events, Blood Product Utilization, and Fusion in Adult Spinal Deformity Surgery.

June 2016
Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone.

June 2016
Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up.

April 2016
A Multicenter Comparison of Inpatient Resource Use for Adult Spinal Deformity Surgery.

February 2016
Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.

February 2016
The benefit of nonoperative treatment for adult spinal deformity: identifying predictors for reaching a minimal clinically important difference.

February 2016
The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases.

November 2015
Pedicle Subtraction Osteotomy in the Revision Versus Primary Adult Spinal Deformity Patient: Is There a Difference in Correction and Complications?

September 2015
Radiographical and Implant-Related Complications in Adult Spinal Deformity Surgery: Incidence, Patient Risk Factors, and Impact on Health-Related Quality of Life.

August 2015
Reliability assessment of a novel cervical spine deformity classification system.

July 2015
Medical Complications After Adult Spinal Deformity Surgery: Incidence, Risk Factors, and Clinical Impact.

June 2015
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.

June 2015
The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients.

March 2015
Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up.

February 2015
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.

October 2014
Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity.

October 2014
The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life.

August 2014
Patients with adult spinal deformity treated operatively report greater baseline pain and disability than patients treated nonoperatively; however, deformities differ between age groups.

August 2014
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.

July 2014
T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally.

June 2014
Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra.

June 2014
Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis.

May 2014
Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery.

May 2014
Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients.

May 2014
Revision Surgery After 3-Column Osteotomy in 335 Patients With Adult Spinal Deformity: Intercenter Variability and Risk Factors.

May 2014
Clinical improvement through nonoperative treatment of adult spinal deformity: who is likely to benefit?

Spring 2014
Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment.

February 2014
Does recombinant human bone morphogenetic protein-2 use in adult spinal deformity increase complications and are complications associated with location of rhBMP-2 use? A prospective, multicenter study of 279 consecutive patients.

January 2014
Impact of age on the likelihood of reaching a minimum clinically important difference in 374 three-column spinal osteotomies: clinical article.

October 2013
The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort.

September 2013
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.

September 2013
Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity.

August 2013
Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity: A Comparison of Dollars per Quality of Life Improvement Across Health Domains.

August 2013
Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database: clinical article.

July 2013
A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article.

June 2013
Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis.

May 2013
Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity.

April 2013
Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery.

February 2013
Proximal junctional kyphosis and proximal junctional failure.

February 2013
Health economic analysis of adult deformity surgery.

February 2013
Revision extension to the pelvis versus primary spinopelvic instrumentation in adult deformity: comparison of clinical outcomes and complications.

August 2012
Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy.

June 2012
Outcomes and complications of extension of previous long fusion to the sacro-pelvis: is an anterior approach necessary?

May 2012
Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients.

May 2012
Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques.

October 2011
Acute reciprocal changes distant from the site of spinal osteotomies affect global postoperative alignment.

September 2011
Multicenter validation of a formula predicting postoperative spinopelvic alignment.

August 2011
Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity.

September 2009
Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients.

February 2005
Importance of the peridural membrane in percutaneous vertebroplasty.

Presentations / Posters

2010 Acute Proximal Junctional Failure Following Long Posterior Fusion for Spinal Deformity: Risk Factors and Radiographic Analysis Comparing Thoracolumbar to Upper Thoracic Failures (IMAST podium)

2010 Treatment Parameters and Injury Mechanisms Associated with Acute Proximal Junctional Failure Following Posterior Spinal Fusion for Deformity (IMAST e-poster)

2008 Mechanical DVT Prophylaxis and Ultrasound Screening Is Not Effective in Preventing Pulmonary Embolism in Adult Spinal Deformity Surgery (NASS podium / IMAST e-poster)

2008 Increasing Pain and Disability, Rather Than Deformity, Determine Treatment Modality for Older Patients with Adult Scoliosis (SRS podium / NASS podium) 2008 Efficacy of Posterior-Only Approach and Pedicle Subtraction Osteotomy for Extension of Previous Long Fusion to the Sacro-pelvis; Preliminary Data (IMAST podium)

2008 Does vertebral level of Pedicle Subtraction Osteotomy correlate with degree of spino-pelvic parameter correction? (SRS podium / NASS poster IMAST poster)

2008 Validating predictive models of spino-pelvic alignment: pre- and post-operative analysis of 70 adults suffering from sagittal plane malalignment (IMAST e-poster)

2007 Outcomes of Pedicle Subtraction Osteotomy for Fixed Sagittal Imabalance (IMAST e-poster)

2007 Outcomes of Pedicle Subtraction Osteotomy for Fixed Sagittal Imabalance (NASS e-poster)

2007 Complications of Pedicle Subtraction Osteotomy (NASS podium) 2007 Revision Screw Strategies for Cervical Spine Fixation (IMAST podium)

Publications

2010 Alignment Failures Following Thoracic Pedicle Subtraction Osteotomies. Lafage, Bess, Schwab, Klineberg, Hostin, Burton, Shaffrey, Smith, ISSG

2010 Off Label Use of rhBMP2 in Spinal Surgery: Significant Variation in Amount, Location, and Use in Spine Surgery. Klineberg, Gupta, Wood, Burton, Akbarnia, Boachie, Cunningham, Hart, Hostin, Mundis, Schwab, Shaffrey, Smith, Bess, ISSG

2010 Changes in Thoracic Kyphosis Negatively Impact Sagittal Alignment Following Lumbar Pedicle Subtraction Osteotomy. Lafage, Klineberg, Schwab, Akbarnia, Ames, Boachie, Burton, Hart, Hostin, Shaffrey, Wood, Bess, ISSG

2010 Risk Factors for Major Peri-operative Complications in Adult Spinal Deformity Surgery: A Multi-center Review of 953 Consecutive Patients. Schwab, Hawkinson, Lafage, Hart, Mundis, Burton, Line, Akbarnia, Boachie, Hostin, Shaffrey, Smith, Wood, Bess, ISSG

2010 Common Mathematical Formulas Fail to Predict Postoperative Sagittal Alignment: Confirmation of a Need for More Advanced Equations. Smith, Bess, Shaffrey, Burton, Hart, Hostin, ISSG

2010 Thoracic Pedicle Subtraction Osteotomy for Adult Spinal Deformity Improves Regional Spinal Deformity and Pelvic Tilt. Bess , Schwab, Lafage, Hostin, Ames, Klineberg, Boachie, Burton, Hart, Shaffrey, Smith, ISSG

2009 Patients Perceive Perioperative Complications as More Severe and Having Greater Negative Consequences than Surgeons. Cabalo, Bess, Lanning, Akbarnia, Boachie-Adjei, Burton, Gupta, Hostin, Shaffrey, Wood, Kebaish, Cunningham, Hart, ISSG

2009 Extension Of Previous Fusions to the Sacro-Pelvis Vs. Primary Spino-Pelvic Fusions in the Setting Of Adult Deformity: A Comparison of Health Related Quality of Life Measures and Complications. Burton , Kebaish, Shaffrey, Schwab, Hostin, Shelokov, Bess, Boachie-Adjei, Akbarnia, ISSG

2009 Outcomes and Complications of Extension of Previous Long Fusion to the Sacro-Pelvis: Does Surgical Approach Make a Difference? Burton , Boachie-Adjei, Shaffrey, Schwab, Hostin, Shelokov, Bess, Akbarnia, ISSG

2009 The Impact of Reciprocal Regional Alignment Changes Distant from the Site of Spinal Osteotomies Affects Post-Operative Spinal Balance. Lafage, Schwab, Boachie-Adjei, Farcy, Shelokov, Hostin, Hart, Akbarnia, O’Brien, Burton, Shaffrey, ISSG

2009 PSO Failures can be Predicted by High Pre-Op SVA And Pelvic Tilt. Lafage, Schwab, Smith, Farcy, Boachie-Adjei, Shelokov, Hostin, Hart, Akbarnia, O’Brien, Burton, Shaffrey, ISSG

2009 Pre-Operative Pelvic Parameters Must be Considered to Achieve Adequate Sagittal Balance After Lumbar Osteotomy. Schwab, Lafage, Shaffrey, Farcy, Boachie-Adjei, Shelokov, Hostin, Hart, Akbarnia, O’Brien, Burton, ISSG

2009 Major Complications Following Adult Spinal Deformity Surgery: Is There A High Risk Patient Profile? Hawkinson,Schwab, Kelly, Farcy, Mundis, Cunningham, Akbarnia, Hostin, Hart, Boachie-Adjei, Burton, Klineberg, Shaffrey, Bess, ISSG

2008 A biomechanical evaluation of three revision screw strategies for failed lateral mass fixation. Spine.

2008 Oct 15;33(22):2415-21. 2005 Importance of the peridural membrane in percutaneous vertebroplasty. Hostin R, Carr J, Gupta M, Hazelwood S, Dublin A. J Spinal Disord Tech. 2005 Feb;18(1):34-9. 2003 Hostin R, James M. Reconstruction of the hypoplastic thumb. JASSH. 2004 Nov; 4(4):275-290.

Current Research Studies & Projects

Baylor Scoliosis Center Electronic Research Database AxialBiotech Scoliosis Genetic Marker Study ScoliScore AIS Prognostic Test DePuySpine HEALOS Study Health Economics Cost Analysis Study

Additional Research

1997 Honors Research Raymond Papka, Ph.D., Department of Anatomical Sciences. Examined alterations in neuronal activity in the paracervical ganglia and spinal cord associated with pregnancy and parturition 1995-1996 Clinical Research Assistant Amgen, The Normal Hematocrit Cardiac Study

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