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John Persing, John A. Jane Jr. and John A. Jane Sr.

more adequately reshaped the deformed skull bone, repositioning it, as well as removing the fused suture. As the entirety of the skull deformity became more scrutinized, it was clear that not only were there hypoplastic deformities, but compensatory skull abnormalities that had developed as a result of continued growth of the brain. Initially, it was recognized that there is a flattened frontal bone skull deformity associated with conditions like unilateral coronal synostosis. Subsequently, it was apparent that there was also contralateral frontal bossing evident in

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William Gump

time that elective skull deformity procedures have been applied to adults. These ideas include the concept of extreme body modification, and the position promoted by the International Trepanation Advocacy Group. Both movements have relatively well-defined modern histories. Body Modification Deliberate alteration of the human body for nonmedical reasons has a lengthy and rich history in human culture. 3 These practices can be carried out for religious reasons, aesthetic purposes, sexual enhancement, as a rite of passage, to denote affiliation, or for shock

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Sarah E. Duff, Paul L. Grundy and Steven S. Gill

A nkylosing spondylitis frequently results in fixed flexion deformities of the spine, typically in the thoracolumbar area; cervical deformities are less frequently encountered. Patients with severe cervical flexion deformities can be significantly disabled and may be unable to see directly ahead; in severe cases they may also have difficulty eating and breathing. These patients may be treated by means of a corrective cervicothoracic osteotomy; this procedure is usually performed at the C7—T1 level, as described by several authors. 5, 7, 8, 10 Osteotomies at

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Praveen V. Mummaneni, Christopher I. Shaffrey, Lawrence G. Lenke, Paul Park, Michael Y. Wang, Frank La Marca, Justin S. Smith, Gregory M. Mundis Jr., David O. Okonkwo, Bertrand Moal, Richard G. Fessler, Neel Anand, Juan S. Uribe, Adam S. Kanter, Behrooz Akbarnia and Kai-Ming G. Fu

W ith the aging of the US population, adult degenerative scoliosis is increasing in incidence with significant impact on health and disability. 5 , 9–11 Surgical correction of adult degenerative scoliosis has traditionally been performed using open surgical approaches. Open spinal deformity correction surgery is associated with a large amount of intraoperative blood loss and significant complication rates. 6 A multicenter study from the International Spine Study Group reviewing 953 adult spinal deformity patients revealed a major complication rate of 7

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Steven Knafo, Charles Court and Fabrice Parker

S pinal deformity is a well-documented complication after surgery involving a multilevel laminectomy. 4 Postoperative kyphosis has been reported to occur in 10%–14% of surgeries for cervical spondylotic myelopathy. 11 Risk factors associated with postlaminectomy sagittal deformity are pediatric patient age, 2 , 10 , 12 number of spinal levels involved in the laminectomy, 5 , 6 preoperative kyphosis, 6 arthrectomy, 5 inclusion of a spinal junction in the laminectomy, 6 adjuvant radiotherapy, 2 , 5 and surgical reintervention. 1 The issue of

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Charles A. Sansur, Kai-Ming G. Fu, Rod J. Oskouian Jr., Jay Jagannathan, Charles Kuntz iv and Christopher I. Shaffrey

A nkylosing spondylitis is an inflammatory rheumatic disease primarily affecting the axial skeleton. This continued inflammatory disease process leads to a progressive rigidity of the entire spine. Clinical criteria for diagnosing AS include low-back pain and stiffness of greater than 3 months' duration and restriction of lumbar motion in both the sagittal and frontal planes. 14 This restriction coupled with an often present thoracolumbar kyphotic deformity can lead to sagittal-plane imbalance. 13 In a longitudinal observational cohort, 49% of patients

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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

subjacent global spinal alignment and pelvic tilt as compensatory changes occur to maintain horizontal gaze. In the past, research conducted on the relationship between spinal malalignment and HRQOL has largely focused on the thoracolumbar and pelvic regions, and comparatively little attention has been given to the cervical spine. Currently, indications for surgery to correct cervical alignment are not well defined and there is no set standard to address the amount of correction to be achieved. Furthermore, classifications of cervical deformity have yet to be fully

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Stephen E. Rawe and John C. VanGilder

O steomas that result in extensive displacement of the orbital contents are infrequent. The large size of this tumor, its unusual presentation, technique of surgical excision, and reconstruction of the orbit prompted reporting of this case. Case Report This 56-year-old man was admitted to the West Haven Veterans' Administration Hospital, neurosurgical service, in November, 1972. Four years prior to admission he noted a nontender progressive protuberance of his right eye; this increasing ocular deformity had caused diplopia for 3 years. He had no other

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Cheerag D. Upadhyaya, Sigurd Berven and Praveen V. Mummaneni

P edicle subtraction osteotomy is a powerful technique for the correction of a fixed sagittal plane deformity. This type of osteotomy has been associated with significant perioperative morbidity, 1 , 2 , 4–6 which we have described as > 50% in patients undergoing PSO in a revision setting. We here report a rare case of pseudarthrosis at the level of a PSO due to spondylolisthesis of the PSO segment. Case Report History and Examination This 50-year-old man who had undergone 4 prior thoracolumbar operations over the past decade presented with

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Robert F. Heary and Reza J. Karimi

L umbar scoliosis is increasingly recognized as a cause of debility in the adult population. 3 , 8 , 17 , 20 , 22 , 25 In contrast to thoracic scoliosis, in which the deformity itself is often the cause of concern for the patient, in lumbar scoliosis, the most frequent presenting complaint is radicular pain caused by nerve root compression. 22 The causes of lumbar scoliotic deformities can be categorized as idiopathic, degenerative, or iatrogenic due to factors following prior unsuccessful spinal surgery. 1 , 17 In each of these categories, there is a