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Seung-Jae Hyun, Ki-Jeong Kim, and Tae-Ahn Jahng

thoracolumbar deformity can be better understood. 5 , 19–21 No reports have described how cervical reconstructive surgery affects GSA, including the lower extremities, and HRQOL. The purpose of this study was to elucidate the effects of cervical reconstruction on GSA, including the lower extremities, and HRQOL scores through a retrospective single-center study. Methods Patient Population After obtaining IRB approval for the study from Seoul National University Bundang Hospital, a retrospective analysis of clinical and radiographic data was performed for patients

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Richard Whitehill, Anthony D. Cicoria, William E. Hooper, William W. Maggio, and John A. Jane

reconstructing cervical segments destabilized by trauma. Materials and Methods Clinical Material Since 1973, the Department of Neurosurgery at the University of Virginia has been performing a posterior cervical reconstruction procedure using methyl methacrylate cement and metallic cerclage wires. We reviewed all such cases. This study includes only those patients treated for cervical trauma. A requirement for inclusion in the study was that the complete medical records and all pertinent radiographs were available, including postoperative lateral flexion and extension

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Yoshihisa Kotani, Bryan W. Cunningham, Kuniyoshi Abumi, Anton E. Dmitriev, Manabu Ito, Niabin Hu, Yasuo Shikinami, Paul C. McAfee, and Akio Minami

reduced the motion compared with the 3D FD (p < 0.05). Fig. 4. Bar graphs showing the operative level ROM (upper) and NZ (lower) of anterior cervical reconstructions under axial rotation, flexion—extension, and lateral bending. Upper: The asterisk indicates a statistically significant difference from the 3D FD and the number sign indicates statistically significant difference between all other groups. Lower: The asterisk indicates a statistically significant difference compared with the intact segment. Auto + Plate = anterior cervical plate

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Kurtis I. Auguste, Cynthia Chin, Frank L. Acosta, and Christopher P. Ames

F , : Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy . J Neurosurg 86 : 990 – 997 , 1997 35 Majd ME , Vadhva M , Holt RT : Anterior cervical reconstruction using titanium cages with anterior plating . Spine 24 : 1604 – 1610 , 1999 36 Malinin TI , Brown MD : Bone allografts in spinal surgery . Clin Orthop Relat Res 154 : 68 – 73 , 1981 37 Matsui H , Tatezaki S , Tsuji H : Ceramic vertebral body replacement for metastatic spine tumors . J Spinal Disord 7 : 248 – 254 , 1994

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Shiveindra B. Jeyamohan, Tyler J. Kenning, Karen A. Petronis, Paul J. Feustel, Doniel Drazin, and Darryl J. DiRisio

OBJECT

Anterior cervical discectomy and fusion (ACDF) is an effective procedure for the treatment of cervical radiculopathy and/or myelopathy; however, postoperative dysphagia is a significant concern. Dexamethasone, although potentially protective against perioperative dysphagia and airway compromise, could inhibit fusion, a generally proinflammatory process. The authors conducted a prospective, randomized, double-blinded, controlled study of the effects of steroids on swallowing, the airway, and arthrodesis related to multilevel anterior cervical reconstruction in patients who were undergoing ACDF at Albany Medical Center between 2008 and 2012. The objective of this study was to determine if perioperative steroid use improves perioperative dysphagia and airway edema.

METHODS

A total of 112 patients were enrolled and randomly assigned to receive saline or dexamethasone. Data gathered included demographics, functional status (including modified Japanese Orthopaedic Association myelopathy score, neck disability index, 12-Item Short-Form Health Survey score, and patient-reported visual analog scale score of axial and radiating pain), functional outcome swallowing scale score, interval postoperative imaging, fusion status, and complications/reoperations. Follow-up was performed at 1, 3, 6, 12, and 24 months, and CT was performed 6, 12, and 24 months after surgery for fusion assessment.

RESULTS

Baseline demographics were not significantly different between the 2 groups, indicating adequate randomization. In terms of patient-reported functional and pain-related outcomes, there were no differences in the steroid and placebo groups. However, the severity of dysphagia in the postoperative period up to 1 month proved to be significantly lower in the steroid group than in the placebo group (p = 0.027). Furthermore, airway difficulty and a need for intubation trended toward significance in the placebo group (p = 0.057). Last, fusion rates at 6 months proved to be significantly lower in the steroid group but lost significance at 12 months (p = 0.048 and 0.57, respectively).

CONCLUSIONS

Dexamethasone administered perioperatively significantly improved swallowing function and airway edema and shortened length of stay. It did not affect pain, functional outcomes, or long-term swallowing status. However, it significantly delayed fusion, but the long-term fusion rates remained unaffected.

Clinical trial registration no.: NCT01065961 (clinicaltrials.gov)

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Zeena Dorai, Howard Morgan, and Caetano Coimbra

autograft-assisted fusion was performed. A graft collapse of greater than or equal to 3 mm was demonstrated in 19% of the former patients, whereas the rate was 11% in the autograft-treated patients. A metaanalysis of cases involving one- and two-level anterior cervical interbody fusion in 310 patients showed that autografts were associated with a significantly higher fusion rate than allografts. 6 Most recently, cages approved by the Food and Drug Administration for lumbar fusion have been used for cervical reconstruction, and the preliminary results have been excellent

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Ely Ashkenazi, Yossi Smorgick, Nahshon Rand, Michael A. Millgram, Yigal Mirovsky, and Yizhar Floman

: Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86: 990–997, 1997 11. Majd ME , Vadhva M , Holt RT : Anterior cervical reconstruction using titanium cages with anterior plating. Spine 24 : 1604 – 1610 , 1999 Majd ME, Vadhva M, Holt RT: Anterior cervical reconstruction using titanium cages with anterior plating. Spine 24: 1604–1610, 1999 12. Reidy D , Finkelstein J , Nagpurkar A , Mousavi P , Whyne C : Cervical spine loading

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Surgical stabilization of cervical spinal fractures using methyl methacrylate

Technical considerations and long-term results in 52 patients

Thomas A. Duff, Agha Khan, and Joseph E. Corbett

: 1145–1157, 1986 9. Six E , Kelly DL Jr : Technique for C-1, C-2, and C-3 fixation in cases of odontoid fracture. Neurosurgery 8 : 374 – 377 , 1981 Six E, Kelly DL Jr: Technique for C-1, C-2, and C-3 fixation in cases of odontoid fracture. Neurosurgery 8: 374–377, 1981 10. Whitehill R , Cicoria AD , Hooper WE , et al : Posterior cervical reconstruction with methyl methacrylate cement and wire: a clinical review. J Neurosurg 68 : 576 – 584 , 1988 Whitehill R, Cicoria AD

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Jyi-Feng Chen, Chieh-Tsai Wu, Sai-Cheung Lee, and Shih-Tseng Lee

2 ([approx~] 95 mm 2 for cancellous bone filling). The PMMA strut was easily cut to any desired length by using a saw and then molded with a cutting bur. The PMMA strut was used as a substitute for cortical bone and filled with a local bone autograft for anterior cervical reconstruction and fusion. F ig . 1. Photographs showing cylindrical PMMA struts of various lengths. Surgical Technique Surgery was performed after induction of general anesthesia. Each patient underwent standard right-sided anterior cervical corpectomy. After radiographic

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Shiuh-Lin Hwang, Chih-Lung Lin, Ann-Shung Lieu, Kung-Shing Lee, Tai-Hung Kuo, Yan-Fen Hwang, Yu-Feng Su, and Shen-Long Howng

been encouraging after one- and two-level interbody cage—assisted fusion for cervical DDD. 6, 7, 14 Procedures involving interbody cages and plate fixation for multilevel anterior cervical reconstruction have also been reported to yield good results. 11 To our knowledge, however, clinical results after three- and four-level interbody cage—assisted ACDF for DDDs have not been reported. In this study, we investigated the safety and effectiveness of interbody cages used in the three- and four-level cervical spinal fusion and evaluated the results when performed with