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  • Journal of Neurosurgery: Spine x
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Srinath Samudrala, Shoshanna Vaynman, Ty Thiayananthan, Samer Ghostine, Darren L. Bergey, Neel Anand, Robert S. Pashman and J. Patrick Johnson

mass. This method has its fulcrum through the anterior spinal column and ultimately “shortens” the spinal canal. It also results in bone-on-bone contact in all 3 columns to facilitate fusion. In this study, we characterize CTJ deformity and describe how PSO performed at the CTJ can be used to correct the regional sagittal alignment of the cervical spine and the location of the head in relation to the thoracic spine. We report the surgical technique and the postoperative results following osteotomy at the CTJ in 8 patients. Methods We identified and conducted a

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J. Patrick Johnson, Robert S. Pashman, Carl Lauryssen, Neel Anand, John J. Regan and Robert S. Bray

body habitus and spinal column alignment that may exhibit a characteristic asymmetrical hump in the presence of significant scoliotic deformity ( Fig. 6 ). Full-length (36 × 14—in) standing spinal radiography is performed to assess the overall spinal balance ( Fig. 2 ). Cobb angles are measured on these radiographs by using a goniometer in both AP and lateral orientations (briefly, a perpendicular line is drawn from the endplates of the most angulated vertebrae involved in the pathological curve [ Fig. 7 ]). Coronal and sagittal alignment is assessed using a plumb

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Paul Park, Kai-Ming Fu, Praveen V. Mummaneni, Juan S. Uribe, Michael Y. Wang, Stacie Tran, Adam S. Kanter, Pierce D. Nunley, David O. Okonkwo, Christopher I. Shaffrey, Gregory M. Mundis Jr., Dean Chou, Robert Eastlack, Neel Anand, Khoi D. Than, Joseph M. Zavatsky, Richard G. Fessler and the International Spine Study Group

involved either a combination of approaches, such as multilevel lateral lumbar interbody fusion (LLIF), and/or MIS transforaminal lumbar interbody fusion (TLIF) followed by percutaneous fixation or hybrid surgeries typically involving LLIF combined with open posterior surgery. However, one of the potential disadvantages of MIS is that if more advanced techniques, such as anterior column realignment, are not performed, inadequate sagittal correction is a possibility. In the treatment of spinal deformity, there is substantial evidence that sagittal alignment is correlated

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Paul Park, Michael Y. Wang, Virginie Lafage, Stacie Nguyen, John Ziewacz, David O. Okonkwo, Juan S. Uribe, Robert K. Eastlack, Neel Anand, Raqeeb Haque, Richard G. Fessler, Adam S. Kanter, Vedat Deviren, Frank La Marca, Justin S. Smith, Christopher I. Shaffrey, Gregory M. Mundis Jr. and Praveen V. Mummaneni

, including adult spinal deformity (ASD). Anand et al. 3 initially reported the feasibility of applying several different MIS techniques to treat symptomatic lumbar scoliosis. Subsequent reports have all confirmed successful MIS treatment of ASD. 5 , 17 , 21 , 24 These studies, however, have been limited by the relatively small numbers of patients evaluated, as well as the lack of focus on sagittal alignment and spinopelvic parameters, which are factors known to significantly impact long-term disability. 12 , 18 In addition, there has been no uniform MIS technique or

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Khoi D. Than, Paul Park, Kai-Ming Fu, Stacie Nguyen, Michael Y. Wang, Dean Chou, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Christopher I. Shaffrey, Shay Bess, Behrooz A. Akbarnia, Vedat Deviren, Juan S. Uribe, Frank La Marca, Adam S. Kanter, David O. Okonkwo, Gregory M. Mundis Jr., Praveen V. Mummaneni and the International Spine Study Group

that the spines of patients who do the worst are not appropriately corrected in the sagittal plane and are perhaps fused into a fixed sagittal plane deformity. The increased mean SVA in both groups probably represents the limited ability to improve sagittal alignment with early MIS techniques. Similarly, the unchanged PILL mismatch in the worst group reflects a lack of sagittal alignment improvement obtained by the early MIS approaches we used. These results highlight the basis of the MISDEF algorithm we created to guide MIS versus open treatment in patients with