Spine Clinical Outcomes Research Center

Our Work

The UCSF Spine Center strives for innovation and excellence, and is continuously collaborating with our basic/translational research team to perform a multitude of projects and clinical trials that involve non-invasive and complex spine surgeries.

Current Projects

Spine Bundle Payment Risk Pool Analysis

  • This project aims to create risk pools that reduce the variability of total episode cost within a given pool. The study will look at the 90 day bundled payment costs for Spine MS-DRGs in bundled payment and determine predictors of 90 day bundled payment episode costs. The end goal is to propose risk pools with less cost variability than MSDRGs. The methods would reproduce those used to address hip fractures treated with a hemi or total joint arthroplasty, resulting in their removal from elective primary total joint replacement, and placement into a separate risk pool.

A Concurrently Controlled Study of the LimiFlex™ Paraspinous Tension Band in the Treatment of Lumbar Degenerative Spondylolisthesis with Spinal Stenosis

  • This study aims to demonstrate the safety and effectiveness of the Empirical Spine LimiFlex™ Paraspinous Tension Band when used for spinal stabilization, at one level from L1-S1, in skeletally mature patients following surgical decompression for treatment of lumbar degenerative spondylolisthesis (Grade I per Meyerding classification) with spinal stenosis.

Identifying risk factors for pseudarthrosis:

  • Led by Dr. Sigurd Berven, this recently funded project of the Center for Disruptive for Musculoskeletal Innovations (CDMI) aims to identify risk factors for pseudoarthrosis. Proposed risk factors of interest include bone quality, preoperative medication use, age and surgical technique.

Static and Dynamic Changes in Spinopelvic Parameters and Sagittal Alignment

  • Led by Dr. Shane Burch, and also recently funded by the CDMI, this project aims to find alterations in sagittal spinopelvic alignment that lead to a significant decrease in function and quality of life. The goal would be to use advanced motion analysis to examine how changes in pelvic parameters from walking, sitting and standing affect dynamic sagittal balance in patients with and without adult spinal deformity and with and without fusions. Data from this project will aid in surgical decision making in patients with adult spinal deformity.

Patient-Reported Outcomes (PROs)

  • Our center actively collects outcome measurements on patients who are both operative and non-operative. Over 80,000 patients have been enrolled and entered into our unique database, SID, and have contributed to many projects and publications.


  1. Tuchman A, Lenke LG, Cerpa M, Fehlings MG, Lewis SJ, Shaffrey CI, Cheung KMC, Carreon LY, Dekutoski MB, Schwab FJ, Boachie-Adjei O, Kebaish K, Ames CP, Qiu Y, Matsuyama Y, Dahl BT, Mehdian H, Pellisé F, Berven SH. Unilateral vs. Bilateral Lower Extremity Motor Deficit Following Complex Adult Spinal Deformity Surgery: Is there a Difference in Recovery Up to 2 Year F/U? Spine J. 2018 Aug 14. pii: S1529-9430(18)31091-X. doi: 10.1016/j.spinee.2018.08.003. PMID: 30118851
  2. Lieberman JA, Lyon R, Jasiukaitis P, Berven SH, Burch S, Feiner J. The reliability of motor evoked potentials to predict dorsiflexion injuries during lumbosacral deformity surgery: importance of multiple myotomal monitoring. Spine J. 2018 Jul 17. pii: S1529-9430(18)31004-0. doi: 10.1016/j.spinee.2018.07.006. PMID: 30025994
  3. Berven S, Mummaneni PV. Degenerative Spinal Deformity: Creating Lordosis in the Lumbar Spine. Neurosurg Clin N Am. 2018 Jul;29(3):xiii-xiv. doi: 10.1016/j.nec.2018.04.001. No abstract available. PMID: 29933815
  4. Berven S, Wadhwa R. Sagittal Alignment of the Lumbar Spine. Neurosurg Clin N Am. 2018 Jul;29(3):331-339. doi: 10.1016/j.nec.2018.03.009. Review.
  5. PMID: 29933801
  6. Kato S, Fehlings MG, Lewis SJ, Lenke LG, Shaffrey CI, Cheung KMC, Carreon LY, Dekutoski MB, Schwab FJ, Boachie-Adjei O, Kebaish KM, Ames CP, Qiu Y, Matsuyama Y, Dahl BT, Mehdian H, Pellisé F, Berven SH. An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery: A Subanalysis of Scoli-RISK-1 Study. Spine (Phila Pa 1976). 2018 Jul 1;43(13):905-912. doi: 10.1097/BRS.0000000000002486. PMID: 29894429
  7. Arutyunyan GG, Angevine PD, Berven S. Cost-Effectiveness in Adult Spinal Deformity Surgery. Neurosurgery. 2018 Oct 1;83(4):597-601. doi: 10.1093/neuros/nyx575. PMID: 29566174
  8. McGilvray KC, Easley J, Seim HB, Regan D, Berven SH, Hsu WK, Mroz TE, Puttlitz CM. Bony ingrowth potential of 3D-printed porous titanium alloy: a direct comparison of interbody cage materials in an in vivo ovine lumbar fusion model. Spine J. 2018 Jul;18(7):1250-1260. doi: 10.1016/j.spinee.2018.02.018. Epub 2018 Feb 26. PMID: 29496624
  9. Gussous Y, Theologis AA, Demb JB, Tangtiphaiboontana J, Berven S. Correlation Between Lumbopelvic and Sagittal Parameters and Health-Related Quality of Life in Adults With Lumbosacral Spondylolisthesis. Global Spine J. 2018 Feb;8(1):17-24. doi: 10.1177/2192568217696692. Epub 2017 May 31. PMID: 29456911
  10. Fehlings MG, Kato S, Lenke LG, Nakashima H, Nagoshi N, Shaffrey CI, Cheung KMC, Carreon L, Dekutoski MB, Schwab FJ, Boachie-Adjei O, Kebaish KM, Ames CP, Qiu Y, Matsuyama Y, Dahl BT, Mehdian H, Pellisé-Urquiza F, Lewis SJ, Berven SH. Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. Spine J. 2018 Feb 13. pii: S1529-9430(18)30057-3. doi: 10.1016/j.spinee.2018.02.001. PMID: 29452281
  11. Jain D, Berven SH, Carter J, Zhang AL, Deviren V. Bariatric surgery before elective posterior lumbar fusion is associated with reduced medical complications and infection. Spine J. 2018 Sep;18(9):1526-1532. doi: 10.1016/j.spinee.2018.01.023. Epub 2018 Feb 23. PMID:29408400
  12. Khashan M, Camisa W, Berven S, Leasure J. Stand-alone anterior interbody fusion for substitution of iliac fixation in long spinal fixation constructs. Arch Orthop Trauma Surg. 2018 Apr;138(4):479-486. doi: 10.1007/s00402-017-2865-x. Epub 2017 Dec 29. PMID: 29288274
  13. Bae J, Theologis AA, Strom R, Tay B, Burch S, Berven S, Mummaneni PV, Chou D, Ames CP, Deviren V. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine. 2018 Jan;28(1):40-49. doi: 10.3171/2017.5.SPINE161370. Epub 2017 Nov 3. PMID: 29087808
  14. Berven SH, Kamper SJ, Germscheid NM, Dahl B, Shaffrey CI, Lenke LG, Lewis SJ, Cheung KM, Alanay A, Ito M, Polly DW, Qiu Y, de Kleuver M. An international consensus on the appropriate evaluation and treatment for adults with spinal deformity. AOSpine Knowledge Forum Deformity. Eur Spine J. 2018 Mar;27(3):585-596. doi: 10.1007/s00586-017-5241-1. Epub 2017 Aug 5. PMID: 28780621
  15. Jain D, Verma K, Mulvihill J, Mizutani J, Tay B, Burch S, Deviren V. Comparison of Stand-Alone, Transpsoas Lateral Interbody Fusion at L3-4 and Cranial vs Transforaminal Interbody Fusion at L3-4 and L4-5 for the Treatment of Lumbar Adjacent Segment Disease. Int J Spine Surg. 2018 Aug 31;12(4):469-474. doi: 10.14444/5056. eCollection 2018 Aug. PMID: 30276107
  16.  Khanna K, Janghala A, Sing D, Vail B, Arutyunyan G, Tay B, Deviren V. An Analysis of Implant Retention and Antibiotic Suppression in Instrumented Spine Infections: A Preliminary Data Set of 67 Patients. Preliminary Data Set of 67 Patients. Int J Spine Surg. 2018 Aug 31;12(4):490-497. doi: 10.14444/5060. 2018 Aug. PMID: 30276110
  17.  Uribe JS, Schwab F, Mundis GM Jr, Xu DS, Januszewski J, Kanter AS, Okonkwo DO, Hu SS, Vedat D, Eastlack R, Berjano P, Mummaneni PV. The comprehensive anatomical spinal osteotomy and anterior column realignment classification. J Neurosurg Spine. 2018 Aug 24:1-11. doi: 10.3171/2018.4.SPINE171206. PMID: 30141765
  18. Dalle Ore CL, Ames CP, Deviren V, Lau D. Outcomes Following Single-Stage Posterior Vertebral Column Resection for Severe Thoracic Kyphosis. World Neurosurg. 2018 Aug 2. pii: S1878-8750(18)31689-9. doi: 10.1016/j.wneu.2018.07.209. PMID: 30077025
  19. Zygourakis CC, DiGiorgio AM, Crutcher CL 2nd, Safaee M, Nicholls FH, Dalle Ore C, Ahmed AK, Deviren V, Ames CP. The Safety and Efficacy of CT-Guided, Fluoroscopy-Free Vertebroplasty in Adult Spinal Deformity Surgery. World Neurosurg. 2018 Aug;116:e944-e950. doi: 10.1016/j.wneu.2018.05.139. Epub 2018 May 29. PMID: 29857213
  20. Mizutani J, Strom R, Abumi K, Endo K, Ishii K, Yagi M, Tay B, Deviren V, Ames C. How Cervical Reconstruction Surgery Affects Global Spinal Alignment. Neurosurgery. 2018 Apr 28. doi: 10.1093/neuros/nyy141. PMID: 29718359
  21. Safaee MM, Dalle Ore CL, Zygourakis CC, Deviren V, Ames CP. The unreimbursed costs of preventing revision surgery in adult spinal deformity: analysis of cost-effectiveness of proximal junctional failure prevention with ligament augmentation. Neurosurg Focus. 2018 May;44(5):E13. doi: 10.3171/2018.1.FOCUS17806. PMID: 29712521
  22. Dalle Ore CL, Ames CP, Magill ST, Deviren V, Aghi MK, Lau D. Initial Experience with Intraoperative Phosphorous-32 Brachytherapy During Resection of Malignant Spinal Tumors. World Neurosurg. 2018 Jul;115:e785-e793. doi: 10.1016/j.wneu.2018.04.105. Epub 2018 Apr 24. PMID: 29702311
  23. Daniels AH, Bess S, Line B, Eltorai AEM, Reid DBC, Lafage V, Akbarnia BA, Ames CP, Boachie-Adjei O, Burton DC, Deviren V, Kim HJ, Hart RA, Kebaish KM, Klineberg EO, Gupta M, Mundis GM Jr, Hostin RA Jr, O'Brien M, Schwab FJ, Shaffrey CI, Smith JS; International Spine Study Group Foundation. Peak Timing for Complications After Adult Spinal Deformity Surgery. World Neurosurg. 2018 Jul;115:e509-e515. doi: 10.1016/j.wneu.2018.04.084. Epub 2018 Apr 22. PMID: 29689393
  24.  Lau D, Osorio JA, Deviren V, Ames CP. The relationship of older age and perioperative outcomes following thoracolumbar three-column osteotomy for adult spinal deformity: an analysis of 300 consecutive cases. J Neurosurg Spine. 2018 Jun;28(6):593-606. doi: 10.3171/2017.10.SPINE17374. Epub 2018 Apr 6. PMID: 29624129
  25. Safaee MM, Deviren V, Dalle Ore C, Scheer JK, Lau D, Osorio JA, Nicholls F, Ames CP. Ligament augmentation for prevention of proximal junctional kyphosis and proximal junctional failure in adult spinal deformity. J Neurosurg Spine. 2018 May;28(5):512-519. doi: 10.3171/2017.9.SPINE1710. Epub 2018 Feb 23. PMID: 29473789
  26. Safaee MM, Ames CP, Deviren V, Clark AJ. Minimally Invasive Lateral Retroperitoneal Approach for Resection of Extraforaminal Lumbar Plexus Schwannomas: Operative Techniques and Literature Review. Oper Neurosurg (Hagerstown). 2018 Nov 1;15(5):516-521. doi: 10.1093/ons/opx304. PMID: 29351647
  27. Smith JS, Shaffrey CI, Kim HJ, Passias P, Protopsaltis T, Lafage R, Mundis GM Jr, Klineberg E, Lafage V, Schwab FJ, Scheer JK, Miller E, Kelly M, Hamilton DK, Gupta M, Deviren V, Hostin R, Albert T, Riew KD, Hart R, Burton D, Bess S, Ames CP. Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity. Neurosurgery. 2018 Jan 17. doi: 10.1093/neuros/nyx605. PMID: 29351637
  28. Ailon T, Smith JS, Shaffrey CI, Kim HJ, Mundis G, Gupta M, Klineberg E, Schwab F, Lafage V, Lafage R, Passias P, Protopsaltis T, Neuman B, Daniels A, Scheer JK, Soroceanu A, Hart R, Hostin R, Burton D, Deviren V, Albert TJ, Riew KD, Bess S, Ames CP; International Spine Study Group. Outcomes of Operative Treatment for Adult Cervical Deformity: A Prospective Multicenter Assessment With 1-Year Follow-up. Neurosurgery. 2018 Nov 1;83(5):1031-1039. doi: 10.1093/neuros/nyx574. PMID: 29281107
  29. Gupta S, Eksi MS, Ames CP, Deviren V, Durbin-Johnson B, Smith JS, Gupta MC. A Novel 4-Rod Technique Offers Potential to Reduce Rod Breakage and Pseudarthrosis in Pedicle Subtraction Osteotomies for Adult Spinal Deformity Correction. Oper Neurosurg (Hagerstown). 2018 Apr 1;14(4):449-456. doi: 10.1093/ons/opx151. PMID: 28973658
  30. Passias PG, Jalai CM, Lafage V, Lafage R, Protopsaltis T, Ramchandran S, Horn SR, Poorman GW, Gupta M, Hart RA, Deviren V, Soroceanu A, Smith JS, Schwab F, Shaffrey CI, Ames CP; International Spine Study Group (Littleton, Colorado). Primary Drivers of Adult Cervical Deformity: Prevalence, Variations in Presentation, and Effect of Surgical Treatment Strategies on Early Postoperative Alignment. Neurosurgery. 2018 Oct 1;83(4):651-659. doi: 10.1093/neuros/nyx438. PMID: 28950349
  31. Mizutani J, Verma K, Endo K, Ishii K, Abumi K, Yagi M, Hosogane N, Yang J, Tay B, Deviren V, Ames C. Thoracolumbar Alignment in the Compensatory Mechanism. Neurosurgery. 2018 May 1;82(5):686-694. doi: 10.1093/neuros/nyx288. PMID: 2859178
  32. Witiw CD, Fessler RG, Nguyen S, Mummaneni P, Anand N, Blaskiewicz D, Uribe J, Wang MY, Kanter AS, Okonkwo D, Park P, Deviren V, Akbarnia BA, Eastlack RK, Shaffrey C, Mundis GM Jr. Re-operation After Long-Segment Fusions for Adult Spinal Deformity: The Impact of Extending the Construct Below the Lumbar Spine. Neurosurgery. 2018 Feb 1;82(2):211-219. Doi: 10.1093/neuros/nyx163. PMID: 28472486
  33. Su BW, Theologis AA, Byers RH, Shimer AL, Schroeder GD, Vaccaro AR, Tay B. Quantitative Assessment of the Anatomical Footprint of the C1 Pedicle Relative to the Lateral Mass: A Guide for C1 Lateral Mass Fixation. Global Spine J. 2018 Aug;8(5):507-511. doi: 10.1177/2192568217744530. Epub 2017 Dec 10. PMID: 30258757