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Steven Casha and Michael G. Fehlings

applied, and when these devices confer a fusion-related advantage over noninstrumented procedures. The variety of anterior plate designs has increased the complexity of the issue. Furthermore, the choice of graft material also remains controversial; although autograft provides an advantage in fusion over allo- or xenograft, their drawback includes increased postoperative pain and graft site—related complications. 2, 4, 18 Anterior cervical plate—augmented fusion has several theoretical advantages over noninstrumented fusion. The plate is thought to provide a buttress

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Charles H. Tator and Michael G. Fehlings

: Blocked N-methyl-D-aspartate receptors may protect against ischemia damage in the brain. Science 226 : 850 – 852 , 1984 Simon RP, Swan JH, Griffiths J, et al: Blocked N-methyl-D-aspartate receptors may protect against ischemia damage in the brain. Science 226: 850–852, 1984 116. Somerson SK , Stokes BT : Functional analysis of an electromechanical spinal cord injury device. Exp Neurol 96 : 82 – 96 , 1987 Somerson SK, Stokes BT: Functional analysis of an electromechanical spinal cord injury device. Exp Neurol

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Julio C. Furlan and Michael G. Fehlings

autonomic dysreflexia is summarized in a clinical algorithm that includes monitoring of blood pressure and heart rate after each step. First, the individual should be immediately put in a sitting position if the person is supine. Second, clothing or constrictive devices need to be loosened. Third, potential triggers including bladder distension and bowel impaction should be investigated. If the systolic blood pressure is as elevated as 150 mm Hg or higher, clinicians may consider pharmacological management with a rapid-onset and short-duration antihypertensive agent (such

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Gwen Schwartz and Michael G. Fehlings

the same representative subsample that had been randomly selected for quantitative retrograde axonal tracing. The area of the cavity and residual tissue (white matter and gray matter) was quantified on a personal computer running Image Pro Plus software and connected to a charge-coupled device camera mounted on a microscope. The injury epicenter and every 10th section (corresponding to every 100 µm of tissue) rostral and caudal to the epicenter were digitized, traced, and false colored according to predefined pixel color values corresponding to histochemical

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Michael G. Fehlings and Charles H. Tator

I : New principles of resuscitation for brain and spinal injury. NC Med J 45 : 701 – 708 , 1984 Rosner MJ, Elias Z, Coley I: New principles of resuscitation for brain and spinal injury. NC Med J 45: 701–708, 1984 82. Somerson SK , Stokes BT : Functional analysis of an electromechanical spinal cord injury device. Exp Neurol 96 : 82 – 96 , 1987 Somerson SK, Stokes BT: Functional analysis of an electromechanical spinal cord injury device. Exp Neurol 96: 82–96, 1987 83. Sonntag VK

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Editorial

Motion preservation following anterior cervical discectomy

Michael G. Fehlings and Doron Rabin

Anterior cervical decompression is an accepted treatment option for the management of cervical radiculopathy and/or myelopathy secondary to degenerative disc disease. This procedure is usually followed by an interbody fusion, which may be supplemented with instrumentation. 2 Concern regarding the potential for accelerated adjacent level degeneration with symptomatic axial pain or neural compromise prompted the development of cervical arthroplasty devices. A number of artificial cervical discs, with differing designs and biomechanical properties, aim to allow

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Editorial

Interspinous ligamentoplasty

Michael G. Fehlings and Soo Yong Chua

article by Hong et al., Ghiselli et al. 1 reported only 3% symptomatic caudal adjacent-segment disease for single-level fusion at L4–5 after a mean follow-up of 7.3 years. Hong et al. had an adjacent-segment disease incidence of 4% (1 case out of 23), which is comparable to the rate following single-level fusion at the same level. The above-mentioned issues have provided the impetus for spine surgeons to examine new devices, including dynamic implants. A number of semirigid implant designs have been developed to improve segmental stability, unload posterior elements

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Editorial

The impact of continued cord compression following traumatic spinal cord injury

Michael G. Fehlings

issue of Journal of Neurosurgery: Spine , Swartz and colleagues 8 have undertaken an experimental study in rodents that adds further weight to the experimental evidence supporting the concept that continued static compression of the cord after an initial impact exacerbates the effect of the initial SCI. In their study, Swartz et al. used a calibrated impactor device to produce a contusive lesion of the T-10 cord in rodents. This injury was followed by varied times of static compression (ranging from 0 seconds to 5 minutes). Outcomes included an assessment of

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Editorial

Pedicle screws and great vessels

Michael G. Fehlings and Sorin C. Craciunas

Pedicle screw constructs are widely used in spinal surgery because of their superior biomechanical properties, which enhance fusion rates and enable early painfree mobilization. 7 , 8 Although the techniques of pedicle screw insertion are well described in the literature and intraoperative imaging and navigation devices are now largely available, the insertion of pedicle screws can still be a technically challenging procedure with a potential risk for neurological, vascular, or visceral injury. The rate of malpositioning pedicle screws varies from 4% to 25

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Michael G. Fehlings and Reza Mobasheri

– 1121 , 2005 16 Zou X , Xue Q , Li H , Bünger M , Lind M , Bunge C : Effect of alendronate on bone ingrowth into porous tantalum and carbon fiber interbody devices: an experimental study on spinal fusion in pigs . Acta Orthop Scand 74 : 596 – 603 , 2003