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Darryl Lau, Ethan A. Winkler, Khoi D. Than, Dean Chou and Praveen V. Mummaneni

assess whether LPSF allows for greater neck pain relief when compared with laminoplasty for multilevel CSM in cohorts of patients with similar postoperative cervical lordosis. This study compared perioperative and follow-up outcomes of patients with matched cervical sagittal alignment who had undergone either laminoplasty or LPSF. The analysis of neck pain outcomes takes into consideration the presence of preoperative pain via subgroup analysis. Additionally, we attempted to define the relationship between cervical sagittal curvatures and neck pain outcomes. Methods

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Michael Y. Wang and Praveen V. Mummaneni

(radiculopathic) and axial back pain by patient self-report. Radiographic parameters included preoperative and postoperative Cobb angles to assess sagittal and coronal plane deformity correction based on standing 36-inch radiographs. The sagittal alignment was obtained between the T-11 or T-12 and the S-1 endplates. Fusion status was assessed using fine-slice helical CT scans as determined by attending neuroradiologists. All data were collected with institutional review board approval. Surgical Technique All patients underwent combined anterior-posterior surgery in a

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Darryl Lau, Dean Chou and Praveen V. Mummaneni

Japanese Orthopaedic Association score and pain). Following these 2 studies, Park et al. performed a large retrospective review of prospectively collected data comparing outcomes of 52 patients who underwent 1-level ACCF versus 45 patients who underwent 2-level ACDF for CSM. 19 Their findings after at least 1 year of follow-up suggested that the 2 procedures yielded comparable results in terms of sagittal alignment, cervical lordosis, graft subsidence, and adjacent-level ossification. Taken together, it seems from these studies that 2-level ACDF was associated with less

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Praveen V. Mummaneni, Sanjay S. Dhall, Gerald E. Rodts and Regis W. Haid

fixated the cervical spine with posterior screw-rod augmentation. Sasso and Mummaneni 32 recently described a cervical osteotomy technique for correction of a midcervical chinon-chest kyphosis using a cervical pedicle subtraction osteotomy with anterior release (discectomy or corpectomy) and removal of the midcervical transverse foramen (to avoid vertebral artery kinking with midcervical reduction). These techniques have not only allowed for correction of sagittal alignment, but more importantly, have enabled improved functional outcomes in patients with severely

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Darryl Lau, John E. Ziewacz, Hai Le, Rishi Wadhwa and Praveen V. Mummaneni

N ormal cervical lordosis is becoming well recognized as a critical component in maintaining normal sagittal alignment and sagittal balance. 28 When the normal cervical curvature is reversed and cervical kyphosis is present, patients may have pain symptomatology. 2 Cervical kyphosis has been shown to contribute to the pathogenesis of spinal cord injury and myelopathy through direct ventral pressure and flattening of the spinal cord. 17 , 37 , 40 Therefore, addressing cervical kyphosis is critical in improving functional status and mitigating potential

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Fred C. Lam, Adam S. Kanter, David O. Okonkwo, James W. Ogilvie and Praveen V. Mummaneni

colleagues 13 , 14 first reported the use of carbon fiber cages in PLIF. 118 Hoshijima et al. 48 and Eck and associates 34 reported their experiences with titanium mesh cages in PLIF and ALIF surgery, respectively, with reasonable fusion rates and maintenance of lordosis in the latter 1990s. In 2002, Lenke and Bridwell 63 reviewed their experience with the use of mesh cages in the treatment of 130 patients with AIS and reported adequate sagittal alignment and an acceptable pseudarthrosis rate. Equal efficacy was reported in the adult population by Eck et al. 35 in

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Adam S. Kanter, David S. Bradford, David O. Okonkwo, Setti S. Rengachary and Praveen V. Mummaneni

in place of Dwyer's cables and placing the screws more posteriorly to enhance de-rotation and reduce kyphosis. This strategy provided more durable fixation with spinal de-rotation and fewer fixed segments and therefore fewer flat backs, ultimately leading to superior sagittal alignment as well. 41 Early enthusiasm was once again blunted by criticism as long-term results revealed pseudarthrosis and hardware failure rates of 23%, likely due to the limited durability of a single rod system. Hall attempted to strengthen the fusion construct by modifying Moe's facet

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Praveen V. Mummaneni, J. Kenneth Burkus, Regis W. Haid, Vincent C. Traynelis and Thomas A. Zdeblick

rates. Discussion During the last few decades, spine surgeons have treated symptomatic cervical disc herniations with either a posterior foraminotomy or an ACDF. The focus of research has been on improving fusion rates, minimizing bone graft harvesting morbidity, and restoring anatomical DSH and sagittal-plane contours. Spinal implants have improved the fusion rates, reduced postoperative immobilization, improved overall sagittal alignment, and, most importantly, improved patient outcomes and satisfaction. 5 , 7 , 23 , 35 Although fusion is often beneficial

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Gurpreet Gandhoke, Jau-Ching Wu, Nathan C. Rowland, Scott A. Meyer, Camilla Gupta and Praveen V. Mummaneni

3 Cabraja M , Abbushi A , Koeppen D , Kroppenstedt S , Woiciechowsky C : Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome . Neurosurg Focus 28 : 3 E15 , 2010 4 Chagas H , Domingues F , Aversa A , Vidal Fonseca AL , de Souza JM : Cervical spondylotic myelopathy: 10 years of prospective outcome analysis of anterior decompression and fusion . Surg Neurol 64 : Suppl 1 S1:30 – S1:36 , 2005 5 Chiles BW III , Leonard MA

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Dominic Amara, Praveen V. Mummaneni, Christopher P. Ames, Bobby Tay, Vedat Deviren, Shane Burch, Sigurd H. Berven and Dean Chou

(PI), pelvic tilt (PT), lumbar lordosis (LL), pelvic incidence–lumbar lordosis (PI-LL) mismatch, sagittal vertical axis (SVA), coronal vertical axis (CVA), and major curve magnitude. The proportion of patients with sagittal alignment and sagittal malalignment in each of the three groups was noted as well. Patients were considered to be well aligned if their SVA was < 5 cm, their PT was < 20°, and the difference between their PI and LL was < 10°. FIG. 2. Illustrations showing FC-only fusion (L4–S1, A ), sacrum to lower thoracic fusion (T10, B ) and sacrum to upper