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Rafael De la Garza Ramos, Jonathan Nakhla, Daniel M. Sciubba and Reza Yassari

-analysis, there was variation in the usage of anterior interbody support, but all studies, except for that by Guler et al. (in which no patient received anterior instrumentation), included a high proportion of patients in whom anterior column support was added to the construct. 7 Kebaish suggested that anterior fusion be considered in long-segment constructs to relieve stress from the posterior elements and to enhance bony fusion. 10 Over the past years, several studies have shown that anterior support improves segmental sagittal alignment, allows for direct decompression of

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Paraspinal muscle size as an independent risk factor for proximal junctional kyphosis in patients undergoing thoracolumbar fusion

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

Zach Pennington, Ethan Cottrill, A. Karim Ahmed, Peter Passias, Themistocles Protopsaltis, Brian Neuman, Khaled M. Kebaish, Jeff Ehresman, Erick M. Westbroek, Matthew L. Goodwin and Daniel M. Sciubba

multilevel fusion operations for adult spinal deformity. Here, we demonstrated that the most significant risk factor for PJK is postoperative sagittal alignment. Additionally, we demonstrated that among patients experiencing PJK, paraspinal muscle size independently predicts time to PJK. In light of this, we believe that surgeons should preoperatively consider both the overall sagittal correction sought and the ability of the patient to maintain said correction, as demonstrated by the size of their paraspinal muscles. References Disclosures Dr. Passias: consultant for

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Matthew J. McGirt, Frank J. Attenello, Daniel M. Sciubba, Ziya L. Gokaslan and Jean-Paul Wolinsky

decompression and sagittal alignment with adequate hardware placement ( Figs. 1C and 2 right ). The patient remained at full strength postoperatively and was discharged home on postoperative Day 9 on a regular diet. Three months after surgery, the patient remains without deficits, tolerating a regular diet well with resolution of his head and neck pain. Case 3 History and Presentation This 14-year-old girl with osteogenesis imperfecta presented with a 6-month history of progressive dysphagia and numbness in her left upper extremity. On examination, the patient

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Daniel M. Sciubba, Kaisorn L. Chaichana, Graeme F. Woodworth, Matthew J. McGirt, Ziya L. Gokaslan and George I. Jallo

C ervical laminectomy is most commonly performed as a decompressive procedure for cervical stenosis caused by degenerative changes in the mobile cervical spine. Although cervical laminectomy frequently results in good resolution or improvement of myelopathy in adult patients with normal preoperative sagittal alignment and no radiographic/imaging evidence of overt instability, 8 , 17 its association with postlaminectomy kyphotic deformity is not rare. 4 , 11 , 20 , 21 , 33 , 37 Specifically, the incidence of postlaminectomy kyphotic deformity has been

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Daniel M. Sciubba, Clarke Nelson, Patrick Hsieh, Ziya L. Gokaslan, Steve Ondra and Ali Bydon

Williams & Wilkins). Patient Positioning Proper positioning of a patient with AS in the operating room or the ICU is imperative not only for the patient with an unstable fracture, but in all AS patients because of their an increased risk of iatrogenic injury. During head positioning, the surgeon must take into account the sagittal alignment of the cervical spine, which may often be significantly kyphotic. When fractures already exist in these patients, inadequate assessment of the mass of the head and the extent of cervical kyphosis can have disastrous effects

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Sakibul Huq, Jeffrey Ehresman, Ethan Cottrill, A. Karim Ahmed, Zach Pennington, Erick M. Westbroek and Daniel M. Sciubba

LA , Shalabi ST , Perez-Romera AB , Muquit S , Ghasemi AR , Mehdian H : Analysis of cervical sagittal alignment change following correction of thoracic and thoracolumbar Scheuermann’s kyphosis . Eur Spine J 26 : 2187 – 2197 , 2017 51 Nerubay J , Katznelson A : Dual approach in the surgical treatment of juvenile kyphosis . Spine (Phila Pa 1976) 11 : 101 – 102 , 1986 52 Otsuka NY , Hall JE , Mah JY : Posterior fusion for Scheuermann’s kyphosis . Clin Orthop Relat Res ( 251 ): 134 – 139 , 1990 53 Palazzo C , Sailhan F

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Patrick C. Hsieh, Tyler R. Koski, Daniel M. Sciubba, Dave J. Moller, Brian A. O'shaughnessy, Khan W. Li, Ziya L. Gokaslan, Stephen L. Ondra, Richard G. Fessler, and John C. Liu

. Case 2. Axial CT scan demonstrating the L-5 burst fracture with bone fragment retropulsion into the canal and encroachment of the spinal canal and lateral recess. F ig . 4. Case 2. Left: Axial CT scan revealing spinal canal and lateral recess decompression following minimally invasive laminectomy. Right: Sagittal CT scan demonstrating no significant residual retropulsion of the L-5 burst fracture and acceptable sagittal alignment following percutaneous instrumentation,. F ig . 5. Case 2. Lateral flexion (left) and extension (right

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Beril Gok, Daniel M. Sciubba, Gregory S. McLoughlin, Matthew McGirt, Selim Ayhan, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

C ervical spondylosis is the most common acquired cause of myelopathy in the cervical spine. 1 , 3 , 6 , 8 , 23 , 29 Surgical decompression is generally indicated for patients with significant neurological deficits. 4 , 9 , 15 The goal of surgery is to decompress the spinal cord while maintaining the stability and sagittal alignment of the cervical spine. A variety of surgical approaches are used to treat CSM, depending on the primary site of compression, sagittal alignment, number of levels of compression, and the patient's age and comorbidities

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Scott L. Parker, Anubhav G. Amin, S. Harrison Farber, Matthew J. McGirt, Daniel M. Sciubba, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

pedicle cortex and inner margin of the screw. Additional note was made of intraoperatively identified pedicle-breached screws that required intraoperative repositioning. Because EMG monitoring was not designed to reliably alert the surgeon to a lateral breach, these screw breaches were not included in the statistical analysis. Surgical Technique Free-hand pedicle screw placement is performed using anatomical landmarks and intraoperative localizing lateral radiographs to establish the regional sagittal alignment of the spine. Pilot holes are fashioned using a high

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Risheng Xu, Giannina L. Garcés-Ambrossi, Matthew J. McGirt, Timothy F. Witham, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Daniel M. Sciubba

. Spine 32 : 2875 – 2879 , 2007 43 Powell ET IV , Krengel WF III , King HA , Lagrone MO : Comparison of same-day sequential anterior and posterior spinal fusion with delayed two-stage anterior and posterior spinal fusion . Spine 19 : 1256 – 1259 , 1994 44 Pradhan BB , Bae HW , Kropf MA , Patel VV , Delamarter RB : Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment . Spine 31 : 435 – 441 , 2006 45 Pradhan BB , Nassar JA , Delamarter