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Lali Sekhon and Neil Duggal

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Kenzo Uchida, Hideaki Nakajima, Ryuichiro Sato, Takafumi Yayama, Erisa S. Mwaka, Shigeru Kobayashi and Hisatoshi Baba

A ssessing the sagittal alignment of the cervical spinal column is essential when a patient is amenable to neurosurgical treatment for cervical compressive myelopathy. The kyphotic deformity associated with cervical spondylosis is the result of progressive subluxation of the apophyseal joints due to degenerative changes in the facet joints and discs. 30 , 35 , 39 In patients with kyphotic deformities, the spinal cord shifts to the anterior portion of the spinal canal and abuts the posterior aspect of the vertebral bodies at the apex of the deformity. 2

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Hasan R. Syed, Kurt Yaeger and Faheem A. Sandhu

Several studies have described the radiographic, histological, and morphological changes to the paraspinal muscle in patients with chronic low-back pain due to degenerative diseases of the spine. Gross anatomical illustrations have shown that the psoas muscle lies lateral to the L4–5 vertebrae and subsequently thins and dissociates from the vertebral body at L5–S1 in a ventrolateral course. A “rising psoas” may influence the location of the lumbar plexus and result in transient neurological injury on lateral approach to the spine. It is postulated that axial back pain may be exacerbated by anatomical changes of paraspinal musculature as a direct result of degenerative spine conditions. To their knowledge, the authors present the first reported case of a more anteriorly positioned psoas muscle and its resolution following correction of spondylolisthesis in a 62-year-old woman. This case highlights the dynamic nature of degenerative spinal disorders and illustrates that psoas muscle position can be affected by sagittal balance. Normal anatomical positioning can be restored following correction of spinal alignment.

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Frank L. Acosta Jr., John Liu, Nicholas Slimack, David Moller, Richard Fessler and Tyler Koski

. Nevertheless, precise measurements of changes in segmental, regional, and global sagittal alignment after the lateral transpsoas approach are lacking. Data on the ability of this technique to improve coronal and sagittal plane alignment will be important in determining its overall usefulness as a surgical tool for the correction of spinal imbalance resulting from degenerative lumbar disease. The purpose of this study was to analyze the effect of minimally invasive lumbar interbody fusion via the lateral transpsoas approach utilizing the DLIF technique on segmental, regional

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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Benjamin Blondel, Frank Schwab, Richard Hostin, Robert Hart, Brian O'Shaughnessy, Shay Bess, Serena S. Hu, Vedat Deviren, Christopher P. Ames and International Spine Study Group

P ositive sagittal malalignment (defined as anterior deviation of the C-7 plumb line >5 cm from the posterior superior corner of S-1) is recognized as a cause of pain and disability in cases of ASD. 8 , 20 , 28 , 30 , 31 Poor sagittal alignment has been shown to require increased energy expenditure, and multiple compensatory measures have been described, including knee flexion, pelvic retroversion, and thoracic hypokyphosis. 20 , 30 , 31 Surgical correction of positive sagittal malalignment has been correlated with significant improvement in health

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Søren Ohrt-Nissen, Casper Dragsted, Benny Dahl, John A. I. Ferguson and Martin Gehrchen

with intraoperative correction techniques and the biochemical properties of the rods. 1 , 5 , 11 Various rod insertion techniques have been described to optimize 3D correction, including derotation, cantilever reduction, translation, and in situ rod bending, but none of these have shown a consistent positive effect on sagittal alignment. 7 , 17 , 27 , 37 Recently, a study assessed the effect of increasing rod strength by introducing bilateral beam-like rods (BRs), which have a larger anteroposterior (AP) diameter than traditional circular rods ( Fig. 1 ). This

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Sumit Thakar, Dilip Mohan, Sunil V. Furtado, Narayanam Anantha Sai Kiran, Ravi Dadlani, Saritha Aryan, Arun S. Rao and Alangar S. Hegde

intervention. 8 , 10 , 24 , 27 , 30 , 32 Changes in paraspinal muscle morphometry and their relationship with postoperative sagittal alignment in CSM have, however, only been implicated and never analyzed. Factors Affecting Cervical Paraspinal Muscle Anthropometry and Function Various aspects of paraspinal muscle CSA and function have been studied previously, both in normal subjects and in specific disease groups. The strength of cervical paraspinal muscles has been shown to directly correspond to their CSA, 18 and this extrapolation adds clinical significance to

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Kazunori Hayashi, Louis Boissière, Fernando Guevara-Villazón, Daniel Larrieu, Susana Núñez-Pereira, Anouar Bourghli, Olivier Gille, Jean-Marc Vital, Ferran Pellisé, Francisco Javier Sánchez Pérez-Grueso, Frank Kleinstück, Emre Acaroğlu, Ahmet Alanay and Ibrahim Obeid

that surgeons cannot ignore sagittal alignment despite the fact that an ideal SVA does not always coexist with substantial satisfaction. According to entire analysis, a patient’s self-image, standing ability, relief from pain, and sagittal alignment may be useful goals for surgeons and physicians managing ASD in improving patient satisfaction. FIG. 1. Distribution of the subdomains of the satisfaction score and SRS-22R SI/appearance at 2 years after surgery. FIG. 2. Distribution of the subdomains of the satisfaction score and SVA at 2 years after surgery. Limitations

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Konstantinos A. Starantzis, Babak Mirzashahi, Eyal Behrbalk, Mirmostafa Sadat and Masood Shafafy

alignment ( Fig. 4C ). Following this partial reduction of S-1 on S-2, the anatomical landmarks of L-5 become more accessible, and a polyaxial screw is inserted on the right ( Fig. 4D ). Reduction is fostered with a permanent rod inserted on the right, and the temporary rod is then removed on the left, allowing a left L-5 pedicle screw insertion with subsequent permanent rod fixation on the left. With the permanent rods and the L-5 screws in situ, we continue with reduction of the translation until we achieve normal sagittal alignment ( Fig. 4E ). In the presence of any

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Justin K. Scheer, Jessica A. Tang, Justin S. Smith, Frank L. Acosta Jr., Themistocles S. Protopsaltis, Benjamin Blondel, Shay Bess, Christopher I. Shaffrey, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher P. Ames and the International Spine Study Group

bodies from C-2 to C-7 and then summing the segmental angles for an overall cervical curvature angle. Translation of the cervical spine in the sagittal plane is measured through the cervical SVA, for which there are different methods of measurement. Both C-2 SVA ( Figs. 2 and 3 left ) and C-7 SVA have been used to define sagittal alignment globally by measuring the distance between the C-2 and C-7 plumb lines, respectively, from the posterior superior corner of the sacrum. Cervical SVA can also be defined regionally using the distance between a plumb line dropped