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Shota Tamagawa, Takatoshi Okuda, Hidetoshi Nojiri, Tatsuya Sato, Rei Momomura, Yukoh Ohara, Takeshi Hara, and Muneaki Ishijima

due to the dorsal overhang of the closed posterior superior iliac spine and paravertebral muscle. 19–21 Moreover, previous reports have highlighted the complications of L5 nerve root injury when S1 pedicle screws were inserted anterolaterally. 22–24 Although some cadaveric studies have demonstrated the anatomical relationship between the lumbar pedicle and adjacent dural sac and nerve roots, 25–27 few reports have detailed the anatomy of the L5 nerve root in the pelvis. Previous reports have measured the distance from the sacroiliac joint to the L5 nerve root

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Charles Kuntz IV, Linda S. Levin, Stephen L. Ondra, Christopher I. Shaffrey, and Chad J. Morgan

deformity and adjacent-segment disease as well as to ensure improved clinical outcomes. 5 , 11 , 17 , 20 , 26 To better understand regional and global neutral upright sagittal spinal alignment, we performed a literature review to identify studies undertaken to evaluate neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults without spinal disease and with demographic features similar to those in patients evaluated in an adult spine clinic. Primary inclusion criteria were used to identify studies with large numbers of asymptomatic

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Richard Menger, Paul J. Park, Elise C. Bixby, Gerard Marciano, Meghan Cerpa, David Roye, Benjamin D. Roye, Michael Vitale, and Lawrence Lenke

P roximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following long fusions to the sacrum or pelvis in adult populations have been well described in the literature. However, early complications, including PJK and PJF, in ambulatory pediatric patients who have undergone fusion to the sacrum with pelvic instrumentation have been much less studied. Tsirikos et al. found that fusion extending to the sacrum and instrumentation to the pelvis in ambulatory patients provided deformity correction and maintained ambulatory function

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Ehud Mendel, Joel L. Mayerson, Narendra Nathoo, Rick L. Edgar, Carl Schmidt, and Michael J. Miller

S arcomas involving the bone of the pelvis and sacrum are uncommon, and often large at diagnosis, and their close association with the pelvic viscera, nerves, and blood vessels present challenging surgical problems. Today, en bloc resection of primary malignant sacral tumors has become the primary modality of treatment as current adjuvant therapies are ineffective. 4 , 9 , 11 Widespread local involvement of the hemisacrum, with lateral extension of the tumor to the pelvic wing and involvement of the greater sciatic notch and its contents, requires an

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Amer F. Samdani, Ashish Ranade, Henry J. Dolch, Reed Williams, Tricia St. Hilaire, Patrick Cahill, and Randal R. Betz

any exposure of the spine, thus potentially limiting any spontaneous fusion that may occur. 13 However, using the ilium as an attachment site may limit mobility in the ambulatory child. In this paper we report on our experience with using bilateral VEPTRs from the ribs to the pelvis for children with severe, early onset scoliosis. Methods Study Design After obtaining Institutional Review Board approval, we identified 11 children who were treated using bilateral VEPTRs from the ribs to the pelvis. We excluded children who had undergone thoracostomies with

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Ehud Mendel, Narendra Nathoo, Thomas Scharschmidt, Carl Schmidt, James Boehmler, and Joel L. Mayerson

P resently , en bloc resection of chondrosarcomas remains the mainstay of treatment, as current adjuvant therapies remain ineffective. 1 , 3 , 5 , 10 , 11 Primary malignant sarcomas involving the lumbar spine, sacrum, and pelvis are rare but challenging tumors usually requiring complex surgical solutions. Local invasiveness, close proximity to abdominopelvic viscera, nerves, and blood vessels of the lumbosacral region, and the need for en bloc resection to prevent local recurrences, as well as the biomechanical demands for a successful lumbopelvic

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Patrick M. Flanigan, Anthony L. Mikula, Pierce A. Peters, Soliman Oushy, Jeremy L. Fogelson, Mohamad Bydon, Brett A. Freedman, Arjun S. Sebastian, Bradford L. Currier, Ahmad Nassr, Kurt A. Kennel, Paul A. Anderson, David W. Polly, and Benjamin D. Elder

lumbar spine CT, including the pelvis. Inclusion criteria were treatment with at least 6 months of teriparatide and CT encompassing all spinal ROIs both before and after treatment. The pre- and posttreatment CT scans had been obtained within a 3-year period. Collected data included age, height, weight, sex, BMI, osteoporosis medications, smoking status, metabolic laboratory tests, hemodialysis status, duration of teriparatide treatment, time between CT scans, time between DXA scans, and BMD at various anatomical regions on DXA. We also manually measured HUs in various

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Presacral ganglioneuromas

Report of five cases and review of the literature

Ashok Modha, Philip Paty, and Mark H. Bilsky

free &  pain  extending into the  w/ presacral mobilization  attributed to recurrence  no recurrence  midline from lt S2–3  of rectum; STR  w/in S2–3  foramen; sacral  lam & for w/ CR * CR = complete resection; for = foraminotomy; lam = laminectomy; LE = lower-extremity; LSP = lumbosacral plexus; STR = subtotal resection. Tumors located in the midline, low in the pelvis (Cases 3–5), were exposed via an anterior intraperitoneal approach (midline incision and

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Konstantinos A. Starantzis, Vasileios I. Sakellariou, Peter S. Rose, Michael J. Yaszemski, and Panayiotis J. Papagelopoulos

(fibroblastic sarcoma) with a pelvis extension ( Fig. 2 ), underwent a standard procedure. The second patient (Case 2), a 30-year-old man, underwent an extended version with additional visceral resections for a recurrent adenocarcinoma of the rectum with local extension into the sacrum and right sciatic nerve encasement ( Fig. 3 ). F ig . 2. Case 1. Transverse CT image (A) , coronal CT image (B) , and models (C and D) showing tumor extension in a 39-year-old woman with fibroblastic osteosarcoma of the left ilium with extension to left sacroiliac joint and left

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James D. Lin, Lee A. Tan, Chao Wei, Jamal N. Shillingford, Joseph L. Laratta, Joseph M. Lombardi, Yongjung J. Kim, Ronald A. Lehman Jr., and Lawrence G. Lenke

spinal deformity surgery performed at a single institution by the senior author (L.G.L.) were identified. Patients were excluded if the preoperative CT scan was not available, or if the CT scan did not show enough of the pelvis and sciatic notch to evaluate S2AI screw placement. Simulated Screw Placement Simulated S2AI screws were placed using preoperative CT scans by manipulating the gantry in three axes with 3D visualization software (VitreaCore version 6.7.6; ViTAL). Measurements were performed by two independent observers. Images were viewed simultaneously in axial