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Daniel M. Sciubba, Clarke Nelson, Patrick Hsieh, Ziya L. Gokaslan, Steve Ondra and Ali Bydon

patient in the sitting position and with local anesthesia. Such operations carry a high risk of neurological complications due to the potential for iatrogenic cervical subluxation and spinal cord compromise, and thus continual feedback on neurological status provided by the awake patient is especially important. 1 , 10 , 29 Nevertheless, performing these complex corrective spinal procedures on awake patients is a challenging task and is done on a rare basis. Many complex spine surgeries however, require patients to be in the prone position for prolonged periods with

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Giannina L. Garcés-Ambrossi, Matthew J. McGirt, Roger Samuels, Daniel M. Sciubba, Ali Bydon, Ziya L. Gokaslan and George I. Jallo

intradural tumors in 3 patients (10%). Six patients (20%) presented with an associated syrinx, 3 (10%) with scoliosis, 3 (10%) with cutaneous stigmata, and 1 (3%) with hip subluxation. The median (IQR) length of stay was 6 days (4–8 days). Perioperative complications included 3 cases (10%) of surgical site infection and 2 (10%) CSF leaks. There were no deep vein thromboses or pulmonary emboli. All patients were discharged home except 1 (3%). Two patients (7%) underwent a second untethering procedure at 42 and at 11 months. Postoperative Outcomes By 18 months

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, reduced ROM, >2 level ACDF, ligamentous injuries >3.5mm subluxation or >11° of angulation, burst fractures with retropulsion, lateral mass fractures with incongruity, delayed cervical instability, junction spanning instrumentation. Patients who are pain free, without neurologic deficit, have full ROM, radiologic evidence of a healed axis lateral mass fractures, odontoid fractures, non-displaced Jefferson fractures, <2 level ACDF, single level corpectomies, compression fractures, fractures without retropulsion, chronic discs, fully fused, asymptomatic, non

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Paul E. Kaloostian, Jennifer E. Kim, Ali Bydon, Daniel M. Sciubba, Jean-Paul Wolinsky, Ziya L. Gokaslan and Timothy F. Witham

, spondylolisthesis LIF incidental yes 12 hrs CBH bilat cerebellar hemispheres full recovery Lu et al., 2002 59, F FBS LIF incidental yes 4 days SDH parietal lobe craniotomy full recovery Miglis & Levine, 2010 45, F spondylosis LIF DT unnoticed yes 1 days ICH temporal lobe neurological defects Mikawa et al., 1994 75, M atlantoaxial subluxation LIF incidental yes 36 hrs SAH, CBH pst fossa, rt cerebellar hemisphere suboccipital decomp died due to pneumonia Morandi et al., 2001 34, M

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Mohamad Bydon, Joseph A. Lin, Rafael de la Garza-Ramos, Daniel M. Sciubba, Jean Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan and Ali Bydon

increased instability postoperatively. 18 , 65 Voo et al. found that facet resections exceeding 50% in the cervical spine result in significant increases in annulus stresses and segmental mobility. 65 F ig . 4. Example of segmental instability revealed by flexion-extension radiographs. Left: Moderate facet joint narrowing at C2–3 and C3–4 causing 3-mm anterior subluxation of C-2 over C-3 and 5-mm anterior subluxation of C-3 over C-4 in flexion. Right: Anterior subluxation of C-2 over C-3 decreases slightly in extension to approximately 1 mm. In our case