Background
Pediatric and Young Adult High Grade Spondylolisthesis is a relatively rare kyphotic deformity of the L5-S1 junction, leading to back and radicular leg pain, significantly impacting QoL in adulthood, often requiring surgical treatment.  Due to the low incidence institutional cohorts are small, and data spans many years.

Knowledge Gap
Currently it is not known which treatment options are most effective and safe to treat pediatric and young adult high grade spondylolisthesis.

Background
Deformities of trunk, chest and spine (especially when they occur early in life) are accompanied by exercise intolerance and shortness of breath, often leading to decreased QoL in adulthood.

Knowledge Gap
Currently it is not known how to adequately evaluate pulmonary function in pediatric and adult patients with a spinal deformity.

Background
Many rare diseases are accompanied by abnormal growth of the spine, leading to a spinal deformity.

Knowledge Gap
For rare diseases (‘orphan diseases’) etiology, natural history and optimal treatment of the spinal deformity are unknown.

Background
Scoliosis and other spinal deformities that develop during growth are a result of abnormal, asymmetric growth of the spine and trunk. Brace or surgical treatment has been shown to be effective in selected patients.

Knowledge Gap
Currently it is not known how optimally to modulate abnormal spinal growth (operatively and non-operatively) in order to reduce or treat the spine and trunk deformity.

Background
Surgical treatment of spinal deformities employs the use of metal alloy implants. Concern has been raised (also in total joint arthroplasty surgery) about increased serum metal ion levels in patients, especially when Cobalt Chrome alloys are implanted.

Knowledge Gap
Currently it is not known whether metal alloy implants employed in spinal deformity surgery have long term toxicological effects.

Background
Early treatment of adolescent idiopathic scoliosis (AIS) by brace treatment has been shown to modulate the natural history, can reduce the severity of the spinal deformity at the end of growth, and may reduce the need for surgery.

Knowledge Gap
Currently it is not known whether early detection of AIS by a (global) screening program can lead to early intervention and improved patient outcomes in a cost-effective manner.

Background
There is a large variation in presentation and outcomes of patients with a spinal deformity, due to the complex combination of unique patient factors over time, including general health, spine specific factors, spinal imaging and underlying etiology. It is not possible to predict individual patient outcomes.

Knowledge Gap
Currently there is a lack of adequate models (based on biomechanical modeling, biofidelity, patient registry data sets, Machine learning etc). to predict outcomes of natural history (e.g. progression of  AIS and ASD) and treatment (eg Proximal junctional kyphosis) for pediatric and adult patients with a spinal deformity.

Background
Much is still unknown regarding the molecular biology and genetics of the etiology of AIS.

Knowledge Gap
A large scale database of DNA, blood samples, imaging, sensorineural testing among other variables would enhance research into the etiology of AIS.

Background
The efficacy of Physiotherapeutic Scoliosis Specific Exercises (PSSE) and night-time bracing are non-operative treatments of AIS that currently being used.

Knowledge Gap
What is the efficacy and what are the indications for use of PSSE and night-time bracing to treat AIS?

Background
Instrumentation for AIS has evolved from Harrington Instrumentation to complex screw and dual rod constructs over the last 35 years.

Knowledge Gap
What are the long-term outcomes (greater than 20 years) after surgery for AIS with use of third generation spine instrumentation (pedicle screw constructs)?

Background
The current limited knowledge concerning natural history of untreated AIS has been defined by long term studies from Iowa and Scandinavia.

Knowledge Gap
What types and sizes of AIS curves, untreated in adolescence, are likely to be symptomatic and/or require surgery later in life?

Background
Our aging population lives longer and healthier that in the past.  This has led to a growing number of patients with symptomatic adult deformity.

Knowledge Gap
What is the natural history of adult spinal deformity and what variables predict a symptomatic deformity?

Background
Very little is known about efficacy of non-operative treatments of ASD.

Knowledge Gap
What non-operative treatments for ASD are efficacious and what is their indication for use?

Background
The complication rate for ASD surgery is high and factors associated with aging such as sarcopenia, osteoporosis, and frailty have an association with increased risk of complication.

Knowledge Gap
How does sarcopenia, osteoporosis, and frailty effect ASD surgery and how can they be modified to improve outcomes?