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Doniel Drazin, Terrence T. Kim, David W. Polly Jr and J. Patrick Johnson

original manuscripts. The application of image guidance navigation techniques to address simple or complex pathologies has translated into better outcomes and faster recovery in all areas of the spine. Kim and colleagues demonstrate that minimally invasive surgeries with the use of spinal navigation procedures can be accomplished with a high level of accuracy and safety. In the case of more complex revision surgeries, Hsieh and colleagues show that in a historically challenged procedure, the accuracy of instrumentation placement can approach that seen in index primary

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Terrence T. Kim, Doniel Drazin, Faris Shweikeh, Robert Pashman and J. Patrick Johnson

postoperative complications were noted. The mean clinical follow-up period was 18 months (range 3–39 months). The overall clinical outcomes, measured by the VAS (back pain scores), were improved significantly postoperatively at 3 months compared with preoperatively (6.35 vs 3.57; p < 0.0001). No revision surgery was performed for screw misplacement or neurological deterioration. Discussion The use of intraoperative CT-IGN for pedicle screw instrumentation has increasingly gained in popularity. The literature contains several reports on this newest generation imaging

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Tyler J. Kenning, John C. Dalfino, John W. German, Doniel Drazin and Matthew A. Adamo

placement & OR evac NA 3.6 ± 3.8 NA * OR evac = operating room evacuation. In patients classified as having an SEPS failure, the time between the revision surgery and initial SEPS placement was 3.6 ± 3.8 days (range 0–17 days). All of these patients were treated with craniotomies for SDH evacuation; the exception was 1 patient in whom bur hole craniostomies were initially attempted for bilateral collections. This procedure also failed, and bilateral craniotomies were performed 16 days later. This patient was the only one to require more than 1 operation for

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Joseph C. Hsieh, Doniel Drazin, Alexander O. Firempong, Robert Pashman, J. Patrick Johnson and Terrence T. Kim

, particularly computed tomography image–guided surgery (CT-IGS), has emerged as an alternative to fluoroscopy-based techniques. The argument for CT-IGS has been most compelling in cases of brain and spinal cord tumors, trauma, complex deformity (acquired or congenital), obesity, osteoporosis, and revision surgery. In each of these instances, anatomy is significantly altered and difficulties are compounded by limitations in imaging visualization of bony landmarks. This study focuses on evaluating the performance of CT-IGS in the setting of primary versus revision spine surgery

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Doniel Drazin, Neil Bhamb, Lutfi T. Al-Khouja, Ari D. Kappel, Terrence T. Kim, J. Patrick Johnson and Earl Brien

avoid injury to the anterior structures. Intraoperative Assessment of Tumor Resection Intraoperative post–tumor resection CT images can be obtained with the mobile cone-beam CT scanner to assess adequacy of tumor margins in conjunction with intraoperative examination of frozen sections. This was done routinely in all our sacral tumor cases to confirm wide resection and avoid additional postoperative imaging and possible revision surgery. Margins were also sent for pathological examination to confirm wide excision. Results We identified 6 patients (2 women

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Mayur Sharma, Nicholas Dietz, Ahmad Alhourani, Beatrice Ugiliweneza, Dengzhi Wang, Doniel Drazin and Maxwell Boakye

fusion, with no evidence of persistent/recurrent infection requiring revision surgery as of the most recent follow-up visit. Similarly, Aryan et al. 3 reported the use of a titanium cage with rhBMP-2 (with morcellized autograft/allograft) in 15 patients following corpectomy for VO in their institutional retrospective series. The cervical spine was the region most commonly affected (n = 6, 40%) followed by the thoracic (n = 5, 33.3%) and lumbar spine (n = 4, 26.7%). Two-level corpectomies were performed in 13 of the 15 cases, 1 patient had a 6-level corpectomy, and 10

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Nicholas Dietz, Mayur Sharma, Ahmad Alhourani, Beatrice Ugiliweneza, Dengzhi Wang, Miriam A. Nuño, Doniel Drazin and Maxwell Boakye

Pt Age (yrs) Registry Diagnosis/Spinal Procedure Outcomes Measured Follow-Up (mos) Spratt et al., 2004 40 Median 59.8 None Lumbar spinal stenosis/partial laminectomy/arthrectomy (or laminarthrectomy) VAS, WDI, ODI, LBOS 12 Hegarty & Shorten, 2012 53 Range 18–65 None Lumbar discectomy Persistent post-surgical pain using VAS 3 McGirt et al., 2015 1803 Mean 55.92 QOD Degenerative lumbar condition ODI, RTW 12 McGirt et al., 2017 7618 Median 60 QOD Stenosis, spondylolisthesis, disc herniation, revision surgery for disc herniation/lumbar decompression & fusion ODI, EQ-5D

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Doniel Drazin, Mir Hussain, Jonathan Harris, John Hao, Matt Phillips, Terrence T. Kim, J. Patrick Johnson and Brandon Bucklen

-grade spondylolisthesis. 22 Fusion outcomes using 1 technique have been well reported. 24 , 34 Nemani et al. reported that only 10% of the 117 patients required revision surgery following a stand-alone treatment of L5–S1. 34 Therefore, research will be needed to study whether use of more than one construct will improve patient outcomes. In addition, it would be important to assess different implants that have larger lordotic footprints and whether they would increase the stiffness across the constructs at the larger sacral slopes. This study was a biomechanical investigation

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Rani Nasser, Doniel Drazin, Jonathan Nakhla, Lutfi Al-Khouja, Earl Brien, Eli M. Baron, Terrence T. Kim, J. Patrick Johnson and Reza Yassari

use them in open tumor surgery ( Fig. 3 ). FIG. 3. Photograph showing a navigated tap being used with a guide-wire to confirm and maintain the pedicle trajectory. Intraoperative Assessment of Tumor resection Intraoperative post-resection CT images can be obtained with the mobile cone-beam CT scanner to assess adequacy of tumor margins. This was done routinely in all our spinal tumor cases to confirm wide resection and avoid additional postoperative imaging and the need for revision surgery. Results In the total group of 50 patients (27 male, 23

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of a decade to determine their consistency over time and to assess complications and revision surgeries. Methods: 463 patients were enrolled and received the study surgical treatments in a prospective, randomized, controlled, multi-center study with a 1:1 randomization scheme. No statistical differences were seen between the groups for demographics and preoperative measures. As of May 28, 2010, 5-year follow-up data were available for 193/242 (79.8%) of the arthroplasty patients and 159/221 (71.9%) of the control patients. The study's primary outcome measure