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Nasir A. Quraishi, Jean-Paul Wolinsky, Ali Bydon, Timothy Witham and Ziya L. Gokaslan

failure/rod breakage developed kyphotic deformity above instrumentation, LBP manageable 5 20, M extradural tumor, S1–5 involvement, all sacral nerve roots involved bilat, well-encapsulated, no significant infiltration into adjacent tissues, presacral violation w/ some displacement of rectum worsening LBP (6 mos), sensory loss from knee down bilat, no bowel/bladder symptoms excision of intra-/extradural tumor, S1–2 laminectomy, S2–5 & coccyx excised, only lt S-4 nerve root sacrificed, transperineal exposure ventral to coccyx w/ mobilization of rectum, EBL 1

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Ryan M. Kretzer, Daniel M. Sciubba, Carlos A. Bagley, Jean-Paul Wolinsky, Ziya L. Gokaslan and Ira M. Garonzik

one patient a single T-1 translaminar screw was implanted after failed PS placement. TABLE 1 Demographic, presentation, operative, and complication data * Case No. Age (yrs), Sex Indication for Op Lesion Presentation Trans Screw Placement Procedure Complication 1 22, M trauma C-7 burst fracture, kyphotic deformity acute paraplegia T-1 (single screw) Stage 1: ant C-7 corp, C6–T1 fusion w/ IBG, C6–T1 ant fixation w/cervical plate; Stage 2: pst C5–T1 fixation w/ cervical lat mass screws, T-1 PS, T-1

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Ziev B. Moses, Rory R. Mayer, Benjamin A. Strickland, Ryan M. Kretzer, Jean-Paul Wolinsky, Ziya L. Gokaslan and Ali A. Baaj

. Reprinted from Clin Neurol Neurosurg 115(3), Baaj AA et al., O-Arm-based image guidance in minimally invasive spine surgery: technical note, pp 342–345, copyright 2013, with permission from Elsevier. Image Guidance in Lumbosacral MISS A 2007 meta-analysis of freehand pedicle screw placement in the lumbar spine reported a median accuracy rate of 79.0%. 20 Further, during deformity surgery, thoracolumbar pedicle screw inaccuracy has been reported at levels as high as 30%. 35 Therefore, surgical adjuncts including fluoroscopy and image guidance have been

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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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Oren N. Gottfried, Ibrahim Omeis, Vivek A. Mehta, Can Solakoglu, Ziya L. Gokaslan and Jean-Paul Wolinsky

adequate surgical correction of adult deformity and postfusion fixed sagittal imbalance; 11 , 23 , 37 however, it is not clear if the PI can be altered. There are only 2 reports that document changes of PI in adulthood, and these cases occurred in the setting of H-type sacral fractures resulting in complete lumbopelvic dissociation and SI joint instability. 15 , 18 F ig . 1. Drawings. Pelvic incidence, which reflects the morphology of the pelvis, is constant for each adult, and is defined as the angle between a line perpendicular to the midpoint of the sacral

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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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Paul J. Holman, Dima Suki, Ian McCutcheon, Jean-Paul Wolinsky, Laurence D. Rhines and Ziya L. Gokaslan

patient with metastatic breast carcinoma in whom pathological collapse of L-1 VB occurred. Preoperative axial (A) and sagittal (B) T 1 -weighted MR images demonstrating cord compression and local kyphotic deformity. A simultaneous anterior—posterior L-1 vertebrectomy and thoracolumbar stabilization procedure was performed in the lateral decubitus position because of the patient's large body habitus. Intraoperatively, the T-12 vertebra was also seen to be compromised with tumor such that it was inadequate for inclusion in the PMMA—chest tube anterior reconstruction; thus

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Daniel M. Sciubba, Joseph C. Noggle, Ananth K. Vellimana, Hassan Alosh, Matthew J. McGirt, Ziya L. Gokaslan and Jean-Paul Wolinsky

, deformity), cause of cervical instability (trauma or degenerative disease), length of follow-up, and complications were reviewed in all cases. In addition, postoperative CT scans were evaluated to determine the presence and extent of cortical breach. Such evaluation was done by first reviewing the entire C-2 pars and pedicle from posterior to anterior on coronally reconstructed CT images ( Fig. 1 ). When a breach was suspected, the images were reformatted to create views truly orthogonal to the screw so as to more accurately quantify the extent of breach in line with the

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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