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Paolo Missori, Sergio Pandolfi, Manila Antonelli, and Maurizio Domenicucci

, fibrolipomatous hamartoma of nerve, lipofibroma of nerve, and neurolipomatosis. The WHO classification 24 published in 2002 designated this benign tumor as “lipomatosis of nerve.” A striking predilection exists for the upper extremities. Approximately 80% of upper-extremity lesions originate in the median nerve. 26 A neural fibrolipoma originating from a thoracic nerve and extending from the epidural space into the thoracic cavity is exceedingly rare. A patient with an epidural thoracic neural fibrolipoma is reported. Case Report Examination This 49-year

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Nardin Samuel, Christina L. Goldstein, Carlo Santaguida, and Michael G. Fehlings

history of any preceding trauma, and the patient denied any weakness in his leg or any gait dysfunction. He also denied bowel and bladder dysfunction. There were no symptoms on the right side of his body. His medical history was remarkable for hypertension, hypercholesterolemia, acid reflux, and benign prostatic hypertrophy. He had previously undergone procedures for hernia repairs and a hemorrhoidectomy. On examination, he denied tenderness to palpation over the thoracic spine. No focal motor weakness was detectable. Standard gait, tandem gait, heel walking, and toe

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Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Presented at the 2013 Joint Spine Section Meeting 

Christoph J. Griessenauer, David F. Bauer, Thomas A. Moore II, Patrick R. Pritchard, and Mark N. Hadley

T horacic arachnoid pathology includes ventral and dorsal arachnoid bands, arachnoid duplication cysts, posttraumatic and surgical tethering, spinal cord herniation, posthemorrhagic arachnoid loculations, calcific arachnoiditis, and arachnoiditis and frequently manifests as thoracic myelopathy with or without syrinx formation. Presenting symptoms and signs across all these entities may also include paraparesis, sensory, and gait dysfunction and typically manifest in an insidious, progressive fashion. Once present, they rarely improve with time and

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Miriam L. Donohue, Ross R. Moquin, Amit Singla, and Blair Calancie

I n virtually all spine surgeries in which the “freehand” technique (Lenke) is used for pedicle screw placement, assessing the integrity of the established pedicle track using a ball-tipped probe is a crucial stage. 7 , 10 , 12 , 13 , 17 The freehand technique involves using a midline incision and exposing the spine to the tips of the transverse processes bilaterally. 7 , 10 , 12 , 13 For thoracic levels, a cortical bur can be used to initiate a posterior starting point. 7 , 10 , 12 , 13 Once the cortical bone has been removed by the bur, a pedicle

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Michael J. Strong, Julianne Santarosa, Timothy P. Sullivan, Noojan Kazemi, Jacob R. Joseph, Osama N. Kashlan, Mark E. Oppenlander, Nicholas J. Szerlip, Paul Park, and Clay M. Elswick

A ccurate localization in the thoracic spine remains a significant challenge in surgery. Sixty-eight percent of spine surgeons surveyed have admitted to wrong-level localization, although some of the wrong-level exposures were rectified intraoperatively. 1 Furthermore, approximately 1 of every 2 spine surgeons has performed a wrong-level surgery. 2 Wrong-level surgery falls under the broader term “wrong-site surgery” and is considered a sentinel event that exposes the patient to additional risks and unnecessary procedures, harms the doctor

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Andrew T. Healy, Prasath Mageswaran, Daniel Lubelski, Benjamin P. Rosenbaum, Virgilio Matheus, Edward C. Benzel, and Thomas E. Mroz

and contribute to surgical planning. Thus, we sought to determine if existing lumbar degenerative disease grading systems would correlate with native ROM or the change in ROM after decompressive procedures in the thoracic spine. We hypothesized that systematically graded degenerative changes on CT imaging would correlate with decreased specimen ROM before and after surgical procedures, and that one could use this grading system to predict postsurgical instability and perhaps identify levels at risk for adjacent-segment degeneration. Methods Specimens

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Lisa B. E. Shields, John R. Johnson, and Christopher B. Shields

during an anterior approach for a T4–5 discectomy. The pathogenesis and mechanism of PRES are also described. Case Report History and Examination A 47-year-old woman (height 5′11.5′′, weight 186 pounds [84.37 kg]; body mass index [BMI] 25.58 kg/m 2 ) presented with an 8-month history of thoracic pain and a 2-month history of left leg weakness, numbness in both feet, and poor balance. She had well-controlled hypertension, hyperthyroidism, and a 30 pack-year smoking history. Thoracic MRI demonstrated a large disc herniation at T4–5 with left-sided spinal

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Nestor G. Rodriguez-Martinez, Sam Safavi-Abbasi, Luis Perez-Orribo, Anna G. U. S. Newcomb, Phillip M. Reyes, Galyna Loughran, Nicholas Theodore, and Neil R. Crawford

Spinal Fixation System (UC) (Zimmer Spine) is a novel sublaminar implant currently used in conjunction with pedicle screws at the thoracic levels to correct scoliosis. The UC is a flexible polyester sublaminar loop that attaches to the pedicle screw interconnecting rod, allowing greater flexibility than a screw or metallic sublaminar cable. Using the UC as an option for correcting adolescent idiopathic scoliosis has been described before with good clinical results. 12 , 15 , 18 A hybrid construction (UC together with rigid screw fixation) has been shown to be an

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Placement of thoracic transvertebral pedicle screws using 3D image guidance

Presented at the 2012 Joint Spine Section Meeting 

Eric W. Nottmeier and Stephen M. Pirris

O riginally described by Abdu et al., 1 transvertebral pedicle screws have been used successfully in the treatment of high-grade L5–S1 spondylolisthesis. 2 , 11 An advantage of transvertebral pedicle screws is that the screws purchase multiple cortical layers across 2 vertebrae, thereby increasing the stability of the construct. 7 The use of transvertebral pedicle screws at spinal levels other than L5–S1 has not been reported. We describe our technique of transvertebral pedicle screw placement in the thoracic spine with the aid of 3D image guidance

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Corey T. Walker, M. Yashar S. Kalani, Mark E. Oppenlander, Jakub Godzik, Nikolay L. Martirosyan, Robert J. Standerfer, and Nicholas Theodore

I ntervertebral disc herniation occurs when a rupture of the fibrous tissue surrounding the nucleus pulposus allows the nucleus of the compromised disc to invade the epidural space of the spinal canal and, in some cases, to compress the spinal cord. 1 Although symptomatic herniated thoracic discs are rare (only 1 in 1,000,000 persons), the sequelae of the herniation can be devastating. 1 When more than 40% of the spinal canal is occluded by such a herniation, the rupture is considered “giant,” 10 and the disc will often adhere to the dura mater, eventually