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The efficacy of intraoperative multimodal monitoring in pedicle subtraction osteotomies of the lumbar spine

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

Jianning Shao, Maxwell Y. Lee, Shreya Louis, Konrad Knusel, Bryan S. Lee, Dominic W. Pelle, Jason Savage, Joseph E. Tanenbaum, Thomas E. Mroz and Michael P. Steinmetz

operation time and cost, it is useful to determine its efficacy in given procedures to support its continued utilization in PSOs of the lumbar spine. Specifically, it would be compelling to determine whether IOM usage led to improved patient outcomes postoperatively. To shed light on this question, the present endeavor assesses the impact of IOM guidance on perioperative neurological complications and postoperative patient outcomes, as assayed by QOL scores, in patients who underwent PSOs of the lumbar spine. Methods Study Population All patients older than 18 years who

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Michael F. Shriver, Valerie Zeer, Vincent J. Alentado, Thomas E. Mroz, Edward C. Benzel and Michael P. Steinmetz

E xposure of the lumbar spine is achieved through a variety of intraoperative surgical positions. 4 The prone, kneeling, knee-chest, knee-elbow, and lateral decubitus positions represent plausible positions that allow for exposure of the lumbar spine. However, each of these positions has an array of unique complications. 4 , 6 , 11 , 14 , 28 , 30 These complications result from excessive pressure applied to ventral or lateral structures, causing potentially significant postoperative morbidity. 4 , 9 , 11 , 14 , 15 , 22 , 31 , 33 , 39 , 47 While certain

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Jay M. Levin, Robert D. Winkelman, Joseph E. Tanenbaum, Edward C. Benzel, Thomas E. Mroz and Michael P. Steinmetz

satisfaction is particularly acute for common and costly procedures, which have the largest potential impact on hospital reimbursement. The incidence and cost of lumbar spine surgery are increasing in the United States. 4 , 8 , 22 , 25 , 28 For example, aggregate hospital charges for surgical treatment of lumbar stenosis has increased by 40% between 2002 and 2007, mostly attributed to the rising rate of complex fusions performed. Additionally, as the United States population continues to age, the prevalence of spinal stenosis, the most common indication for lumbar spine

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Rakesh D. Patel, Humberto G. Rosas, Michael P. Steinmetz and Paul A. Anderson

U nilateral and bilateral pars interarticularis defects in the lumbar spine are common, occurring in 6%–11% of the population. 12 Although the majority of these patients are asymptomatic, some have incapacitating back pain presumably secondary to the pars defect, associated instability, and less commonly L-5 nerve root compression. The initial treatment is nonoperative management, consisting of activity restrictions, orthosis, trunk exercises, and antiinflammatory medication. When symptoms are refractory to nonoperative management, surgery may be

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clinical differences will develop. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2013.1.FOC-LSRSABSTRACTS Poster Abstract Poster 3. Use Of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) Without Iliac Crest Bone Graft In Posterolateral Lumbar Spine Fusion (PLF) Daniel K. Park , MD , Sung Soo Kim , and Scott Boden , MD William Beaumont Hospital, Orthopedic Surgery, Southfield, MI 1 2013 34 1 The Science of Neurosurgical Practice A2

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Sina Pourtaheri, Akshay Sharma, Jason Savage, Iain Kalfas, Thomas E. Mroz, Edward Benzel and Michael P. Steinmetz

Previously, pelvic retroversion in patients with sagittal imbalance was thought to be solely compensatory for the sagittal imbalance. 5 , 18 , 19 , 20 , 22 , 24 , 26 Fig. 1. Diagrams showing that compensatory lumbar flexion due to lumbar stenosis increases C-2 SVA. Figure is available in color online only. Fig. 2. The flexed posture of the proximal (L1–3) or distal (L4–S1) lumbar spine increases the diameter of the spinal canal and neuroforamina and can relieve neurogenic claudication symptoms. Distal lumbar flexion can result in pelvic retroversion; therefore, in cases of

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positioning on IOP in lumbar spine fusion patients. Methods Surgeries were performed on 52 patients at one institution. Inclusion criteria were lumbar spine fusion in patients 18–80 years old. Exclusion criteria included eye disease or injury, history of cervical stenosis, neck pain, trauma or current neoplasm. The control group had the head in neutral position with the face parallel to the level operating room table and the experimental group had the neck extended so the face had an angle of inclination of 10° with the table. All patients were managed with Gardner

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SP was widest at 11.09 ± 2.85 mm. L5 had a slope of 23.68 ± 10.51 degrees relative to the mechanical axis, which was steeper than other levels. At L2-L5, more SPs have convex morphology. Conversely, L1 exhibits convex morphology only 38.7% of the time ( Table 1 ). Discussion: Past studies have examined the quantitative anatomy of the lumbar spine as it pertains to pedicle fixation for posterior spinal fusions. Little work, however, has been done to examine lumbar spinous processes and their variable morphology. Spinous process length, width, height and slope

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Yumeng Li, Daniel Lubelski, Kalil G. Abdullah, Thomas E. Mroz and Michael P. Steinmetz

patient series . Pain Physician 9 : 53 – 56 , 2006 12 Dullerud R : [Diagnostic imaging in lumbago and sciatica.] . Ugeskr Laeger 161 : 5299 – 5303 , 1999 . (Danish) 13 Elster AD : Bertolotti's syndrome revisited. Transitional vertebrae of the lumbar spine . Spine (Phila Pa 1976) 14 : 1373 – 1377 , 1989 14 Hashimoto M , Watanabe O , Hirano H : Extraforaminal stenosis in the lumbosacral spine. Efficacy of MR imaging in the coronal plane . Acta Radiol 37 : 610 – 613 , 1996 15 Jönsson B , Strömqvist B , Egund N : Anomalous

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Joshua L. Golubovsky, Arbaz Momin, Nicolas R. Thompson and Michael P. Steinmetz

disorders . Spine (Phila Pa 1976) 29 : 2290 – 2303 , 2004 10.1097/01.brs.0000142221.88111.0f 15480144 3 Apazidis A , Ricart PA , Diefenbach CM , Spivak JM : The prevalence of transitional vertebrae in the lumbar spine . Spine J 11 : 858 – 862 , 2011 21951610 10.1016/j.spinee.2011.08.005 4 Babu H , Lagman C , Kim TT , Grode M , Johnson JP , Drazin D : Intraoperative navigation-guided resection of anomalous transverse processes in patients with Bertolotti’s syndrome . Surg Neurol Int 8 : 236 , 2017 10.4103/sni.sni_173_17 29026672 5