4 Northwestern Department of Orthopaedics, Chicago, IL, US; 5 Chicago, IL, US; 6 NorthShore University, Chicago, IL, US BACKGROUND CONTEXT: Recent studies suggest that athletes who de- velop a herniated lumbar intervertebral disc while playing in the National Football League (NFL) can return to play to have a successful career. How- ever, the effects of a pre-existing herniated lumbar disc on career longevity and performance before a player’s career begins has not been evaluated. PURPOSE: To determine whether the type of treatment or the affected level of a diagnosed lumbar disc herniation at the NFL combine affects a player’s career performance and longevity compared to all participating athletes. STUDY DESIGN/SETTING: Cohort study. PATIENT SAMPLE: All prospective National Football League athletes at the pre-draft combine OUTCOME MEASURES: Career statistics were compiled including years played, games played and number of games started in the NFL from public sources such as NFL.com and ESPN.com. Additionally, a previ- ously established and validated ‘‘Performance Score’’ utilizing statistical data pertinent to a particular position was calculated for all players exclud- ing offensive linemen and kickers/punters METHODS: The written medical evaluations and imaging reports of pro- spective athletes from 2003-2011 during the NFL Combine were eval- uated. Drafted athletes diagnosed with a lumbar disc herniation were matched by age, position, year- and round-drafted to control draftees. Those with a herniated lumbar disc were also stratified based on type of treatment and level of herniation. Career statistics and performance scores were calculated. RESULTS: Out of a total of 2,965 athletes who participated in the NFL combine, 146 were identified with a lumbar disc herniation. Players with- out a history of a lumbar disc herniation were more likely to be drafted than those with this condition (78.4% vs 60.3% respectively, p ! 0.001). In 88 athletes with a herniated lumbar disc who were drafted, there was no significant difference in the number of years played, games played, games started, or performance score compared to matched controls (p O 0.05). In the herniated disc group, 4 players (5%) required surgery at some point in their NFL career, compared to none of the control players (p 5 0.04). Type of treatment (conservatived75 athletes vs surgicald13 ath- letes) and herniation level did not affect number of games played, games started, or performance score (p O 0.05). CONCLUSIONS: This study suggests that a pre-existing lumbar disc her- niation did not affect an NFL player’s career longevity or performance. These results are independent of operative versus nonoperative treatment and level of herniation. This information can be valuable to players and evaluators alike for expectations of an NFL player’s career. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.295 P42. The Effect of Complications and Reoperation on Recovery Kinetics in 149 Adult Spinal Deformity Patients with Two-Year Follow-Up: An Area under the Curve Analysis International Spine Study Group 1 , Christopher P. Ames, MD 2 , Justin K. Scheer, BS 3 , Gregory M. Mundis, Jr., MD 4 , Eric O. Klineberg, MD 5 , Robert A. Hart, MD 6 , Michael P. Kelly, MD 7 , Vedat Deviren, MD 2 , Douglas C. Burton, MD 8 , Ian McCarthy, PhD 9 , Shay Bess, MD 10 , Frank J. Schwab, MD 11 , Christopher I. Shaffrey, MD 12 , Virginie Lafage, PhD 11 , Justin S. Smith, MD, PhD 13 ; 1 Brighton, CO, US; 2 University of California San Francisco, San Francisco, CA, US; 3 University of California San Diego, San Diego, CA, US; 4 San Diego Center for Spinal Disorders, La Jolla, CA, US; 5 University of California Davis School of Medicine, Sacramento, CA, US; 6 Oregon Health and Science University, Portland, OR, US; 7 St. Louis, MO, US; 8 University of Kansas Medical Center, Kansas City, KS, US; 9 Baylor Health Care System, Dallas, TX, US; 10 Rocky Mountain Scoliosis and Spine, Denver, CO, US; 11 New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, US; 12 University of Virginia Department of Neurosurgery, Charlottesville, VA, US; 13 University of Virginia Health System, Charlottesville, VA, US BACKGROUND CONTEXT: Complication rates in adult spinal deform- ity (ASD) surgery are high and the effects on overall recovery are not well understood. Current methods of reporting outcomes are limited to static outcome time points perhaps diminishing the health impact of the entire recovery experience. PURPOSE: This study aims to identify the effect of complications on the kinetics of the recovery process (recovery kinetics) by examining the effect of HRQOL over time via an area under the curve analysis (AUC). STUDY DESIGN/SETTING: A retrospective review of a multicenter, prospective ASD database. PATIENT SAMPLE: 149 O 18 years of age with ASD. OUTCOME MEASURES: HRQOL collected included Oswestry Dis- ability Index (ODI), Short Form-36 (SF-36), and Scoliosis Research Soci- ety-22 (SRS22) at baseline, 6wks, 1 and 2 yrs postop. METHODS: A retrospective review of a multicenter, prospective ASD da- tabase. Inclusion criteria, $18yrs, ASD. Complication number, type and need for reoperation (reop) were recorded. Patients were stratified as hav- ing no complication (NOCOMP) any complication (COMP), proximal junctional kyphosis (PJK) or proximal junctional failure (PJF). PJK and PJF were defined as follows: PJK: O10  UIV to UIVþ2, PJF: PJK and either vertebral fx of UIV or UIVþ1, posterior ligamentous disruption, or screw pull-out. All HRQOL was normalized to each patient’s baseline scores as a comparison relative to where the patients started. An AUC was then calculated across the entire 2 yrs. Standard HRQOL, normalized HRQOL, and AUC means were compared between groups. RESULTS: 149 patients were included (COMP:84, NOCOMP:45, PJK:30, PJF:25). There were no significant HRQOL differences at any time point be- tween COMP and NOCOMP (p O 0.05 for all). However, after normalizing the HRQOL, COMP had significantly lower SRS mental scores at 1 yr (1.160.2vs1.260.3, p50.0002) and 2 yrs (1.160.3 vs 1.360.4, p50.0003). COMP had significantly lower SRS Mental AUC than NOCOMP (3.260.5vs3.560.6, p50.0023). 28 (19%) patients had a reop. There were no significant differences between any HRQOL 2-yr AUC values between pa- tients with complications requiring reop and those with no reop (p O 0.05 for all). There were no significant differences in standard HRQOL between PJK and PJF at any time point (p O 0.05 for all) with the exception of PJF have lower 1yr SRS appearance (p ! 0.05). Normalized HRQOL showed PJK having low- er SRS pain at 1yr (1.360.4vs1.760.6, p50.0092) and 2yrs (1.360.5vs1.860.8, p50.0017, Figure1) than PJF. PJK had significantly low- er SRS pain AUC than PJF (3.460.9vs4.361.3, p50.0064). CONCLUSIONS: Static HRQOL analysis would suggest no difference between complication groups. Area under the curve (AUC) analysis sug- gests a significantly protracted mental recovery phase associated with at least one complication and the addition of reop does not affect the recovery kinetics. Patients who develop PJK or PJF at 2 yrs have similar preop and 2 yr standard HRQOL. However, based on an AUC analysis using normal- ized HRQOL, patients with PJF have more favorable recovery kinetics regarding postoperative pain than patients with PJK. Current literature def- initions do not allow appropriate separation of PJK and PJF based on HRQOL and recovery kinetics. New definitions are needed. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.296 P43. Preoperative Cervical Hyperlordosis and C2-T3 Angle Are Correlated to Increased Risk of Postop Sagittal Spinal Pelvic Malalignment in Adult Spinal Deformity Patients at Two-Year Follow-up International Spine Study Group 1 , Peter G. Passias, MD 2 , Sun Yang, BA 3 , Alexandra Soroceanu, MD, MPH 4 , Justin K. Scheer, BS 5 , Frank J. Schwab, 119S Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.