Criteria:

Inclusion Criteria:

1. Diagnosis of adult congenital, degenerative, idiopathic or iatrogenic spinal deformity

2. Full body EOS radiographic assessment (sagittal and coronal visualization from skull to foot)

3. Complex patients are defined as and meeting any one of the subsequent criteria:

   1. Radiographic criteria:

      • PI-LL ≥ 25 degrees
      • TPA ≥ 30 degrees
      • SVA>15cm
      • Thoracic scoliosis ≥ 70 degrees
      • Thoracolumbar/lumbar scoliosis ≥ 50 degrees
      • Global coronal malalignment >7cm

   2. Procedural criteria:

      • Posterior spinal fusion > 12 levels
      • 3 column osteotomy or ACR

   3. Geriatric criteria:

      • Age >65 years and minimum 7 levels of spinal instrumentation during surgery

Exclusion Criteria:

1. Age <18 years of age
2. Active spine tumor or infection
3. Deformity due to acute trauma
4. Neuromuscular conditions/diseases (Parkinson's, Multiple Sclerosis, Post-polio syndrome)
5. Syndromic scoliosis
6. Inflammatory arthritis/auto immune diseases (Rheumatoid arthritis, Lupus, Ankylosing Spondylitis)
7. Prisoners
8. Women who are pregnant
9. Non English speaking patients