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Darryl Lau and Dean Chou

percutaneous instrumentation compared with open instrumented fusion. In this study, all corpectomies were performed in the thoracic spine, and the majority of instrumentation involved the thoracic spine and thoracolumbar junction. Compared with the lumbar spine, the thoracic spine intrinsically has less motion and increases stability due to rib cage support and less facet cartilage. This could result in auto-arthrodesis of the facets after instrumentation. Alternatively, it may be that the thoracic spine is naturally at lower risk of implant failure due to less normal motion

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Darryl Lau and Dean Chou

, Denaro L , Barnaba SA , Papalia R , Santini D , : ‘Internal bracing' surgery in the management of solid tumor metastases of the thoracic and lumbar spine . Oncol Rep 21 : 431 – 435 , 2009 19 Fang T , Dong J , Zhou X , McGuire RA Jr , Li X : Comparison of mini-open anterior corpectomy and posterior total en bloc spondylectomy for solitary metastases of the thoracolumbar spine . J Neurosurg Spine 17 : 271 – 279 , 2012 20 Gokaslan ZL , York JE , Walsh GL , McCutcheon IE , Lang FF , Putnam JB Jr

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Daniel C. Lu, Darryl Lau, Jasmine G. Lee and Dean Chou

T-11), rib removal, and diaphragm split to access the upper lumbar spine. The third was a retroperitoneal approach over the lumbar spine without entering the chest cavity. In all patients with pleural cavity violation we placed routine postoperative chest tubes. Rib Head and Expandable Cages in Transpedicular Corpectomies All transpedicular corpectomies were performed with the rib heads intact. To place expandable cages from a transpedicular approach, the rib heads were managed in 1 of 3 ways. One method was the trap-door rib-head osteotomy, another was a

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John E. Ziewacz, Darryl Lau, Frank La Marca and Paul Park

from the thigh, retroperitoneal space, or knee. Three patients (38%) were unable to ambulate prior to surgery. Metastases occurred in the thoracic spine in 6 patients (75%) and in the lumbar spine in 2 (25%). The specific surgical procedure performed varied for each patient, ranging from aggressive procedures, such as vertebrectomy with anterior and posterior instrumentation, to laminectomy for resection of epidural tumor ( Figs. 1 and 2 ). In all cases, tumor resection was intralesional. While the goal was maximal tumor resection, residual disease was likely

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Darryl Lau, Mitchel S. Berger, Dhruv Khullar and John Maa

inappropriate connective tissue deposition at the surgical site, delayed wound healing, and increased risks of wound infection. 53 , 107 Intraoperative Blood Loss In the neurosurgical literature, 2 retrospective clinical studies suggest that active smokers tend to have higher intraoperative blood loss following craniotomy for tumor resection and lumbar spine surgery. 20 , 53 The exact underlying mechanism has yet to be defined. In the literature regarding craniotomy for tumor resection, there is evidence that cigarette smoking can lead to an acute hyperemia response

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Ramin A. Morshed, Darryl Lau, Peter P. Sun and Lauren R. Ostling

ventricle CPP Lesions in cerebellar tonsils & obex, both cavernous sinuses, & spinal region w/ lesions by cervical cord down to sacral region Intrathecal Ara-C w/ systemic cisplatin, bleomycin, & vincristine 6 yrs Died ∼6 yrs after 1st presentation (2 mos after biopsy of cervical lesion) Kaptanoglu et al., 2007 51, F CPP 4th ventricle CPP L4–5 lesion Lumbar lesion resected 7 yrs At 1 yr, neurologically intact & pain free Akil et al., 2008 74, M CPP (WHO Grade I) 4th ventricle Not available Multiple thoracic & lumbar spine lesions Only 4th ventricular lesion resected

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Darryl Lau, Andrew K. Chan, Vedat Deverin and Christopher P. Ames

same-level anterior lumbar spine revisions. 23 The reported complication rates in revision cases are 3–5 times higher than in primary cases. In revision cases, reoperation of the same level is associated with a much higher incidence of vein lacerations due to scarring (23.7% vs 3.6%). When counseling patients who have undergone prior surgery, it is important to take into account the specific procedure being performed. Our study has limitations because of its retrospective design and the presence of small sample sizes in particular subgroups. Retrospective studies

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Cecilia L. Dalle Ore, Christopher P. Ames, Vedat Deviren and Darryl Lau

such as atlantoaxial subluxation, cranial settling, and subaxial subluxation. 12 Lumbar involvement in RA is less well characterized; however, prior imaging-based studies have found that a majority of patients with RA also have lumbar spine abnormalities. 14 Historically, the literature has predominantly reported outcomes and complications regarding cervical spine surgery in RA patients. 29 Series of lumbar surgical outcomes in RA patients suggest an elevated incidence of complications in patients with RA compared to similar interventions in patients without RA, 5

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Darryl Lau, Joseph A. Osorio, Vedat Deviren and Christopher P. Ames

single-level PSO can result in greater than 35° of sagittal plane correction when performed in the middle to lower lumbar spine. 18 The main drawbacks to performing 3-column osteotomies are the high risk for significant blood loss, perioperative morbidity (with major complication rates around 35%), and risk for spinal cord injury or nerve root compression at osteotomy sites. 5 , 6 , 41 Nonetheless, over the past 5–10 years the technique has been refined and has been used more frequently for the correction of fixed spinal deformities. Even in older patients, spinal

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Darryl Lau, Dean Chou, John E. Ziewacz and Praveen V. Mummaneni

spine surgery evaluated long-term outcomes and fusion rates, and only a few studies evaluated perioperative outcomes. 7 , 11 , 18 , 23 , 28 , 34 Dean et al. performed a retrospective study of 500 patients who underwent lumbar spine surgery and demonstrated with linear regression that smokers had significantly greater mean EBL per decompressed level (97 vs 137 ml) and mean EBL per fused level (162 vs 221 ml). 5 A similar phenomenon was also observed among smokers who underwent craniotomy for tumor resection. 17 Although we did not demonstrate statistically