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Khoi D. Than, Jill N. Curran, Daniel K. Resnick, Christopher I. Shaffrey, Zoher Ghogawala and Praveen V. Mummaneni

norm-based SF-36 6 ; and the visual analog scale (VAS) 5 for back pain, all preoperatively and at 1, 3, 6, and 12 months postoperatively. Return to work and complication assessments were completed by an independent study coordinator at each site. Complications included all major adverse events (death, myocardial infarction, pulmonary embolus, infection, cerebrospinal fluid leakage, new neurological deficit [such as foot drop], readmission, and reoperation). Delayed complications (such as reoperation, fusion complications, problems with instrumentation, and deformity

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Daniel K. Resnick, William C. Watters III, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Jason C. Eck, Alok Sharan, Michael W. Groff, Jeffrey C. Wang, Zoher Ghogawala, Sanjay S. Dhall and Michael G. Kaiser

Recommendations There is no evidence that conflicts with the previous recommendations published in the original “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine.” Grade B Surgical decompression is recommended for patients with symptomatic neurogenic claudication due to lumbar stenosis without spondylolisthesis who elect to undergo surgical intervention (Level II/III evidence). Grade C In the absence of deformity or instability, lumbar fusion has not been shown to improve outcomes in patients with

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Paul A. Anderson, Paul G. Matz, Michael W. Groff, Robert F. Heary, Langston T. Holly, Michael G. Kaiser, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

improved 1 grade, 5 two grades, & 8 ≥ three grades. 2 patients had plate failure. III Good neurological outcomes. No radio-graphic analysis. Miyazaki et al., 1989 46 patients w/ myelopathy from CSM & OPLL w/ instability or deformity. Outcome assessed w/ radiography & JOA scale. Mean FU 53 mos (range 12–118 mos). Used French door technique w/ onlay bone graft. JOA score improved 89%. >5 points in 46%, 3–4 points in 13%, & 1–2 points in 30%. Radiographic stability achieved in only 80% & 1 case worsening. Kyphosis increased 40%. Fusion occurred in 65%. No

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

deformity in whom there is evidence of spinal instability. 3) The addition of pedicle screw instrumentation is not recommended in conjunction with PLF following decompression for lumbar stenosis in patients without spinal deformity or instability. Rationale The surgical management of patients with lumbar stenosis without spondylolisthesis has traditionally involved posterior decompressive procedures including laminectomy or laminotomy and judicious use of partial medial facetectomies and foraminotomies, with or without discectomy. In a subset of patients who

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Alok Sharan, Michael W. Groff, Andrew T. Dailey, Zoher Ghogawala, Daniel K. Resnick, William C. Watters III, Praveen V. Mummaneni, Tanvir F. Choudhri, Jason C. Eck, Jeffrey C. Wang, Sanjay S. Dhall and Michael G. Kaiser

data are insufficient to support a recommendation regarding the use of neuromonitoring as a modality that can be used for the preservation of nerve root function during lumbar fusion surgery (one Level IV study). Rationale Intraoperative monitoring (IOM) is commonly used during spinal deformity surgery and resection of intramedullary tumors, as well as other nonspine surgeries including repair of aortic aneurysms. 2–8 The use of IOM during routine surgery for degenerative lumbar disease remains controversial; however, supporters of IOM claim that this modality

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Timothy C. Ryken, Robert F. Heary, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Langston T. Holly, Michael G. Kaiser, Praveen V. Mummaneni, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

radiographs. Hamanishi & Tanaka, 1996 69 patients, 34 judged unstable combined w/ fusion. JOA scale used, mean FU 3.5 yrs. III Results:  No fusion: 50.8% improvement.  Fusion: 51.2% improvement (p = NS). Authors concluded that wide laminectomy w/ or w/o posterolateral fusion is a simple operation that can be recommended. Ishida et al., 1989 Retrospective comparison: laminectomy (55); laminoplasty (55). Evaluation of postop radiographs JOA assessment. Mean FU 61 mos. III Laminectomy: 13 of 55 (24%) developed kyphotic deformity. Overall JOA

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Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Michael G. Kaiser, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

timing of surgery. Rationale The purpose of this review is to examine questions regarding the efficacy of laminoplasty using an evidence-based approach. Cervical laminoplasty was described in the 1970s as an alternative to laminectomy in patients with myelopathy. 10 The impetus for laminoplasty was the desire to decompress long segments while avoiding postlaminectomy membrane formation and/or kyphotic deformity. 10 The authors of multiple reports have demonstrated that laminoplasty increases canal diameter. 23 , 28 However, this increase in canal diameter

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Michael G. Kaiser, Praveen V. Mummaneni, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

pseudarthrosis. 11 , 24 , 25 Complaints associated with a cervical nonunion include persistent or recurrent axial neck pain, radiculopathy, and myelopathy. Development of a pseudarthrosis has also been associated with kyphotic deformity, potentially leading to pain and neurological deficits. Search Criteria We completed a computerized search of the database of the National Library of Medicine and the Cochrane database between 1966 and 2007 using the MeSH search terms “cervical pseudo-arthrosis,” “cervical spine AND fusion failure,” and “cervical spine AND revision

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

Recommendations Standards There is insufficient evidence to recommend a treatment standard. Guidelines There is insufficient evidence to recommend a treatment guideline. Options 1) Lumbar spinal fusion is not recommended as routine treatment following primary disc excision in patients with a herniated lumbar disc causing radiculopathy. 2) Lumbar spinal fusion is recommended as a potential surgical adjunct in patients with a herniated disc in whom there is evidence of preoperative lumbar spinal deformity or instability. 3) Lumbar spinal

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

instability is anticipated. Rationale Patients with lumbar stenosis often present with concomitant degenerative spondylolisthesis. Decompression alone in this population may result in deformity progression. Lumbar PLF has been used as a means to prevent postoperative deformity progression and to improve functional outcome after decompressive surgery in this population. The purpose of this review is to examine the literature concerning the role of fusion after decompression surgery in patients with degenerative spondylolisthesis and stenosis. Search Criteria