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Kalil G. Abdullah, Daniel Lubelski, Paolo G. P. Nucifora and Steven Brem

D iffusion tensor imaging is a form of diffusion-weighted MRI that assesses physiological water directionality and motion, providing images of important white matter tracts within the CNS. 25 Conventional MRI techniques provide purely anatomical information without data regarding CNS connectivity. The ability to visualize important white matter tracts in the brain enables neurosurgeons to better guide their surgical approach and resection. Below, we provide a primer on the biophysical basis of DTI, review the current state of the literature on the use of

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Matthew D. Alvin, Daniel Lubelski, Edward C. Benzel and Thomas E. Mroz

selection of the optimal surgical approach. Decision-making algorithms have also been suggested based on the location of the stenosis and alignment of the cervical spine. 11 This review presents the state of the literature regarding the comparative effectiveness of ventral multilevel discectomy and fusion as opposed to dorsal fusion surgery for treating CSM. We summarize the recent studies comparing the 2 procedures based on QOL outcomes, postoperative complication profiles, and cost-effectiveness. This review seeks to provide a comprehensive guide to the published

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Yumeng Li, Daniel Lubelski, Kalil G. Abdullah, Thomas E. Mroz and Michael P. Steinmetz

a larger clinical series in which this surgical technique was used. The diagnostic evaluation, surgical approach, and outcomes are described. Additionally, a decision-making algorithm is proposed to guide the surgeon in the evaluation of back pain concurrent with LSTV. Methods The electronic medical records were queried for all patients between 2007 and 2011 who underwent surgery performed by the senior author (M.P.S.) for symptoms related to Bertolotti's syndrome. Patient charts were retrospectively reviewed. Data collected included demographic information

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Surgical management of giant presacral schwannoma: systematic review of published cases and meta-analysis

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Zach Pennington, Erick M. Westbroek, A. Karim Ahmed, Ethan Cottrill, Daniel Lubelski, Matthew L. Goodwin and Daniel M. Sciubba

presacral schwannoma, and 2) perform a meta-analysis to look for significant differences in local recurrence, estimated blood loss (EBL), and complication rates as a function of both surgical approach and extent of resection (EOR). The main questions we sought to address were: 1) what are the most common presenting symptoms of giant presacral schwannoma; 2) does en bloc resection provide superior recurrence-free survival relative to piecemeal gross-total (GTR) or subtotal resection (STR); 3) do complication rates differ among the available surgical approaches; and 4) does

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Daniel Lubelski, Matthew D. Alvin, Sergiy Nesterenko, Swetha J. Sundar, Nicolas R. Thompson, Edward C. Benzel and Thomas E. Mroz

commonly considered to be within the standard of care. Much discussion has revolved around the comparative advantages of the ventral versus dorsal approaches, each with their own unique complication profile and relative advantages and disadvantages. Very few retrospective and small prospective cohort studies have been published evaluating the different surgical approaches for CSM. 1 Most have shown no statistically significant differences in quality of life (QOL) outcomes before and after surgery. One of the limitations of these studies, however, is their

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Benjamin D. Kuhns, Daniel Lubelski, Matthew D. Alvin, Jason S. Taub, Matthew J. McGirt, Edward C. Benzel and Thomas E. Mroz

, additional imaging and laboratory tests, and culture-directed parenteral antibiotic therapy. 2 , 15 The dorsal surgical approach to the cervical spine has a 4.5%–9% postoperative infection rate compared with a 0%–1% rate associated with a ventral approach. 3 , 7 , 17 , 21 Whereas preoperative risk factors for postoperative cervical infections (including smoking, diabetes, and intraoperative blood loss) have been investigated, few studies have assessed the quality of life (QOL) and hospital costs associated with these infections. 24 , 33 Quantifying cost and QOL

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Roy Xiao, Jacob A. Miller, Navin C. Sabharwal, Daniel Lubelski, Vincent J. Alentado, Andrew T. Healy, Thomas E. Mroz and Edward C. Benzel


Improvements in imaging technology have steadily advanced surgical approaches. Within the field of spine surgery, assistance from the O-arm Multidimensional Surgical Imaging System has been established to yield superior accuracy of pedicle screw insertion compared with freehand and fluoroscopic approaches. Despite this evidence, no studies have investigated the clinical relevance associated with increased accuracy. Accordingly, the objective of this study was to investigate the clinical outcomes following thoracolumbar spinal fusion associated with O-arm–assisted navigation. The authors hypothesized that increased accuracy achieved with O-arm–assisted navigation decreases the rate of reoperation secondary to reduced hardware failure and screw misplacement.


A consecutive retrospective review of all patients who underwent open thoracolumbar spinal fusion at a single tertiary-care institution between December 2012 and December 2014 was conducted. Outcomes assessed included operative time, length of hospital stay, and rates of readmission and reoperation. Mixed-effects Cox proportional hazards modeling, with surgeon as a random effect, was used to investigate the association between O-arm–assisted navigation and postoperative outcomes.


Among 1208 procedures, 614 were performed with O-arm–assisted navigation, 356 using freehand techniques, and 238 using fluoroscopic guidance. The most common indication for surgery was spondylolisthesis (56.2%), and most patients underwent a posterolateral fusion only (59.4%). Although O-arm procedures involved more vertebral levels compared with the combined freehand/fluoroscopy cohort (4.79 vs 4.26 vertebral levels; p < 0.01), no significant differences in operative time were observed (4.40 vs 4.30 hours; p = 0.38). Patients who underwent an O-arm procedure experienced shorter hospital stays (4.72 vs 5.43 days; p < 0.01). O-arm–assisted navigation trended toward predicting decreased risk of spine-related readmission (0.8% vs 2.2%, risk ratio [RR] 0.37; p = 0.05) and overall readmissions (4.9% vs 7.4%, RR 0.66; p = 0.07). The O-arm was significantly associated with decreased risk of reoperation for hardware failure (2.9% vs 5.9%, RR 0.50; p = 0.01), screw misplacement (1.6% vs 4.2%, RR 0.39; p < 0.01), and all-cause reoperation (5.2% vs 10.9%, RR 0.48; p < 0.01). Mixed-effects Cox proportional hazards modeling revealed that O-arm–assisted navigation was a significant predictor of decreased risk of reoperation (HR 0.49; p < 0.01). The protective effect of O-arm–assisted navigation against reoperation was durable in subset analysis of procedures involving < 5 vertebral levels (HR 0.44; p = 0.01) and ≥ 5 levels (HR 0.48; p = 0.03). Further subset analysis demonstrated that O-arm–assisted navigation predicted decreased risk of reoperation among patients undergoing posterolateral fusion only (HR 0.39; p < 0.01) and anterior lumbar interbody fusion (HR 0.22; p = 0.03), but not posterior/transforaminal lumbar interbody fusion.


To the authors' knowledge, the present study is the first to investigate clinical outcomes associated with O-arm–assisted navigation following thoracolumbar spinal fusion. O-arm–assisted navigation decreased the risk of reoperation to less than half the risk associated with freehand and fluoroscopic approaches. Future randomized controlled trials to corroborate the findings of the present study are warranted.

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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

C ervical spondylotic myelopathy (CSM) is a common but frequently undiagnosed manifestation of the spinal degenerative process. The pathology involves chronic, repetitive trauma to the spinal cord. CSM is the most common etiology of acquired spinal cord dysfunction in the adult population. 6 , 7 , 31 , 34 , 36 , 43 Conservative, nonoperative management is only appropriate for mild, nonprogressive CSM, and surgical treatment is warranted for progressive, moderate to severe CSM. 9 , 28 Both ventral and dorsal surgical approaches, as well as a combination of both

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systematically distribute any published materials without written permission from JNSPG. 2013 Introduction: Interbody arthrodesis for the lumbar spine has been performed historically through open surgical approaches. Recently, there has been substantial growth in the utilization of the minimally invasive lateral approach with sparse outcomes data reported. Methods: This is a retrospective review performed with multiple surgeons from Orthopaedic and Neurosurgery backgrounds. All patients at a single institution undergoing lateral fusions from July 2008 until

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-TLIF). The purpose of this study is to compare the surgical and functional outcomes following a primary 1-level transformational lumbar interbody fusion between open and minimally invasive techniques. Methods A retrospective cohort analysis of 406 consecutive patients who underwent a primary single level MIS-TLIF for degenerative etiologies between 2008–2014 was performed utilizing a prospectively maintained registry. Patients were stratified into cohorts based upon surgical approach (open or MIS) and assessed with regards to demographics comorbidity, surgical