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Minoru Ikenaga, Jitsuhiko Shikata, and Chiaki Tanaka

). Postoperative MR imaging revealed complete decompression of the spinal cord ( Fig. 5 right ). The 3-month postoperative and follow-up JOA scores increased to 14 points. Fig. 5. Left and Center: Seven-year postoperative AP (left) and lateral (center) radiographs revealing successful C2–7 anterior fusion. Single-screw fixation was used. Right: Postoperative axial image obtained at C4–5, revealing complete decompression of the spinal cord. Discussion Whitecloud and LaRocca 40 first reported anterior corpectomy and fusion in conjunction with

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Michael H. Sukoff and Vicki Czaykowski

Object The authors conducted a study to investigate the long-term results and postoperative complications of a new surgical technique, fibular strut graft–assisted anterior corpectomy and fusion for multilevel (> four) cervical myelopathy. Multilevel anterior corpectomy and subsequent strut graft placement is considered a challenging procedure because of complications relating to graft dislodgment, pseudoarthrosis, greater operative duration, and increased blood loss. Methods The study comprised 100 patients with cervical myelopathy who underwent

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Taolin Fang, Jian Dong, Xiaogang Zhou, Robert A. McGuire Jr., and Xilei Li

all segments of the spine. Pain relief and preservation of neurological function can be accomplished by partial or total excision of the lesion from the vertebra 6 , 12 , 21 , 26 , 34 anteriorly or posteriorly with sufficient surgical decompression. 6 , 12 , 15 , 34 Anterior corpectomy via thoracolumbar approaches was applied more frequently in the setting of metastatic spinal cancer surgery, 8 although this traditional wide-open anterior approach may cause significant complications, such as intercostal neuralgia and postthoracotomy pain. 19 The thoracoscopic

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Zihao Chen, Bin Liu, Jianwen Dong, Feng Feng, Ruiqiang Chen, Peigen Xie, Liangming Zhang, and Limin Rong

demonstrate increased signal on T2-weighted MRI of the cervical cord. 6 Surgical decompression can be performed via an anterior, a posterior, or a combined anteroposterior approach. Anterior corpectomy and fusion (ACF) and posterior laminoplasty are 2 traditional surgical procedures that are widely used for treating patients with OPLL. The ACF procedure is used to achieve direct decompression by resection of the ossified mass via an anterior approach. The advantages of the anterior approach are as follows: 1) removal of the ossified mass enables complete decompression

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Alexander A. Theologis, Ehsan Tabaraee, Paul Toogood, Abbey Kennedy, Harjus Birk, R. Trigg McClellan, and Murat Pekmezci

Surgical technique The patient is brought to the operating room and intubated. Dose-appropriate antibiotics are administered preoperatively. If the patient is to undergo both an anterior corpectomy and posterior instrumentation, he or she is then placed prone on a Jackson table in preparation for the posterior instrumentation. Posterior Instrumentation: Open Versus Percutaneous Patients with a greenstick lamina fracture, a neurological deficit, or both, undergo standard posterior instrumentation and fusion. In the absence of these findings, percutaneous pedicle

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Matthew T. Mayr, Brian R. Subach, Christopher H. Comey, Gerald E. Rodts, and Regis W. Haid Jr.

. In performing an anterior cervical corpectomy, one must carefully select a structural graft, plating system, and means of postoperative immobilization. Table 6 summarizes the literature covering anterior corpectomy with or without plates. 3, 5, 6, 8, 13–17, 25–27, 29, 31, 37, 39, 42, 43, 45, 47, 48 The majority of these authors used autologous bone without a plate to reconstruct the spine. Variations in operative techniques, graft materials, and fixation devices make comparisons among the series difficult. TABLE 6 Summary of published series of patients

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Gurpreet Gandhoke, Jau-Ching Wu, Nathan C. Rowland, Scott A. Meyer, Camilla Gupta, and Praveen V. Mummaneni

adjacent-segment disease in patients with previous anterior cervical decompression and fusion . Spine (Phila Pa 1976) 31 : 1332 – 1337 , 2006 20 Mayr MT , Subach BR , Comey CH , Rodts GE , Haid RW Jr : Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation . J Neurosurg 96 : 1 Suppl 10 – 16 , 2002 21 Meyer SA , Wu JC , Mummaneni PV : Laminoplasty outcomes: is there a difference between patients with degenerative stenosis and those with ossification of the posterior longitudinal

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Daniel C. Lu, Darryl Lau, Jasmine G. Lee, and Dean Chou

probability values were performed to evaluate for statistically significant differences. The ASIA scores were assessed on admission and the most recent follow-up; if the patient was lost to follow-up, the last documented ASIA score was used. Anterior Approaches In patients who underwent anterior corpectomies of the thoracolumbar spine, 1 of 3 methods of approach was used. One was a standard transthoracic approach via thoracotomy, with 1 rib removed for exposure and for use as an autograft. The second was a thoracoabdominal approach via low thoracotomy (usually T-10 or

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Pregnancy-related vertebral hemangioma

Case report, review of the literature, and management algorithm

John H. Chi, Geoffrey T. Manley, and Dean Chou

Pregnancy is a recognized risk factor for quiescent vertebral hemangiomas becoming symptomatic; this usually occurs during the 3rd month of gestation. The natural history of these lesions is poorly understood, and treatment practices must consider the overall safety of the mother and fetus. The authors report a case of cervical vertebral hemangioma presenting during the 24th week of pregnancy and review the current literature.

A 26-year-old woman in her 24th week of pregnancy presented with upper-back pain and progressive spastic paresis in the legs. Neuroimaging studies revealed a diffuse C-7 vertebral body lesion with extradural extension and compression of the spinal cord consistent with a vertebral hemangioma. Successful decompression was accomplished, and the fetus experienced no adverse effects from the surgery.

In a review of the literature, 23 cases of pregnancy-related vertebral hemangioma dating back to 1927 were identified. Prepartum surgical decompression was performed in eight patients, postpartum surgery was performed in 12, and surgery was not performed in four. Overall, patients experienced excellent neurological recovery, regardless of the severity and duration of spastic paresis.

Observation should be considered for symptomatic patients at greater than 32 weeks gestation. Surgery should be considered for patients with severe neurological deficits at less than 32 weeks of gestation.

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Vanessa Hubertus, Jens Gempt, Michelle Mariño, Björn Sommer, Sven O. Eicker, Martin Stangenberg, Marc Dreimann, Insa Janssen, Christoph Wipplinger, Arthur Wagner, Nicole Lange, Ann-Kathrin Jörger, Marcus Czabanka, Veit Rohde, Karl Schaller, Claudius Thomé, Peter Vajkoczy, Julia S. Onken, and Bernhard Meyer

in 238 patients with spinal metastases at the CTJ in a multicenter, international, European observational trial. Patients underwent posterior decompression only (group 1), posterior decompression and fusion (group 2), anterior corpectomy and fusion (group 3), or anterior corpectomy and 360° fusion (group 4). Primary endpoints were surgical and medical complications and surgical revision rate, and the secondary endpoint was postoperative survival. Methods Clinical Data Consecutive data sets of patients who, between 2005 and 2019, had undergone surgical