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Ali A. Baaj, Katheryne Downes, Alexander R. Vaccaro, Juan S. Uribe and Fernando L. Vale

L umbar spine trauma is among the most common entities facing spine surgeons. Management decisions, whether surgical or conservative, significantly affect length of stay, discharge disposition, and hospital costs. On a national level, these cumulative decisions likely have a significant socioeconomic impact. There is a limited number of peer-reviewed published studies addressing recent socioeconomics of traumatic lumbar spine diseases in the US. 2 , 4 , 8 , 10 The goal of this work is to analyze trends of lumbar spine fractures using a nationwide

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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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Alexander R. Vaccaro and Luke Madigan

]) demonstrated a significantly enhanced fusion rate in a lumbar spine application at 6 months as determined by radiographic evaluation. 57 Another in vivo study by Van Dijk, et al., 58 compared two resorbable polymer cages and a titanium cage in the same goat model. The two implants had different properties of compression strength and stiffness: this was achieved using the same material and outer dimensions, but varying the wall thickness 1.5 to 0.75 mm. The titanium implant had a wall thickness of 1.5 mm. Fusion success was significantly better with the resorbable cages and

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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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John M. Beiner, Jonathan Grauer, Brian K. Kwon and Alexander R. Vaccaro

Postoperative spinal wound infections occur in 1 to 12% of patients. The rate of infection is related to the type and duration of the procedure, comorbidities, nutritional status, and various other risk factors. Antibiotic prophylactic therapy has been clearly shown to decrease the rate of infection dramatically after lumbar surgery. These infections typically manifest with signs and symptoms of wound swelling, erythema, and drainage. Laboratory-detected values such as the erythrocyte sedimentation rate and C-reactive protein can be elevated beyond what is normal for the uncomplicated postoperative course following lumbar surgery, and combined with the clinical symptoms should alert the physician to the possibility of infection. When detected, these infections should be managed aggressively with operative debridment and irrigation, including the deep subfascial layer in all cases except those with clearly demarcated superficial infection. The choice of one versus multiple debridments can be made based on the appearance of the wound, patient factors, and nutritional status. Hardware and incorporated bone graft can be left in place in the majority of cases, adding to stability. Outcomes following aggressive treatment of this complication can be excellent, with no long-term loss of function and complete eradication of the infection.

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George M. Ghobrial, Christopher M. Maulucci, Mitchell Maltenfort, Richard T. Dalyai, Alexander R. Vaccaro, Michael G. Fehlings, John Street, Paul M. Arnold and James S. Harrop

were “operative lumbar spine adverse events” and “nonoperative lumbar spine adverse events,” as well as within the Medical Subject Heading (MeSH) terminology: “postoperative complications” and “neurosurgery:surgical procedure, operative.” Furthermore, articles were supplemented with known literature on the topic as well as reviews of articles in references. Inclusion Criteria Articles included were those already published or published online prior to print, written in English, and that involved only human subjects. Comparative case series, comparative cohort

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Gregory D. Schroeder, Christopher K. Kepler, MD MBA and Alexander R. Vaccaro

minimally invasive versus open transforaminal lumbar interbody fusion . Spine (Phila Pa 1976) 34 : 1385 – 1389 , 2009 22 Rajaraman V , Vingan R , Roth P , Heary RF , Conklin L , Jacobs GB : Visceral and vascular complications resulting from anterior lumbar interbody fusion . J Neurosurg 91 : 1 Suppl 60 – 64 , 1999 23 Regan JJ , Yuan H , McAfee PC : Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery . A prospective multicenter study evaluating open and laparoscopic lumbar fusion Spine (Phila Pa 1976) 24 : 402

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Christopher Paul O'Boynick, Mark F. Kurd, Bruce V. Darden II, Alexander R. Vaccaro and Michael G. Fehlings

S pine fractures comprise an estimated 6% of all fractures worldwide. 12 The thoracic and lumbar spinal segments are most commonly involved, with an estimated incidence of 700,000 fractures each year. 46 The thoracolumbar segment composed of T10–L2 accounts for more than half of these fractures, with the lower lumbar spine and upper thoracic spine accounting for 32% and 16%, respectively. 22 The role of early surgical stabilization and resultant early mobilization as a method to reduce morbidity and mortality associated with these fractures has sparked

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Myles Luszczyk, Justin S. Smith, Jeffrey S. Fischgrund, Steven C. Ludwig, Rick C. Sasso, Christopher I. Shaffrey and Alexander R. Vaccaro

of a graft to incorporate and ultimately prevent a fusion mass from forming. In particular, nicotine has been shown to negatively affect bone healing. 4 , 12 , 18 , 21 , 22 , 38 , 39 Studies of the lumbar spine have demonstrated that smokers have lower rates of fusion as well as poorer clinical outcomes. 6 , 21 These findings have also been documented in smokers undergoing multilevel anterior cervical decompression and fusion. 1 , 23 Less convincing is the effect of smoking on single-level anterior cervical fusions. Some studies have shown a trend toward an