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Evaluation and treatment of adult spinal deformity

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

Robert F. Heary

examination findings specific to spinal deformity should also be assessed. The patient is examined in the standing position from both an anterior and lateral vantage as well as forward bending from the waist and in the prone position. The relative heights of the iliac crests, the shoulders, and the presence or absence of a rib hump should be recorded with notation made of any discrepancies. Coronal-plane decompensation is determined by placement of the C7—gluteal plumb line. This is determined by dropping a perpendicular measuring device from C-7 and recording its location

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Robert F. Heary, Ira M. Goldstein, Katarzyna M. Getto and Nitin Agarwal

(HO) and/or spontaneous fusion after CDA with the ProDisc-C Total Disc Replacement system (Synthes Spine, Inc.), PCM (NuVasive, Inc.), Mobi-C Cervical Disc Prosthesis (LDR Spine USA, Inc.), SECURE-C Cervical Artificial Disc (Globus Medical, Inc.), and PRESTIGE Cervical Disc System (Globus Medical, Inc.). 3 , 6 , 7 , 12–14 , 16 , 22 , 24 , 27 All of the reported cases of fusion involving CDA occurred with devices that are semiconstrained. We report a case of spontaneous fusion around a nonconstrained device (DISCOVER Artificial Cervical Disc; DePuy Spine, Inc

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Robert F. Heary and Reza J. Karimi

: Adult degenerative lumbar scoliosis . Am J Orthop (Belle Mead NJ) 32 : 77 – 82 , 2003 9 Heary RF , Kumar S , Karimi RJ : Dorsal lumbar interbody fusion for chronic axial, mechanical low back pain: a modification of two established techniques . Neurosurgery 63 : 1 Suppl 1 ONS102 – ONS107 , 2008 10 Jiya T , Smit T , Deddens J , Mullender M : Posterior lumbar interbody fusion using nonresorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D,L-lactide fusion devices: a prospective, randomized study to assess fusion and

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Robert F. Heary and Christopher M. Bono

now ready to be closed. This was accomplished by using a compressor device placed on the posted screws immediately above and below. Gentle, continuous force was applied to achieve a controlled correction. The dura and neural elements must be visualized at all times during this maneuver. Although dural redundancy is inevitable at the osteotomy level, osseous impingement of the adjacent lamina borders onto the dura mater must not be left unaddressed. If needed, additional bone resection should be performed. Final inspection of the dura included probing its anterior

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Mohammed F. Shamji, Harrison J. Westwick and Robert F. Heary

achieved. Figure 1 presents an illustrative example of a patient implanted with such a device. With appropriately selected patients at centers with interdisciplinary expertise, the trial-to-implant conversion rates can be quite encouraging: in the 65%–80% range for various diagnoses, 15 although from a nationwide perspective, the actual conversion rate remains less encouraging at approximately 41%. 7 FIG. 1. Anteroposterior radiograph of a patient in whom an SCS device was placed for the management of PPNP. The paddle lead is attached via extensions to an

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Paul A. Anderson, Paul M. Arnold and Robert F. Heary

, neuromonitoring, navigation, and surgical technique. Advances in the surgical arena are both technique related and device related. Minimally invasive surgical techniques have become popular in the last few years, as has the use of expandable cages that can allow ventral reconstruction from a posterior approach. Intraoperative spinal imaging and navigation have increased the accuracy of pedicle screw placement, and the direct lateral approach to the spine has allowed for the use of large interbody grafts to enhance fusion success. All of this new knowledge has been translated

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Robert F. Heary, Paul A. Anderson and Paul M. Arnold

surgeons who are constantly looking for new ways to improve outcome results for our patients. In 2002, lateral approaches to the lumbar spine for the treatment of spondylolisthesis were unheard of. Today, thanks to innovation, this approach has expanded the surgical armamentarium for many surgeons. In addition, the value of surgical registries has become increasingly recognized, and numerous papers that summarize the results from groups of practices have led to expanding the knowledge base of our constituents. The utilization of interbody devices, whether autograft bone

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Robert F. Heary, Christopher M. Bono and Margaret Black

6 : 19 – 24 , 1997 Panjabi MM, O'Holleran JD, Crisco JJ III, et al: Complexity of the thoracic spine pedicle anatomy. Eur Spine J 6: 19–24, 1997 22. Pennig D , Brug E : A target device for placement of implants in the thoracolumbar pedicles. J Bone Joint Surg Br 72 : 886 – 888 , 1990 Pennig D, Brug E: A target device for placement of implants in the thoracolumbar pedicles. J Bone Joint Surg Br 72: 886–888, 1990 23. Rodgers WB , Williams MS , Schwend RM , et al : Spinal

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Neginder Saini, Mohammad Zaidi, Maureen T. Barry and Robert F. Heary

of the posterior musculature and neural elements, better distraction of the involved vertebrae, and the ability to place a larger implant than in other approaches. 13 , 17 , 19 In addition, sagittal alignment is more easily improved with the use of large, lordotic-shaped cages placed in the lower lumbar spine. Especially for degenerative pathologies, the ALIF procedure has become a mainstay of spinal surgery; however, controversy exists regarding which surgical approach provides the best outcomes. 17–19 The stand-alone interbody cage device has been proposed as an

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Nitin Agarwal, Robert F. Heary and Prateek Agarwal

, thoracic pedicle screws have been reported to produce better biomechanical and clinical outcomes than do hooks. These benefits include thoracic and apical rotational capabilities, torsional strength, and clinical outcomes that are better than those obtained with other hybrid constructs. 6 , 15 , 34 , 36–38 , 46 , 56 On December 30, 2016, after a comprehensive review process, the FDA formally reclassified pedicle screws from class III to class II devices. This reclassification indicates recognition by the FDA that pedicle screws are a reasonable surgical alternative