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Masashi Neo, Shunsuke Fujibayashi, Makoto Yoshida and Takashi Nakamura

which nonunion of the grafted bone had occurred with or without plate migration (nonunion cases) and two in which dislodgment of the grafted bone had occurred (dislodgment cases). In all cases except Case 5, an anterior cervical plate was used. In four cases, the plate was removed during the revision surgery because of loosening and migration. In the nonunion cases, no thorough resection or refreshment of the pseudarthrosis was performed and no bone graft was harvested from other sites. In the two dislodgment cases, the original bone graft was replaced without

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Masato Nakano, Norikazu Hirano, Hirokazu Ishihara, Yoshiharu Kawaguchi, Hiroki Watanabe and Kousou Matsuura

biodegradable or osteoconductive, nor is it remodeled to bone. There is the possibility of intraoperative and long-term complications in PMMA-assisted vertebroplasty, including hypotension resulting from absorption of the PMMA monomer, an exothermic reaction, and the lack of osseous integration of PMMA. Furthermore, PMMA cement is hard to remove when catastrophic extrusion of the cement induces major neurological complications. Although CPC has the same risk of cement extrusion, it may be easy to remove at revision surgery due to its compressive and torsional strength, which

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Gwynedd E. Pickett, Lali H. S. Sekhon, William R. Sears and Neil Duggal

(ROM 22°, extension 16°), presumably compensating for the lower fused segment. Although the prosthesis functioned well initially, with ROM limited to 12°, by 9 months postoperatively the motion segment again exhibited hypermobility. The total ROM was 17° (extension 13°), with probable partial internal subluxation of the prosthesis in extension ( Fig. 4 ). Because the patient was completely asymptomatic, she declined revision surgery. F ig . 3. Neutral cervical radiographs acquired in a 41-year-old woman preoperatively (left) and at 3 months (right

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Gabriel Y. F. Lee, Guillermo Paradiso, Charles H. Tator, Fred Gentili, Eric M. Massicotte and Michael G. Fehlings

suggested that retethering is relatively common. They found that among 52 patients followed up for 2 to 11 years, 52% required revision surgery by age 5 years. After a second release procedure, the revision rate was 57%. In contrast, the incidence of retethering in adults seems to be significantly lower. Huttman, et al., 6 have reported that over a mean follow-up period of 8 years, nine (16%) of 56 patients were deemed to require repeated detethering surgery. In the current study, two patients (3.3%) required repeated detethering procedures during the follow-up period

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Rudolf Bertagnoli, James J. Yue, Andrea Fenk-Mayer, Jonathan Eerulkar and John W. Emerson

adjacent-segment lumbar DDD following remote fusion. Significant improvements in patient satisfaction and disability scores were observed 3 months after surgery and were maintained throughout the 2-year follow-up period. No hardware-related complications occurred and revision surgery was not necessary. Acknowledgments We thank Mr. Armin Karg, Ms. Regina Nanieva, and Dr. Frank Pfeiffer for their assistance in this project. At the time of manuscript preparation, the ProDisc was not a Federal Drug Administration–approved device. References 1 Bertagnoli R

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Hiroshi Taneichi, Kota Suda, Tomomichi Kajino, Akira Matsumura, Hiroshi Moridaira and Kiyoshi Kaneda

without neurological compromise, she did not agree to undergo a revision surgery. She was treated conservatively with long-term brace therapy and remained asymptomatic for 36 months after surgery. At the final follow-up examination, consolidation of the L4–5 segment was apparent in not only the interbody fusion but also the PLF. The other patients in whom a fusion status was Category E or D ( Table 3 ) had no critical symptoms related to pseudarthrosis, and none required revision surgery. One female patient suffered a deep surgical site infection, which was cured by

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Violette M. Renard and Richard B. North

T he use of a cylindrical electrode, inserted percutaneously through a Tuohy needle, facilitates the mapping of pain/paresthesia overlap during SCS trials by providing access to multiple levels of the spine. When implanted in a system designed to be permanent, however, percutaneous electrodes are prone to migration (change in physical position), leading to a loss of pain/paresthesia overlap that cannot always be recaptured, even by revision surgery. Use of multicontact percutaneous electrodes sometimes allows clinicians to restore lost overlap by setting

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Michael P. Steinmetz, Jared Miller, Ann Warbel, Ajit A. Krishnaney, William Bingaman and Edward C. Benzel

Patients in whom CTJ treatment failure occurred were followed for a mean of 20 months (range 6–72 months). In those cases in which treatment failure did not occur, the mean follow-up duration was 13 months (range 1–89 months). Although there were 50 such patients in the failure group, none was lost to follow up. Twelve of these patients died before the final follow-up examination, and 38 did not return for their scheduled follow-up visit. The reason was not recorded. Thirteen of 14 patients required revision surgery for CTJ treatment failure. After undergoing a ventral

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Jin-Yul Lee, Werner Stenzel, Mario Löhr, Hartmut Stützer, Ralf-Ingo Ernestus and Norfrid Klug

K : Revision surgery for lumbar disc herniation. An analysis of 45 patients . Int Orthop 19 : 98 – 102 , 1995 2 Benoist M , Ficat C , Baraf P , Cauchoix J : Postoperative lumbar epiduro-arachnoiditis. Diagnostic and therapeutic aspects . Spine 5 : 432 – 436 , 1980 3 Bernard TN Jr : Using computed tomography/discography and enhanced magnetic resonance imaging to distinguish between scar tissue and recurrent lumbar disc herniation . Spine 19 : 2826 – 2832 , 1994 4 Burton CV , Kirkaldy-Willis WH , Yong-Hing K , Heithoff

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Shinya Okuda, Akira Miyauchi, Takenori Oda, Takamitsu Haku, Tomio Yamamoto and Motoki Iwasaki

who did not undergo revision surgery were assessed at the final follow-up examination. The clinical results of the patients who underwent revision surgery were assessed immediately before the second operation. The average pre- and postoperative JOA scores for all patients were 13 and 24 points, respectively. Intraoperative Complications Intraoperative complications occurred in 26 patients. Nineteen patients (7.6%) experienced dural tearing, and seven (2.8%) had pedicle screw malposition (one pedicle screw malposition per patient; Table 2 ). No major