pre-printTo The Editor: We read with interest the article by Kawabata et al.15 (Kawabata S, Watanabe K, Hosogane N, et al: Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1. Report of 3 cases. J Neurosurg Spine 18:274-279, March 2013). Reconstructive spinal surgery has undergone a tremendous transformation in the last several decades, with improvements in imaging, biologics, and implant technologies. Not uncommonly, the spine surgical community may abandon an older technique when it becomes evident that a new approach or technology is clearly safer or superior. Comparative clinical trials of older versus newer techniques are often limited to a small number of cases published over a short period of time and are typically not performed under the rigors of randomized controlled study sufficient to meet the standards set by governmental agencies to gain regulatory approval. Lateral mass screw fixation (LMSF) of the cervical spine, which has generally supplanted older wiring and hook cervical fixation methods, is one such technique
