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Kaisorn L. Chaichana, Mohamad Bydon, David R. Santiago-Dieppa, Lee Hwang, Gregory McLoughlin, Daniel M. Sciubba, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy Witham

L umbar fusion is a relatively common spine procedure, accounting for over 400,000 procedures annually. 9 , 35 In addition, there was an approximate 15-fold increase in the number of lumbar instrumentation procedures performed from 2002 to 2007. 9 As the number of spinal fusion procedures increases, the number of complications is also expected to rise. 9 One of these complications is spinal infection. 9 Postoperative spinal infection occurs in approximately 1%–5% of patients undergoing spine surgery. 5 , 13 , 28 This risk is highest in patients

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Mohamad Bydon, Rafael De la Garza-Ramos and Ziya L. Gokaslan

, Clarke et al. performed 36 primary posterior-only en bloc sacral resections, most of them for sacral chordomas. 1 There were 13 complications (36.1%), including 9 (25.0%) wound infections/revisions. Furthermore, the nerve roots sacrificed ranged from preservation of the S-4 nerve roots and above, to bilateral sacrifice of S-1 and all nerve roots below. The performed operations included 2 total, 8 high, 9 middle, 12 low, and 5 distal sacrectomies. In this issue of Journal of Neurosurgery: Spine , Zang et al. report outcomes of 10 patients undergoing total sacrectomy

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Anshit Goyal, Che Ngufor, Panagiotis Kerezoudis, Brandon McCutcheon, Curtis Storlie and Mohamad Bydon

.56–0.72, as noted in a systematic review published in the Journal of the American Medical Association . 24 The authors concluded that results might be improved by including functional and social variables in addition to variables for medical comorbidities. Other studies from NSQIP and retrospective cohort analysis of single-institutional data suggest that postoperative complications such as wound infection, pain, and comorbidities such as COPD and CHF are significant predictors of readmission. It is important to note that socioeconomic variables such as insurance status

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Risheng Xu, Mohamad Bydon, Ziya L. Gokaslan, Jean-Paul Wolinsky, Timothy F. Witham and Ali Bydon

site pain, increased radicular pain, light-headedness, nausea, headache, vomiting, facial flushing, vasovagal reaction, increased blood glucose, and intraoperative hypertension. 7–9 , 34 , 50 The overall incidence of minor side effects ranges from 5.5 to 15.6%. Nevertheless, serious complications such as dural puncture, spinal cord trauma, infection, hematoma formation, abscess formation, subdural injection, intracranial air injection, epidural lipomatosis, pneumothorax, nerve damage, brain damage, increased intracranial pressure, intravascular injection, vascular

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Mohamad Bydon, Vance Fredrickson, Rafael De la Garza-Ramos, Yiping Li, Ronald A. Lehman Jr., Gregory R. Trost and Ziya L. Gokaslan

in whom a neurological deficit is present are best treated with decompression of the spinal canal or nerve roots, with or without fragment reduction and fixation. Surgical Complications and Outcomes Few studies to date have specifically evaluated the rate of complications following instrumented fixation of sacral fractures. Bellabarba et al. reported a 16% infection rate, 11% wound complication rate, instrumentation failure in 31% of cases and unplanned reoperation rate of 42%. 1 Nonetheless, the most common problem encountered in patients with sacral

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Mohammed Adeeb Sebai, Panagiotis Kerezoudis, Mohammed Ali Alvi, Jang Won Yoon, Robert J. Spinner and Mohamad Bydon

, reoperations were reported in 8 (44%) of 18 patients. Reoperations occurred mainly due to tumor recurrence (n = 5). Other reasons included CSF leakage (n = 1), pulmonary embolism (n = 1), and superficial infection (n = 1). 19 Interestingly in the study by Ahmad et al., there were 7 cases in which partial facetectomies were performed without fusion, none of which later developed instability (at an average follow-up of 35 months). 1 Study Limitations Our study has some limitations. First, it is single institutional in nature, thereby reflecting distinct practice patterns and

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Rafael De la Garza-Ramos, Risheng Xu, Seba Ramhmdani, Thomas Kosztowski, Mohamad Bydon, Daniel M. Sciubba, Jean-Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan and Ali Bydon

18 years undergoing 3- or 4-level ACDF for treatment of cervical spondylosis with myelopathy and/or radiculopathy (n = 166). Exclusion criteria were 1) patients with a history of previous cervical spine surgery (n = 19), 2) patients with neck pain only (n = 10), and 3) patients with less than 12 months of follow-up (n = 40). Patients undergoing ACDF following trauma, tumor resection, or primary spinal infections, patients undergoing corpectomy with cage reconstruction, and patients undergoing combined (anterior-posterior) approaches were not included in this study

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Mohamad Bydon, Mohamed Macki, Rafael De la Garza-Ramos, Daniel M. Sciubba, Jean-Paul Wolinsky, Ziya L. Gokaslan, Timothy F. Witham and Ali Bydon

for reoperation included wound dehiscence, infection, hematoma, and progression of spinal degeneration. The latter was defined either as progression of the initial spinal disorder or as a spinal disorder at the adjacent segment. The primary end point of the study was to identify predictors of reoperation in patients who had previously undergone a lumbar laminectomy. However, as with all cohort studies, a follow-up bias may lead to underreporting of the true outcome rate (that is, the rate of reoperation). To minimize these errors, patients who did not return for

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Mohamad Bydon, Nicholas B. Abt, Rafael De la Garza-Ramos, Mohamed Macki, Timothy F. Witham, Ziya L. Gokaslan, Ali Bydon and Judy Huang

have been prospectively collected, including over 60,000 neurosurgical cases. Definition of Morbidity and Mortality The primary outcome was short-term (30-day) overall postoperative morbidity, which was an aggregation of all available complications in the NSQIP database. These complications include wound infection, systemic infection, cardiac, respiratory, renal, neurological, thromboembolic events, and unplanned returns to the operating room. Mortality was also defined within a 30-day postoperative window. The operating surgeon(s), whether an attending only or

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Lorenzo Rinaldo, Brandon A. McCutcheon, Meghan E. Murphy, Daniel L. Shepherd, Patrick R. Maloney, Panagiotis Kerezoudis, Mohamad Bydon and Giuseppe Lanzino

, 12–14 Complications Complications are defined by the CDB/RM as any one of the reportable complications delineated by Vizient, the Agency for Healthcare Research and Quality, and Centers for Medicare and Medicaid Services. Complications recorded by CDB/RM that were included for analysis consisted of adverse events due to anesthesia; air embolism; aspiration pneumonia; catheter-associated urinary tract infection; central venous catheter–associated bloodstream infection; gastrointestinal hemorrhage; hospital-acquired acute myocardial infarction; hospital