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L. Philip Carter

The operating microscope provides the neurosurgeon with excellent magnification and binocular vision in the depths of small wounds. A great deal of microsurgical instrumentation has been developed for work with soft tissue, tumor removal, and deep suturing; however, available instruments for osseous dissection have been quite limited. Because most bone dissection instruments are large and awkward for use in a microsurgical field, we have developed a set of punches and curettes with a bayonetted offset so that the surgeon's hands can be held out of the surgical

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Allan D. O. Levi, Curtis A. Dickman, and Volker K. H. Sonntag

O ver the last two decades, major advances in surgical instrumentation of the vertebral column have emerged for a number of spinal pathologies including fractures and degenerative and neoplastic diseases. 2, 19, 22, 23, 25 The inherent advantages of a number of instrumentation systems include immediate stabilization of the spine, which permits more rapid mobilization of the patient; correction of deformities; and maintenance and reconstruction of the spine after decompressive surgery. The potential hazards that result from the application of rigid internal

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Joseph C. Maroon, Esther Roberts, Mitsuo Numoto, and R. M. Peardon Donaghy

essential in performing microvascular surgery and emphasizes various methods for reducing their cost. Instrumentation Instruments Adopted for Microsurgery The basic instruments used routinely in this laboratory during the past 11 years are illustrated in Figs 1 – 3 (also see cover ). Excellent descriptions of most of these including the bipolar coagulator may be found in texts on microneurosurgery. 2, 5, 6 Several, however, require additional comments. Fig. 1. 1) Bayonet forceps. 2) Self-constructed bayonet forceps for bipolar coagulation. 3) Dumont

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Peter G. Campbell, Sanjay Yadla, Jennifer Malone, Mitchell G. Maltenfort, James S. Harrop, Ashwini D. Sharan, and John K. Ratliff

G iven the impact of patient diagnosis and individual pathological entities, spine surgeons must remain critical when determining the indications for the use of instrumentation in spinal procedures. Several recent evaluations of administrative databases have revealed increases in the rates of spinal fusions. 9 , 16 , 24 In the cervical spine, one group of authors noted a 206% increase in the rate of fusions performed in the Medicare population from 1992 to 2005. 24 The Nationwide Inpatient Sample, in a review from 1990 to 2000, revealed a 90% increase in

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Shahin Etebar and David W. Cahill

T he risks of fusion performed to treat degenerative conditions in the lumbar spine are well known. 2–4, 9, 11, 14, 16 The operative risks include blood loss, infection, and nerve root or cauda equina injury, and the postoperative risks include pseudarthrosis or fusion failure with or without hardware failure. The risk that the fusion will fail appears to decrease when rigid segmental (pedicle screw and plate or rod) instrumentation is applied. 24 However, with successful fusion there is a risk of adjacent-segment degeneration and failure. Such failures

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Mohammed Eleraky, Matthias Setzer, Ali A. Baaj, Ioannis Papanastassiou, Bryan P. Conrad, and Frank D. Vrionis

or biomechanics at this location. Posterior screw and rod systems have shown greater biomechanical stability than anterior constructs by taking advantage of the stronger fixation offered by lateral mass and pedicle screws and a greater distance of fixation from the midsagittal plane. 4 , 17 Treating unstable conditions with instrumentation at the CTJ is challenging, as there is a sharp transition between the lordotic cervical spine and the more rigid kyphotic thoracic spine. The insertion of instrumentation across this abrupt transition—laterally directed lateral

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Chien-Jen Hsu, Wen-Ying Chou, Wei-Ning Chang, and Chi-Yin Wong

S pinal surgery may sometimes leave patients with residual symptoms that have not improved or have even worsened. Unfortunately, the reported rate of failed spinal surgery or unsatisfactory outcome ranges from 10 to 30%. 11 , 14 , 28 Plain radiography may demonstrate misplaced instrumentation, loosened or broken PSs, pseudarthrosis, or adjacent-segment problems, but often some causes are difficult to elucidate. 2 , 14 , 27 , 28 Although the results of revision surgery are sometimes satisfactory, 6 , 23 , 28 the authors of many studies have reported

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Nader S. Dahdaleh, Satoshi Nakamura, James C. Torner, Tae-Hong Lim, and Patrick W. Hitchon

L aminectomy is an effective operation for the control of spondylotic myelopathy, with an acceptable risk of complications. 1 , 7 , 11 Albeit infrequently, laminectomy for spondylotic myelopathy has been accompanied by instability and kyphosis in at least 20% of cases. 8 , 11 , 16 , 23 , 28 , 29 The rostrocaudal and lateral extents of the laminectomy, age of the patient, and preexisting lordosis or kyphosis are important factors contributing to postoperative kyphosis. 1 , 16 Instrumentation after laminectomy has the potential advantages of increasing

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Chandan Reddy, Aditya V. Ingalhalikar, Scott Channon, Tae-Hong Lim, James Torner, and Patrick W. Hitchon

I nstability arising from odontoid fractures, rheumatoid disease, infection, and metastases may require instrumentation involving the atlas and axis. In cases of sub-axial instability, the axis is also often incorporated in fusion constructs. Although surgical constructs involving C1–2 transarticular screw fixation or C1 lateral mass–C2 pedicle screw fixation have been associated with excellent clinical results, 2 , 4 , 7 , 14 they can be demanding due to the danger of injury to the VA. 3 , 22 Vertebral artery injury can lead to serious consequences such

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Matthew R. MacEwan, Michael R. Talcott, Daniel W. Moran, and Eric C. Leuthardt

I njuries of the back and spine represent the leading cause of lost productivity and immobility in the United States. 24 Of the 279,000 surgeries conducted annually in the United States for the treatment of low-back pain, 160,000 involve such spinal fusion procedures. 1 , 24 Recent literature suggests that only 68% of patients undergoing lumbar spinal fusion experienced satisfactory outcomes, and 20%–40% of spinal fusion procedures failed. 30 Spinal instrumentation has been demonstrated to increase the rate of fusion in single-level lumbar interbody