{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T19:02:35Z","timestamp":1777489355509,"version":"3.51.4"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,5,19]]},"abstract":"\n BACKGROUND<\/jats:title>\n The treatment of thoracic ossification of the posterior longitudinal ligament (OPLL) remains a significant challenge, with a postoperative paralysis rate exceeding 30%. The underlying mechanisms of postoperative paralysis are still unclear, necessitating further investigation into potential risk factors and preventive strategies.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report the case of a 42-year-old male with diabetes and hypertension who developed complete lower limb paralysis after surgery for thoracic myelopathy due to OPLL. Intraoperative monitoring showed absent motor evoked potentials until the posterior longitudinal ligament was severed, after which they became detectable. The surgery lasted more than 13 hours, with mean arterial pressure maintained between 44 and 91 mm Hg. Postoperative MRI revealed extensive spinal cord edema without severe compression. The exact cause of postoperative paralysis in this case remains unclear; however, possible causes include white cord syndrome or spinal cord ischemia.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Postoperative paralysis in thoracic OPLL surgery remains poorly understood. Identifying and addressing risk factors for spinal cord ischemia and reperfusion injury are crucial. The authors propose strategies to reduce risk, including prone and supine position tests, the use of an ultrasonic surgical aspirator to prevent heat-induced spinal cord damage, shortening surgical duration, and meticulous blood pressure management.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25195<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25195","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T06:41:21Z","timestamp":1747723281000},"source":"Crossref","is-referenced-by-count":4,"title":["Postoperative paralysis following the surgery for thoracic ossification of the posterior longitudinal ligament: perioperative and intraoperative management strategies. Illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9705-0201","authenticated-orcid":true,"given":"Kohei","family":"Takahashi","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ko","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichiro","family":"Yahata","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9934-9656","authenticated-orcid":true,"given":"Takahiro","family":"Onoki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junya","family":"Kusakabe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1634-3945","authenticated-orcid":true,"given":"Tomonori","family":"Kawaharada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshimi","family":"Aizawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"23","key":"bib1","series-title":"Spine","first-page":"E1389","article-title":"Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study","volume":"43","author":"Imagama","year":"2018","unstructured":"Imagama SAndo KTakeuchi KPerioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. Spine. 2018;43(23):E1389-E1397."},{"issue":"19","key":"bib2","series-title":"Spine","first-page":"E1159","article-title":"Postoperative paralysis from thoracic ossification of posterior longitudinal ligament surgery risk factor of neurologic injury: nationwide multiinstitution survey","volume":"41","author":"Ito","year":"2016","unstructured":"Ito ZMatsuyama YAndo MPostoperative paralysis from thoracic ossification of posterior longitudinal ligament surgery risk factor of neurologic injury: nationwide multiinstitution survey. Spine. 2016;41(19):E1159-E1163."},{"issue":"11","key":"bib3","series-title":"J Bone Joint Surg Br","first-page":"1541","article-title":"Potential risk of thermal damage to cervical nerve roots by a high-speed drill","volume":"91","author":"Hosono","year":"2009","unstructured":"Hosono NMiwa TMukai YTakenaka SMakino TFuji T.Potential risk of thermal damage to cervical nerve roots by a high-speed drill. J Bone Joint Surg Br. 2009;91(11):1541-1544."},{"issue":"4","key":"bib4","series-title":"Bone Joint J","first-page":"554","article-title":"The incidence of nerve root injury by high-speed drill can be reduced by chilled saline irrigation in a rabbit model","volume":"99-B","author":"Tamai","year":"2017","unstructured":"Tamai KSuzuki ATakahashi SThe incidence of nerve root injury by high-speed drill can be reduced by chilled saline irrigation in a rabbit model. Bone Joint J. 2017;99-B(4):554-560."},{"issue":"12","key":"bib5","series-title":"Acta Neurochir (Wien)","first-page":"2321","article-title":"Bone temperature elevation by drilling friction and neurological outcome in the cervical spino-laminoplasty","volume":"155","author":"Yamamoto","year":"2013","unstructured":"Yamamoto SKim PAbe YBone temperature elevation by drilling friction and neurological outcome in the cervical spino-laminoplasty. Acta Neurochir (Wien). 2013;155(12):2321-2325."},{"issue":"1","key":"bib6","series-title":"Eur Spine J","first-page":"50","article-title":"\u201cWhite Cord Syndrome\u201d as clinical manifestation of the spinal cord reperfusion syndrome: a systematic review of risk factors, treatments, and outcome","volume":"34","author":"Bagherzadeh","year":"2025","unstructured":"Bagherzadeh SRostami MJafari MRoohollahi F.\u201cWhite Cord Syndrome\u201d as clinical manifestation of the spinal cord reperfusion syndrome: a systematic review of risk factors, treatments, and outcome. Eur Spine J. 2025;34(1):50-63."},{"issue":"3","key":"bib7","series-title":"J Neurosurg Spine","first-page":"326","article-title":"Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note","volume":"31","author":"Kanematsu","year":"2019","unstructured":"Kanematsu RHanakita JTakahashi TTomita YMinami M.Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note. 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J Neurosurg Spine. 2021;34(3):492-497."},{"issue":"2","key":"bib13","series-title":"J Orthop Sci","first-page":"323","article-title":"Retrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament: posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach","volume":"27","author":"Aizawa","year":"2022","unstructured":"Aizawa THashimoto KKanno HRetrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament: posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach. J Orthop Sci. 2022;27(2):323-329."},{"key":"bib14","series-title":"Front Surg","first-page":"1120069","article-title":"Anterior shift of the ventral dura mater: a novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine","volume":"10","author":"Takahashi","year":"2023","unstructured":"Takahashi KHashimoto KOnoki TKanno HOzawa HAizawa T.Anterior shift of the ventral dura mater: a novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine. Front Surg. 2023;10:1120069."},{"issue":"6","key":"bib15","series-title":"J Spinal Cord Med","first-page":"535","article-title":"International standards for neurological classification of spinal cord injury (revised 2011)","volume":"34","author":"Kirshblum","year":"2011","unstructured":"Kirshblum SCBurns SPBiering-Sorensen FInternational standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535-546."},{"issue":"5","key":"bib16","series-title":"J Spine Res","first-page":"753","article-title":"Neurological deterioration characteristics and risk factors after anterior decompression through a posterior approach for patients with thoracic ossification of posterior longitudinal ligament","volume":"15","author":"Takahashi","year":"2024","unstructured":"Takahashi KHashimoto KYahata KNeurological deterioration characteristics and risk factors after anterior decompression through a posterior approach for patients with thoracic ossification of posterior longitudinal ligament.Article in Japanese. J Spine Res. 2024;15(5):753-760."},{"issue":"11","key":"bib17","series-title":"Spine","first-page":"1199","article-title":"Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament","volume":"33","author":"Takahata","year":"2008","unstructured":"Takahata MIto MAbumi KKotani YSudo HMinami A.Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. 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Orthop Surg. 2010;2(1):71-76."},{"issue":"2","key":"bib20","series-title":"Neurosurg Focus","first-page":"E5","article-title":"The Mini-Open transpedicular thoracic discectomy: surgical technique and assessment","volume":"25","author":"Chi","year":"2008","unstructured":"Chi JHDhall SSKanter ASMummaneni PV.The Mini-Open transpedicular thoracic discectomy: surgical technique and assessment. Neurosurg Focus. 2008;25(2):E5."},{"issue":"3","key":"bib21","series-title":"Global Spine J","first-page":"1653","article-title":"Does elevated mean-arterial pressure lead to better outcomes in degenerative cervical myelopathy?- A prospective, pilot randomized control trial","volume":"15","author":"Sharma","year":"2025","unstructured":"Sharma AJaiswal AMarathe NDoes elevated mean-arterial pressure lead to better outcomes in degenerative cervical myelopathy?- A prospective, pilot randomized control trial. Global Spine J. 2025;15(3):1653-1661."},{"issue":"1","key":"bib22","series-title":"Surg Radiol Anat","first-page":"3","article-title":"Relevance of the anatomical location of the Adamkiewicz artery in spine surgery","volume":"33","author":"Charles","year":"2011","unstructured":"Charles YPBarbe BBeaujeux RBoujan FSteib JP.Relevance of the anatomical location of the Adamkiewicz artery in spine surgery. Surg Radiol Anat. 2011;33(1):3-9."},{"issue":"18","key":"bib23","series-title":"Spine","first-page":"1436","article-title":"The influence of diabetes on surgical outcomes in cervical myelopathy","volume":"41","author":"Kusin","year":"2016","unstructured":"Kusin DJAhn UMAhn NU.The influence of diabetes on surgical outcomes in cervical myelopathy. Spine. 2016;41(18):1436-1440."},{"issue":"1","key":"bib24","series-title":"J Craniovertebr Junction Spine","first-page":"68","article-title":"Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus Misonix bonescalpel in spinal surgery","volume":"9","author":"Tarazi","year":"2018","unstructured":"Tarazi NMunigangaiah SJadaan MMcCabe JP.Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus Misonix bonescalpel in spinal surgery. J Craniovertebr Junction Spine. 2018;9(1):68-72."},{"issue":"4","key":"bib25","series-title":"Orthop Surg","first-page":"386","article-title":"Influence of postoperative hypertension on the development of spinal epidural hematoma","volume":"9","author":"Ohba","year":"2017","unstructured":"Ohba TEbata SHaro H.Influence of postoperative hypertension on the development of spinal epidural hematoma. Orthop Surg. 2017;9(4):386-390."},{"issue":"13","key":"bib26","series-title":"Spine","first-page":"1046","article-title":"Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery","volume":"40","author":"Yamada","year":"2015","unstructured":"Yamada KAbe YSatoh SYanagibashi YHyakumachi TMasuda T.Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine. 2015;40(13):1046-1052."},{"issue":"23","key":"bib1","series-title":"Spine","first-page":"E1389","article-title":"Perioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study","volume":"43","author":"Imagama","year":"2018","unstructured":"Imagama SAndo KTakeuchi KPerioperative complications after surgery for thoracic ossification of posterior longitudinal ligament: a nationwide multicenter prospective study. Spine. 2018;43(23):E1389-E1397."},{"issue":"19","key":"bib2","series-title":"Spine","first-page":"E1159","article-title":"Postoperative paralysis from thoracic ossification of posterior longitudinal ligament surgery risk factor of neurologic injury: nationwide multiinstitution survey","volume":"41","author":"Ito","year":"2016","unstructured":"Ito ZMatsuyama YAndo MPostoperative paralysis from thoracic ossification of posterior longitudinal ligament surgery risk factor of neurologic injury: nationwide multiinstitution survey. Spine. 2016;41(19):E1159-E1163."},{"issue":"11","key":"bib3","series-title":"J Bone Joint Surg Br","first-page":"1541","article-title":"Potential risk of thermal damage to cervical nerve roots by a high-speed drill","volume":"91","author":"Hosono","year":"2009","unstructured":"Hosono NMiwa TMukai YTakenaka SMakino TFuji T.Potential risk of thermal damage to cervical nerve roots by a high-speed drill. J Bone Joint Surg Br. 2009;91(11):1541-1544."},{"issue":"4","key":"bib4","series-title":"Bone Joint J","first-page":"554","article-title":"The incidence of nerve root injury by high-speed drill can be reduced by chilled saline irrigation in a rabbit model","volume":"99-B","author":"Tamai","year":"2017","unstructured":"Tamai KSuzuki ATakahashi SThe incidence of nerve root injury by high-speed drill can be reduced by chilled saline irrigation in a rabbit model. Bone Joint J. 2017;99-B(4):554-560."},{"issue":"12","key":"bib5","series-title":"Acta Neurochir (Wien)","first-page":"2321","article-title":"Bone temperature elevation by drilling friction and neurological outcome in the cervical spino-laminoplasty","volume":"155","author":"Yamamoto","year":"2013","unstructured":"Yamamoto SKim PAbe YBone temperature elevation by drilling friction and neurological outcome in the cervical spino-laminoplasty. Acta Neurochir (Wien). 2013;155(12):2321-2325."},{"issue":"1","key":"bib6","series-title":"Eur Spine J","first-page":"50","article-title":"\u201cWhite Cord Syndrome\u201d as clinical manifestation of the spinal cord reperfusion syndrome: a systematic review of risk factors, treatments, and outcome","volume":"34","author":"Bagherzadeh","year":"2025","unstructured":"Bagherzadeh SRostami MJafari MRoohollahi F.\u201cWhite Cord Syndrome\u201d as clinical manifestation of the spinal cord reperfusion syndrome: a systematic review of risk factors, treatments, and outcome. Eur Spine J. 2025;34(1):50-63."},{"issue":"3","key":"bib7","series-title":"J Neurosurg Spine","first-page":"326","article-title":"Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note","volume":"31","author":"Kanematsu","year":"2019","unstructured":"Kanematsu RHanakita JTakahashi TTomita YMinami M.Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note. J Neurosurg Spine. 2019;31(3):326-333."},{"issue":"2","key":"bib8","series-title":"Asian Spine J","first-page":"294","article-title":"The versatile approach: a novel single incision combined with anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine","volume":"11","author":"Srivastava","year":"2017","unstructured":"Srivastava SKAggarwal RABhosale SKRoy KNemade PS.The versatile approach: a novel single incision combined with anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine. Asian Spine J. 2017;11(2):294-304."},{"issue":"3 S","key":"bib9","series-title":"J Neurosurg","first-page":"245","article-title":"Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study","volume":"100","author":"Matsunaga","year":"2004","unstructured":"Matsunaga SSakou TTaketomi EKomiya S.Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study. J Neurosurg. 2004;100(3 Suppl Spine):245-248."},{"issue":"5","key":"bib10","series-title":"Neurosurgery","first-page":"800","article-title":"Risk factors for ineffectiveness of posterior decompression and dekyphotic corrective fusion with instrumentation for beak-type thoracic ossification of the posterior longitudinal ligament: a single institute study","volume":"80","author":"Imagama","year":"2017","unstructured":"Imagama SAndo KIto ZRisk factors for ineffectiveness of posterior decompression and dekyphotic corrective fusion with instrumentation for beak-type thoracic ossification of the posterior longitudinal ligament: a single institute study. Neurosurgery. 2017;80(5):800-808."},{"issue":"2","key":"bib11","series-title":"J Neurosurg Spine","first-page":"276","article-title":"Anterior decompression through a posterior approach for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a novel concept in anterior decompression and technical notes with the preliminary outcomes","volume":"36","author":"Kanno","year":"2022","unstructured":"Kanno HAizawa THashimoto KItoi EOzawa H.Anterior decompression through a posterior approach for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a novel concept in anterior decompression and technical notes with the preliminary outcomes. J Neurosurg Spine. 2022;36(2):276-286."},{"issue":"3","key":"bib12","series-title":"J Neurosurg Spine","first-page":"492","article-title":"Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach","volume":"34","author":"Aizawa","year":"2021","unstructured":"Aizawa TEto THashimoto KKanno HItoi EOzawa H.Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach. J Neurosurg Spine. 2021;34(3):492-497."},{"issue":"2","key":"bib13","series-title":"J Orthop Sci","first-page":"323","article-title":"Retrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament: posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach","volume":"27","author":"Aizawa","year":"2022","unstructured":"Aizawa THashimoto KKanno HRetrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament: posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach. J Orthop Sci. 2022;27(2):323-329."},{"key":"bib14","series-title":"Front Surg","first-page":"1120069","article-title":"Anterior shift of the ventral dura mater: a novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine","volume":"10","author":"Takahashi","year":"2023","unstructured":"Takahashi KHashimoto KOnoki TKanno HOzawa HAizawa T.Anterior shift of the ventral dura mater: a novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine. Front Surg. 2023;10:1120069."},{"issue":"6","key":"bib15","series-title":"J Spinal Cord Med","first-page":"535","article-title":"International standards for neurological classification of spinal cord injury (revised 2011)","volume":"34","author":"Kirshblum","year":"2011","unstructured":"Kirshblum SCBurns SPBiering-Sorensen FInternational standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535-546."},{"issue":"5","key":"bib16","series-title":"J Spine Res","first-page":"753","article-title":"Neurological deterioration characteristics and risk factors after anterior decompression through a posterior approach for patients with thoracic ossification of posterior longitudinal ligament","volume":"15","author":"Takahashi","year":"2024","unstructured":"Takahashi KHashimoto KYahata KNeurological deterioration characteristics and risk factors after anterior decompression through a posterior approach for patients with thoracic ossification of posterior longitudinal ligament.Article in Japanese. J Spine Res. 2024;15(5):753-760."},{"issue":"11","key":"bib17","series-title":"Spine","first-page":"1199","article-title":"Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament","volume":"33","author":"Takahata","year":"2008","unstructured":"Takahata MIto MAbumi KKotani YSudo HMinami A.Clinical results and complications of circumferential spinal cord decompression through a single posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament. Spine. 2008;33(11):1199-1208."},{"issue":"3","key":"bib18","series-title":"JBJS Case Connect","first-page":"e19.00610","article-title":"Delayed postoperative spinal cord ischemia after posterior spinal fusion in a pediatric patient with syrinx and decompressed chiari: a case report","volume":"10","author":"Welling","year":"2020","unstructured":"Welling SEBauer JM.Delayed postoperative spinal cord ischemia after posterior spinal fusion in a pediatric patient with syrinx and decompressed chiari: a case report. JBJS Case Connect. 2020;10(3):e19.00610."},{"issue":"1","key":"bib19","series-title":"Orthop Surg","first-page":"71","article-title":"Delayed paraplegia following correction of severe thoracolumbar kyphotic deformity by posterior vertebral column resection","volume":"2","author":"Li","year":"2010","unstructured":"Li JLv GHWang XBWang BLu C.Delayed paraplegia following correction of severe thoracolumbar kyphotic deformity by posterior vertebral column resection. Orthop Surg. 2010;2(1):71-76."},{"issue":"2","key":"bib20","series-title":"Neurosurg Focus","first-page":"E5","article-title":"The Mini-Open transpedicular thoracic discectomy: surgical technique and assessment","volume":"25","author":"Chi","year":"2008","unstructured":"Chi JHDhall SSKanter ASMummaneni PV.The Mini-Open transpedicular thoracic discectomy: surgical technique and assessment. Neurosurg Focus. 2008;25(2):E5."},{"issue":"3","key":"bib21","series-title":"Global Spine J","first-page":"1653","article-title":"Does elevated mean-arterial pressure lead to better outcomes in degenerative cervical myelopathy?- A prospective, pilot randomized control trial","volume":"15","author":"Sharma","year":"2025","unstructured":"Sharma AJaiswal AMarathe NDoes elevated mean-arterial pressure lead to better outcomes in degenerative cervical myelopathy?- A prospective, pilot randomized control trial. Global Spine J. 2025;15(3):1653-1661."},{"issue":"1","key":"bib22","series-title":"Surg Radiol Anat","first-page":"3","article-title":"Relevance of the anatomical location of the Adamkiewicz artery in spine surgery","volume":"33","author":"Charles","year":"2011","unstructured":"Charles YPBarbe BBeaujeux RBoujan FSteib JP.Relevance of the anatomical location of the Adamkiewicz artery in spine surgery. Surg Radiol Anat. 2011;33(1):3-9."},{"issue":"18","key":"bib23","series-title":"Spine","first-page":"1436","article-title":"The influence of diabetes on surgical outcomes in cervical myelopathy","volume":"41","author":"Kusin","year":"2016","unstructured":"Kusin DJAhn UMAhn NU.The influence of diabetes on surgical outcomes in cervical myelopathy. Spine. 2016;41(18):1436-1440."},{"issue":"1","key":"bib24","series-title":"J Craniovertebr Junction Spine","first-page":"68","article-title":"Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus Misonix bonescalpel in spinal surgery","volume":"9","author":"Tarazi","year":"2018","unstructured":"Tarazi NMunigangaiah SJadaan MMcCabe JP.Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus Misonix bonescalpel in spinal surgery. J Craniovertebr Junction Spine. 2018;9(1):68-72."},{"issue":"4","key":"bib25","series-title":"Orthop Surg","first-page":"386","article-title":"Influence of postoperative hypertension on the development of spinal epidural hematoma","volume":"9","author":"Ohba","year":"2017","unstructured":"Ohba TEbata SHaro H.Influence of postoperative hypertension on the development of spinal epidural hematoma. 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