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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

) ( Table 2 ), with a median age at surgery of 52 years; 55.6% were male. The most common location was the thoracolumbar spine (61.9% of cases), and 50% of patients had instrumentation of 3 or more spinal segments. The surgical approach was posterior alone in 38.9% of cases, anterior alone in 26.6%, and combined in 34.5%. The mortality rate was 3.2%, and the median LOS was 16 days. The percentage of patients who developed at least 1 in-hospital complication was 38.8%. The proportion of patients with spinal TB who required surgery was 23.1%, 20.0%, 13.6%, 16.9%, 23.4%, 25

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Gary L. Gallia, Daniel M. Sciubba, Ali Bydon, Ian Suk, Jean-Paul Wolinsky, Ziya L. Gokaslan and Timothy F. Witham

. Spine 30 : S66 – S70 , 2005 9 Gaines RW , Nichols WK : Treatment of spondyloptosis by two stage L5 vertebrectomy and reduction of L4 onto S1 . Spine 10 : 680 – 686 , 1985 10 Gandhi S , Walsh GL , Komaki R , Gokaslan ZL , Nesbitt JC , Putnam JB Jr , : A multidisciplinary surgical approach to superior sulcus tumors with vertebral invasion . Ann Thorac Surg 68 : 1778 – 1785 , 1999 11 Grunenwald D , Mazel C , Girard P , Berthiot G , Dromer C , Baldeyrou P : Total vertebrectomy for en bloc resection of lung

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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

decompression of the spinal cord, complete vertebrectomy, and anterior spinal column reconstruction. This treatment can be accomplished from an anterior, posterior, or a combined anterior-posterior approach. Currently, within each general category of surgical approach, different techniques exist. Thus, with the anterior (or transthoracic) approach, the T1–2 vertebrae may be accessed with or without sternotomy and anterior neck dissection. 9 , 42 , 54 The T3–4 region may be reached via the “trap door” exposure, an amalgam of the anterolateral cervical approach, a partial

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C. Rory Goodwin, Pablo F. Recinos, Ibrahim Omeis, Eric N. Momin, Timothy F. Witham, Ali Bydon, Ziya L. Gokaslan and Jean-Paul Wolinsky

D iseases of the sacrum requiring surgical management present complex issues due to their anatomical location. These include benign tumors such as osteoblastomas, sacral cysts, and osteochondromas and malignant tumors such as chordomas, chondrosarcomas, plasmacytomas, and metastatic neoplasms. 5 , 6 The pathology of the lesion and the location of the disease process within the sacrum determine the extent of anatomical dissection required to attempt gross-total resection. Common surgical approaches include posterior sacrectomy, anterior-posterior sacrectomy

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Daniel M. Sciubba, Rory J. Petteys, Giannina L. Garces-Ambrossi, Joseph C. Noggle, Matthew J. McGirt, Jean-Paul Wolinsky, Timothy F. Witham and Ziya L. Gokaslan

diagnostic workup or therapeutic strategies. 66 The T1- and T2-weighted images are useful in defining tumor size, location, and characteristic features, and may yield enough information to make a presumptive diagnosis. Once thought to enhance the diagnostic power of MR imaging, diffusion weighted imaging has shown no superior usefulness over routine noncontrastenhanced imaging in identifying metastases. 12 In addition to its diagnostic abilities, MR imaging is also very useful for planning guided biopsy and surgical approaches because of its superior ability to define

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Rory J. Petteys, Steven M. Spitz, C. Rory Goodwin, Nancy Abu-Bonsrah, Ali Bydon, Timothy F. Witham, Jean-Paul Wolinsky, Ziya L. Gokaslan and Daniel M. Sciubba

approach was determined by the primary operating surgeons and ranged from decompressive laminectomy to en bloc resection with negative margins via spondylectomy. Internal fixation and stabilization were performed in all but 1 patient. Patients who underwent an instrumented fusion in the absence of tumor-related spinal instability or of impending tumor-related instability underwent this fusion because of instability caused by the surgical approach. Preoperative arterial embolization was performed in 24 patients (80%). All patients were transferred to the intensive care

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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

, histopathological characteristics of the tumor, use of internal fixation, surgical approach (for example, posterior approach alone vs staged, anteriorposterior approach), en bloc versus intralesional resection, presence of CSF leak, need for complex soft-tissue reconstruction, postoperative bowel and bladder function, intraoperative blood loss, and number of surgeons scrubbed in. All patients were followed for at least 6 months postoperatively. Special attention was given to the presence of wound complications or need for revision surgery. The medical records of patients with

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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

C ervical spondylosis is the most common acquired cause of myelopathy in the cervical spine. 1 , 3 , 6 , 8 , 23 , 29 Surgical decompression is generally indicated for patients with significant neurological deficits. 4 , 9 , 15 The goal of surgery is to decompress the spinal cord while maintaining the stability and sagittal alignment of the cervical spine. A variety of surgical approaches are used to treat CSM, depending on the primary site of compression, sagittal alignment, number of levels of compression, and the patient's age and comorbidities

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

presentations can vary based on the primary source of the bone lytic lesions. Cases in the present report represent the largest series of spinal metastatic pheochromocytoma and feature outcomes, surgical approach, and postoperative management of alpha blockade. In a review of the literature, we discuss common preoperative considerations in patients with metastatic pheochromocytoma in the spine and how to manage postoperative hemodynamic complications. We previously reported a single case in the literature, and this patient is included in the present series. 12 Case

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

anterior and posterior approach. For the posterior-only cases, the first case illustrates the typical positioning and surgical approach, with subsequent cases highlighting clinical points of interest. Methods Following institutional review board approval for the research of primary and metastatic tumors, we retrospectively reviewed the records of all patients who had undergone a combined hemisacrectomy and internal hemipelvectomy performed by a single surgeon between 2002 and 2011. Patients who were offered a procedure were medically cleared for surgery and had