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Michael Y. Wang, Ram Vasudevan and Stefan A. Mindea

. The anterior and posterior longitudinal ligaments are preserved to allow tensioning of these structures, with cage distraction to improve structural rigidity and allow for indirect neural decompression. Cage height is chosen based on preoperative disc height, mobility of the motion segment with intraoperative manipulation, bone density, and degree of indirect decompression needed. An appropriately sized polyetheretherketone (PEEK) or carbon fiber cage is then filled with two recombinant human bone morphogenetic protein–2 (rhBMP-2) sponges (InFuse, Medtronic

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Michael Y. Wang, Matthew D. Cummock, Yong Yu and Rikin A. Trivedi

the exiting and traversing nerve roots. This was followed by disc removal and placement of a carbon fiber cage and rhBMP-2 sponges. The retractor was then removed, and the pedicles of interest were cannulated using a Jamshidi needle under anteroposterior and lateral fluoroscopic guidance. This needle was then exchanged for a Kirschner wire placement, which allowed insertion of a cannulated awl, tap, and Viper pedicle screw (Depuy Spine, Inc.). The screw heads were then connected with percutaneously inserted rods bilaterally. All operations included bilateral