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Taylor E. Purvis, C. Rory Goodwin, Camilo A. Molina, Steven M. Frank and Daniel M. Sciubba

and hip surgery have demonstrated that restrictive transfusion “triggers” are associated with similar or better outcomes in patients when compared with liberal triggers. 6 , 7 , 17 , 20 We have previously shown that transfusion using a liberal trigger is associated with increased perioperative morbidity within spine surgery. 30 However, guidelines based on nadir Hb concentrations assume that the amount of acceptable blood loss does not vary by baseline Hb level and do not consider the range of potential Hb levels in the normal population. 23 Several studies in

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Rafael De la Garza Ramos, C. Rory Goodwin, Nancy Abu-Bonsrah, Amit Jain, Emily K. Miller, Nicole Huang, Khaled M. Kebaish, Paul D. Sponseller and Daniel M. Sciubba

A dolescent idiopathic scoliosis (AIS) is the most common form of structural coronal spine deformity in the younger population, presenting between the ages of 10 years and skeletal maturity, typically 18 years old. 14 Corrective surgery is usually reserved for patients with curves of at least 50°, rapidly progressive curves in skeletally immature patients, progressive double curves, curves producing significant trunk imbalance, curves not controlled by bracing, and, on some occasions, curves causing psychological distress due to cosmetic appearance. 23

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Daniel M. Sciubba

studies examining the interaction of the spine field with the legal system, which indubitably impacts all stakeholders, especially in countries such as the United States. 2 , 3 , 5 In their article, “Malpractice litigation following spine surgery,” Daniels and colleagues provide a timely and relevant look at some data surrounding medical malpractice suits involving spine care. 1 After positing that few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards, they sought “to identify the most

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Paul E. Kaloostian, Jennifer E. Kim, Ali Bydon, Daniel M. Sciubba, Jean-Paul Wolinsky, Ziya L. Gokaslan and Timothy F. Witham

I ntracranial hemorrhage is an extremely rare complication of spinal surgery, with fewer than 35 individual cases reported in the literature and a proposed incidence rate of 0.8%. 6 , 11 The etiology of remote ICH remains unclear, but evidence suggests that it is caused by excessive CSF loss, which results in cerebral dehydration causing stretching and eventually tearing of the bridging veins. The postoperative hemorrhage may be classified as cerebellar hemorrhage (CBH), subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), or intraventricular

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Sean Dangelmajer, Patricia L. Zadnik, Samuel T. Rodriguez, Ziya L. Gokaslan and Daniel M. Sciubba

, 51 In patients with DLS, decompressive laminectomy alone or with foraminotomy may be considered as a conservative treatment strategy, as it relieves the symptoms without addressing the overall sagittal imbalance, lateral listhesis, or coronal deformity. For elderly patients, this approach provides symptom relief without the risks of major surgery. Following decompressive laminectomy, a subset of patients may experience mechanical instability and recurrent radiculopathy. 5 Fusion with posterior multilevel pedicle screw placement has become common for DLS patients

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Kaisorn L. Chaichana, Courtney Pendleton, Daniel M. Sciubba, Jean-Paul Wolinsky and Ziya L. Gokaslan

consisted of corticosteroid agents and radiotherapy. 5 , 15 However, with recent advances in neuroimaging, surgical techniques, and spinal instrumentation, direct decompressive surgery has become the standard treatment for metastatic lesions from solid primary tumors. 6 , 14 , 17 In fact, this approach has recently been shown to be superior to radiotherapy in preserving neurological function in patients with metastatic spine tumors that are not significantly radiosensitive. 17 These studies, however, have grouped all patients with different histological types of

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Rafael De la Garza Ramos, C. Rory Goodwin, Nancy Abu-Bonsrah, Ali Bydon, Timothy F. Witham, Jean-Paul Wolinsky and Daniel M. Sciubba

fusion were identified via ICD-9 procedural codes 81.00–81.09. Recorded Variables Documented admission information included the following: patient age; sex; race; comorbid conditions; primary payer (insurance); hospital region (Northeast, Midwest or North Central, South, or West); hospital teaching status; hospital location (urban vs rural); in-hospital mortality rate; and length of stay (LOS). For patients who underwent spinal surgery, the following complications were recorded: neurological complications; iatrogenic stroke; respiratory complications (including

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Paul E. Kaloostian, Patricia L. Zadnik, Ahmed J. Awad, Edward McCarthy, Jean-Paul Wolinsky and Daniel M. Sciubba

(right side) . Lower: Photomicrograph demonstrating nests of round to oval tumor cells within a fibrovascular stroma. Many blood vessels can be seen abutting the tumor nests. H & E, original magnification ×40 (upper) and ×400 (lower). Postoperative Course The patient was found to be neurologically intact and was sent to the ICU. The endocrinology team suggested that the adrenergic blockade continue for several days to weeks after this surgery to prevent a perioperative hypertensive crisis in the setting of tumor removal. However, roughly 24 hours after the

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Daniel M. Sciubba, Rory J. Petteys, Mark B. Dekutoski, Charles G. Fisher, Michael G. Fehlings, Stephen L. Ondra, Laurence D. Rhines and Ziya L. Gokaslan

lesions that originate from primary tumors with abundant vascularity (that is, renal cell, thyroid, angiosarcoma, leiomyosarcoma, hepatocellular, and neuroendocrine tumors), knowledge of the vascular supply of metastases may prove invaluable if surgery is considered. 65 Angiography may also permit preoperative embolization of metastases, which can be an effective alternative treatment for patients who are not candidates for surgical treatment. 103 Embolization reduces intraoperative blood loss 65 , 115 and facilitates complete resection of the lesion. In addition to

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Rafael De la Garza-Ramos, Amit Jain, Khaled M. Kebaish, Ali Bydon, Peter G. Passias and Daniel M. Sciubba

A dult spinal deformity (ASD) is a common spinal disorder in patients over 60 years of age, with studies suggesting prevalence as high as 68%. 17 Although corrective surgery achieves better outcomes in terms of leg pain and disability compared with nonoperative treatment, 15 , 19 complication rates range from 37% to 78% in the literature. 1 , 3 , 9 , 18 Risk factors for complication development include age over 65 years, longer constructs, female sex, revision procedures, and having surgery performed by a low-volume surgeon or at a low-volume hospital