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Curtis A. Dickman, Richard G. Fessler, Michael MacMillan and Regis W. Haid

stability, prevents rod migration, and inhibits lateral shift of the instrumentation. 13, 15, 26 Instrument Failure Like other spinal instrumentation, pedicle screw systems are susceptible to eventual failure because of heavy loads and repetitive stresses placed upon the instrumentation. 5, 13 Due to the lumbar lordosis, the screws are subjected to large cantilever bending forces that can cause screws to break or bend. 13–15, 21, 26, 29, 36–39, 41 Since metal fatigues and can break, instrumentation must be viewed as a temporary measure for internal fixation

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Donald D. Dietze Jr., Richard G. Fessler and R. Patrick Jacob

and rectal muscular tone. The patient's preoperative erythrocyte sedimentation rate was 120 mm/hour. Radiological studies showed L3–4 disc space destruction with adjacent vertebral body destruction and loss of lumbar lordosis with mild left-sided spondylolisthesis ( Fig. 1A ). Magnetic resonance (MR) imaging showed osteomyelitic changes in the L-3 and L-4 vertebrae with associated ventral epidural and noncontiguous dorsal epidural abscesses ( Fig. 1B ). Emergency left-sided retroperitoneal L3–4 discectomy and complete L-3 and partial L-4 corpectomy were performed

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Nader S. Dahdaleh, Albert P. Wong, Zachary A. Smith, Ricky H. Wong, Sandi K. Lam and Richard G. Fessler

hospitalization time. 3 We have used a minimally invasive technique to treat certain cases of cervical spondylotic myelopathy. The patients are primarily those who have acceptable preoperative effective cervical lordosis, 6 whose preoperative flexion-extension radiographs do not indicate abnormal motion, and whose radiographs do not show segmental listhesis. The technique involves a unilateral paramedian approach through small incisions, with minimal muscle dissection, through which decompressive single or multilevel bilateral hemilaminotomies are achieved with total

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Nader S. Dahdaleh, Alexander T. Nixon, Cort D. Lawton, Albert P. Wong, Zachary A. Smith and Richard G. Fessler

Instrumentation (16 pts) p Value postop VAS-BP 2.1 ± 2.1 2.6 ± 2.4 0.5 postop VAS-LP 2.1 ± 2.8 2.6 ± 3.0 0.6 postop ODI 17.9 ± 18.7 22.7 ± 17.3 0.4 postop SF36-P 44.8 ± 10.8 41.8 ± 8.4 0.4 postop SF36-M 44.2 ± 10.9 53.9 ± 10.2 0.1 * Values represent mean scores ± SDs unless otherwise indicated. Radiographic Outcomes The preoperative segmental lordosis was −13.7º in the bilateral instrumentation group and −9.3º in the unilateral instrumentation group. Following surgery the segmental lordosis did not change

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Omar M. Uddin, Raqeeb Haque, Patrick A. Sugrue, Yousef M. Ahmed, Tarek Y. El Ahmadieh, Joel M. Press, Tyler Koski and Richard G. Fessler

traditional open surgery through a posterior midline approach. One neurosurgeon (R.F.) operated on all of the patients in the MIS cohort and another neurosurgeon (T.K.) operated on all of the patients in the Open cohort. The cohorts were matched for age, body mass index (BMI), comorbidities, prior spine surgeries, preoperative sagittal vertical axis (SVA), and preoperative lumbar lordosis. Exclusion criteria included workers’ compensation cases, patients receiving disability insurance, and thoracic-level disease. Costs Cost data were obtained from the Northwestern

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Patrick C. Hsieh, Tyler R. Koski, Daniel M. Sciubba, Dave J. Moller, Brian A. O'shaughnessy, Khan W. Li, Ziya L. Gokaslan, Stephen L. Ondra, Richard G. Fessler, and John C. Liu

. Moreover, SPOs can be performed through minimal-access retractors with decreased disruption of normal soft tissues. With the latest percutaneous instrumentation technologies, safe closure of osteotomies can be performed to increase segmental lordosis and to allow apposition of osseous surfaces for subsequent fusion. Illustrative Case Case 3 This 61-year-old woman with a history of adolescent idiopathic scoliosis had been monitored for her spinal deformity for many years ( Fig. 6 ). Over the last few years, she experienced late progression of the adolescent

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Paul Park, Kai-Ming Fu, Robert K. Eastlack, Stacie Tran, Gregory M. Mundis Jr., Juan S. Uribe, Michael Y. Wang, Khoi D. Than, David O. Okonkwo, Adam S. Kanter, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Dean Chou, Mark E. Oppenlander, Praveen V. Mummaneni and the International Spine Study Group

I n the surgical treatment of symptomatic adult spinal deformity (ASD), spinopelvic alignment is considered an important factor in achieving a successful result. Specifically, several parameters, including pelvic tilt (PT), pelvic incidence to lumbar lordosis (PI-LL) mismatch, and sagittal vertical axis (SVA), have been correlated with clinical outcomes. It has been proposed that optimal spinopelvic alignment goals should consist of a PT < 20°, a PI-LL mismatch ± 9°, and an SVA < 50 mm. 9 Based predominantly on correlation studies, it has been presumed that

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Praveen V. Mummaneni, Christopher I. Shaffrey, Lawrence G. Lenke, Paul Park, Michael Y. Wang, Frank La Marca, Justin S. Smith, Gregory M. Mundis Jr., David O. Okonkwo, Bertrand Moal, Richard G. Fessler, Neel Anand, Juan S. Uribe, Adam S. Kanter, Behrooz Akbarnia and Kai-Ming G. Fu

published in journals and book chapters. 7 , 8 , 13 , 16 , 17 Images included posterior/anterior and lateral scoliosis radiographs as well as select MRI views. A short history of symptoms and the measured radiographic parameters (coronal Cobb angle, pelvic tilt [PT], lumbar lordosis/pelvic incidence [LL-PI] mismatch, and sagittal vertebral axis [SVA]) were provided for each case. Responses were collected and tabulated. After a minimum interval of 2 months, the cases were re-sent to the participating surgeons to be reread. Complete evaluations were obtained for both

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Albert P. Wong, Zachary A. Smith, Alexander T. Nixon, Cort D. Lawton, Nader S. Dahdaleh, Ricky H. Wong, Brenda Auffinger, Sandi Lam, John K. Song, John C. Liu, Tyler R. Koski and Richard G. Fessler

. References 1 Anand N , Hamilton JF , Perri B , Miraliakbar H , Goldstein T : Cantilever TLIF with structural allograft and RhBMP2 for correction and maintenance of segmental sagittal lordosis: long-term clinical, radiographic, and functional outcome . Spine (Phila Pa 1976) 31 : E748 – E753 , 2006 2 Archavlis E , Carvi y Nievas M : Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis . Eur Spine J 22 : 1731 – 1740 , 2013 3 Deutsch

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Raqeeb M. Haque, Gregory M. Mundis Jr., Yousef Ahmed, Tarek Y. El Ahmadieh, Michael Y. Wang, Praveen V. Mummaneni, Juan S. Uribe, David O. Okonkwo, Robert K. Eastlack, Neel Anand, Adam S. Kanter, Frank La Marca, Behrooz A. Akbarnia, Paul Park, Virginie Lafage, Jamie S. Terran, Christopher I. Shaffrey, Eric Klineberg, Vedat Deviren and Richard G. Fessler

-screw fixation and spinal fusion, and facet osteotomies if needed. Finally, patients in the open group underwent a traditional open posterior spinal fusion with instrumentation with or without osteotomies. Radiographic Outcome Assessment The following spinal parameters were assessed: 1) lumbar major Cobb angle, 2) lumbar lordosis (measured from T12 to S1), 3) pelvic incidence minus lumbar lordosis (PI−LL), 4) sagittal vertical axis (SVA), defined as the offset from the C-7 plumb line to the posterosuperior corner of S-1, and 5) pelvic tilt, the angle subtended by a