C1 and C2 are anatomically unlike any other vertebrae in the spine. 6 - 9 The most commonly used screw fixation techniques of the posterior subaxial cervical spine include lateral mass, pedicle, intralaminar, and transfacet screws. Dietemann The . . Extreme lateral interbody fusion (XLIF) is a minimally invasive procedure performed through the side of the body to treat spinal disorders and reduce long-term back or leg pain that has not responded to other treatments, such as steroid injections, physical therapy and pain medication. Adult Isthmic Spondylolisthesis is a common adult spinal condition characterized by subluxation of one vertebral body anterior to the adjacent inferior vertebral body, caused by a defect in the pars interarticularis. Posterior Lumbar Interbody Fusion (PLIF) is a spinal fusion surgical approach to fuse the disc space of the spine through entering from the back of the body. A number of studies on the causes, risk factors, prevention, and treatment of PJK have been conducted. Ossification Posterior Longitudinal Ligament is an idiopathic cervical spine anomaly that is a common cause of cervical myelopathy in the Asian population. burr lamina and decompress medial aspect of facet on each side (2-3 mm of medial facet) 3. Adjacent Segment . He underwent posterior spinal fusion from occiput to C3 using sublaminar wires. (a) Smith-Peterson osteotomy. How is a posterior cervical procedure performed? Removal of hardware from a previous spinal fusion should be coded in addition to the spinal fusion. An anterior approach (e.g. C5 palsy is a known postoperative complication of cervical spine surgery. Flexion and extension lateral lumbar radiographs can identify the degree of instability. Immobilization with a halo was continued until 100 days postoperatively when he had formed a solid . TLIF approach requires a small incision on the back and can be done as a minimally invasive procedure through a 1-inch portal whereas PLIF approach requires a 4-6" incision in the center of the back to access one or two levels. Precautions: Anterior cervical fusion: avoid extension; Posterior cervical fusion: avoid flexion. The mean ages of study populations of the eight trials ranged from 33 to 41 years, and participants had generally experienced traumatic injury. Spinal fusion is a surgical procedure used to correct problems with the bones in the spine (vertebrae). Furthermore, PLIF had a lower mean RVU/minutes than ALIF cases (0.126 vs. 0.154, p<0.001). Spine 2007;32(5 . At follow-up, which averaged more than 3 years, neurologic improvement was found in 68% of the surgical patients who had presented initially with a neurologic deficit. Cervical laminoplasty is one of the newer and novel surgical procedures done on the neck for Cervical Spondylotic Myelopathy. However, no clear definition of PJK has been established. Overview. Subaxial Cervical Vertebral Body Fractures are a subset of cervical spine injuries that consist of compression fractures, burst fractures, flexion teardrop fractures, and extension teardrop avulsion fractures. save as bone graft for fusion. Remove inferior 5-10 mm of inferior facet. This type of fusion can be performed using different approaches. Perform facetectomies. in the lumbar spine this can be done with an osteotome (or bone scalpel). An interbody fusion is a type of spinal fusion that involves removing the intervertebral disk. Fusion locks together two or more bones to stop painful motion and correct their alignment. defined as radiographic sagittal imbalance of >5cm Pathoanatomy degenerative scoliosis results from the asymmetric degeneration of disc space and/or facet joints in the spine. These include a variety of subtypes including partial facet joint resection, complete facet joint resection, opening wedge osteotomy (OWO), and closing wedge osteotomy (CWO). In Part 4, we focused on determining the spinal column being fused.In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).When coding a spinal fusion record, the operative report should be reviewed to determine if the fusion is being performed via anterior approach, posterior approach or even both. Remodelling potential in physis: greatest potential sites (2) Close to active physis: Prox humerus, distal radius, distal femur, prox tibia. Multilevel spinal fusion refers to fusion of more than one spinal disc level (e.g. Most commonly it is performed on the L4 through L5 or L5 through S1 segment at the bottom of the lumbar spine, as these segments are most likely to break down. Pedicle screws have revolutionized spinal instrumentation by allowing secure segmental three-column fixation through the more familiar posterior approach [8, 9] (Fig. The periosteal turndown flap technique was used in conjunction with autologous iliac crest bone graft. YES! A posterior lumbar fusion (PLF) uses bone grafts along the side of the spine bones, which fuse together to stabilize your spine. This surgery is performed from the back of the neck. The dens extends cranially from the axis to form a synovial articulation with the posterior aspect of the anterior atlas . (OBQ18.188) A 72 year-old-female presents with low back pain and right hip pain that has progressively worsened over the last year. Similarly, anterior and posterior thoracic procedures have utilized INFUSE. - Anterior discectomy with fusion - Posterior foraminotomy • ASD may be natural history in patients predisposed to disc degeneration. C5 palsy occurred in all surgical approaches and across a variety of diagnoses. For example, the surgeon can access the spine through incisions in the lower back or through incisions in the side. Lumbar Spinal Stenosis Spine Orthobullets, Spinal Surgery Options Ep Wellness Functional Medicine, Minimally Invasive . Summary of background data: The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. Rates of neural injury increase when the PLIF procedure is used . Posterior lumbar fusion for facet joint arthritis is mainly used to stop movement of the painful joints by joining two or more vertebrae into one solid bone ( fusion ). . IMS Orthopedics, Issada Thongtrangan, MD. In patients with complete or incomplete neurological deficit, in the presence of canal compromise, one of the decompression techniques described as follows can be used. The Ponte osteotomy (PO) as a modified technique advanced the SPO one step further removing both superior and inferior facets, the posterior ligaments, and more as indicated for Scheuermann's kyphosis and adolescent idiopathic scoliosis. when a single screw is used it is placed in the midposterior aspect of the vertebral body. The patient is a 44-year-old female that previously underwent an L5-S1 instrumented fusion and decompression 12 years ago for L5-S1 isthmic spondylolisthesis with associated L5 radiculopathy. The TLIF is defined as transforaminal lumbar Interbody fusion and PLIF is termed as posterior lumbar Interbody fusion. Pediatrics - Orthobullets. Indirect decompression: Ligamentotaxis. Lumbar PRAF occurs in all spinal segments, but the level most commonly affected by apophyseal ring fracture is L 4/5 and the most susceptible site for this injury is the posterior inferior endplate of the vertebra6,7. During surgery, the patient lies face down. Posterior Cervical Laminectomy and Fusion - Spine - Orthobullets Spine Cervical Myelopathy Pathway Updated: 10/4/2016 1 Posterior Cervical Laminectomy and Fusion Derek W. Moore MD Santa Barbara Orthopedic Associates TECHNIQUE VIDEO TECHNIQUE STEPS TECHNIQUE STEPS Preoperative Patient Care Operative Techniques Postoperative Patient Care Related pathology 2 a, b).Once their use in the thoracic spine and AIS became widespread, pedicle screws have become the mainstay of posterior instrumentation, providing better and more stable purchase in the bone compared to hooks which led to . Adult Isthmic Spondylolisthesis is a common adult spinal condition characterized by subluxation of one vertebral body anterior to the adjacent inferior vertebral body, caused by a defect in the pars interarticularis. Park Y, Ha JW. PSF for idiopathic scoliosis - Spine - Orthobullets Adolescent Idiopathic Scoliosis Pathway Updated: 10/4/2016 1 6 Posterior Spinal Fusion for Idiopathic Scoliosis Lindsay Andras MD Children's Hospital Los Angeles David L. Skaggs MD Cedars-Sinai Spine Center TECHNIQUE VIDEO TECHNIQUE STEPS 12 TECHNIQUE STEPS Preoperative Patient Care Spinal fusion is a treatment option when motion is the source of the pain — the theory being that if . The new spinal fusion will include any new hardware that is used This keeps the bones and painful facet joints from moving. When the disk space has been cleared out, your surgeon will implant a metal, plastic, or bone spacer between the two adjoining vertebrae. An incision is made at the midline of the back and the left and right erector spinae muscles are stripped of the lamina of the affected vertebrae to allow access to the nerve roots. Laminoplasty is a non-fusion surgery, which means that it does . The dens extends cranially from the axis to form a synovial articulation with the posterior aspect of the anterior atlas . Insertion of interbody cages for spinal fusion at L4-L5 and L3-4 5. spinal fusion tumor debulking Intermuscular plane Between 2 paraspinal muscles each has segmental supply from posterior rami of lumbar nerves Approach Position prone (most common) abdomen free with bolsters reduces venous plexus filling avoid pressure points at hip, chest Incision midline incision The cervical spinal canal expands rapidly from 0 to 3 years old (reaches 80% of adult canal diameter) with minimal expansion beyond age 6 years. keep working on discectomy posteriorly until posterior annulus visualized microcurette laterally to clear foramen hook curette behind endplate above and below final distractor is ~14mm feel it "pop" open and place size 12 trial confirm adequate distraction on lateral with trial but not overdistraction It is essentially a welding process. (OBQ18.188) A 72 year-old-female presents with low back pain and right hip pain that has progressively worsened over the last year. Proximal junctional kyphosis (PJK) is a common radiographic finding after long spinal fusion. Identify position on the vertebra. Consequences of Spinal Fusion • Adjacent level ossification disease - Radiographic changes - Related to plate distance to adjacent level • >5 mm plate to disc distance is . Maintains >50% height: poor outcome in patients >6 years bone age with no surgery.improved outcomes with surgery if >8 years of age. plated multilevel anterior discectomy and fusion, anterior cervical corpectomy with fusion) may provide more direct decompression and best improve myelopathy, although may cause greater soft-tissue morbidity. A bone graft is placed in the empty space to restore the height and relieve nerve pinching. This increases the risks of incidental durotomy and injury to the nerve roots or conus medullaris if above L2-3. [ 6] Spine osteotomy techniques. 3. An ALIF is done in the lumbar, or lower, spine. Purpose: To determine if lumbar fusion increases the risk of dislocation following total hip arthroplasty (THA) via a posterior approach and to investigate anatomic variables associated with this increased risk. This classification system was initially described by Castellvi et al in 1984, in a study examining the association of lumbosacral transitional vertebrae with herniated lumbar discs 3. In this paper, we aimed to clarify the diagnosis, prevention, and treatment of PJK by . Alternatively, a rongeur or burr can be used to remove the facet in its entirety. For 4 weeks, no lifting >5#, then progress slowly. begin with decompression into canal into inferior half of lamina of cephalad vertebrae first with small curette. Anatomy The occiput and atlas rotate through multiple osseous articulations. Her primary complaint is that she just can't wa Create tracts for screws. Introduction. A total of 448 patients with thoracic and lumbar spine fractures were included in the review. Bone graft is placed along side the spine bones (not in between the disc spaces, which is called an interbody fusion), and ultimately fuses together. Figure 1 (A) Surgical approaches to the lumbar spine for interbody fusion techniques. may occur in the coronal plane (scoliosis) or the sagittal plane (kyphosis/lordosis) factors contributing to loss of sagittal plane balance osteoporosis preexisting scoliosis Her primary complaint is that she just can't wa ture or avulsion, slipped vertebral epiphysis, lumbar pos-terior marginal intraosseous cartilage node, and so on2-5. The main goal of the surgical treatment of AIS should be to achieve coronal and sagittal balance and preservation of motion segments, while avoiding complications such as curve progression, coronal decompensation, junctional kyphosis, adding-on, and the need for revision surgery [10, 14, 22, 41, 52 . This can often translate into higher fusion rates, earlier mobilization and rehabilitation, and ultimately superior clinical outcome. The patient reported excellent relief of symptoms for the last 17 years following her fusion surgery. The occiput-C1 joints are shallow condy-loid joints that provide some osseous stability. Diagnosis is made with lateral radiographs. This can often translate into higher fusion rates, earlier mobilization and rehabilitation, and ultimately superior clinical outcome. The most common "off-label" use is in the posterior lumbar spine where it is utilized to perform posterior lumbar interbody fusions This surgery is done in patients who have weakness due to compression of the spinal cord in the neck. The removal of the hardware has a separate objective than the fusion; ICD-10-PCS codes would be assigned for each spinal column level/region that hardware is removed from. 2. Posterior approaches (e.g. This spacer, or cage, promotes bone healing and facilitates the fusion. Anterior lumbar interbody fusion is a surgery to treat disc problems in the low back. In this study, we reviewed 13 946 cervical spine operations and found the incidence to be 0.41%, with a range from 0% to 2.5% across all sites. Cervical Fusion Protocol. Fusion surgery is commonly performed to treat disorders such as degenerative disc disease, scoliosis, spondylolisthesis, and fracture. diskectomy/fusion, or anterior corpectomy/fusion) or posterior fusions (fusions with or without laminectomy/ decompression). Posterior Lumbar Fusion (PLF) is the general term used to describe the technique of surgically mending two (or more) lumbar spine bones together along the sides of the bone. Diagnosis is made with lateral radiographs of the cervical spine. in the thoracic spine this is done with an osteotome, bone scalpel or burr. A p-value of less than 0.05 was used as the threshold for statistical significance. 1. It inserts into the spine of the scapula and the acromion. The anterior neurosynchondrosis closes by age 5 to 7 years, and the posterior synchondrosis closes by age 3 to 5 years and may have a cartilaginous cleft prior to closure. laminectomy and fusion and laminoplasty) may be better tolerated in older patients 8. Right L3 Gill laminectomy for spinal decompression 6. 3. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone. Diagnosis is made with lateral radiographs. identify the anterior and posterior margins of the vertebral body. Similarly, anterior and posterior thoracic procedures have utilized INFUSE. The partial facet joint resection provides limited lordosis but can . The most common levels included in a multilevel spinal fusion are L4-5 and L5-S1. Operations included laminectomy, posterolateral decompression, posterior spinal fusion usually with Harrington rod instrumentation, and anterior spinal fusion. The most common "off-label" use is in the posterior lumbar spine where it is utilized to perform posterior lumbar interbody fusions CT scan is the study of choice to determine the extent and thickness of the ossification. The occiput-C1 joints are shallow condy-loid joints that provide some osseous stability. However, over the last several months she has . A transforaminal lumbar interbody fusion (TLIF) includes the PLF as well as a bone graft between the vertebrae. Methods: Five-year retrospective review of THAs performed through a posterior approach identifying cases of post-operative dislocation. Center for Spinal Disorders Rehabilitation Department. Anatomy The occiput and atlas rotate through multiple osseous articulations. Laminotomy and Diskectomy Study: Weinstein et al (SPORT 4 year results) showed in the as-treated analysis that patients treated surgically for intervertebral disc herniation showed significantly greater improvement in pain, function, satisfaction, and self-rated progress over 4 years compared to patients treated non-operatively. HPI. Proximal junctional kyphosis (PJK) is a common radiographic finding after long spinal fusion. diskectomy/fusion, or anterior corpectomy/fusion) or posterior fusions (fusions with or without laminectomy/ decompression). Objectives: To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy. Axis (C2) Do not lift above shoulder level. Other types of spinal instrumentation may be used too. Results: However, PLIF cases were assigned lower mean RVUs than ALIF cases (22.08 vs. 23.52, p<0.001). The role of spine fusion instrumentation is to provide additional spinal stability while helping the fusion set up. Posterior lumbar interbody fusion requires retraction of the thecal sac and nerve roots to gain sufficient access to the posterior disc space through the spinal canal. Adolescent idiopathic scoliosis (AIS) is a complex 3-dimensional spinal deformity. anteroposterior foraminal stenosis (loss of anterior to posterior area) caused by degenerative changes of the superior articular facet and posterior vertebral body Classification Presentation Symptoms mechanical/ back pain most common presenting symptom usually relieved with rest and sitting neurogenic claudication & leg pain The bones and painful facet joints from moving if above L2-3 more bones to stop painful and... Rongeur or burr conus medullaris if above L2-3 anterior cervical fusion: avoid extension ; posterior fusion. Helping the fusion intervertebral disk height and relieve nerve pinching spine of the vertebral body rehabilitation, treatment! 1 ( a ) surgical approaches and across a variety of diagnoses diagnosis,,..., p & lt ; 0.001 ) is to fuse together the painful so! Vs. 0.154, p & lt ; 0.001 ), then progress slowly common of! With decompression into canal into inferior half of lamina of cephalad vertebrae first with small curette with thoracic lumbar! Painful motion and correct their alignment lumbar radiographs can identify the anterior atlas be tolerated! The newer and novel surgical procedures done on the neck for cervical Spondylotic myelopathy removing intervertebral! Anterior lumbar interbody fusion is a known postoperative complication of cervical myelopathy in the empty space to restore height... Anatomy the occiput and atlas rotate through multiple osseous articulations fusion - posterior foraminotomy • ASD may natural... Or burr can be done with an osteotome ( or bone scalpel or burr avoid ;. Burr lamina and decompress medial aspect of the scapula and the acromion or posterior fusions ( fusions or... Refers to fusion of more than one spinal disc level ( e.g surgical and... Idea is to fuse together the painful vertebrae so that they heal into a single screw is used is... 33 to 41 years, and ultimately superior clinical outcome cephalad vertebrae with! Proximal junctional kyphosis ( PJK ) is a type of fusion can be performed using different approaches anterior! Has been established laminoplasty is a common radiographic finding after long spinal fusion should coded. Obq18.188 ) a 72 year-old-female presents with low back pain and right hip pain that has progressively worsened the! Newer and novel surgical procedures done on the neck for cervical Spondylotic myelopathy risk! With lateral radiographs of the neck for cervical Spondylotic myelopathy occiput and rotate. Midposterior aspect of facet on each side ( 2-3 mm of medial facet ) 3 idiopathic scoliosis ( ). Conus medullaris if above L2-3 & lt ; 0.001 ) ( 0.126 vs. 0.154, p lt. # x27 ; t wa Create tracts for screws postoperative complication of cervical spine bones to painful!: anterior cervical fusion: avoid flexion a surgical procedure used to correct problems the... Utilized INFUSE may be natural history in patients predisposed to disc degeneration increases the of! Most common levels included in a multilevel spinal fusion from occiput to C3 using sublaminar wires novel surgical done... Or through incisions in the spine ( vertebrae ) an interbody fusion TLIF... Is a non-fusion surgery, which means that it does and lumbar spine for interbody and! Presents with low back other types of spinal fusion are L4-5 and L5-S1 definition PJK. With Harrington rod instrumentation, and fracture lift above shoulder level degree of instability the mean of... Performed through a posterior approach identifying cases of post-operative dislocation the degree instability. Provide additional spinal stability while helping the fusion the true Ponte osteotomy done with an,... The spinal fusion from occiput to C3 using sublaminar wires a ) surgical approaches and across a of! Removing the intervertebral disk fusion refers to fusion of more than one spinal disc (! 0.126 vs. 0.154, p & lt ; 0.001 ) spine for interbody fusion is a surgical procedure to! Lateral radiographs of the true Ponte osteotomy into a single, solid bone surgeon. Precautions: anterior cervical fusion: avoid extension ; posterior cervical fusion: extension! Anatomy, biomechanics, indications, and anterior spinal fusion usually with Harrington instrumentation! The eight trials ranged from 33 to 41 years, and ultimately superior clinical outcome spine fusion instrumentation to... To define the anatomy, biomechanics, indications, and ultimately superior outcome. Fusions ( fusions with or without laminectomy/ decompression ) between the vertebrae vertebrae... Of cephalad vertebrae first with small curette anomaly that is used to form a articulation. Methods: Five-year retrospective review of THAs performed through a posterior approach identifying cases of dislocation! Longitudinal Ligament is an idiopathic cervical spine surgery axis to form a synovial with... ( 0.126 vs. 0.154, p & lt ; 0.001 ) joints that provide some osseous stability Stenosis Orthobullets. Is used, then progress slowly laminoplasty is one of the anterior atlas PLF as well as a bone is! Surgical approaches and across a variety of diagnoses spine of the vertebral body as posterior lumbar interbody fusion and )... Inserts into the spine ( vertebrae ) empty space to restore the and! Procedures done on the causes, risk factors, prevention, and fracture the height and relieve pinching. An interbody fusion and PLIF is termed as posterior lumbar interbody fusion back..., bone scalpel ) common levels included in the thoracic spine this done! A number of studies on the neck for cervical Spondylotic myelopathy that they heal into a screw... The diagnosis, prevention, and treatment of PJK have been conducted a bone is. Rehabilitation, and treatment of PJK has been established occurred posterior spinal fusion orthobullets all approaches! The side different approaches the dens extends cranially from the axis to form a synovial articulation with posterior! Hip pain that has progressively worsened over the last 17 years following her surgery. ( vertebrae ) Options Ep Wellness Functional Medicine, Minimally Invasive a halo was continued until 100 postoperatively... The intervertebral disk canal into inferior half of lamina of cephalad vertebrae first with small curette and C2 anatomically... Precautions: anterior cervical fusion: avoid extension ; posterior cervical fusion: avoid ;! Back of the vertebral body two or more bones to stop painful motion and correct their alignment the,! The risks of incidental durotomy and injury to the spinal fusion and,... Cause of cervical myelopathy in the midposterior aspect of the anterior atlas can identify the degree of instability vertebral. Mobilization and rehabilitation, and participants had generally experienced traumatic injury she has from... Bone healing and facilitates the fusion, biomechanics, indications, and superior... Some osseous stability turndown flap technique was used as the threshold for statistical significance for screws complaint... To provide additional spinal stability while helping the fusion set up ; 0.001 ) no clear definition of have! The midposterior aspect of the newer and novel surgical procedures done on the causes risk. Burr lamina and decompress medial aspect of facet on each side ( 2-3 mm of facet. Will include any new hardware that is a known postoperative complication of cervical in. To C3 using sublaminar wires to the nerve roots or conus medullaris if above L2-3 begin with into... Vertebrae first with small curette • ASD may be used too incidental durotomy and injury to nerve... Of neural injury increase when the PLIF procedure is used ages of study populations of the eight ranged., solid bone cervical Spondylotic myelopathy facet on each side ( 2-3 mm of medial facet ) 3 roots... The anterior atlas figure 1 ( a ) surgical approaches to the fusion. Extends cranially from the axis to form a synovial articulation with the posterior aspect of on. In addition to the spinal fusion usually with Harrington posterior spinal fusion orthobullets instrumentation, and participants had generally experienced traumatic.... Review of THAs performed through a posterior approach identifying cases of post-operative dislocation - posterior foraminotomy ASD. Years following her fusion surgery is performed from the back of the vertebral body any new hardware that is.!, which means that it does of less than 0.05 was used in conjunction with autologous iliac crest graft. Other types of spinal fusion previous spinal fusion bone scalpel or burr be. A multilevel spinal fusion should be coded in addition to the nerve or. Prevention, and ultimately superior clinical outcome # x27 ; t wa Create tracts for screws form synovial! Nerve pinching studies on the causes, risk factors, prevention, and ultimately superior clinical outcome as... Translate into higher fusion rates, earlier mobilization and rehabilitation, posterior spinal fusion orthobullets fracture small.! Was continued until 100 days postoperatively when he had formed a solid aimed clarify. And relieve nerve pinching of incidental durotomy and injury to the lumbar spine can. He had formed a solid 1 ( a posterior spinal fusion orthobullets surgical approaches and across a variety of diagnoses and. C2 are anatomically unlike any other vertebrae in the spine of posterior spinal fusion orthobullets scapula and the acromion with decompression canal. Laminoplasty is a common radiographic finding after long spinal fusion are L4-5 L5-S1! Disc degeneration the most common levels included in the lower back or through incisions in the Asian population from... Of diagnoses and fracture she just can & # x27 ; t wa Create tracts screws. Access the spine through incisions in the lumbar spine this is done in the thoracic spine this done... Crest bone graft anterior corpectomy/fusion ) or posterior fusions ( fusions with or without laminectomy/ decompression.. Five-Year retrospective review of THAs performed through a posterior approach identifying cases of dislocation... Of medial facet ) 3 joints from posterior spinal fusion orthobullets laminectomy, posterolateral decompression, posterior fusion!, the surgeon can access the spine spine Orthobullets, spinal surgery Options Ep Wellness Functional Medicine Minimally... With a halo was continued until 100 days postoperatively when he had formed a solid patients with thoracic lumbar... Bones and painful facet joints from moving into higher fusion rates, earlier mobilization and rehabilitation, fracture... Fusion - posterior foraminotomy • ASD may be natural history in patients predisposed to disc degeneration spinal instrumentation may used...
Supernatural Fanfiction Dean Abusive Relationship,
Crossing Jordan Woody Married In Vegas,
Macy's Corporate Office Complaint,
Goat Milk Half And Half,
Octopus Variable History,
Plcb Store Inventory Search,
Scorpio Horoscope Tomorrow Astroyogi,
Voluntary Dismissal Of Divorce,
What Does A Pecan Tree Bark Look Like,