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Daniel M. Sciubba, Rory J. Petteys, Sophia F. Shakur, Ziya L. Gokaslan, Edward F. McCarthy, Michael T. Collins, Matthew J. McGirt, Patrick C. Hsieh, Clarke S. Nelson and Jean-Paul Wolinsky

developed persistent back pain, difficulty walking, and bilateral hip fractures. Osteoporosis was initially diagnosed and treated with teriparatide, but the patient's symptoms progressively worsened and she became disabled and unemployed. Subsequent evaluation noted hypophosphatemia (1.9 mg/dl [normal range 2.5–3.5 mg/dl]), and elevated PTH (132.0 pg/ml [normal range 16.0–87.0 pg/ml]). The low phosphorus level was believed to be secondary to hyperparathyroidism, and a thyroid ultrasound scan revealed a right lobe hypoechoic mass approximately 8-mm in size. She was

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Kaisorn L. Chaichana, Courtney Pendleton, Daniel M. Sciubba, Jean-Paul Wolinsky and Ziya L. Gokaslan

. Because preoperative neurological function often predicts postoperative neurological outcome in MESCC, 6 , 14 , 17 patients with prostate cancer should be closely monitored for the development of motor deficits. Additionally, patients with breast cancer had the highest incidence of vertebral compression fractures. This may be due to the nature of this type of tumor, or the fact that osteoporosis is more common in female patients. 19 Since vertebral compression fractures have been associated with poor ambulatory outcomes, 6 patients with breast cancer may be at

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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

because of negative prognostic factors such as osteoporosis and malnutrition. Unfortunately, such patients cannot benefit from the fusion-promoting properties of rhBMPs because their use has been contraindicated in the tumor resection bed based on previous in vitro and in vivo studies presenting an unclear and often contradictory interaction between rhBMPs and neoplasms. For example, some in vitro studies have suggested that rhBMPs are oncogenic; 19 , 45 , 50 , 59 however, there have been no reported clinical associations between rhBMPs and tumorigenicity or metastasis

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

suffered new, remote thoracic VB metastatic collapse that subjected the constructs to excessive bending moments. This highlights the importance of recognizing the global sagittal spinal balance when contemplating anterior-only compared with circumferential reconstruction for high lumbar lesions. Patients with thoracic hyperkyphosis and positive sagittal balance due to thoracic lesions, steroid-induced osteoporosis, or degenerative changes may be better served by posterior fixation across the thoracolumbar junction and even above the apex of the kyphotic level(s) to avoid

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Mohamad Bydon, Mohamed Macki, Rafael De la Garza-Ramos, Daniel M. Sciubba, Jean-Paul Wolinsky, Ziya L. Gokaslan, Timothy F. Witham and Ali Bydon

excluded, as were patients with complete facetectomy, fusion, or both (instrumented or in situ). To maintain the consistency, adequacy, and accuracy of data collection, all charts were reviewed by a single researcher and confirmed by a senior neurosurgeon. Our study population was limited to patients undergoing a 1-, 2-, or 3-level lumbar laminectomy. A total of 500 patients met our selection criteria. Comorbidities, including coronary artery disease, diabetes mellitus, osteoporosis, obesity, ever smoking (that is, past or present smoking), chronic obstructive

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Mohamad Bydon, Risheng Xu, David Santiago-Dieppa, Mohamed Macki, Daniel M. Sciubba, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

-up. Demographic information, such as age and sex; comorbidities, such as obesity, smoking, hypertension, diabetes, coronary artery disease, and osteoporosis; and presenting symptoms manifested by the patients, such as low-back pain, radiculopathy, weakness, sensory deficits, bowel and bladder dysfunction, were collected and documented for all patients. Intraoperative and perioperative data, such as the number of levels in the arthrodesis construct, intraoperative blood loss, hospitalization length, iatrogenic durotomies, CSF fistula, deep venous thrombosis, pulmonary embolism

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Risheng Xu, Matthew J. McGirt, Edward G. Sutter, Daniel M. Sciubba, Jean-Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan and Ali Bydon

in C-7, this factor is especially relevant given that long lever arms place additional stresses on distal instrumentation. 7 , 18 Thus, we sought to directly investigate the immediate and postcyclical rigidities of subaxial constructs terminating at C-7 by comparing C4–6 lateral mass screws with C-7 pedicle versus C-7 lateral mass screw constructs in an in vitro biomechanical model. Methods Ten fresh-frozen human cadaveric spines (C1–T6) were obtained from the Maryland State Anatomy Board. 59 The absence of osteoporosis was confirmed with DEXA (Discovery

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Scott L. Parker, Anubhav G. Amin, S. Harrison Farber, Matthew J. McGirt, Daniel M. Sciubba, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

from these chronically damaged nerve roots. 8 Other patient factors may also influence the main flaw in using EMG monitoring to determine the accuracy of pedicle placement, which is its high number of falsely stimulated screws that are in fact well within the medial pedicle cortex. The structural bone integrity of the preexisting spine can be taken into consideration when deciding to use EMG monitoring because degenerated bone, as in the case of patients with osteoporosis or the elderly population, will have minor bone defects that may be clinically insignificant

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Mohamad Bydon, Dimitrios Mathios, Mohamed Macki, Rafael de la Garza-Ramos, Daniel M. Sciubba, Timothy F. Witham, Jean-Paul Wolinsky, Ziya L. Gokaslan and Ali Bydon

spondylosis * Variable Value (%) no. of cases 151 mean age in yrs (± SD) 56 ± 13.6 no. of males 107 (70.8) comorbidities  diabetes 10 (7)  smoking history 35 (23.2)  CHF 2 (1.3)  CAD 12 (7.9)  osteoporosis 2 (1.3)  obesity 6 (4) presenting symptoms  neck pain 64 (42.4)  radiculopathy 151 (100)  motor deficit 75 (49.7)  sensory deficit 59 (39) PCF operative indication  disc herniation 56 (37.1)  osteophyte 11 (7.3)  complex osteophyte

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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

-year-old female with a history of breast cancer and osteoporosis who presented with acute onset of severe lower-back pain, urinary incontinence, and lower-extremity weakness. a: A sagittal MR image demonstrated a T-11 pathological fracture. b and c: An axial MR image (b) and CT scan (c) showed retropulsion of the bone into the spinal canal and subsequent conus compression. The patient underwent bilateral T10–12 laminectomies, right costal transversectomy, right T-11 rhizotomy, and transpedicular removal of the T-11 vertebral body via a posterior approach. Anterior