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Alan D. Legatt, Avra S. Laarakker, Jonathan P. Nakhla, Rani Nasser and David J. Altschul

level of the cervicomedullary junction (cuneate nucleus), and the N20 component is generated in the primary somatosensory cortex. 7 Within the spinal cord, these SSEPs are mediated by the dorsal columns, not the spinothalamic tracts, 2 and spinal cord compromise would typically affect both cortical and subcortical SSEPs. We report herein a case of anterior cervical discectomy and fusion (ACDF) surgery during which the cortical and subcortical SSEPs to left ulnar nerve stimulation were differentially affected. This IOM finding led to the correction of carotid artery

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Vincent C. Traynelis, Jonathan Sherman, Eric Nottmeier, Vaneet Singh, Kirk McGilvray, Christian M. Puttlitz and Patrick Devin Leahy

A nterior cervical discectomy and fusion (ACDF) is a safe and effective means of treating clinically significant degenerative cervical disc disease. Some patients may not experience fusion with time, and although not all of these patients will be symptomatic, the development of a solid arthrodesis is associated with an optimal outcome. Fusion rates for a construct consisting of allograft and an anterior plate at 1 level have been reported to be 96%–97%. 7 , 13 These rates are reduced with the inclusion of additional levels to the fusion procedure, with 2

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Syed I. Khalid, Ryan Kelly, Adam Carlton, Owoicho Adogwa, Patrick Kim, Arjun Ranade, Jessica Moreno, Samantha Maasarani, Rita Wu, Patrick Melville and Jonathan Citow

A nterior cervical discectomy and fusion (ACDF) procedures increased roughly 8-fold between the years of 1990 and 2004, with inflation-adjusted societal costs of such procedures rising from $672 million in 1990 to $2.1 billion in 2000. 6 , 9 These procedures are not only becoming more frequent, they are becoming more costly as well. With the costs related to the United States medical system constantly rising, increasing efforts are being made to turn traditional inpatient procedures into outpatient surgeries performed in the ambulatory setting. The goal is not

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W. Bryan Wilent, John P. Ney, Jeffrey Balzer, Miriam L. Donohue, Jeffrey H. Gertsch, Robert Holdefer, Faisal R. Jahangiri, Kathryn Overzet, Jay Shils and Richard Vogel

that intraoperative neurophysiological monitoring (IONM) was not performed for patients in the non-IONM cohort; however, that is an imprudent assumption, and many, or most, of the procedures in the non-IONM cohort may have utilized IONM. The authors report that only 7% of anterior cervical discectomies and fusions (ACDFs) in the US utilized IONM in this data set, but a recent survey of spine surgeons indicates that 61%–73% routinely use IONM during ACDF. 5 The low utilization rate found here is a result of the reliance of the presence of the ICD-9 code for IONM on a

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Jacqueline Nguyen, Bryant Chu, Calvin C. Kuo, Jeremi M. Leasure, Christopher Ames and Dimitriy Kondrashov

discectomy and fusion (ACDF) is an established procedure originally described in 1958 by Smith and Robinson. 31 It has evolved to include a range of different techniques, including direct or indirect decompression of the uncovertebral joint, resection or preservation of posterior longitudinal ligament (PLL), and the use of a graft or cage in the intervertebral disc space. The ACDF procedure is appropriate in the presence of uncovertebral spurs and central disc herniations and is advantageous in that it does not necessarily need to expose the spinal canal. 12 , 33

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Matthew J. McGirt, Saniya S. Godil, Anthony L. Asher, Scott L. Parker and Clinton J. Devin

S ince Smith, Robinson, and Cloward first described the procedure in 1958, 4 , 15 anterior cervical discectomy and fusion (ACDF) has become one of the most commonly performed spinal operations. ACDF is considered the gold standard for many degenerative cervical spine diseases due to its relative simplicity, minimal risk, and reliability. 5 The total number of cervical spine procedures performed annually more than doubled from 1990 to 2000, from 53,810 to 112,400. 10 In fact, more ACDFs have been performed from 1999 to 2004 than were undertaken the

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Jack Mullins, Mirza Pojskić, Frederick A. Boop and Kenan I. Arnautović

A nterior cervical discectomy and fusion (ACDF) is considered the gold standard for many degenerative diseases of the cervical spine because of its relative simplicity, minimal risk, and reliability. 8 It was first described by several authors in 1958 5 , 31 and has become established as one of the most common spine procedures. A recent population-based observational study revealed a steady increase in cervical spine surgeries in both inpatient and outpatient settings. 3 The increasing interest in cost-saving strategies has shifted many medical procedures to

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Katie L. Krause, James T. Obayashi, Kelly J. Bridges, Ahmed M. Raslan and Khoi D. Than

A nterior cervical discectomy and fusion (ACDF) is one of the most common neurosurgical procedures performed for the treatment of cervical myelopathy and radiculopathy. 1 Although immediate symptomatic relief is generally due to decompression of the affected neural structures, long-term success is dependent on the placement of an appropriate interbody graft within the disc space to maintain disc and foraminal height, restore cervical lordosis, and promote bone fusion. 11 , 13 As surgeons continue to refine this common procedure, options for graft material have

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Ronald H. M. A. Bartels and Jan Goffin

A nterior cervical discectomy with fusion (ACDF) is a well-known, frequently performed procedure in daily spinal practice. The first descriptions of the procedure were attributed to Cloward 1 and Smith and Robinson. 4 , 11 However, the procedure was described earlier in Neurochirurgie , a French-language neurosurgical journal. In this paper, we discuss 2 articles written by Albert Dereymaeker and Joseph Cyriel Mulier and provide biographical detail on each man. First Article In 1956, Albert Dereymaeker and Joseph Cyriel Mulier described in Neurochirurgie

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Rafael De la Garza-Ramos, Risheng Xu, Seba Ramhmdani, Thomas Kosztowski, Mohamad Bydon, Daniel M. Sciubba, Jean-Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan and Ali Bydon

F irst introduced by Smith, Robinson, and Cloward in 1958, 6 , 27 anterior cervical discectomy and fusion (ACDF) is currently one of the most commonly performed procedures in the cervical spine. 17 , 19 Usually reserved for patients with myelopathy and/or intractable radiculopathy secondary to age-related degeneration, ACDF most commonly addresses 1- or 2-level disease. 4 Three-level and 4-level ACDF procedures, however, are less common and there are limited data regarding their clinical outcomes, particularly for 4-level ACDF. 2 , 15 , 16 Furthermore