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Charles Kuntz IV, Linda S. Levin, Stephen L. Ondra, Christopher I. Shaffrey and Chad J. Morgan

. Discussion The preoperative assessment of upright sagittal spinal alignment is increasingly recognized as important. Matsunaga and colleagues 20 performed a follow-up study (≥ 5 years) of 38 patients with rheumatoid arthritis who underwent occipitocervical fusion; fixation/fusion in patients with an abnormal lordotic occipitocervical angle was associated with the development of subaxial kyphosis or swan-neck deformity, whereas fixation/fusion in patients with an abnormal kyphotic occipitocervical angle was associated with the development of subaxial subluxation. No

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Sean M. Jones-Quaidoo, Travis Hunt, Christopher I. Shaffrey and Vincent Arlet

spondylolisthesis. A comparison of three surgical approaches . Spine 24 : 1701 – 1711 , 1999 11 Newman PH : A clinical syndrome associated with severe lumbosacral subluxation . J Bone Joint Surg Br 47 : 472 – 481 , 1965 12 Ogilvie JW : Complications in spondylolisthesis surgery . Spine 30 : 6 Suppl S97 – S101 , 2005 13 Schoenecker PL , Cole HO , Herring JA , Capelli AM , Bradford DS : Cauda equina syndrome after in situ arthrodesis for severe spondylolisthesis at the lumbosacral junction . J Bone Joint Surg Am 72 : 369 – 377 , 1990 14

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Russ P. Nockels, Christopher I. Shaffrey, Adam S. Kanter, Syed Azeem and Julie E. York

flow and glucose uptake in ischemic canine myocardium determined with fluorine-18-deoxyglucose . J Nucl Med 33 : 1346 – 1353 , 1992 15 Kraus DR , Peppelman WC , Agarwal AK , DeLeeuw HW , Donaldson WF III : Incidence of subaxial subluxation in patients with generalized rheumatoid arthritis who have had previous occipital cervical fusions . Spine 16 : 10 Suppl 486 – 489 , 1991 16 Malcolm GP , Ransford AO , Crockard HA : Treatment of non-rheumatoid occipitocervical instability. Internal fixation with the Hartshill-Ransford loop . J

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Charles A. Sansur, Kai-Ming G. Fu, Rod J. Oskouian Jr., Jay Jagannathan, Charles Kuntz iv and Christopher I. Shaffrey

technique. The preoperative mean cervical kyphosis in his series was 23°, and this was corrected to a mean of 31° of lordosis (correction of 54°). All the patients were able to see straight ahead. Complications included 1 patient with quadriparesis after 1 week, 2 patients with transient C-8 palsies, subluxation at the site of osteotomy in 4 patients, and episodes of pseudarthrosis requiring anterior fusion in 4 patients. 11 Simmons et al. 12 published a large retrospective review of their results in the treatment of AS patients with cervical extension osteotomies

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Christopher I. Shaffrey

subluxation, atlantoaxial rotatory fixation, and atlantoaxial facet locking. 2 , 5 , 6 Most reports show that early initiation of treatment (with either immobilization or traction) following symptom onset results in resolution of radiographically documented abnormalities and clinical symptoms. 5 , 6 My concerns about this series of 14 patients presented by Goel and Shah 2 are the limited information provided on the CT evaluation and the methods and duration of nonoperative treatment prior to initiating operative intervention. There are inherent risks of surgery

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D. Kojo Hamilton, Justin S. Smith, Charles A. Sansur, Aaron S. Dumont and Christopher I. Shaffrey

A tlantoaxial stability can be compromised as a result of degenerative disease, trauma, congenital malformations, inflammatory disease, infection, and neoplasms. Significant C1–2 subluxation is often best treated using reduction and fusion. Several different techniques have been applied to achieve C1–2 fixation and arthrodesis for instability, including posterior wiring, Brooks fusion, Gallie fusion, interlaminar clamping, and transarticular screws. 2 , 9 , 18 , 25 Brooks and Gallie fusions are traditionally performed using structural autograft and often

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Vincent C. Traynelis

to access the joint in cases of fixed unilateral C1–2 rotatory subluxation on the side of which the C-1 lateral mass is anteriorly displaced. This publication and the experience of Goel et al. 2 provide compelling data that C-2 neurectomy is well tolerated, but that has not been a universal experience. Yeom et al. prospectively studied 23 patients in which the C-2 root was transected and reported that 6 patients (26%) had occipital neuralgia at the 1-year follow-up. Two of these patients had unilateral occipital neuralgia preoperatively and suffered from

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Robert G. Grossman, Ralph F. Frankowski, Keith D. Burau, Elizabeth G. Toups, John W. Crommett, Michele M. Johnson, Michael G. Fehlings, Charles H. Tator, Christopher I. Shaffrey, Susan J. Harkema, Jonathan E. Hodes, Bizhan Aarabi, Michael K. Rosner, James D. Guest and James S. Harrop

or a legally authorized representative provided informed consent to participate in the study. Patient Care The nature of the care that patients with SCI receive has an obvious bearing on the complications that they may sustain. Care of the patients in the study was standardized among the centers. Patients received the care for SCI as described in the “Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries.” 12 Treatment modalities included rapid ventilatory, cardiovascular, and nutritional support; reduction of vertebral subluxations

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, reduced ROM, >2 level ACDF, ligamentous injuries >3.5mm subluxation or >11° of angulation, burst fractures with retropulsion, lateral mass fractures with incongruity, delayed cervical instability, junction spanning instrumentation. Patients who are pain free, without neurologic deficit, have full ROM, radiologic evidence of a healed axis lateral mass fractures, odontoid fractures, non-displaced Jefferson fractures, <2 level ACDF, single level corpectomies, compression fractures, fractures without retropulsion, chronic discs, fully fused, asymptomatic, non

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Michael P. Kelly, Lawrence G. Lenke, Christopher I. Shaffrey, Christopher P. Ames, Leah Y. Carreon, Virginie Lafage, Justin S. Smith and Adam L. Shimer

rates of complication in one series, whereas others have suggested that primary and revision surgeries have similar rates of early and late complications. 10 , 19 Buchowski et al. 7 noted an 11.1% rate of new neurological deficits in a series of 108 PSOs. The majority of these deficits were transient; the authors noted a permanent deficit rate of 2.8%. These deficits were the result of inadequate decompression, subluxation, or buckling of the dura, suggesting that procedure factors and not patient factors play a role in the development of neurological deficits