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Richard P. Schlenk, Todd Stewart and Edward C. Benzel

Revision spinal surgery is usually indicated in cases of persistent or recurrent symptoms related to neural compression, spinal deformity, or construct failure. An understanding of fundamental biomechanical principles of both spinal decompression and reconstructive strategies is essential to avoid unnecessary subsequent spinal operations.

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Kalil G. Abdullah, Edward C. Benzel and Thomas E. Mroz

are a convenient measure of differentiating between the 2 procedures, but ultimately follow-up visits, repeat imaging as a result of symptomatology, and delayed complications and revision surgeries are important in the consideration of a surgical cost profile. The authors acknowledged these limitations in the study, which was intended as a viability analysis for a larger, more sophisticated study. The study makes a strong case for a larger cohort and longer follow-up time, and it stands as one of the few studies (possibly the only one) led by a primarily

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

was performed only after complete decompression of the spinal cord was achieved. Therefore, monitoring of the spinal cord was not thought to be useful. No case of neurological worsening was observed. The complications in this series are predominantly related to multilevel cervical revision surgery as opposed to the reduction of kyphosis. The authors of other series have also reported an increased incidence of complications following ventral deformity correction surgery. 11, 18 Herman and Sonntag 11 reported a 15% incidence of vocal cord paresis in their series in

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Matthew D. Alvin, Daniel Lubelski, Edward C. Benzel and Thomas E. Mroz

and is limited to patients who have either neutral or lordotic alignment. A ventral approach allows for direct decompression of ventral pathological entities in kyphotic, neutral, or lordotic spines, and avoids the pain associated with a posterior paraspinal musculature stripping approach, but is associated with its own complications including dysphagia, hoarseness, and cardiopulmonary events. 1 , 4 , 5 , 10 , 21 Traditional postoperative outcome measures such as complications, readmission rates, revision surgery rates, and return to work measures do not fully

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John H. Shin, Michael P. Steinmetz, Edward C. Benzel and Ajit A. Krishnaney

Chen et al. 7 reported on 83 patients who underwent laminectomy and instrumented fusion with an average follow-up of 4.8 years. The mean JOA score significantly increased, and neurological improvement was sustained in 62.4% of patients. The degree of stenosis was not associated with a difference in outcomes in this series. Lordosis was maintained postoperatively with no revision surgeries. Progression of OPLL was not measured in this series. Postoperative nerve root palsy was seen in 10 patients and was the main complication. This was thought to be related to

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Cumhur Kilinçer, Michael P. Steinmetz, Moon Jun Sohn, Edward C. Benzel and William Bingaman

probability values less than 0.05 were considered significant. Results Demographic Data Fifty men (39%) and 79 women (61%) were included in this series. The mean age was 58.6 years (range 25–91 years). Seventy-nine patients underwent lumbar surgery for the first time (61%), whereas in 50 patients (39%) the procedure was revision surgery. In Group I, 40 patients (47%) had failed prior surgery, whereas in Group II, 10 patients (22.7%) had failed prior surgery. This difference was statistically significant (p = 0.008). Medical Comorbidities In 79 patients

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Daniel Lubelski, William E. McCormick, Lisa Ferrara, Edward C. Benzel and Mark Kayanja

are not necessary in all cervical pathologic conditions but are important when there is a risk of construct failure related to poor bone integrity (e.g., in osteoporosis, in revision surgery, and in smokers with poor bone quality). Nonetheless, several studies have found that dynamic constructs provide rostral stabilization. Dvorak et al., 3 in a cadaveric biomechanical study, found no significant differences in cervical range of motion of fixed versus dynamic plate constructs, except for extension, where dynamic plates provided statistically significantly

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Daniel Lubelski, Nilgun Senol, Michael P. Silverstein, Matthew D. Alvin, Edward C. Benzel, Thomas E. Mroz and Richard Schlenk

quantify quality of life (QOL) outcomes after primary compared with revision discectomy. We therefore investigated QOL outcomes after primary and revision discectomy (i.e., 2-time herniation) by using validated health status measures: EQ-5D, the Patient Health Questionnaire–9 (PHQ-9), and the Pain and Disability Questionnaire (PDQ). Our hypothesis was that QOL would improve for all patients after primary and revision discectomy but that the improvements would be reduced after revision surgery. Methods We retrospectively reviewed records of all patients who had

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Michael P. Steinmetz, Jared Miller, Ann Warbel, Ajit A. Krishnaney, William Bingaman and Edward C. Benzel

Patients in whom CTJ treatment failure occurred were followed for a mean of 20 months (range 6–72 months). In those cases in which treatment failure did not occur, the mean follow-up duration was 13 months (range 1–89 months). Although there were 50 such patients in the failure group, none was lost to follow up. Twelve of these patients died before the final follow-up examination, and 38 did not return for their scheduled follow-up visit. The reason was not recorded. Thirteen of 14 patients required revision surgery for CTJ treatment failure. After undergoing a ventral

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Syed K. Mehdi, Vincent J. Alentado, Bryan S. Lee, Thomas E. Mroz, Edward C. Benzel and Michael P. Steinmetz

, there were a total of 217 complications and 41 unique revision surgeries. The overall prevalence of complications was 14.6% (95% CI 10.7%–18.4%) ( Fig. 6 ), and the overall prevalence of revision operations was 0.59% (95% CI 0.06%–1.1%). The 3 most common complications were C-5 palsy (55 of 217;25.3%), dural tears (50 of 217; 23.0%), and hoarseness/dysphagia (40 of 217; 18.4%). The 3 most common causes for revision surgeries were inadequate decompression (10 of 41; 24.4%), epidural hematoma (8 of 41; 19.5%), and CSF leak/dural defect (8 of 41; 19.5%) ( Table 5 ). An