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Major changes in techniques are constantly and rapidly evolving, and dissection has become extremely “respectful” of the soft tissues that are encountered. The small-incision trend of arthroscopy is now entering the spinal surgery environment. Adequate decompression, prevention of further malalignment, and obtaining a solid fusion are still the basic goals of spinal surgery intervention.

The number of mobile segments needing to be immobilized has decreased, however, as the use of the Harrington rods and hooks has given way to the stronger pedicle screws and rod systems. Now, most fracture surgeries will fuse only the mobile segments that are immediately involved with the unstable fractured vertebrae, compared with the historical rod and hook placements of three levels above and three levels below.

The use of bone graft substitutes, such as coraline hydroxyapatite, in fusions has reduced the incidence of chronic pain at the posterior iliac crest graft site from approximately 20% to 0%. The dissection involving the bone graft donor site would increase intraoperative blood loss and injury to local sensory nerves.

As well, stripping of a portion of the gluteus maximus, which later would have to reattach to the raw cancellous iliac crest, will leave some painful dysfunction, at least temporarily in the hip extensors. The use of electrocautery, autologous blood banking preoperatively, and the Cell-Saver has decreased the need for transfusions during spinal surgeries.

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