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Patrick C. Hsieh and Ziya L. Gokaslan

Over the past 2 decades, we have seen an exponential increase in the number of spine surgeries 3–5 as a result of an expanding elderly population and explosion of technical innovations. During the period from 1990 to 2001, there was a greater than 220% increase in the number of spine fusions performed for degenerative spine diseases. 3 In fact, the rate of spine fusion rose more rapidly in patients older than 60 years than in any other age group, 3 , 4 with a 15-fold increase in the number of complex spine surgeries for elderly patients with spinal

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Albert E. Telfeian, Anand Veeravagu, Adetokunbo A. Oyelese and Ziya L. Gokaslan

T he history of endoscopic spine surgery has involved 3 phases: inspiration, invention, and innovation. The inspired early practitioners sought a means of accessing lumbar disc herniations that would be less invasive than traditional open techniques. The early endoscopic surgeons targeted disc pathology through a corridor that would become known eponymously for its originator, Dr. Parvis Kambin. Invention would then be required to make endoscopic discectomy a feasible and then a successful procedure: better working-channel rigid endoscopes, high

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Carlos A. Bagley and Ziya L. Gokaslan

Cauda equina syndrome (CES) is defined as the constellation of symptoms that includes low-back pain, sciatica, saddle anesthesia, decreased rectal tone and perineal reflexes, bowel and bladder dysfunction, and variable amounts of lower-extremity weakness. There are several causes of this syndrome including trauma, central disc protrusion, hemorrhage, and neoplastic invasion. In this manuscript the authors reviewed CES in the setting of both primary and secondary neoplasms. They examined the various primary tumor types in this region as well as those representative of metastatic spread. Both surgical and nonsurgical management in this setting were studied.

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Wesley Hsu, Ryan M. Kretzer, Michael J. Dorsi and Ziya L. Gokaslan

W rong -site surgery is a rare occurrence that can have devastating consequences for patient care. In a survey of members of the American Academy of Neurological Surgeons performed by Mody et al., 13 50% of responding surgeons reported that they had performed at least 1 wrong-level surgery during their career. Of 418 wrong-level surgeries, 17% resulted in litigation or monetary settlement. The WSS can take many forms, including surgical intervention at the incorrect location, performing the wrong procedure on a patient, or operating on the wrong patient

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Daryl R. Fourney and Ziya L. Gokaslan

Sacral chordomas are relatively rare, locally invasive, malignant neoplasms. Although metastasis is infrequent at presentation, the prognosis for patients with chordoma of the sacrum is reported to be poor and attributable in most cases to intralesional resection. The value of adjuvant treatment is uncertain, and resection remains the primary mode of treatment. Chordomas are difficult to excise completely, but recent improvements in imaging and surgical techniques have allowed surgeons to perform more frequently en bloc sacral resections with wide surgical margins. The technical challenges of such operations, and the functional costs for the patient (with respect to anorectal and urogenital dysfunction) are significantly increased when the tumor involves high sacral levels. The authors review the clinical presentation and natural history of sacral chordoma and discuss the current treatment techniques and outcomes.

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Ziya L. Gokaslan, Albert E. Telfeian and Michael Y. Wang

A lthough the beginning of endoscopic spine surgery happened more than 40 years ago, the field today is “new” and represents the culmination of the evolution of both technology and surgical experience. Endoscopic spine surgery is defined as spine surgery performed using endoscopic visualization. Direct visualization of spine pathology requires light to travel 30–50 cm to the surgeon's eye, whether through loupe magnification, microscopic magnification, or no magnification at all. Indirect visualization of spine pathology puts the camera's eye millimeters

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Albert E. Telfeian, Gabriele P. Jasper, Adetokunbo A. Oyelese and Ziya L. Gokaslan

I ntervertebral disc herniations at the thoracolumbar junction (T12–L1, L1–2, and L2–3) make up only approximately 1%–2% of lumbar disc herniations, 4 , 10 which may be due to the decreased motion occurring at this area of the spinal column. The reported outcomes for discectomy surgery at the thoracolumbar junction are inferior to those reported in the lower lumbar spine. The worse outcomes for thoracolumbar disc surgery may be related to the anatomical features peculiar to the thoracolumbar region. The narrow space between the two partes interarticulares

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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

I ntracranial hemorrhage is an extremely rare complication of spinal surgery, with fewer than 35 individual cases reported in the literature and a proposed incidence rate of 0.8%. 6 , 11 The etiology of remote ICH remains unclear, but evidence suggests that it is caused by excessive CSF loss, which results in cerebral dehydration causing stretching and eventually tearing of the bridging veins. The postoperative hemorrhage may be classified as cerebellar hemorrhage (CBH), subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), or intraventricular

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Use of “MAPS” for determining the optimal surgical approach to metastatic disease of the thoracolumbar spine: anterior, posterior, or combined

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Daryl R. Fourney and Ziya L. Gokaslan

greater role for surgery in the treatment of metastatic spinal tumors. First, the widespread use of MR imaging has provided more accurate and potentially earlier diagnosis. 18 Second, spinal instrumentation has allowed surgeons to perform safe, effective reconstruction and stabilization of the spine after tumor resection. 15, 17 More recently, oncologically oriented surgical strategies have been used in selected cases of solitary spinal metastasis; reports of improved local control and occasional “cure” have been encouraging. 1, 5, 16, 50, 57, 58 Surgical

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The evolution of surgical management for vertebral column tumors

JNSPG 75th Anniversary Invited Review Article

Jared Fridley and Ziya L. Gokaslan

and molecular information to personalize cancer therapy, particularly for metastatic disease. While the goal of surgery for metastatic spine disease remains palliative, the typical poor prognosis given to these patients is trending toward a more optimistic outlook. With each advance, traditional prognostic scoring methods for metastatic spinal disease are becoming less accurate. Unlike metastases, most primary spine tumors continue to be treated primarily with surgery, but advances in surgical techniques that have incorporated principles from the treatment of long