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Matthew J. McGirt, Kaisorn L. Chaichana, April Atiba, Ali Bydon, Timothy F. Witham, Kevin C. Yao and George I. Jallo

progressive spinal deformity often develops and complicates functional outcomes years after surgery. 5 , 17 , 18 , 22 , 32 Spinal deformity is a well-documented complication following IMSCT resection, and has been reported in 24–100% of cases. 5 , 17 , 18 , 22 , 32 This high incidence is probably multifactorial. 9 Some studies have reported that the length and extent of laminectomy, which leads to a loss of posterior supporting elements, is directly associated with an increased risk of postoperative deformity. 17 , 22 , 32 As a result, some investigators have theorized

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Christopher I. Shaffrey

Various techniques have been advocated to optimize pedicle screw positioning. Intraoperative fluoroscopy and plain radiography, fluoroscopy and CT-based image guidance, robotic screw placement systems, direct visualization of the medial wall after laminotomy, and a variety of electrophysiological monitoring techniques have been suggested as methods to improve placement accuracy or reduce complications. Surgeons are increasingly faced with revision cases in which normal anatomical landmarks have been distorted or are absent and with complex spinal deformity

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Rafael De la Garza Ramos, C. Rory Goodwin, Nancy Abu-Bonsrah, Ali Bydon, Timothy F. Witham, Jean-Paul Wolinsky and Daniel M. Sciubba

S pinal tuberculosis (TB) is a known cause of spinal deformity and paraplegia. First described in the modern era by English surgeon Percival Pott in 1779 (i.e., Pott's disease), 20 it is currently regarded as a disease affecting people in the developing world. 7 Nevertheless, TB remains a problem in developed regions such as Europe and the US. 6 , 16 , 25 In 2014 alone, a total of 9421 new cases of TB were reported in the US, corresponding to an incidence of 2.96 cases per 100,000 persons. 5 Pott was the first to recognize the link between TB

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Dimitrios Mathios, Paul Edward Kaloostian, Ali Bydon, Daniel M. Sciubba, Jean Paul Wolinsky, Ziya L. Gokaslan and Timothy F. Witham

A nterior reconstruction of the lumbosacral junction is necessitated by pathological processes that cause deformity, instability, and/or compromise of the structural integrity of the vertebral bodies and neural elements. 14 , 17 Examples of such processes include degenerative spondylosis, traumatic fractures, osteomyelitis/discitis, osteoporotic fractures, primary neoplastic disease, or more frequently metastatic disease to the spine. In 1996 the Food and Drug Administration (FDA) first approved the use of titanium cages for posterior lumbar interbody

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Paul E. Kaloostian, Jennifer E. Kim, Ali Bydon, Daniel M. Sciubba, Jean-Paul Wolinsky, Ziya L. Gokaslan and Timothy F. Witham

are summarized in Tables 1 – 3 . Initial Presentation Our 8 patients ranged in age from 42 to 81 years old (median age 63.5 years). Four patients presented with scoliotic deformity, 2 with disc herniation, 1 with failed instrumentation, and 1 with left pelvic osteosarcoma. Three of the 8 patients had undergone previous spinal surgeries. Medical histories were remarkable for preoperative daily intake of aspirin, which was stopped well prior to surgery (n = 2), anemia and factor V Leiden thrombophilia (n = 1), hyperlipidemia (n = 3), clinical hypertension (n

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Camilo A. Molina, Rachel Sarabia-Estrada, Ziya L. Gokaslan, Timothy F. Witham, Ali Bydon, Jean-Paul Wolinsky and Daniel M. Sciubba

single-level lumbar fusion: The role of bone morphogenetic protein . Spine (Phila Pa 1976) 36 : 2354 – 2362 , 2011 16 Chang H , Brown CW , Matzuk MM : Genetic analysis of the mammalian transforming growth factor-beta superfamily . Endocr Rev 23 : 787 – 823 , 2002 17 Cho SK , Stoker GE , Bridwell KH : Spinal reconstruction with pedicle screw-based instrumentation and rhBMP-2 in patients with neurofibromatosis and severe dural ectasia and spinal deformity: report of two cases and a review of the literature . J Bone Joint Surg Am 93 : e86

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Beril Gok, Daniel M. Sciubba, Gregory S. McLoughlin, Matthew McGirt, Selim Ayhan, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

, patients with a cervical kyphosis and/or both anterior and posterior compression often require a combined anterior and posterior decompression and fusion. Theoretically, such front-back surgery is done to prevent further iatrogenic instability while performing substantial canal decompression and deformity correction. The anterior procedure includes a single-or multilevel ACDF or corpectomy depending on the extent of decompression required. The posterior procedure consists of a posterior instrumented fusion, with or without a laminectomy. At our institution, laminoplasty

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Risheng Xu, Giannina L. Garcés-Ambrossi, Matthew J. McGirt, Timothy F. Witham, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Daniel M. Sciubba

reconstruction was performed using a distractible titanium cage. The patient was discharged home on postsurgery Day 9. c and d: The patient did not experience any surgically related complications during his follow-up, and at his most recent visit (1-year postoperatively) anteroposterior (c) and lateral (d) plain radiographs showed no hardware failure and no presence of kyphotic deformity. We defined a posterior approach as transpedicular corpectomies, sometimes accompanied by costotransversectomies, laminectomies, and/or facetectomies ( Fig. 2 ). Lateral extracavitary

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Daniel M. Sciubba, Clarke Nelson, Beryl Gok, Matthew J. McGirt, Gregory S. McLoughlin, Joseph C. Noggle, Jean Paul Wolinsky, Timothy F. Witham, Ali Bydon and Ziya L. Gokaslan

suffered no perioperative complications. However, 5 months postoperatively, the patient developed acute upper back pain and was found to have a focal kyphotic deformity at the top of the construct with bilateral pars interarticularis fractures and bilateral pedicle screw pullout at L-3. Revision surgery involved additional placement of pedicle screws from T-9 through L-2 bilaterally and replacement of Galveston rods. There were no perioperative complications with this revision surgery. This patient did well for ~ 6 months, after which she experienced an audible and

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Michelle J. Clarke, Patricia L. Zadnik, Mari L. Groves, Daniel M. Sciubba, Timothy F. Witham, Ali Bydon, Ziya L. Gokaslan and Jean-Paul Wolinsky

further visualized on coronal (F) and sagittal (G) CT scans. H: One year after surgery, the patient presented with neck pain and was found to have a new cervical deformity and fracture of her right posterior rod above the crossbar. The first stage involved placement of posterior occipitocervicothoracic instrumentation with mobilization of the tumor via a posterior approach. The patient was placed prone in a neutral position, and a standard midline approach was performed. Care was taken not to violate the tumor capsule, leaving a margin of tissue around the