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Edward C. Benzel

male and four were female. Patients with significant scoliotic deformities, significant translational deformities, evidence of translational instability, disruption of the lamina immediately rostral or caudal to the fractured level, or multiple-level fractures did not undergo spinal fixation with the SRTC technique. All patients were assigned a neurological grade at the time of admission and at the 6-month follow-up examination according to a previously reported grading scale ( Table 1 ), 13 and all had the angles of their spinal deformity measured preoperatively

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Richard P. Schlenk, Robert J. Kowalski and Edward C. Benzel

The correction of spinal deformity may be achieved by a variety of methods, each of which has advantages and disadvantages. The goals of spinal deformity surgery include reasonable correction of the curvature, prevention of further deformation, improvement of sagittal and coronal balance, optimization of cosmetic issues, and restoration/preservation of function. The failure to consider all these factors appropriately may result in a suboptimal outcome. Understanding fundamental biomechanical principles involved in the formation, progression, and treatment of spinal deformities is essential in the clinical decision-making process.

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Edward C. Benzel and Nevan G. Baldwin

the construct is distracted. At this point, manipulation of the rods and screws is accomplished to correct a major spinal deformation, if such reduction is necessary. If an angular sagittal plane deformity is present, distraction or compression of either the anterior or the posterior rod can be performed to achieve reduction. For translational deformities in the sagittal plane, the two rods are manipulated simultaneously using either pliers or in situ rod manipulators to provide reduction by means of a parallelogram effect. Correction of coronal plane

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Edward C. Benzel

subsidence in the posterior lumbar fusion—alone group. The authors significantly elevated disc space height (distraction) and reduced translational deformity in both patient groups. In the posterior lumbar fusion—alone group, treatment relied solely on pedicle screw implants to maintain the disc space height (DSH) gained, without an interbody strut for additional support. Alternatively, had they reduced translational deformity, decompressed the spinal canal and neural foramina, and compressed rather than distracted the motion segment (that is, decreased the DSH), a more

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Edward C. Benzel

Kulkarni, et al., have provided insight and confirmed most surgeons' biases regarding degenerative changes at adjacent-level segments following fusion for cervical spondylotic myelopathy. Their findings suggest, but do not prove, that kyphotic deformity predisposes to accelerated degenerative changes and that fusion itself predisposes to such lesions. The fact that they observed disc bulging at adjacent levels, however, does not prove that these changes were related to the prior fusion because no control population was evaluated in this retrospective study

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Edward C. Benzel and Perry A. Ball

deformity is complicated by the biomechanics of the lumbosacral junction. The angular stresses placed on the spine in the lumbosacral region via axial loading are significant, and the inadequate length of available spine (that is, suboptimum moment arm length) to which one affixes spinal implants at its caudal terminus (the sacrum) is problematic. These factors are compounded by the fact that the bones of the sacrum and the ilium are of relatively low density, often providing insufficient resistance to applied loads of an implant that is affixed (with screws) to

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Nevan G. Baldwin and Edward C. Benzel

supplied in a variety of thicknesses ( Fig. 1 ), offering a range of choices that can greatly reduce the difficulty associated with rod attachment. The application of forces (compression, distraction, or rotation) for deformity correction is accomplished as rod fixation progresses. Following implant insertion, the bone graft is placed and the wound is closed in layers. Postoperatively, a thoracolumbosacral orthosis is used by the patient for at least 3 months. Physical therapy for ambulation and strengthening exercises are begun on the 3rd day postoperatively

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Edward C. Benzel and Lee Kesterson

universally appropriate. 23 Anterior approaches may be useful in some cases of spine trauma; 2 however, they do not allow the reduction of dislocated facets, nor do they effectively reduce dislocations. Anterior fusions alone, in addition, do not offer acute stability and are associated with subsequent spinal deformities. 10, 29, 32, 34 By forcing the bone graft medially into the interspinous space during the tightening of the compression wire, an acceptable interspinous distance is usually achieved with the technique described here. This “wedge” of bone prevents the

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Michael P. Steinmetz, Christopher D. Kager and Edward C. Benzel

T he development of cervical deformity such as kyphosis may be secondary to advanced degenerative disease, trauma, neoplastic disease, or postsurgical changes. 12 Postoperative cervical kyphosis may develop after either ventral or dorsal approaches. After ventral cervical surgery, kyphosis may result from pseudarthrosis 6, 8, 18 or the failure to restore adequate lordosis during surgery. 8 Following dorsal surgery, kyphosis may develop and progress in response to disruption of the natural stabilizing structures, such as the tension band, of the dorsal

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Edward C. Benzel, Perry A. Ball, Nevan G. Baldwin and Erich P. Marchand

rod. For the seven trauma patients, a 12-hook configuration was used with the construct positioned from three levels above to two levels below the unstable segment. In three patients, complex thoracolumbar and lumbar degenerative deformities were corrected. One or two Danek Crosslinks were employed in all cases (CE Johnston, et al. , unpublished data). Fig. 1. A central-post pedicle hook. Note the narrow configuration of the rod attachment site. Of the seven trauma patients, one had a lateral extracavitary decompression with an accompanying anterior