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Tobias A. Mattei, Martin Morris, Kathleen Nowak, Daniel Smith, Jeremy Yee, Carlos R. Goulart, Anne Zborowski and Julian J. Lin

the performance of 10 hydrocephalus shunts in vitro . Neurosurgery 42 : 327 – 334 , 1998 7 Gruber R , Jenny P , Herzog B : Experiences with the anti-siphon device (ASD) in shunt therapy of pediatric hydrocephalus . J Neurosurg 61 : 156 – 162 , 1984 8 Harris DL , Hakim S : Shunt system for the transport of cerebrospinal fluid. US patent 3,889,687 . June 17 1975 9 Kestle J , Drake J , Milner R , Sainte-Rose C , Cinalli G , Boop F , : Long-term follow-up data from the Shunt Design Trial . Pediatr Neurosurg 33 : 230

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Owoicho Adogwa, Ricardo K. Carr, Katherine Kudyba, Isaac Karikari, Carlos A. Bagley, Ziya L. Gokaslan, Nicholas Theodore and Joseph S. Cheng

Elderly patients requiring revision decompression and fusion for various etiologies of failed–back surgery syndrome (ASD, pseudarthrosis, and same-level recurrent stenosis) are a particularly difficult cohort to treat. Revision surgery can be technically challenging, and elderly patients often present with long durations of symptoms coupled with anxiety regarding surgeries that they believe have already failed. Moreover, the prevalence of medical comorbidities in this population makes the procedure even more complicated. Hence, outcomes after revision neural

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Owoicho Adogwa, Ryan Owens, Isaac Karikari, Vijay Agarwal, Oren N. Gottfried, Carlos A. Bagley, Robert E. Isaacs and Joseph S. Cheng

population continue to mount, governmental agencies and third-party payers are aiming to preferentially support higher value care and decrease spending on disease states with less impact on their population's health. Accordingly, there is a growing need to clearly define the treatment cost as well as the cost-effectiveness of revision decompression and extension of fusion for symptomatic pseudarthrosis, ASD, and same-level recurrent stenosis for this elderly population. Recently, funding of the Patient-Centered Outcomes Research Institute in the Patient Protection and

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adjacent segment disease (ASD) in the cervical spine. Methods: 888 patients received ACDFs for symptomatic degenerative disease of the cervical spine over the past 22 years at our institution. Of these, 108 patients received repeat ACDF surgeries due to symptomatic ASD. 77 received revision surgeries anteriorly, and 31 received posterior surgeries. Pre, intra, peri, and post-operative data were collected via clinical notes and patient interviews. Patients were followed up for an average of 111.8±76.5 months after the first ACDF. Results: In general, patients

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Association of Neurological Surgeons 2013.4.FOC-LSRSABSTRACTS Oral Presentation Abstracts Paper 47. Age, Sagittal Deformity and Operative Correction are Risk Factors for Proximal Junctional Failure (PJF) Following Adult Spinal Deformity (ASD) Surgery Robert Hart , MD , Richard Hostin , MD , Themistocles Protopsaltis , MD , Shay Bess , MD , Frank Schwab , MD , Virginie Lafage , PhD; , Praveen Mummaneni , MD , Christopher Ames , MD , Christopher Shaffrey , MD , Justin

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Michael Y. Wang

Adult spinal deformities (ASD) pose a challenge for the spinal surgeon. Because the spine is often rigid, mobilization of the segments is critical for effective correction, particularly in the sagittal plane. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained problematic using MIS approaches, including MIS lateral methods. This video illustrates one method for achieving improvement of coronal and sagittal correction without the extensive exposure and soft tissue envelope disruption needed in open surgery, particularly for less severe deformities. By using multi-level TLIFs through a mini-open surgery, curves of less than 60° can be managed with minimal blood loss and within a reasonable surgical timeframe. While feasibility will have to be proven with larger series and improved surgical methods, this technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.

The video can be found here: http://youtu.be/I0rkDSAVas0.

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Hironobu Sakaura, Tomoya Yamashita, Toshitada Miwa, Kenji Ohzono and Tetsuo Ohwada

, including symptomatic ASD. Statistical Analysis The unpaired t-test, Mann-Whitney U-test, Fisher exact probability test, Wilcoxon signed-rank test, repeated-measure 1-way ANOVA, and Fisher protected least significant difference were used for statistical analysis with JMP 5.0.1 software (SAS Institute), as appropriate. Values of p < 0.05 were considered significant. Results Clinical Results The mean operation time and estimated intraoperative blood loss were 218 ± 49 minutes (range 164–393 minutes) and 612 ± 424 ml (range 160–2000 ml) in the 2-level PLIF

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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

established and treatment options defined and clarified. Therefore, the purpose of this article is to provide a comprehensive review of cervical alignment parameters and related outcome measures that may provide guidance for proper surgical treatment and highlight deficiencies in the current literature. Comparisons to established spinal pelvic parameters that predict disability in thoracolumbar surgery will be described. Other pathologies that are closely influenced by cervical deformity, including ASD and myelopathy, are also discussed. Cervical Spine Alignment

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Haichun Liu, Wenliang Wu, Yi Li, Jinwei Liu, Kaiyun Yang and Yunzhen Chen

L umbar fusion has increasingly become a standard treatment for spinal disorders during the past decades. 3 , 12 Degenerative lumbar disorders, including lumbar disc herniation, lumbar spinal stenosis, and spondylolisthesis, 13 have been noted as the most common indication for spinal fusion. 15 Although lumbar fusion results in high union rates and has yielded good clinical results in decreasing pain and paralysis, 5–8 it has also been associated with an increased incidence of ASD. 9 This pathology is now considered a potential late complication of

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Daniel Nilsson, Johanna Svensson, Betül A. Korkmaz, Helena Nelvig and Magnus Tisell

later in life is unknown. With more balanced drainage of the ventricles and more normal growth of the skull this may have been avoided. Data on the incidence of shunt-induced craniosynostosis necessitating surgery are scarce, but the incidence of slit ventricle syndrome has been reported to range from 0.9% to as high as 37%. 2 , 3 , 11 , 13–16 However, the studies with the highest incidences of slit ventricle syndrome (24% and 37%) were both carried out primarily before antisiphon devices (ASDs) and adjustable shunts were available (1966–1984). 2 , 14 In contrast