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Claudio De Tommasi, Mary Lee Vance, David O. Okonkwo, Alfa Diallo and Edward R. Laws Jr.

remission. Despite the large size of these tumors, the transsphenoidal surgical approach, especially if performed using modern techniques, still represents the best treatment to reach the goals of gross-total removal of the tumor and relief of mass effect. From a clinical viewpoint, symptoms typical of CD were present in the majority of the patients in our study and included physical (weight gain, central fat deposition, hirsutism, purple striae, and so forth) and often psychological symptoms. Documented visual loss occurred in 13.5% of the patients with macroadenoma

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

has less effect on pulmonary function than thoracotomy in scoliosis surgery. 53 A recent review by Upasani and Newton 120 eloquently summarized the recent advances in thoracoscopic surgery for idiopathic scoliosis. Sucato and associates 112 have demonstrated promising results using rhBMP-2 in thoracoscopic-assisted anterior spinal fusion in a porcine model. This surgical approach is most applicable to single structural curves. These early innovations will hopefully lead to improved surgical outcomes and decreased morbidity. Posterior Thoracolumbar Minimally

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Lateral lumbar interbody fusion in the elderly: a 10-year experience

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

Nitin Agarwal, Andrew Faramand, Nima Alan, Zachary J. Tempel, D. Kojo Hamilton, David O. Okonkwo and Adam S. Kanter

patients undergoing minimally invasive spine surgery using various surgical approaches. 1 They reported a mean blood loss of 43 ml and a length of hospital stay of 1.7 days. It is worth noting, however, that all patients in their cohort underwent single-level intervention and that the majority of their patients underwent intralaminar decompression and fusion. In this cohort, no statistically significant correlation was observed between the number of levels and the EBL. Rodgers et al. reported outcomes in patients over the age of 80 years who underwent either open PLIF

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Matthew J. Tormenti, Matthew B. Maserati, Christopher M. Bonfield, Peter C. Gerszten, John J. Moossy, Adam S. Kanter, Richard M. Spiro and David O. Okonkwo

F irst described by Harms and Rolinger 13 in 1982, TLIF has become extensively used in the treatment of degenerative spine disease. The advantages of the transforaminal approach have been extensively described in the spine literature. Cloward's 6 PLIF procedure improved on the ALIF by permitting the performance of circumferential arthrodesis through a single surgical approach. However, the PLIF procedure involves placement of bilateral interbody spacers while the dura mater is retracted medially. Notable advantages of the TLIF procedure include the

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Nitin Agarwal, Prateek Agarwal, Ashley Querry, Anna Mazurkiewicz, Zachary J. Tempel, Robert M. Friedlander, Peter C. Gerszten, D. Kojo Hamilton, David O. Okonkwo and Adam S. Kanter

cohort (3.0%), which may indicate differences in case complexity, surgical approach, or patient comorbidities. These factors may have also changed differently over time in the protocol and control cohorts, which further limits comparison of the two groups. Therefore, future randomized controlled experiments within spine surgery might be performed to control for confounding variables and determine the isolated effect of an infection prevention bundle and physician awareness on postoperative SSI rates. Future studies would also benefit from data on speciation of isolated

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The comprehensive anatomical spinal osteotomy and anterior column realignment classification

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

Juan S. Uribe, Frank Schwab, Gregory M. Mundis Jr., David S. Xu, Jacob Januszewski, Adam S. Kanter, David O. Okonkwo, Serena S. Hu, Deviren Vedat, Robert Eastlack, Pedro Berjano and Praveen V. Mummaneni

. Methods Supplemental ACR Classification We divided the possible combinations of ACR with posterior column osteotomies (PCOs) into 6 anatomical grades of anterior column realignment ( Fig. 1 ), each with a concurrent form of PCO according to the well-established Schwab osteotomy classification. Increasing grades of ACR denote a greater extent of posterior column resection. Likewise, an increasing grade reflects more destabilization and potential for segmental lordosis correction ( Fig. 1 ). Furthermore, surgical approach modifiers are added to describe anterior only

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Praveen V. Mummaneni, Christopher I. Shaffrey, Lawrence G. Lenke, Paul Park, Michael Y. Wang, Frank La Marca, Justin S. Smith, Gregory M. Mundis Jr., David O. Okonkwo, Bertrand Moal, Richard G. Fessler, Neel Anand, Juan S. Uribe, Adam S. Kanter, Behrooz Akbarnia and Kai-Ming G. Fu

W ith the aging of the US population, adult degenerative scoliosis is increasing in incidence with significant impact on health and disability. 5 , 9–11 Surgical correction of adult degenerative scoliosis has traditionally been performed using open surgical approaches. Open spinal deformity correction surgery is associated with a large amount of intraoperative blood loss and significant complication rates. 6 A multicenter study from the International Spine Study Group reviewing 953 adult spinal deformity patients revealed a major complication rate of 7

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Khoi D. Than, Praveen V. Mummaneni, Kelly J. Bridges, Stacie Tran, Paul Park, Dean Chou, Frank La Marca, Juan S. Uribe, Todd D. Vogel, Pierce D. Nunley, Robert K. Eastlack, Neel Anand, David O. Okonkwo, Adam S. Kanter and Gregory M. Mundis Jr.

interbody fusion (TLIF) with percutaneous pedicle screw fixation. The hybrid surgery group consisted of patients who had undergone LLIF with open pedicle screw fixation. The surgical approach for each patient was determined at the discretion of the surgeon; all surgeons in this group perform both minimally invasive and hybrid spine surgeries. Data on decompressions (laminectomies, foraminotomies, etc.) and posterior column osteotomies performed were not collected, nor were data on radiation exposure. Patients who underwent 3-column osteotomy as part of their open

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Michael Y. Wang, Praveen V. Mummaneni, Kai-Ming G. Fu, Neel Anand, David O. Okonkwo, Adam S. Kanter, Frank La Marca, Richard Fessler, Juan Uribe, Christopher I. Shaffrey, Virginie Lafage, Raqeeb M. Haque, Vedat Deviren and Gregory M. Mundis Jr.

a study of this size would not allow for a meaningful analysis of center effects. Similarly, the selection process for the surgical procedure was uncontrolled. Factors such as a scoliotic curve's flexibility in the coronal plane were not assessed in this study, and this probably has a significant impact on the surgeon's choice of approach. Thus, the ability to correct a patient's Cobb angle is the result of multiple factors, only one of which is the surgical approach taken. Finally, the number of cases in the stand-alone group was limited to only 7 patients

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Paul Park, Michael Y. Wang, Virginie Lafage, Stacie Nguyen, John Ziewacz, David O. Okonkwo, Juan S. Uribe, Robert K. Eastlack, Neel Anand, Raqeeb Haque, Richard G. Fessler, Adam S. Kanter, Vedat Deviren, Frank La Marca, Justin S. Smith, Christopher I. Shaffrey, Gregory M. Mundis Jr. and Praveen V. Mummaneni

combination of techniques reported for the treatment of ASD. In some studies, a combination of MIS approaches has been used. Alternatively, a hybrid (HYB) surgical approach involving a combination of open and MIS approaches has also been used. It is unclear which method is best, or whether the ideal surgical approach should be individualized to the patient. In this multicenter study, 2 different MIS approaches to ASD are compared, with evaluation of both radiographic and clinical outcomes. The primary aim of this cohort study was to determine the degree of radiographic