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The effect of C2–3 disc angle on postoperative adverse events in cervical spondylotic myelopathy

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Bryan S. Lee, Kevin M. Walsh, Daniel Lubelski, Konrad D. Knusel, Michael P. Steinmetz, Thomas E. Mroz, Richard P. Schlenk, Iain H. Kalfas and Edward C. Benzel

segment disease (symptomatic adjacent segment degeneration with radiculopathy or myelopathy). Descriptive statistics were based on the preoperative and postoperative sagittal alignment as determined by the following independent variables: C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), C2–3 disc angle, and T1 slope. Radiographic angles were measured in a blinded fashion by chief and senior neurosurgery residents at the time of the data collection (B.S.L., K.M.W.). All radiographs were acquired in the standard fashion with the patient in the upright, standing

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Daniel Lubelski, Andrew T. Healy, Prasath Mageswaran, Robb Colbrunn and Richard P. Schlenk

L ateral mass fixation stabilizes the cervical spine with minimal morbidity and high fusion rates. 9 , 12 , 13 In the setting of multilevel cervical spondylotic myelopathy, cervical decompression and instrumented fusion can reduce pain, prevent progression of myelopathy, and improve sagittal alignment. 16 Although clinical studies with long-term follow-up are lacking, 6% of patients who have undergone posterior cervical fusion develop worsening kyphosis or symptomatic adjacent-segment disease. 10 , 19 , 23 Biomechanically, lateral mass fixation constructs

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Daniel Lubelski, William E. McCormick, Lisa Ferrara, Edward C. Benzel and Mark Kayanja

T he use of anterior plating for long (multilevel) cervical fusion has become widely accepted for cervical pathologies. It is believed to increase stability and fusion rate, maintain sagittal alignment, and decrease the duration of and/or requirement for immobilization. 8 , 14 , 18 Complications such as pseudarthrosis, plate/screw fracture, loss of alignment, and progressive kyphotic deformity can lead to early fusion failures. 8 , 16 Since the development and use of the early rigid cervical plate designs, advances in cervical plating technology have

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examined include presence of interbody fusion, rod diameter, rod material, age and preop sagittal alignment. Methods: A retrospective review of a multicenter, prospective ASD database was conducted. Inclusion criteria: age=18yr, ASD, no revisions between >6wk and <2yrs postop. Spinal pelvic parameters, thoracic kyphosis (TK:T2-T12) and lumbar lordosis (LL:L1-S1) were measured overall and within and outside of the instrumented segments. Changes for SVA, PT, PI-LL, TK, and LL between 6wks-2yrs postop were calculated. Of these pts, the amount of thoracic loss and TL

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surveys than NONOP (p<0.05). OP and NONOP had similar coronal alignment (p<0.05). OP had worse sagittal spinopelvic alignment for all measures than NONOP except cervical lordosis, TK and pelvic incidence (PI). OP had greater percentage of pure sagittal classification (type S; OP=23%, NON=14%; p<0.05). OP had worse grades for all modifier categories: PT (26% vs 16%), PI-lumbar lordosis mismatch (37% vs 21%) and global sagittal alignment (29% vs 9%), OP vs NONOP, respectively (p<0.05). Conclusion: Prospective analysis of OP vs NONOP treated ASD patients demonstrated

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-0684 American Association of Neurological Surgeons 10.3171/2017.3.FOC-DSPNabstracts 2017.3.FOC-DSPNABSTRACTS Charles Kuntz Scholar Award Presentations (Abstracts 104–123) 119. Laminoplasty vs. Laminectomy-Fusion for the Treatment of Cervical Myelopathy: Preliminary Results from the CSM-Study Comparing Cervical Sagittal Alignment and Clinical Outcomes Vijay Ravindra , MD, MSPH , Jill Curran , MS , Praveen V. Mummaneni , MD , Adam S. Kanter , MD , Erica Fay Bisson , MD, MPH , Robert F. Heary , MD

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thoracolumbar spine describes a subset of fractures with posterior ligamentous complex disruption in response to a flexion and distraction moment imparted to the thoracolumbar spine. These injuries are mechanically and neurologically unstable and surgical stabilization is frequently necessary to prevent neurological deterioration and maintain sagittal alignment. Conventionally, open posterior fixation and fusion have been utilized as the standard surgical treatment. Recently, percutaneous techniques with pedicle screws insertion are becoming popular as they provide

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Background/Introduction: Transforaminal lumbar interbody fusion (TLIF) has become a popular surgical option to complement posterolateral fusion (PLF) for treatment of degenerative spinal conditions. Purported advantages of TLIF over PLF alone include enhanced fusion rates, improved sagittal alignment, and direct decompression of the neuroforamen. Earlier studies have examined these issues and yielded inconclusive results. Another often suggested advantage, that TLIF provides superior immediate stability and protects against early pedicle screw loosening, has never been

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30; p<0.001). Conclusions The addition of PPI seems to have a protective effect on the development of PJK. The analysis controlled for preoperative sagittal alignment as well as for correction of PI-LL. HYB was effective in restoring sagittal global alignment and cMIS in maintaining it. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2014.3.FOC-DSPNABSTRACTS Abstract Mayfield Clinical Science 243. Microendoscopic Decompression for Cervical Spondylotic Myelopathy

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deformation of non-operative spine fractures and identify predictive variables of angular change. Summary of Background Data Loss of normal sagittal alignment of the spine is a common sequela following thoracolumbar injuries. Patients treated non-operatively are especially at risk; however knowledge of the natural history of these injuries and predictors of deformation over time remains limited. Methods Patients with thoracolumbar fractures were identified via a trauma database. The angular change about the fracture site was determined comparing initial CT