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Nicholas Theodore and Harold L. Rekate

construct, but it does not provide as much stability as transarticular screws. 1–3 Although the authors' sample of three patients is small and includes only one patient who was very young (3 years old), the described technique is yet another option in the expanding armamentarium of atlantoaxial fixation techniques. Ultimately, as with all surgical approaches, the appropriate choice of fixation technique is dictated by anatomical and biomechanical considerations, the outcomes of published series, and the surgeon's experience. Given the small size of children and the

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Michael A. Mooney, Mark E. Oppenlander, U. Kumar Kakarla and Nicholas Theodore

SS : Tumoral calcinosis of the cervical spine in an infant. Case illustration . J Neurosurg 86 : 162 , 1997 10.3171/jns.1997.86.1.0162 24 Mouchaty H , Perrini P , Conti R , Di Lorenzo N : Craniovertebral junction lesions: our experience with the transoral surgical approach . Eur Spine J 18 : Suppl 1 13 – 19 , 2009 10.1007/s00586-009-0988-7 19404689 25 Ohashi K , Yamada T , Ishikawa T , Yamaguchi S , Nakajima H , Takagi M : Idiopathic tumoral calcinosis involving the cervical spine . Skeletal Radiol 25 : 388 – 390 , 1996 10

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Samuel Kalb, Nikolay L. Martirosyan, Luis Perez-Orribo, M. Yashar S. Kalani and Nicholas Theodore

15 32, F systemic hypertension T3–10, T-12 mixed T6–10 laminectomy & fusion * 360° = ACD and corpectomy with posterior laminectomy and fusion. † Type of OPLL as classified by the Japanese Investigation Committee on the Ossification of the Spinal Ligaments. See Tsuyama, 1984. Patients underwent the following surgical approaches ( Table 3 ): ACD and fusion with corpectomy, posterior laminectomy with fusion, posterior open-door laminoplasty, and combined anterior corpectomy with posterior laminectomy and fusion (360° approach). The clinical

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Udaya K. Kakarla, M. Yashar S. Kalani, Giriraj K. Sharma, Volker K. H. Sonntag and Nicholas Theodore

 paresthesias 8  paraplegia 4  paraparesis 1  myelopathy 9  radiculopathy 5 radiological findings  kyphotic deformity 12  epidural abscess 24  discitis on MRI 24  paraspinal abscess common 24 spinal level involved  cervical 11 (26 levels)  thoracic 15 (32 levels)  lumbar 7 (9 levels)  sacral 2 (2 levels) surgical approach  anterior 10  posterior 4  combined anterior-posterior 9  laminectomy 4  instrumentation & fusion 23 pathological diagnosis

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Corey T. Walker, M. Yashar S. Kalani, Mark E. Oppenlander, Jakub Godzik, Nikolay L. Martirosyan, Robert J. Standerfer and Nicholas Theodore

-term sequelae. Although we recognize that the development of this complication in 2 (29%) of the 7 patients represents a substantial percentage, this incidence is within the expected range reported by other groups performing anterior thoracic decompression surgeries. Little is known about the exact rates of CSF–pleural fistulation after transpleural thoracic resection of transdural disc herniations, given the rare nature of this pathology and the diversity of surgical approaches. That said, Hu et al. 12 recently reported on a series of thoracic decompression surgeries in

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Ali A. Baaj, Juan S. Uribe, Tann A. Nichols, Nicholas Theodore, Neil R. Crawford, Volker K. H. Sonntag and Fernando L. Vale

, : Traumatic spinal cord injury mortality, 1981–1998 . J Trauma 66 : 184 – 190 , 2009 19 Sekhon LH , Fehlings MG : Epidemiology, demographics, and pathophysiology of acute spinal cord injury . Spine 26 : 24 Suppl S2 – S12 , 2001 20 Shamji MF , Cook C , Pietrobon R , Tackett S , Brown C , Isaacs RE : Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis . Spine J 9 : 31 – 38 , 2009 21 Shamji MF , Cook C

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Eric M. Horn, Iman Feiz-Erfan, Gregory P. Lekovic, Curtis A. Dickman, Volker K. H. Sonntag and Nicholas Theodore

MR : Treatment of atlantoaxial instability in pediatric patients . Neurosurg Focus 15 : 6 ECP1 , 2003 42 Reed CM , Campbell SE , Beall DP , Bui JS , Stefko RM : Atlanto-occipital dislocation with traumatic pseudomeningocele formation and post-traumatic syringomyelia . Spine 30 : E128 – E133 , 2005 43 Rhoton AL Jr , de Olivera E , Anatomic basis of surgical approaches to the region of the foramen magnum . Dickman CA , Spetzler RF , Sonntag VKH : Surgery of the Craniovertebral Junction New York , Thieme , 1998 . 13

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Daniel D. Cavalcanti, Nikolay L. Martirosyan, Ketan Verma, Sam Safavi-Abbasi, Randall W. Porter, Nicholas Theodore, Volker K. H. Sonntag, Curtis A. Dickman and Robert F. Spetzler

an annual incidence of 1 in 100,000. 30 , 45 Schwannomas in the CCJ are rare skull base neoplasms and are usually described separately in series on surgical approaches, series on tumors involving the jugular foramen and hypoglossal nerve, and series on spinal schwannomas. However, they may share the same symptoms, surgical approaches, and complications. The extension of these lesions along the posterior fossa cisterns and within the internal auditory canal, jugular foramen, hypoglossal canal, foramen magnum, and spinal canal usually places several CNs and the

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Sam Safavi-Abbasi, Joseph M. Zabramski, Pushpa Deshmukh, Cassius V. Reis, Nicholas C. Bambakidis, Nicholas Theodore, Neil R. Crawford, Robert F. Spetzler and Mark C. Preul

C hoosing a surgical approach to access lesions of the posterior fossa and petroclival region requires careful preoperative analysis. Because of the narrow working space and restricted angles of approach, surgical planning in this area can be extremely important. Tumors in this region were once considered inoperable 1 , 52 and remain challenging. 5 , 9 , 19 , 32 , 41 With the advent of diagnostic neuroimaging tools and skull base surgery as a discipline, improvements in neuroanesthesia and neurophysiological monitoring, and refinements in neurosurgical

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disc herniation, a prospective, randomized comparison study would be the ideal protocol. Unfortunately, the rarity of thoracic disc herniations makes such a study impractical. Although the transfacet pedicle-sparing method represents a novel technique for approaching a lateral thoracic disc herniation, it must still be regarded as an unproven procedure and certainly cannot be viewed as a surgical cornerstone, especially based on only six cases. We advocate individualizing the surgical approach for thoracic disc disease. The approach should maximize the visibility of