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Devin K. Binder, Justin S. Smith and Nicholas M. Barbaro

Object

The authors report on the treatment of primary brachial plexus tumors in 25 patients at the University of California, San Francisco. They compare their findings with those obtained in similar series.

Methods

The authors reviewed the electronic and medical records, radiological images, operative reports, and pathological findings in 25 consecutive cases of primary brachial plexus tumors. Cases of metastatic lesions or adjacent neoplasms extending into and involving the brachial plexus were excluded.

At presentation patients ranged in age from 19 to 71 years (mean 47 ±15 years), and neurofibromatosis was present in eight patients (32%). Presenting signs and symptoms included palpable mass (60%), numbness/paresthesias (44%), radiating pain (44%), local pain (16%), and weakness (12%). Duration of symptoms ranged from 2 months to 10 years. Neuroimaging revealed lesions ranging widely in size (volume ~1 to >100 ml). Pathological diagnoses included schwannoma (15 [60%]), neurofibroma (five [20%]), malignant peripheral nerve sheath tumor (four [16%]), and desmoid tumor (one [4%]).

Conclusions

Primary tumors arising in the brachial plexus are rare. Careful workup, surgical technique, and attention to pathological diagnosis optimize management.

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Matthew B. Potts, Justin S. Smith, Annette M. Molinaro and Mitchel S. Berger

, headache without associated mass effect, or endocrinological workup. For patients presenting with headaches, we excluded those with signs of elevated intracranial pressure or those whose tumor demonstrated mass effect, as these factors could account for a headache. Medical records and pre- and postoperative imaging studies were reviewed in a retrospective fashion. Volumetric analysis of the tumor volume and extent of resection was performed using region of interest measurements of axial FLAIR sequences on pre- and postoperative MR imaging studies as previously described

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D. Kojo Hamilton, Justin S. Smith, Tanya Nguyen, Vincent Arlet, Manish K. Kasliwal and Christopher I. Shaffrey

surgery and sexual function, our objective in the present study was to assess sexual function among older adults following thoracolumbar to pelvic fixation for spinal deformity. Methods This was a retrospective review of consecutive cases from a single surgeon at a tertiary care, academic medical center with a high volume of adult patients with scoliosis. Surgeon case logs were reviewed for patients meeting the following inclusion criteria: age ≥50 years, diagnosis of spinal deformity, surgical treatment with posterior thoracolumbar instrumentation (including

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Justin S. Smith, Soonmee Cha, Mary Catherine Mayo, Michael W. McDermott, Andrew T. Parsa, Susan M. Chang, William P. Dillon and Mitchel S. Berger

resection cavity. A thin linear rim of reduced diffusion around the resection cavity without a focal area of nodularity was not considered abnormal. Using inhouse software written in C and Matlab, manual segmentation was performed with region-of-interest analysis to measure volumes of both anatomical and diffusion abnormalities in cubic millimeters. For all patients, the volume of an abnormality on FLAIR imaging (defined as the entire lesion, including both enhancing and nonenhancing components), edema (defined as a nonenhancing FLAIR imaging abnormality), tumor

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Edward F. Chang, Aaron Clark, Justin S. Smith, Mei-Yin Polley, Susan M. Chang, Nicholas M. Barbaro, Andrew T. Parsa, Michael W. McDermott and Mitchel S. Berger

volumetric extent of resection. Manual segmentation was performed with region-of-interest analysis to measure preoperative and postoperative tumor volumes (in cm 3 ) based on FLAIR axial slices (5-mm thickness, no gap) as previously described. Comparisons were made between pre- and postoperative FLAIR imaging as well as postoperative T1-weighted MR imaging to determine areas of residual tumor. Extent of resection was calculated as (preoperative tumor volume – postoperative tumor volume)/preoperative tumor volume × 100%. Preoperative contrast-enhanced T1-weighted images

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Carolyn J. Sparrey, Jeannie F. Bailey, Michael Safaee, Aaron J. Clark, Virginie Lafage, Frank Schwab, Justin S. Smith and Christopher P. Ames

joints closer together. With time, the facet joints become close enough to touch and begin carrying a portion of the spinal load. 52 Altering the load sharing in the lumbar spine due to disc degeneration shields the anterior vertebral body from loading in upright postures and reduces the bone volume fraction in the vertebral body. 6 However, in flexed postures loading in the anterior vertebral body is independent of disc morphology. This can lead to overloading in the weakened anterior vertebral body in flexion and spine fractures. Mechanics in the lumbar spine are

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Bhargav D. Desai, Davis G. Taylor, Ching-Jen Chen, Thomas J. Buell, Jeffrey P. Mullin, Bhiken I. Naik, Justin S. Smith and Christopher I. Shaffrey

S urgical treatments for adult spinal deformity (ASD) are typically complex procedures associated with significant blood loss and the potential risk for perioperative coagulopathy, as well as requisite blood product administration, volume resuscitation, and their associated risks. 28 , 29 Acute intraoperative blood loss can be managed with allogeneic transfusions; however, the risks include transfusion-related acute lung injury, hemolytic transfusion reactions, and transfusion-associated sepsis. 31 Reducing perioperative blood loss in complex spine surgery is

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Peter Komlosi, Deborah Grady, Justin S. Smith, Christopher I. Shaffrey, Allen R. Goode, Patricia G. Judy, Mark Shaffrey and Max Wintermark

(320) 20 0.969 0.6 Head 16 640 53.84 47 Medium head (320) 20 0.969 0.7 Head 16 275 26.41 11 Medium body (500) 40 1.375 0.8 Body 32 600 18.81 12 Large body (500) 20 1.375 0.8 Body 32 600 19.63 10 Large body (500) 40 1.375 0.8 Body 32 600 18.01 CTDI vol = weighted volume CT dose index. * GSI protocol preset names are proprietary manufacturer settings for GE Healthcare and can be selected by the technologist at the time of scanning. † Due to the fast-kilovoltage switching

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Aaron J. Clark, Roxanna M. Garcia, Malla K. Keefe, Tyler R. Koski, Michael K. Rosner, Justin S. Smith, Joseph S. Cheng, Christopher I. Shaffrey, Paul C. McCormick and Christopher P. Ames

pediatric deformity experience, as in neurosurgery. It is unknown how orthopedic surgeons would fare on this survey. Increased spinal surgery specialization was consistently associated with the largest increase in percent correct responses compared with the rates of respondents in less specialized practices across all categories. With the increase in volume of knowledge and implementation of new technology, neurosurgery is moving toward progressively greater subspecialization. 4 Our data appear to argue that increased subspecialization within spinal surgery may be

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Bong Ju Moon, Justin S. Smith, Christopher P. Ames, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Morio Matsumoto, Jong Sam Baik and Yoon Ha

, Schwab F , Shaffrey CI , Moal B , Ames CP , : Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment . Spine (Phila Pa 1976) 38 : 1663 – 1671 , 2013 26 Smith JS , Lafage V , Ryan DJ , Shaffrey CI , Schwab FJ , Patel AA , : Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North