Bridwell and DeWald's Textbook of Spinal Surgery 4th edition

Written by experts from around the world, the latest edition of this leading reference features contributions from both neurosurgeons and orthopaedic surgeons. Presenting the full scope of spinal surgery, chapters discuss anatomy, biomechanics, complications, instrumentation, preoperative and postoperative care, and other core topics for surgeons. And numerous illustrations and clinical video clips provide critical visual context.
 

• New chapters detail current surgical techniques for idiopathic scoliosis procedures.
• Over half of the authors are new—bringing fresh perspectives and approaches to surgical preparation and techniques.
• Technical procedures are written in an easy-to-follow, step-by-step format.
• Covers a wide spectrum of spinal deformities, degenerative disorders, injuries, and traumatic conditions.
• Now with more than 4,000 illustrations—including figures that accurately depict anatomy and procedures, and tables and algorithms for absorbing information quickly.

Table of Contents

Contributing Authors
Foreword
Preface
Acknowledgments
Contents
Introduction A: The Evolution of Pediatric Spine Surgery Since the Third Edition of The Textbook of Spinal Surgery
REFERENCES
Introduction B: The Evolution of Adult Spine Surgery Since the Third Edition of The Textbook of Spinal Surgery
ADULT SPINAL DEFORMITY
NEUROPHYSIOLOGIC INTRAOPERATIVE MONITORING
CERVICAL SPINE SURGERY
SURGICAL TREATMENT OF SPINAL TUMORS
REFERENCES
Volume 1
SECTION I: General Considerations
1. Evaluation and Optimization of the Adult and Pediatric Spine Patient Preoperatively and Perioperatively to Improve Outcome
INTRODUCTION
PREOPERATIVE EVALUATION OPTIMIZATION—ADULT
STEP ONE: APPROPRIATENESS
FITNESS FOR SURGERY
PREOPERATIVE EVALUATION AND OPTIMIZATION—PEDIATRIC
PERIOPERATIVE EVALUATION AND OPTIMIZATION—ADULT
PERIOPERATIVE EVALUATION AND OPTIMIZATION—PEDIATRIC
SYSTEMS APPROACH TO OPTIMIZING PATIENT OUTCOMES
CONCLUSIONS
REFERENCES
2. Normal Spinal Anatomy: Normal Sagittal Plane Alignment
DEVELOPMENT, ANATOMY, AND FUNCTION
THREE-DIMENSIONAL SPINAL ALIGNMENT
TERMINOLOGY OF SPINAL ALIGNMENT
THE CONE OF ECONOMY
SPINAL BALANCE: THE PLUMB LINE
SACROPELVIC AND SPINOPELVIC ALIGNMENT
NORMAL LUMBAR LORDOSIS
THORACOLUMBAR JUNCTION
NORMAL THORACIC KYPHOSIS
NORMAL CERVICAL LORDOSIS
SUMMARY
ACKNOWLEDGMENT
REFERENCES
3. Spinal Cord and Nerve Root Monitoring
INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING APPLICATIONS FOR SPINAL SURGERY
SOMATOSENSORY-EVOKED POTENTIALS
DESCENDING NEUROGENIC–EVOKED POTENTIALS
NERVE ROOT MONITORING
MOTOR-EVOKED POTENTIALS
H-REFLEXES AND F-RESPONSES
REFERENCES
4. Bone Grafting and Biologics for Spine Fusion
INTRODUCTION
BIOLOGY OF SPINAL FUSION
SELECTING A GRAFT MATERIAL
CURRENT BONE GRAFT OPTIONS FOR SPINAL FUSION
AUTOLOGOUS BONE GRAFT IN SPINAL FUSION
ALLOGRAFT BONE
BIOSYNTHETIC GRAFT MATERIALS
CERAMICS
COMPOSITE GRAFTS
OSTEOINDUCTIVE GROWTH FACTORS
RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEINS
GENE THERAPY IN SPINAL FUSION
OSTEOINDUCTIVE SMALL MOLECULES
CONCLUSION
REFERENCES
SECTION II: Biomechanics
5. General Considerations of Biomechanical Testing
INTRODUCTION
BIOMECHANICAL TERMINOLOGY AND ANALYZED PARAMETERS
IN VITRO BIOMECHANICAL TESTING MODELS
TESTING STANDARDIZATION
ASTM STANDARDS
NONDESTRUCTIVE MULTISEGMENTAL SPINE TESTING
LIMITATIONS OF IN VITRO BIOMECHANICS
REFERENCES
6. Clinical Biomechanics of the Cervical Spine
INTRODUCTION TO THE BIOMECHANICAL PROPERTIES OF THE CERVICAL SPINE
ANTERIOR FIXATION IN THE LOWER CERVICAL SPINE
POSTERIOR FIXATION
INSTABILITY DUE TO INJURY AND IATROGENIC DEFECTS
ADJACENT SEGMENT DISEASE AND ARTIFICIAL DISCS
ACKNOWLEDGMENT
REFERENCES
7. Biomechanics of Three-Dimensional Scoliosis Correction
INTRODUCTION
THE THREE-DIMENSIONAL ANATOMY OF IDIOPATHIC SCOLIOSIS
CORONAL PLANE CORRECTION: AXIAL LOADING VERSUS TRANSVERSE APPROXIMATION
MEASUREMENT OF DEFORMITY IN SCOLIOSIS
VISUAL ANALYSIS OF AXIAL ROTATION
THREE-DIMENSIONAL ASPECTS OF SCOLIOSIS CORRECTION
PEDICLE SCREW INSTRUMENTATION
METHODS OF AXIAL PLANE DEROTATION IN ADOLESCENT IDIOPATHIC SCOLIOSIS
SEGMENTAL AXIAL ROTATION ABOUT THE CONCAVE ROD
DEROTATION BY TRANSVERSE PLANE TRANSLATION
SUMMARY
REFERENCES
8. Principles and Applications of Spinal Instrumentation: A Clinical Approach
CLINICAL CONSIDERATIONS
HOOKS
WIRES AND TETHERS
PEDICLE SCREWS
CORTICAL BONE TRAJECTORY SCREWS
INTERBODY DEVICES
POSTERIOR LUMBAR INTERBODY FUSION
TRANSFORAMINAL LUMBAR INTERBODY FUSION
ANTERIOR LUMBAR INTERBODY FUSION
LATERAL LUMBAR INTERBODY FUSION
ANTERIOR TO PSOAS (OBLIQUE LATERAL) APPROACH
ADVANTAGES AND DISADVANTAGES OF INTERBODY APPROACHES
IMPLANT CONSIDERATIONS
PEEK VERSUS TITANIUM
INTERBODY DEVICE SHAPE/DESIGN
SUMMARY
REFERENCES
9. Treatment Considerations and Biomechanics of the Lumbosacral Spine
INTRODUCTION
INDICATIONS/CONTRAINDICATIONS
CLASSIFICATION SYSTEM
ANATOMIC ZONES
ANTERIOR AUGMENTATION WITH INTERBODY FUSION (TABLE 9.2)
POSTOPERATIVE RESTRICTIONS/REHABILITATION
OUTCOMES/RESULTS FOR TECHNIQUE(S)
SUMMARY/CONCLUSION
FUTURE CONSIDERATIONS
REFERENCES
SECTION III: Anatomic Approaches
10. Anterior Cervical Approaches
INTRODUCTION
ANATOMY
SURFACE LANDMARKS
FASCIAL LAYERS
MUSCLES
NERVES
VASCULAR
BONE
TECHNIQUE
PATIENT POSITIONING
TAPING THE FOREHEAD VERSUS TRACTION
NEUROMONITORING
LEFT- VERSUS RIGHT-SIDED APPROACH
INCISION
SUPERFICIAL DISSECTION
DEEP DISSECTION
LOCALIZATION OF LEVEL, LONGUS COLLI ELEVATION, AND RETRACTOR PLACEMENT
COMPLICATIONS
GENERAL
DYSPHAGIA
DYSPHONIA
ARTERIAL INJURY—VERTEBRAL ARTERIES
AIRWAY OBSTRUCTION
ESOPHAGEAL INJURY
THORACIC DUCT INJURY—CHYLOTHORAX
SYMPATHETIC CHAIN INJURY
HEMATOMA
INFECTION
OTHER NERVE INJURIES—C5 PALSY
CONCLUSION
REFERENCES
11. Surgical Approach to the Posterior Cervical Spine
INTRODUCTION
INDICATIONS FOR POSTERIOR CERVICAL APPROACH
SURGICAL ANATOMY
BONE ANATOMY
MUSCULATURE ANATOMY
MUSCULATURE INNERVATION
NUCHAL LIGAMENTS
VASCULAR ANATOMY
SURGICAL TECHNIQUE
ANESTHESIA
POSITIONING
SKIN PREPARATION
SKIN INCISION AND DISSECTION
EXPOSURE SUBAXIAL SPINE
C1–C2 EXPOSURE
OCCIPITAL EXPOSURE
WOUND CLOSURE
COMPLICATIONS
SURGICAL SITE INFECTION
VERTEBRAL ARTERY INJURY
POSTOPERATIVE PAIN AND KYPHOSIS
CHIN-ON-CHEST DEFORMITY
CONCLUSION
REFERENCES
12. Jaw-Splitting Approaches to the Upper Cervical Spine
INTRODUCTION
ANATOMY
MANDIBLE
UPPER NECK EXPOSURE
PATHOLOGY
ANTERIOR APPROACHES TO THE OCCIPITOCERVICAL JUNCTION
TRANSORAL–TRANSPHARYNGEAL
TRANSORAL–TRANSPHARYNGEAL PLUS MAXILLARY OSTEOTOMY
TECHNIQUE
TRANSMANDIBULAR APPROACHES
MEDIAN MANDIBULOTOMY WITH GLOSSOTOMY (TROTTER APPROACH)
MANDIBULAR SWING TRANSCERVICAL APPROACH
TRANSMANDIBULAR–CIRCUMGLOSSAL–RETROPHARYNGEAL APPROACH
BILATERAL SAGITTAL SPLIT MANDIBULAR OSTEOTOMIES
COMBINED TRANSMAXILLARY AND TRANSMANDIBULAR APPROACHES
TRANSCERVICAL ENDOSCOPIC ODONTOIDECTOMY
ODONTOID-SPARING TRANSNASAL APPROACH
ENDOSCOPIC-ASSISTED LATERAL TRANSATLANTAL APPROACH
FAR- VERSUS EXTREME-LATERAL APPROACHES
ENDOSCOPIC ENDONASAL
SUBMANDIBULAR RETROPHARYNGEAL APPROACH
COMPLICATIONS
REFERENCES
13. The Modified Anterior Approach to the Cervicothoracic Junction
INTRODUCTION
ANATOMY
PREOPERATIVE PLANNING
SURGICAL TECHNIQUE
LOW CERVICAL APPROACH
FULL STERNOTOMY APPROACH
UNILATERAL OR BILATERAL MANUBRIOTOMY
MEDIAL CLAVICULAR OSTEOTOMY
MINI-OPEN APPROACH
COMPLICATIONS
DISCUSSION
CONCLUSION
ACKNOWLEDGMENT
REFERENCES
14. Transsternal Approaches to the Spine
INTRODUCTION
ANATOMY
THORACIC CAGE
MUSCULATURE
VASCULATURE
NERVES
TRANSSTERNAL APPROACHES
FULL MEDIAN STERNOTOMY
PARTIAL MEDIAN STERNOTOMY
LATERAL MANUBRIOTOMY
MODIFIED PARTIAL LATERAL MANUBRIOTOMY
STERNOTOMY PLUS ANTEROLATERAL THORACOTOMY
FULL MEDIAN STERNOTOMY AND INTERAORTOCAVAL SUBINNOMINATE APPROACH
PRE- AND POSTOPERATIVE MANAGEMENT
COMPLICATIONS
PARAVERTEBRAL MASSES AND TRANSSTERNAL APPROACHES
CASE ILLUSTRATION
REFERENCES
15. “Microscopic” Approach to the Posterior Lumbar Spine for Decompression
INTRODUCTION
INDICATIONS/PREOPERATIVE PLANNING
SURGICAL TECHNIQUE
POSITIONING AND SETUP
OPERATIVE APPROACHES—UNILATERAL
BILATERAL DECOMPRESSION
EXTRAFORAMINAL DECOMPRESSION
COMPLICATIONS
OUTCOMES
SUMMARY
REFERENCES
16. Minimal Access Techniques Using Tubular Retractors for Disc Herniations and Stenosis
INTRODUCTION
INDICATIONS
GENERAL TECHNIQUE
INCISION
SERIAL DILATION AND TUBULAR RETRACTOR PLACEMENT
INITIAL DRILLING
TECHNIQUE—LUMBAR DISCECTOMY
TECHNIQUE—LUMBAR “OVER-THE-TOP” LAMINECTOMY
TECHNIQUE
CONSIDERATIONS
TECHNIQUE—TRANSFORAMINAL LUMBAR INTERBODY FUSION
INTRAOPERATIVE PLANNING AND INCISION
PEDICLE SCREW PLACEMENT
INTERBODY CAGE
ROD INSERTION AND CLOSURE
OUTCOMES
LUMBAR DISCECTOMY
LAMINECTOMY
TRANSFORAMINAL LUMBAR INTERBODY FUSION
ADDITIONAL BENEFITS OF TUBULAR RETRACTORS
COMPLICATIONS
THE LEARNING CURVE
CONCLUSION
REFERENCES
17. Open Anterior Exposure of the Thoracic, Thoracolumbar, and Lumbar Spines
INTRODUCTION
HIGH TRANSTHORACIC APPROACH T1–T4
INDICATIONS
MID AND LOWER TRANSTHORACIC APPROACH T4–T12 INCLUDING DOUBLE THORACOTOMY AND THORACOPHRENOLUMBOTOMY DOWN TO L5–S1
INDICATIONS
EXPOSURE FOR THORACOLUMBAR/LUMBAR SCOLIOSIS
POSTOPERATIVE MANAGEMENT
RISKS AND COMPLICATIONS
REFERENCES
18. Anterior Approaches to the Distal Lumbar Spine and Sacrum
INTRODUCTION
ANATOMY
LAYERS OF THE ABDOMINAL WALL
PERITONEAL AND RETROPERITONEAL ANATOMY
VASCULATURE
NEURAL STRUCTURES
LYMPHATIC NETWORK
INDICATIONS
PREOPERATIVE EVALUATION
RETROPERITONEAL APPROACH
ADVANTAGE
POSITIONING
EXPOSURE
RETROPERITONEAL MOBILIZATION
NEUROVASCULAR DISSECTION
LUMBOSACRAL EXPOSURE
TRANSPERITONEAL APPROACH
ADVANTAGE
EXPOSURE
NEUROVASCULAR DISSECTION
POSTOPERATIVE MANAGEMENT
VARIATIONS TO THE ANTERIOR APPROACH
LAPAROSCOPIC
LATERAL INTERBODY FUSION
INSTRUMENTATION AND BONE GRAFTING
COMPLICATIONS
CONCLUSION
REFERENCES
19. Direct Lateral Approach to the Lumbar Spine
INTRODUCTION
ANATOMIC CONSIDERATIONS
INDICATIONS
POSITIONING
PROCEDURE
CLOSURE
COMPLICATIONS
CONCLUSIONS
REFERENCES
SECTION IV: The Cervical Degenerative Spine
20. Cervical: State of the Art
21. Evaluation of Axial Neck Pain: Who Is a Surgical Candidate and Who Isn’t: How to Manage the Nonoperative Treatment, How to Work Up the Pathology
INTRODUCTION
INCIDENCE OF AXIAL NECK PAIN
NATURAL HISTORY OF NECK PAIN
PATHOPHYSIOLOGY OF NECK PAIN
DIFFERENTIAL DIAGNOSIS OF NECK PAIN
EVALUATION OF PATIENTS WITH NECK PAIN
NONOPERATIVE INTERVENTIONS
NONOPERATIVE TREATMENT OF ACUTE AND SUBACUTE NECK PAIN
NONOPERATIVE TREATMENT OF CHRONIC NECK PAIN
THERAPEUTIC INJECTIONS AND RADIOFREQUENCY ABLATION FOR CHRONIC NECK PAIN
NONOPERATIVE TREATMENT OF IATROGENIC NECK PAIN WITH DEFORMITY
SURGICAL INDICATIONS FOR AXIAL NECK PAIN
CERVICAL SPONDYLOLISTHESIS
PSEUDOARTHROSIS
DISCOGENIC AXIAL NECK PAIN
FACETOGENIC AXIAL NECK PAIN
CERVICAL KYPHOSIS
CERVICOGENIC HEADACHE
SUMMARY
REFERENCES
22. Nonoperative Management of Cervical Radiculopathy
INTRODUCTION
ANATOMY
CLINICAL EVALUATION
IMAGING EVALUATIONS
OTHER EVALUATIONS
EPIDEMIOLOGY
TREATMENT DECISIONS
NONOPERATIVE THERAPY
MEDICATION TREATMENT
PHYSICAL THERAPY
CERVICAL IMMOBILIZATION
CERVICAL TRACTION
CERVICAL MANIPULATION
STEROID INJECTION
CONCLUSION
REFERENCES
23. Cervical Spondylosis and Radiculopathy
BACKGROUND
ANATOMY
PATHOANATOMY/PATHOPHYSIOLOGY
RADICULOPATHY
DIAGNOSIS
DIAGNOSTIC STUDIES
NATURAL HISTORY
SURGICAL TREATMENT
ANTERIOR CERVICAL DISCECTOMY AND FUSION
POSTERIOR LAMINOFORAMINOTOMY
CERVICAL DISC ARTHROPLASTY
SUMMARY
REFERENCES
24. Cervical Myelopathy
INTRODUCTION
EPIDEMIOLOGY, GENETICS, AND PATHOPHYSIOLOGY
EPIDEMIOLOGY
GENETICS
PATHOPHYSIOLOGY
CLINICAL EVALUATION
HISTORY
PHYSICAL EXAMINATION
DIAGNOSTIC IMAGING
PATIENT-REPORTED OUTCOMES ASSESSMENT
MYELOPATHY TREATMENT
NATURAL HISTORY AND NONOPERATIVE TREATMENT
EVIDENCE FOR SURGICAL TREATMENT
CERVICAL LAMINECTOMY WITHOUT FUSION
POSTERIOR CERVICAL DECOMPRESSION AND FUSION (PCF)
LAMINOPLASTY
ANTERIOR CERVICAL DECOMPRESSION AND FUSION (ACF)
COMBINED ANTERIOR AND POSTERIOR SURGERY
CONCLUSIONS
REFERENCES
25. Anterior Decompression, Instrumentation, Fusion Techniques: Discectomy, Foraminotomy, Disc Space Carpentry
BACKGROUND DATA
ACCEPTED FORMS OF SURGICAL TREATMENT
SURGICAL TREATMENT TECHNIQUES
ANESTHESIA
POSITIONING
NEUROPHYSIOLOGIC MONITORING
OPERATIVE FIELD
APPROACH
EXPOSURE
DISCECTOMY
END PLATE PREPARATION
FORAMINOTOMY
AUTOGENOUS ILIAC CREST BONE GRAFT
INTERBODY GRAFTING
INSTRUMENTATION
POSTOPERATIVE MANAGEMENT
DISCUSSION OF COMPLICATIONS
VASCULAR
NEURAL
OROPHARYNX/ESOPHAGUS
VERTEBRAL BODY FRACTURE
ACUTE POSTOPERATIVE COMPLICATIONS
OUTCOMES
FUTURE TRENDS
SUMMARY
REFERENCES
26. Anterior Decompression, Instrumentation, Fusion Techniques: Corpectomy, Strut Grafting
INTRODUCTION
CLASSIFICATION OF MYELOPATHY
NATURAL HISTORY
PATIENT EVALUATION
HISTORY AND PHYSICAL EXAMINATION
IMAGING STUDIES
MANAGEMENT
NONOPERATIVE TREATMENT
OPERATIVE INDICATIONS
CONTRAINDICATIONS
PERIOPERATIVE CONSIDERATIONS
PATIENT FACTORS
NEUROPHYSIOLOGIC MONITORING
ANESTHETIC CONSIDERATION
POSITIONING
OPERATIVE TECHNIQUE
EXPOSURE
INSTRUMENTATION
GRAFT SELECTION
RESULTS
COMPLICATIONS
INTRAOPERATIVE COMPLICATIONS
AUTOGRAFT HARVEST COMPLICATIONS
POSTOPERATIVE COMPLICATIONS
RESPIRATORY DISTRESS
INSTRUMENTATION FAILURE
PSEUDARTHROSIS
SUMMARY
REFERENCES
27. Anterior Cervical Plating
INTRODUCTION
HISTORICAL PERSPECTIVE
GENERATIONS OF ANTERIOR CERVICAL PLATES
FIRST GENERATION—DYNAMIC NONLOCKING (“UNRESTRICTED BACKOUT”)
SECOND GENERATION—STATIC LOCKING (“RESTRICTED BACKOUT”)
THIRD GENERATION—DYNAMIC LOCKING (“SEMICONSTRAINED”)
FOURTH GENERATION—BIORESORBABLE
PLATING TECHNIQUES AND INTRAOPERATIVE CONSIDERATIONS
CONCLUSIONS
REFERENCES
28. Indications and Techniques for Transoral and Foramen Magnum Decompression
INTRODUCTION
NEURODIAGNOSTIC IMAGING AND TREATMENT ALGORITHMS
SURGICAL APPROACHES
TRANSORAL APPROACH TO THE VENTRAL CRANIOCERVICAL BORDER
PREOPERATIVE ASSESSMENT
OPERATIVE PROCEDURE
INTRADURAL EXPANSION OF TUMOR AND REPAIR OF CSF LEAK
POSTOPERATIVE CARE
ANALYSIS OF POSTOPERATIVE RESULTS IN 806 PATIENTS WHO UNDERWENT THE TRANSORAL PROCEDURE FOR DECOMPRESSION OF THE VENTRAL CRANIOVERTEBRAL JUNCTION
MORBIDITY/INFECTION
MORBIDITY
MORTALITY
POSTEROLATERAL–FAR LATERAL TRANSCONDYLAR APPROACH TO THE VENTRAL FORAMEN MAGNUM AND UPPER CERVICAL CANAL
INDICATIONS
PREOPERATIVE ASSESSMENT
SURGICAL TECHNIQUE
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
LATERAL TRANSCERVICAL EXTRAPHARYNGEAL APPROACH TO THE UPPER CERVICAL SPINE AND CRANIOCERVICAL JUNCTION
COMPLICATIONS
POSTERIOR MIDLINE CRANIECTOMY AND UPPER CERVICAL LAMINECTOMY
CONCLUSION
REFERENCES
29. Occipitocervical and Atlantoaxial Methods of Fusion: Rigid Fixation and Wiring
INTRODUCTION
ATLANTOAXIAL FUSION
GRAFT AND CABLE TECHNIQUE
GRAFT AND CLAMP TECHNIQUE
RIGID FIXATION
TRANSARTICULAR SCREW FIXATION
LATERAL MASS SCREWS AND RODS
OCCIPITOCERVICAL FUSION
ROD AND WIRE (CONTOURED LOOP) FIXATION
SCREW/ROD FIXATION
COMPLICATIONS
SUMMARY
REFERENCES
30. Subaxial Posterior Foraminotomy
HISTORY
ANATOMY/BIOMECHANICS
SURGICAL TECHNIQUE OF POSTERIOR FORAMINOTOMY
OPEN POSTERIOR CERVICAL FORAMINOTOMY
MIS POSTERIOR CERVICAL FORAMINOTOMY
OUTCOMES
POSTERIOR LAMINOFORAMINOTOMY
COMPLICATIONS
OUTCOMES OF MIS POSTERIOR CERVICAL FORAMINOTOMY (MIS PCF)
COST
COMPARISON TO OTHER PROCEDURES
ACDF AND TDR
FULL ENDOSCOPIC POSTERIOR FORAMINOTOMY
REFERENCES
31. Cervical Laminoplasty
INTRODUCTION
BACKGROUND
OPERATIVE TECHNIQUE
LEVEL SELECTION
POSITIONING AND EXPOSURE
BONY DECOMPRESSION AND LAMINOPLASTY STABILIZATION
COMPLETION
POSTOPERATIVE CARE
COMPLICATIONS
EPIDURAL HEMATOMA
INFECTION
POSTLAMINOPLASTY KYPHOSIS
RECURRENT STENOSIS
AXIAL NECK PAIN
MOTOR ROOT PALSY
RESULTS
CONCLUSION
REFERENCES
32. Subaxial Posterior Decompression and Fusion Techniques
INTRODUCTION
OPERATIVE TECHNIQUE
POSTOPERATIVE CARE
COMPLICATIONS
CONCLUSION
ACKNOWLEDGMENT
REFERENCES
33. Subaxial Posterior Laminoplasty and Laminectomy With Lateral Mass Fixation
INTRODUCTION
SUBAXIAL POSTERIOR LAMINOPLASTY AND LAMINECTOMY
OPERATIVE TECHNIQUE
POSTOPERATIVE CARE
COMPLICATIONS
RESULTS
SUBAXIAL POSTERIOR LATERAL MASS FIXATION
ANATOMY
BIOMECHANICS
INDICATIONS/CONTRAINDICATIONS
SURGICAL TECHNIQUE
SCREW TECHNIQUES
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
MINIMALLY INVASIVE APPROACH
CASE SAMPLES
CONCLUSION
REFERENCES
34. Subaxial Posterior Lateral Mass Fixation
INTRODUCTION
ANATOMY
BIOMECHANICS
INDICATIONS AND CONTRAINDICATIONS
SURGICAL TECHNIQUE
SCREW TECHNIQUES
POSTOPERATIVE MANAGEMENT
OUTCOMES AND COMPLICATIONS
MINIMALLY INVASIVE TECHNIQUE
CASE SAMPLES
CASE 1
CASE 2
REFERENCES
35. Subaxial Cervical Pedicle Screw Fixation
INTRODUCTION
INDICATION, LIMITATION, AND CONTRAINDICATION
INDICATION
CONTRAINDICATION AND LIMITATION
SPECIFIC PREOPERATIVE CONSIDERATIONS
PEDICLE SIZE
ANGLE OF PEDICLE AXIS
ANATOMY OF THE VERTEBRAL ARTERY
SURGICAL PROCEDURES
OPERATION ROOM SET-UP/POSITIONING
EXPOSURE
IMPLANTS
PEDICLE SCREW PLACEMENT
COMPLICATIONS (TABLE 35.3)
COMPLICATIONS DIRECTLY ATTRIBUTABLE TO SCREW INSERTION
COMPLICATIONS NOT DIRECTLY ATTRIBUTABLE TO SCREW INSERTION
CASE PRESENTATION
A CASE WITH CERVICAL SPONDYLOTIC MYELOPATHY WITH MONOSEGMENTAL INSTABILITY
A CASE OF SALVAGE SURGERY FOR POSTLAMINECTOMY KYPHOSIS
A CASE OF MULTISEGMENTAL INSTABILITY CAUSED BY SUBAXIAL LESION OF RHEUMATOID ARTHRITIS
SUMMARY
REFERENCES
36. Revision Cervical Spine Surgery
INTRODUCTION
EVALUATION OF THE PATIENT AFTER FAILED CERVICAL SPINE SURGERY
EARLY CAUSES OF REVISION CERVICAL SPINE SURGERY
HEMATOMA
RADICULOPATHY AND RECURRENT SYMPTOMS
LATE CAUSES OF REVISION CERVICAL SPINE SURGERY
ADJACENT SEGMENT DISEASE
PSEUDARTHROSIS
POSTSURGICAL MALALIGNMENT
CONCLUSION
REFERENCES
37. Combined Approaches (Anterior-Posterior, Posterior-Anterior-Posterior) to the Correction of Cervical Kyphosis
INTRODUCTION
EVALUATION OF THE PATIENT WITH CERVICAL DEFORMITY
CLINICAL PRESENTATION AND PHYSICAL EXAMINATION
ETIOLOGY OF CERVICAL DEFORMITY
RADIOGRAPHIC EVALUATION
GOALS OF CERVICAL KYPHOSIS CORRECTION
RESTORATION OF BALANCE AND ALIGNMENT
ACHIEVING A STABLE FUSION CONSTRUCT
CHOOSING THE APPROACH
DECISION-MAKING ALGORITHM
COMPLICATIONS AFTER COMBINED APPROACHES
REFERENCES
38. Cervical Pedicle Subtraction Osteotomy
INTRODUCTION
INDICATION AND PREOPERATIVE EVALUATION
OPERATIVE TECHNIQUE
POSITIONING
EXPOSURE
INSTRUMENTATION
PEDICLE SUBTRACTION OSTEOTOMY
OSTEOTOMY CLOSURE
WOUND CLOSURE
CASE 38.1
COMPLICATIONS
CONCLUSION
REFERENCES
39. Cervical Disc Arthroplasty
INTRODUCTION
HISTORY OF CERVICAL DISC ARTHROPLASTY
CERVICAL DISC PROSTHESIS DESIGN
PROSTHETIC KINEMATICS
MATERIAL CHOICE
INDICATIONS AND CONTRAINDICATIONS
CURRENT INDICATIONS AND CONTRAINDICATIONS
EXPANDED INDICATIONS AND FUTURE DIRECTIONS
MOST RECENT IDE TRIAL DATA
SINGLE-LEVEL DISEASE
TWO-LEVEL DISEASE
META-ANALYSES OF OUTCOMES
PREVENTION OF ADJACENT SEGMENT DISEASE
COMPLICATIONS SPECIFIC TO CDA
AUTHOR’S PREFERRED SURGICAL TECHNIQUE
REFERENCES
40. Complications of Surgical Treatment of the Cervical Spine
BACKGROUND
DEFINING COMPLICATIONS IN CERVICAL SPINE SURGERY
RISK FACTORS FOR CERVICAL SPINE SURGERY COMPLICATIONS
COMPLICATION RATES IN CERVICAL SPINE SURGERY
IMPORTANT COMPLICATIONS ASSOCIATED WITH ANTERIOR CERVICAL SPINE SURGERY
IMPORTANT COMPLICATIONS ASSOCIATED WITH POSTERIOR CERVICAL SPINE SURGERY
IMPORTANT RADIOGRAPHIC COMPLICATIONS OF CERVICAL SPINE SURGERY
FUTURE DIRECTIONS
REFERENCES
SECTION V: The Thoracic and Lumbar Degenerative Spine
41. Thoracic and Lumbar Degenerative Disorders: State of the Art
REFERENCES
42. Evaluation of Thoracic and Lumbar Axial Back Pain: Who Is a Surgical Candidate and Who Is Not?
INTRODUCTION
DEFINITION OF AXIAL BACK PAIN
ANATOMY, PATHOANATOMY, AND PATHOGENESIS OF AXIAL BACK PAIN
RISK FACTORS OF AXIAL BACK PAIN
CLASSIFICATION OF AXIAL BACK PAIN
NATURAL HISTORY OF AXIAL BACK PAIN
HISTORY AND PHYSICAL EVALUATION OF THE PATIENT WITH AXIAL BACK PAIN
DIFFERENTIAL DIAGNOSIS OF THE AXIAL BACK PAIN
MUSCLE STRAIN
DISC DEGENERATION
FACET JOINTS
SPONDYLOLYSIS AND SPONDYLOLISTHESIS
SI JOINT
SPONDYLOARTHROPATHIES
BENIGN AND MALIGNANT TUMORS
INFECTIONS
METABOLIC BONE DISEASE
NONORGANIC BACK PAIN
IMAGING AND DIAGNOSTIC STUDIES FOR AXIAL BACK PAIN
PLAIN RADIOGRAPHS
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
BONE SCAN
DISCOGRAPHY
DIAGNOSTIC INJECTIONS
TREATMENT
NONOPERATIVE MANAGEMENT OF AXIAL BACK PAIN
OPERATIVE MANAGEMENT OF AXIAL BACK PAIN
CONCLUSION
REFERENCES
43. Surgical Treatment of Lumbar Disc Herniation
INTRODUCTION
SURGICAL TECHNIQUE
SPECIAL SITUATIONS
EXTRUDED DISC
FORAMINAL DISC HERNIATIONS
FAR-LATERAL EXTRAFORAMINAL HERNIATIONS
POSTOPERATIVE CARE
REFERENCES
44. Surgical Treatment of Lumbar Spinal Stenosis
INTRODUCTION
PATHOGENESIS AND PATHOANATOMY
MANIFESTATIONS OF LUMBAR SPINAL STENOSIS
NATURAL HISTORY OF LUMBAR SPINAL STENOSIS
HISTORY AND PHYSICAL EXAMINATION OF THE PATIENT WITH LUMBAR SPINAL STENOSIS
IMAGING AND DIAGNOSTIC STUDIES FOR LUMBAR SPINAL STENOSIS
PLAIN RADIOGRAPHS
MAGNETIC RESONANCE IMAGING (MRI)
MYELOGRAPHY/COMPUTED TOMOGRAPHY MYELOGRAPHY
BICYCLE/TREADMILL TEST AND VASCULAR STUDIES
ELECTRODIAGNOSTIC STUDIES
DIFFERENTIAL DIAGNOSIS OF LUMBAR SPINAL STENOSIS
NONOPERATIVE MANAGEMENT OF LUMBAR SPINAL STENOSIS
SURGICAL MANAGEMENT OF LUMBAR SPINAL STENOSIS
INDICATIONS FOR SURGERY AND REVIEW OF SURGICAL TECHNIQUES
SURGICAL TECHNIQUES
CENTRAL LAMINECTOMY
LAMINECTOMY WITH LATERAL RECESS DECOMPRESSION AND FORAMINOTOMY
HEMILAMINOTOMY WITH LATERAL RECESS DECOMPRESSION AND FORAMINOTOMY
LAMINOPLASTY
INTERSPINOUS MICRODECOMPRESSION
POSTERIOR SPINAL FUSION WITH AND WITHOUT INSTRUMENTATION
INTERBODY FUSION
INDIRECT DECOMPRESSION
INTERSPINOUS PROCESS DEVICE
DISC ARTHROPLASTY
MINIMALLY INVASIVE SURGICAL TECHNIQUES
LONG-TERM OUTCOMES
CONCLUSION
REFERENCES
45. Revision Laminectomy: Indications and Techniques
INTRODUCTION
EVALUATION AND INDICATIONS
TREATMENT
SURGICAL TECHNIQUES
OUTCOMES
CLINICAL OUTCOMES
COMPLICATIONS
CONCLUSION
REFERENCES
46. Minimally Invasive Posterior Surgery for the Lumbar Spine
INTRODUCTION
LIMITATIONS
EVOLUTION OF MINIMALLY INVASIVE POSTERIOR LUMBAR SURGICAL APPROACHES
EXPOSURE
LUMBAR DECOMPRESSION
RESULTS
INSTRUMENTED AND UNINSTRUMENTED MINIMALLY INVASIVE POSTEROLATERAL LUMBAR FUSION TECHNIQUES
OVERVIEW
PERCUTANEOUS SPINAL FIXATION
RESULTS
MINIMALLY INVASIVE POSTEROLATERAL FUSION
MINIMALLY INVASIVE POSTERIOR INTERBODY FUSION TECHNIQUES
INTRODUCTION
MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION
TECHNIQUE (AUTHORS’ PREFERENCE)
RESULTS
FUTURE DIRECTION OF MINIMALLY INVASIVE SPINE SURGERY
MINIMALLY INVASIVE TWO-LEVEL TRANSFORAMINAL LUMBAR INTERBODY FUSION
REFERENCES
47. When to Consider ALIF, TLIF, and PLIF With PSF
INTRODUCTION/BACKGROUND
INTERBODY FUSION
POSTERIOR LUMBAR INTERBODY FUSION
TRANSFORAMINAL LUMBAR INTERBODY FUSION
ANTERIOR LUMBAR INTERBODY FUSION
COMPARISON STUDY BETWEEN PLIF AND TLIF
COMPARISON STUDY BETWEEN TLIF AND ALIF
CONCLUSION
REFERENCES
48. Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion
INTRODUCTION
INDICATIONS
ADVANTAGES OF TLIF
PLIF SURGICAL PROTOCOL
TLIF SURGICAL PROTOCOL
POSTOPERATIVE MANAGEMENT
THE IMPORTANCE OF LORDOSIS
OPERATING ROOM SETUP
OPERATING TABLE
DISSECTION
MINIMALLY INVASIVE SURGERY
DECOMPRESSION
BILATERAL FACETECTOMIES
INTERBODY DEVICE
INTERBODY DEVICE PLACEMENT
STEERABLE CAGES
CAGE GEOMETRY (BULLET NOSED, CURVED, WEDGED)
EXPANDABLE CAGES
POSTERIOR INSTRUMENTATION
INTERPEDICULAR COMPRESSION
UNILATERAL VERSUS BILATERAL PEDICLE SCREWS
COMPLICATIONS
CONTRALATERAL RADICULOPATHY
CASE EXAMPLES
CASE 1
CASE 2
CONCLUSION
REFERENCES
49. Revision Lumbar Spine Surgery
INTRODUCTION
CLINICAL EVALUATION
IMAGING EVALUATION
PATIENTS WITHOUT PRIOR INSTRUMENTATION
PATIENTS WITH PRIOR INSTRUMENTATION AND FUSION
ALIGNMENT EVALUATION
SURGICAL INDICATIONS AND PREOPERATIVE OPTIMIZATION
SURGICAL STRATEGIES
REVISION DECOMPRESSIONS
ADJACENT SEGMENT DISEASE
PSEUDARTHROSIS
MALALIGNMENT
CONCLUSIONS
REFERENCES
50. Thoracic Disc Herniation: Diagnosis and Management
INTRODUCTION
ANATOMICAL FINDINGS TO CONSIDER IN TDH
PRESENTATION
LOCATION OF THORACIC DISC HERNIATION
DIAGNOSIS
NONOPERATIVE MANAGEMENT
OPERATIVE MANAGEMENT
IDENTIFICATION OF THE CORRECT LEVEL AND PREVENTION OF WRONG-SITE SURGERY
INTRAOPERATIVE NEUROMONITORING
SURGICAL APPROACH—POSTERIOR
TRANSFACET PEDICLE–SPARING APPROACH
ANTEROLATERAL APPROACH TO THE THORACIC SPINE
SIGNS AND SYMPTOMS OF SUBARACHNOID-PLEURAL FISTULA
Thoracic signs
Neurologic signs
MINIMALLY INVASIVE APPROACHES TO THE THORACIC SPINE
MINI-TRANSTHORACIC APPROACH
THORACIC MICROENDOSCOPIC DISCECTOMY (TMED)
THORACIC MICROSCOPIC DISCECTOMY
MINIMALLY INVASIVE LATERAL APPROACHES TO THORACIC SPINE
CONCLUSION
REFERENCES
51. Thoracic Stenosis
INTRODUCTION
ANATOMY
DIAGNOSIS
PATHOGENESIS
SURGICAL TREATMENT
COMPLICATIONS
POSTOPERATIVE CARE
REFERENCES
52. Treatment of Thoracic Myelopathy
INTRODUCTION
CAUSES OF THORACIC MYELOPATHY
THORACIC DISC HERNIATIONS
THORACIC OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT
THORACIC OSSIFICATION OF YELLOW LIGAMENT
CONCLUSION
REFERENCES
53. Current State of Lumbar Total Disc Replacement: Concepts/Design Strategy/Indications/Contraindications/Complications
CONCEPTS
DESIGN STRATEGY
INDICATIONS
CONTRAINDICATIONS
PHYSICAL EXAMINATION
RADIOGRAPHIC ANALYSIS
PATIENT POSITIONING
COMPLICATIONS
IMPLANTS
EVIDENCE-BASED OUTCOMES
SUMMARY
REFERENCES
54. Sacroiliac Joint Dysfunction
INTRODUCTION
SI JOINT DYSFUNCTION AND LOW BACK PAIN
ANATOMY AND BIOMECHANICS
PATHOLOGY AND PATHOMECHANICS
HISTORY AND PHYSICAL EXAMINATION
CLINICAL HISTORY
PHYSICAL EXAMINATION
IMAGING EVALUATION
DIAGNOSTIC INJECTION
NONSURGICAL TREATMENT
INDICATIONS FOR SURGICAL MANAGEMENT
TRADITIONAL OPEN SURGERY
MINIMALLY INVASIVE SURGERY
MINIMALLY INVASIVE SURGICAL TECHNIQUE
MIS SURGICAL OUTCOMES
COMPLICATIONS
CONCLUSION
REFERENCES
55. The Future: Disc Regeneration and Other Technologies
INTRODUCTION
PROTEIN THERAPIES
INTRODUCTION
GROWTH FACTORS
ANTI-INFLAMMATORY PROTEINS
CONCLUSION
SMALL MOLECULES AND PEPTIDE THERAPIES
INTRODUCTION
PEPTIDE THERAPY
SMALL MOLECULAR THERAPIES
CONCLUSION
CELL-BASED THERAPIES
INTRODUCTION
DISC CELLS
CHONDROCYTES
STEM CELLS
DERMAL FIBROBLASTS
CONCLUSIONS
TISSUE ENGINEERING
INTRODUCTION
NUCLEUS PULPOSUS TISSUE ENGINEERING
ANNULUS FIBROSUS TISSUE ENGINEERING
WHOLE INTERVERTEBRAL DISC ENGINEERING
CONCLUSIONS
CONCLUSIONS
REFERENCES
56. Complications of Lumbosacral Spine Surgery
INTRODUCTION
INSTRUMENTATION AND FUSION COMPLICATIONS
PSEUDARTHROSIS
VASCULAR AND BLEEDING–RELATED COMPLICATIONS
MUSCLE COMPLICATIONS
INFECTION
NEUROLOGIC COMPLICATIONS
SAGITTAL ALIGNMENT AND BALANCE COMPLICATIONS
COST EFFECTIVENESS OF LUMBAR SPINE SURGERY
CONCLUSION
REFERENCES
SECTION VI: Spondylolisthesis
57. Wiltse and Marchetti–Bartolozzi Classifications of Spondylolisthesis: Guidelines for Treatment
CLASSIFICATIONS
TYPE 1 (DYSPLASTIC)
TYPE 2 (ISTHMIC)
TYPE 3 (DEGENERATIVE)
TYPE 4 (TRAUMATIC)
TYPE 5 (PATHOLOGIC)
MARCHETTI–BARTOLOZZI CLASSIFICATION
PROGRESSION OF DEFORMITY
ACQUIRED
MEYERDING GRADING SCALE
TREATMENT
REFERENCES
58. Sagittal Alignment and the Spinal Deformity Study Group Classification
INTRODUCTION
LOCAL, REGIONAL, AND GLOBAL SAGITTAL ALIGNMENTS
LOCAL ALIGNMENT: SLIP GRADE AND LUMBOSACRAL KYPHOSIS
REGIONAL ALIGNMENT: SACROPELVIC MORPHOLOGY, PELVIC BALANCE, AND PROXIMAL FEMORAL ANGLE
GLOBAL ALIGNMENT: SPINAL BALANCE
SPINAL DEFORMITY STUDY GROUP CLASSIFICATION
PROPOSED SURGICAL TREATMENT
REFERENCES
59. Natural History of Spondylolisthesis
INTRODUCTION
REVIEW OF EXISTING CLASSIFICATION
L5–SACRUM RELATIONSHIP
GLOBAL ANATOMICAL CLASSIFICATION
SPINAL DEFORMITY STUDY GROUP (SDSG AND MAC-THIONG) CLASSIFICATION
NATURAL HISTORY: PROPOSAL FOR A NEW CLASSIFICATION INTEGRATING THE TIME-SCALE DIMENSION
CONCLUSION
REFERENCES
60. Pars Interarticularis Repair
INTRODUCTION
REVIEW OF LITERATURE
INDICATIONS
PREOPERATIVE PLANNING
AUTHORS’ PREFERRED METHOD
POSTOPERATIVE CARE
AUTHORS’ SERIES
DISCUSSION AND CONCLUSION
REFERENCES
61. Low-Grade Spondylolisthesis in Children and Adolescents
INTRODUCTION
TREATMENT
COMPLICATIONS
SUMMARY
REFERENCES
62. Adult Degenerative Spondylolisthesis
BACKGROUND AND CLASSIFICATION
ANATOMY AND BIOMECHANICS
NATURAL HISTORY AND EPIDEMIOLOGY
CLINICAL PRESENTATION
IMAGING STUDIES AND WORKUP
LEVEL-1 EVIDENCE FOR DECOMPRESSION ALONE VERSUS DECOMPRESSION WITH FUSION
POSTEROLATERAL FUSION
POSTEROLATERAL FUSION WITH PEDICLE SCREW INSTRUMENTATION
LATERAL LUMBAR INTERBODY FUSION
SURGICAL TECHNIQUES
REFERENCES
63. High-Grade Spondylolisthesis: Decision Making and Fusion Reduction
INTRODUCTION
ALIGNMENT
DECISION MAKING: TO REDUCE OR NOT TO REDUCE
IN SITU FUSION
REDUCTION
CASE ILLUSTRATIONS
CONCLUSION
REFERENCES
64. High-Grade Spondylolisthesis: Partial Reduction
INTRODUCTION
DEFINITION
BIOMECHANICAL KEY POINTS IN HIGH-GRADE SPONDYLOLISTHESIS
POSITIONING OF L5 IN RELATION TO THE SACRUM AND THE FEMORAL HEADS
EFFECT OF THE POSITION OF L5 ON THE LUMBAR LORDOSIS
BALANCED HGS
UNBALANCED HGS
HOW TO REDUCE L5?
OPERATIVE POSITION
L4–L5 COUPLING
REDUCING L5 LISTHESIS
FLAT VERSUS DOME-SHAPED SACRAL ENDPLATE
IS THE POSTERIOR FUSION ENOUGH FOR STABILIZING THE REDUCTION?
IS PARTIAL REDUCTION OF L5 A GOOD OPTION IN BALANCED HGS?
TECHNIQUE OF PARTIAL REDUCTION
SURGICAL TECHNIQUE
SACRAL FIXATION
LUMBAR FIXATION
FUSION
TIPS
ADJUSTING THE REDUCTION OF L5
POSTOPERATIVE MANAGEMENT
NEUROLOGIC EXAMINATION
BRACING
EVALUATION OF THE WIDTH OF L5–S1 DISC SPACE
EXPECTED RESULTS
COSMETIC IMPROVEMENT
NO PAIN
COMPLICATIONS
NEUROLOGIC DEFICITS
LOSS OF REDUCTION
INSTRUMENTATION BULKINESS
CONCLUSION
REFERENCES
65. High-Grade Spondylolisthesis: Posterior Decompression and Spanning/Dowel Fibula
BACKGROUND
TREATMENT
PREOPERATIVE PLANNING
TECHNIQUE
POSTERIOR APPROACH
ANTERIOR–POSTERIOR APPROACH
POSTOPERATIVE CARE
RESULTS
COMPLICATIONS
CASE 1
CASE 2
CONCLUSIONS
REFERENCES
66. High Dysplastic Spondylolisthesis: Anatomic Reduction Harms/Shufflebarger Technique
INTRODUCTION
PATHOMECHANICS OF SPONDYLOLISTHESIS
RATIONALE FOR REDUCTION OF SPONDYLOLISTHESIS
SURGICAL TECHNIQUE OF SPONDYLOLISTHESIS REDUCTION
COMPLICATIONS
RESULTS AND OUTCOMES
REFERENCES
67. Reduction of High-Grade Spondylolisthesis: The Edwards Technique
INTRODUCTION
PATHOMECHANICS OF SPONDYLOLISTHESIS
ADVANTAGES OF REDUCTION
IMPROVES FUSION RATE
PRESERVES MOTION SEGMENTS
STOPS SLIP PROGRESSION
FACILITATES NERVE DECOMPRESSION
RESTORES POSTURE AND MECHANICS
IMPROVES APPEARANCE AND SELF-IMAGE
THE QUEST FOR A REDUCTION CAPABILITY
TRACTION-CAST REDUCTION
POSTERIOR DISTRACTION INSTRUMENTATION
ANTEROPOSTERIOR RESECTION REDUCTIONS
VERTEBRECTOMY
PEDICLE SCREW LEVERED REDUCTION
PRESENT INDICATIONS FOR REDUCTION
NEUROLOGIC IMPAIRMENT
SAGITTAL DECOMPENSATION
COSMETIC DISTRESS
HIGH RISK OF SLIP PROGRESSION
EXCESS LUMBOSACRAL MOBILITY
GRADUAL INSTRUMENTED REDUCTION
THREE CORRECTIVE FORCES
TWO-POINT DISTAL FIXATION
STRESS RELAXATION
ANATOMIC ALIGNMENT
EDWARDS GRADUAL REDUCTION TECHNIQUE
PREOPERATIVE PLANNING
ROOT LENGTHENING LIMIT
POSITIONING AND EXPOSURE
MONITORING NERVE FUNCTION
ALAR DISTRACTION RODS
OVERHEAD TRACTION
L5 ROOT DECOMPRESSION
OPTIONAL SACRAL DOME OSTEOTOMY
THE SPONDYLO CONSTRUCT: SCREW FIXATION
TEMPORARY L4 SCREWS
L5 SCREWS
S1 SCREW OPTIONS
DISTAL SCREW OPTIONS
SPONDYLO CONSTRUCT: ASSEMBLY
GRADUAL INSTRUMENTED REDUCTION
OPTIONAL REDUCTION STAGES
GRAFTING
POSTOPERATIVE BRACING
SPECIAL SITUATIONS
CLINICAL RESULTS
REFERENCES
68. L5 Vertebrectomy for High-Grade Spondylolisthesis: Anterior–Posterior and Posterior-Only Approaches
INTRODUCTION
ETIOLOGY OF SPONDYLOPTOSIS
CLINICAL FEATURES
SURGICAL PROCEDURE: STAGED ANTERIOR–POSTERIOR APPROACH (THE “GAINES PROCEDURE”)
FIRST-STAGE PROCEDURE: ANTERIOR APPROACH (FIG. 68.3)
SECOND-STAGE PROCEDURE: POSTERIOR APPROACH (FIG. 68.6)
SURGICAL PROCEDURE: POSTERIOR-ONLY APPROACH (SENIOR AUTHOR’S TECHNIQUE)
OUTCOMES
STAGED ANTERIOR–POSTERIOR TECHNIQUE
POSTERIOR-ONLY TECHNIQUE
CONCLUSION
ACKNOWLEDGMENT
REFERENCES
69. Complications of Spondylolysis/Spondylolisthesis Surgery
INTRODUCTION
NEUROLOGIC COMPLICATIONS
PSEUDARTHROSIS
SLIP PROGRESSION
INSTRUMENTATION FAILURE
VASCULAR COMPLICATIONS
INFECTION
SUMMARY
REFERENCES
Volume 2
SECTION VII: Idiopathic Scoliosis
70. Natural History Including Measures of Maturity
INTRODUCTION
PREVALENCE AND INCIDENCE
TYPES OF IDIOPATHIC SCOLIOSIS
AGE OF ONSET
PATTERN
CURVE EVOLUTION—PROGRESSION DURING IMMATURITY
INFANTILE
JUVENILE
ADOLESCENT
PROGRESSION IN BRACED PATIENTS
ASSESSING PHYSICAL MATURITY
CURVE PROGRESSION AFTER MATURITY
WHY CURVES PROGRESS
CONSEQUENCES OF SCOLIOSIS
INFLUENCE OF SPINAL DEFORMITY ON THE LUNGS
THORACIC INSUFFICIENCY SYNDROME
MORTALITY
BACK PAIN
PREGNANCY
APPEARANCE
FUNCTION
SUMMARY
EPILOGUE
REFERENCES
71. Clinical Assessment and Parent–Patient Expectations
CLINICAL ASSESSMENT
INTRODUCTION
PATIENT HISTORY
PHYSICAL EXAMINATION
PARENT AND PATIENT PERSPECTIVES
CONCLUSIONS
REFERENCES
72. Spinal Deformity Outcomes Measurement
INTRODUCTION
CHOOSING OUTCOME MEASURES
SRS INSTRUMENT
ADDITIONAL SPINAL DEFORMITY–SPECIFIC INSTRUMENTS
GENERIC AND SPINAL DISORDER–SPECIFIC OUTCOMES
STATISTICAL VALIDATION OF AN INSTRUMENT
CROSS-CULTURAL ADAPTATION
CLINICAL APPLICATION
PATIENT-REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM
HEALTH ECONOMICS
FUTURE PERSPECTIVE
CONCLUSION
REFERENCES
73. Radiographic Classification Scheme: Lenke Classification
INTRODUCTION
RADIOGRAPHIC COMPONENTS OF THE CLASSIFICATION SYSTEM
CURVE TYPES
SUMMARY
CASE EXAMPLES
REFERENCES
74. Fusionless Surgery and Growing-Rod Techniques for Idiopathic Early-Onset Scoliosis
INTRODUCTION
PATIENT EVALUATION
IMAGING ASSESSMENT
MANAGEMENT THEMES
FUSIONLESS SURGERY OR GROWING-ROD EVOLUTION
TRADITIONAL DUAL GROWING RODS
LENGTHENING OF TRADITIONAL GROWING RODS
GRADUATION
MAGNETICALLY CONTROLLED GROWING RODS
SUMMARY
REFERENCES
75. Anterior and Posterior Scoliosis Correction Techniques Without Fusion
INTRODUCTION
VERTEBRAL BODY STAPLING
VBS INDICATIONS
VBS TECHNIQUE
VBS COMPLICATIONS
VERTEBRAL BODY TETHERING
VBT INDICATIONS
VBT TECHNIQUE
VBT COMPLICATIONS
POSTERIOR DYNAMIC CONCAVE DISTRACTION (ApiFix)
POSTERIOR DYNAMIC CONCAVE DISTRACTION INDICATIONS
POSTERIOR DYNAMIC CONCAVE DISTRACTION TECHNIQUE
POSTERIOR DYNAMIC CONCAVE DISTRACTION COMPLICATIONS
SUMMARY
REFERENCES
76. Shilla Technique
INTRODUCTION
PATIENT SELECTION AND PREOPERATIVE PLANNING
SURGICAL TECHNIQUE
POSITIONING
APPROACH
OSTEOTOMIES AND INSTRUMENTATION
DEFORMITY CORRECTION
SURGICAL PEARLS
POSTOPERATIVE CARE
REVISION STRATEGIES
CLINICAL OUTCOMES
RADIOGRAPHIC OUTCOMES
COMPLICATIONS
METALLIC DEBRIS
DEFINITIVE TREATMENT
COMPARISON TO GROWING ROD OUTCOMES
COST EFFECTIVENESS
CASE STUDY
REFERENCES
77. Open and Thoracoscopic Anterior Thoracic Surgery
ANTERIOR THORACIC SURGERY
HISTORICAL PERSPECTIVE AND RECENT ADVANCEMENTS
GOALS OF ANTERIOR THORACIC SURGERY
INDICATIONS FOR ANTERIOR THORACIC SURGERY
CONTRAINDICATIONS FOR ANTERIOR THORACIC SURGERY
SURGICAL TECHNIQUE: OPEN ANTERIOR THORACOTOMY WITH DISC EXCISION AND INSTRUMENTATION
SURGICAL TECHNIQUE: THORACOSCOPIC ANTERIOR RELEASE AND INSTRUMENTATION
RADIOGRAPHIC AND CLINICAL OUTCOMES
CONCLUSIONS
REFERENCES
78. Thoracoplasty
BACKGROUND DATA
TECHNIQUE
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
SUMMARY
REFERENCES
79. Evolution of Instrumentation for Adolescent Idiopathic Scoliosis
NATURAL HISTORY OF SCOLIOSIS
HISTORICAL PERSPECTIVES ON SCOLIOSIS
INITIAL TREATMENTS
POSTERIOR INSTRUMENTED FUSION
ANTERIOR INSTRUMENTATION
NONFUSION INSTRUMENTATION (GROWTH MODULATION TECHNIQUES)
REFERENCES
80. Posterior Spinal Deformity Correction Techniques
INTRODUCTION
PREOPERATIVE ASSESSMENT
CLINICAL ASSESSMENT
RADIOGRAPHIC EVALUATION
HALO-GRAVITY TRACTION
PHYSIOLOGIC ASSESSMENT
INTRAOPERATIVE POSITIONING
IMPLANT CONSIDERATIONS
SOFT TISSUE RELEASES AND OSTEOTOMIES
SOFT TISSUE RELEASES
FACET-BASED OSTEOTOMIES
PEDICLE SUBTRACTION OSTEOTOMY
VERTEBRAL COLUMN RESECTION
CORRECTION TECHNIQUES
POSTEROLATERAL TRANSLATION
ROD DEROTATION TECHNIQUE
VERTEBRAL DEROTATION TECHNIQUES
KYPHOSIS CORRECTION
LORDOTIC CORRECTION
CONCLUSIONS
REFERENCES
81. Anterior Lumbar and Thoracolumbar Correction and Fusion for Adolescent Idiopathic Scoliosis
INTRODUCTION
EVOLUTION OF THE ANTERIOR APPROACH FOR THORACOLUMBAR/LUMBAR SCOLIOSIS
INDICATIONS
FUSION/INSTRUMENTATION LEVELS
SURGICAL TECHNIQUE
SURGICAL APPROACH
SCREW PLACEMENT
DEFORMITY CORRECTION
RESULTS OF ANTERIOR INSTRUMENTATION AND FUSION FOR THORACOLUMBAR/LUMBAR CURVES
FRONTAL PLANE CORRECTION
SAGITTAL PLANE CORRECTION
DEROTATION
COMPARISON WITH THE POSTERIOR APPROACH
COMPLICATIONS
PSEUDARTHROSIS
DECOMPENSATION
UNUSUAL COMPLICATIONS
CONCLUSION
REFERENCES
82. Strategies in the Management of Severe and Neglected Deformities
INTRODUCTION
PREVALENCE OF UNTREATED SPINE DEFORMITY
CLINICAL PRESENTATION
DIAGNOSTIC INVESTIGATIONS
TREATMENT OPTIONS
NONSURGICAL TREATMENT
SURGICAL TREATMENT
POSTERIOR APPROACHES
COMBINED ANTERIOR AND POSTERIOR APPROACHES
THREE-COLUMN OSTEOTOMIES
SURGICAL TECHNIQUE
POSTOPERATIVE MEDICAL MANAGEMENT
PAIN CONTROL
SUMMARY
REFERENCES
83. Complications Associated With Adolescent Idiopathic Scoliosis Surgery
INTRODUCTION
INFECTION
ACUTE DEEP WOUND INFECTIONS
DELAYED DEEP WOUND INFECTION
POSTOPERATIVE EPIDURAL ABSCESS
ANTIBIOTIC PROPHYLAXIS FOR SURGICAL PROCEDURES IN THE SETTING OF SPINAL IMPLANTS
NEUROLOGIC COMPLICATIONS
SPINAL CORD INJURY
ROOT AND PLEXUS INJURIES
PSEUDARTHROSIS
IMPLANT-RELATED COMPLICATIONS
SYMPTOMATIC IMPLANTS, BREAKAGE, AND DISLODGEMENT
COMPLICATIONS OF THORACIC VERTEBRAL BODY SCREWS
COMPLICATIONS OF PEDICLE SCREWS
COMPLICATIONS SPECIFIC TO ANTERIOR APPROACHES
CHYLOTHORAX
RARE AND MINOR COMPLICATIONS
THORACOSCOPIC APPROACH
SPINAL IMBALANCE
CORONAL PLANE IMBALANCE
SAGITTAL PLANE IMBALANCE (IATROGENIC FLATBACK)
CRANKSHAFT AND “ADDING ON”
SHOULDER ASYMMETRY
DEATH
POSITIONING COMPLICATIONS
VISUAL IMPAIRMENT OR LOSS
SKIN ULCERATION
COMPRESSION INJURY OF NERVES
SUPERIOR MESENTERIC ARTERY SYNDROME
LONG-TERM OUTCOME OF THE INSTRUMENTED ADOLESCENT SPINE
CONCLUSION
REFERENCES
SECTION VIII: Adult Spinal Deformity
84. Adult Spinal Deformity: Introduction/State of the Art
85. Adult Spinal Deformity Classification
INTRODUCTION
CLASSIFICATION CONSIDERATIONS
CLASSIFICATION EFFORTS TO DATE
SRS SCHWAB ASD CLASSIFICATION
CLASSIFICATION
CLASSIFICATION AND TREATMENT
SURGICAL OUTCOME AND THE CLASSIFICATION
CONCLUSION
REFERENCES
86. De Novo Scoliosis
INTRODUCTION
NATURAL HISTORY
SAGITTAL ALIGNMENT
DEFINITION OF BALANCE
THE AGING SPINE
PRESENTATION/PHYSICAL EXAMINATION
CLINICAL EVALUATION
RADIOLOGIC EVALUATION
CORONAL EVALUATION
SAGITTAL EVALUATION
NONOPERATIVE TREATMENT
OPERATIVE TREATMENT
SURGICAL MANAGEMENT
THE ROLE OF MINIMALLY INVASIVE TECHNIQUES
OUTCOMES
CONCLUSION
REFERENCES
87. Sagittal Imbalance
BACKGROUND
GLOBAL SAGITTAL ALIGNMENT
C7 SAGITTAL VERTICAL ANGLE
T1 PELVIC ANGLE
SPINO-PELVIC ALIGNMENT
PELVIC COMPENSATION
PELVIC INCIDENCE
PELVIC TILT AND SACRAL SLOPE
REGIONAL SAGITTAL ALIGNMENT
THORACIC KYPHOSIS AND LUMBAR LORDOSIS
SPINAL COMPENSATION
LOWER EXTREMITY ALIGNMENT
REFERENCES
88. Fixed Coronal Malalignment of the Spine: Clinical Significance and Operative Management
INTRODUCTION
SPINAL DEFORMITY AND HRQOL
THE PATHOGENESIS OF FIXED CORONAL PLANE DEFORMITY
CLINICAL EVALUATION OF CORONAL MALALIGNMENT
RADIOGRAPHIC EVALUATION OF CORONAL MALALIGNMENT
INDICATIONS FOR SURGICAL CARE
NONSURGICAL MANAGEMENT OF FIXED CORONAL MALALIGNMENT
SURGICAL MANAGEMENT OF FIXED CORONAL MALALIGNMENT
SPECIFIC CURVE TYPES
DECISION MAKING AND AN ALGORITHM FOR CARE
POSTOPERATIVE MANAGEMENT
REFERENCES
89. Spinal Deformity in the Older Patient With Kyphosis
PATHOGENESIS
ADVERSE HEALTH EFFECTS
MANAGEMENT OF HYPERKYPHOSIS
NONOPERATIVE MANAGEMENT
VERTEBROPLASTY/KYPHOPLASTY
SURGERY
POSTERIOR COLUMN OSTEOTOMY
POSTERIOR COLUMN OSTEOTOMY TECHNIQUE
PEDICLE SUBTRACTION OSTEOTOMY
PSO TECHNIQUE
VERTEBRAL COLUMN RESECTION
VCR TECHNIQUE
SURGICAL OUTCOMES
CONCLUSIONS
REFERENCES
90. Decision Making in Treatment of Adult Spinal Deformity
INTRODUCTION
DECISION MAKING REGARDING TREATMENT FOR ADULT SCOLIOSIS
PRESENTATION OF ADULT SCOLIOSIS
SURGICAL TREATMENT OF ADULT SCOLIOSIS
SPECTRUM OF PRESENTATIONS OF ADULT SCOLIOSIS
RESULTS OF NIH STUDY ON QUALITY OF LIFE IN ADULT SCOLIOSIS
OPERATIVE FACTORS THAT MAY IMPACT OUTCOME IN ADULT SCOLIOSIS
TREATMENT OF FIXED SAGITTAL IMBALANCE/LUMBAR KYPHOSIS
SUMMARY/CONCLUSION
REFERENCES
91. Smith-Petersen Osteotomy of the Spine
INTRODUCTION
HISTORY
INDICATIONS
TECHNIQUE
RESULTS—ANKYLOSING SPONDYLITIS
RESULTS—ADULT SPINAL DEFORMITY
SUMMARY
REFERENCES
92. Pedicle Subtraction Procedures for Complex Spinal Deformity
INTRODUCTION
COMPLEX SPINAL DEFORMITY AND ASSOCIATED DISABILITY
SURGICAL TECHNIQUE
ADULT THORACOLUMBAR DEFORMITY
ADULT CERVICAL DEFORMITY
COMPLICATIONS
CONCLUSIONS
REFERENCES
93. Vertebral Column Resection for Complex Spinal Deformity: Posterior Approach
AUTHORS’ PREFERRED SURGICAL TECHNIQUE
CORRECTION OF SCOLIOSIS DEFORMITY
CORRECTION OF KYPHOSCOLIOSIS
CORRECTION OF KYPHOSIS
CORRECTION OF THORACIC LORDOSIS/LORDOSCOLIOSIS
CORRECTION OF SEVERE RIGID PELVIC OBLIQUITY IN NEGLECTED CONGENITAL SCOLIOSIS WITH INTRASPINAL ANOMALY AND PREVIOUS SURGERY WITH PVCR
AFTERCARE
COMPLICATIONS
INTRAOPERATIVE COMPLICATIONS
INTRAOPERATIVE BLOOD LOSS
NEUROLOGIC COMPLICATIONS
POSTOPERATIVE COMPLICATIONS
INFECTION
IMPLANT FAILURE AND PSEUDARTHROSIS
CONCLUSION
REFERENCES
94. Vertebral Column Resection for Complex Spinal Deformity: Combined Anterior and Posterior Approach
INTRODUCTION AND BACKGROUND
SPINAL SHORTENING PROCEDURES
INDICATIONS FOR VERTEBRAL COLUMN RESECTION
PREOPERATIVE CONSIDERATIONS
PREOPERATIVE EVALUATION
IMAGING
SURGERY
ANTERIOR STAGE
POSTERIOR STAGE
POSTOPERATIVE CARE
CONCLUSIONS
REFERENCES
95. Fusion to the Sacrum and Fixation Techniques of the Sacropelvic Junction
INTRODUCTION
HISTORICAL OVERVIEW
ANATOMIC AND BIOMECHANICAL CONSIDERATIONS
TECHNIQUE TIPS
S1 SCREW PLACEMENT
ILIAC SCREWS WITH PSIS ENTRY
S2-ALAR-ILIAC APPROACH
TRADITIONAL GALVESTON TECHNIQUE
TRANSDISCAL SCREWS
OUTCOMES
SUMMARY
REFERENCES
96. Structural Grafting for Adult Spinal Deformity
INTRODUCTION
INDICATIONS FOR STRUCTURAL GRAFTING
ANTERIOR, LATERAL, AND POSTERIOR APPROACHES
STRUCTURAL GRAFTING MATERIALS AND DESIGN
AUTOGRAFT
ALLOGRAFT
TITANIUM
PEEK
EXPANDABLE DEVICES
COMPLICATIONS
CONCLUSION
REFERENCES
97. Revision Surgeries for Adult Spinal Deformity
INTRODUCTION
PREOPERATIVE ASSESSMENT
CLINICAL PRESENTATION
COMORBIDITIES
PHYSICAL EXAMINATION
RADIOGRAPHIC EVALUATION
SURGICAL CONSIDERATIONS
LIMITING BLOOD LOSS
EXPOSURE
INSTRUMENTATION
DEFORMITY CORRECTION
FUSION
OUTCOMES AND COMPLICATIONS
CONCLUSION
REFERENCES
98. Minimally Invasive Deformity Surgery: Future Directions
INTRODUCTION
PREOPERATIVE ASSESSMENT
PROTOCOL
STAGE 1: INTERBODY FUSION
STAGE 2: POSTERIOR INSTRUMENTATION AND FUSION
OUTCOMES
PITFALLS
TIPS AND PEARLS
CASE EXAMPLE
CONCLUSION
REFERENCES
99. ACR and Minimally Invasive Surgery for Sagittal Plane Deformities
INTRODUCTION
INDICATIONS/CONTRAINDICATIONS
PREOPERATIVE PLANNING
ALIGNMENT
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
APPROACH SIDE
SURGICAL TECHNIQUE
PATIENT POSITIONING
APPROACH
ACR ANATOMY
TECHNIQUE
POSTERIOR CONSTRUCT
COMPLICATIONS
MOTOR/NEUROLOGIC DEFICIT
VASCULAR INJURY
SYMPATHETIC PLEXUS INJURY
PROXIMAL JUNCTIONAL KYPHOSIS
OUTCOMES
CONCLUSION
REFERENCES
SECTION IX: Dysplastic and Congenital Deformities
100. Introduction/State of the Art in the Care of Dysplastic and Congenital Spine Deformities
INTRODUCTION
DIAGNOSIS
IMAGING
CLASSIFICATION
NONOPERATIVE TREATMENT
SURGICAL TREATMENT
CONCLUSION
REFERENCES
101. Dysplastic Scoliosis: Neurofibromatosis Spinal Pathology
INTRODUCTION
GENETICS
DIAGNOSIS
SPINAL DEFORMITIES, GENERAL
IMAGING
CERVICAL DEFORMITY MANAGEMENT
THORACIC AND LUMBAR DEFORMITY MANAGEMENT
SCOLIOSIS
KYPHOSCOLIOSIS
LORDOSCOLIOSIS
SACRUM AND SPONDYLOLISTHESIS
SOFT TISSUE PROBLEMS
DURAL ECTASIA
MENINGOCELE
DUMBBELL LESIONS
ENLARGED VASCULAR CHANNELS
SUMMARY REMARKS
REFERENCES
102. Spinal Deformity in Skeletal Dysplasia Conditions: Diagnosis and Presentation
DISORDERS OF STRUCTURAL GENES
PSEUDOACHONDROPLASIA
SPONDYLOEPIPHYSEAL DYSPLASIA CONGENITA
KNIEST DYSPLASIA, SPONDYLOEPIPHYSEAL METAPHYSEAL DYSPLASIA (STRUDWICK), AND STICKLER SYNDROME
OSTEOGENESIS IMPERFECTA
DISORDERS OF PROTEINS THAT REGULATE DEVELOPMENTAL SIGNALING PATHWAYS
ACHONDROPLASIA/HYPOCHONDROPLASIA
CAMPTOMELIC DYSPLASIA
CONRADI–HUNERMANN SYNDROME (X-LINKED CHONDRODYSPLASIA PUNCTATA 2)
METATROPIC DYSPLASIA
LARSON SYNDROME/ATELOSTEOGENESIS TYPE III
DISORDERS OF ENZYMES RESPONSIBLE METABOLITE PROCESSING OR TRANSPORT
DIASTROPHIC DYSPLASIA
MUCOPOLYSACCHARIDOSES
SUMMARY
REFERENCES
103. Surgical Management of Spinal Deformity in Skeletal Dysplasias
INTRODUCTION
GENERAL CONSIDERATIONS FOR SPINAL SURGERY IN PATIENTS WITH SKELETAL DYSPLASIAS
PREOPERATIVE MANAGEMENT
SPINAL INSTRUMENTATION
POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
SPECIFIC CONDITIONS
FORAMEN MAGNUM STENOSIS
ODONTOID HYPOPLASIA AND ATLANTOAXIAL INSTABILITY
CERVICAL KYPHOSIS
THORACIC AND THORACOLUMBAR KYPHOSIS
SCOLIOSIS AND KYPHOSCOLIOSIS
SPINAL STENOSIS
CONCLUSIONS
REFERENCES
104. The Spine in Osteogenesis Imperfecta
INTRODUCTION
BASILAR INVAGINATION
BONE DENSITY IN OSTEOGENESIS IMPERFECTA
SPONDYLOLYSIS AND SPONDYLOLISTHESIS IN OSTEOGENESIS IMPERFECTA
SCOLIOSIS IN OSTEOGENESIS IMPERFECTA
INCIDENCE AND PREVALENCE
PROGRESSION OF SCOLIOSIS IN OSTEOGENESIS IMPERFECTA
TREATMENT
LONG-TERM COMPLICATIONS OF SCOLIOSIS IN OSTEOGENESIS IMPERFECTA
UNANSWERED QUESTIONS REMAIN
REFERENCES
105. Spinal Deformity in Familial Dysautonomia
INTRODUCTION
ETIOLOGY AND GENETICS
DIAGNOSIS
MEDICAL MANIFESTATIONS
SPINAL DEFORMITY
ONSET AND CURVE BEHAVIOR
NONOPERATIVE TREATMENT
SURGICAL TREATMENT
PREOPERATIVE PERIOD
SURGICAL MANAGEMENT
NEUROGENIC MONITORING/INTRAOPERATIVE CONCERNS
POSTOPERATIVE PERIOD
OTHER TYPES OF HSAN
SUMMARY
REFERENCES
106. Congenital Intraspinal Anomalies: Spinal Dysraphism—Embryology, Pathology, and Treatment
SPINAL DYSRAPHISM—EMBRYOLOGY, PATHOLOGY, AND TREATMENT
EPIDEMIOLOGY
EPIDEMIOLOGY OF OPEN NEURAL TUBE DEFECTS
FOLIC ACID SUPPLEMENTATION AND OPEN NEURAL TUBE DEFECTS
ROLE OF GENETICS IN OPEN NEURAL TUBE DEFECTS
EPIDEMIOLOGY OF SPINA BIFIDA OCCULTA
EMBRYOLOGY
OPEN DYSRAPHIC STATES: MYELOMENINGOCELE
EMBRYOLOGY
ANTENATAL EVALUATION AND TREATMENT—FETAL SURGERY FOR MYELOMENINGOCELE
POSTNATAL PRESENTATION AND EVALUATION
POSTNATAL REPAIR OF MYELOMENINGOCELE
MONITORING FOR HYDROCEPHALUS AFTER MYELOMENINGOCELE REPAIR
CLOSED DYSRAPHIC STATES
INTRODUCTION: GENERAL TYPES AND CLINICAL PRESENTATION
TETHERED CORD SYNDROME
LIPOMYELOMENINGOCELE
SPLIT CORD MALFORMATIONS
DIASTEMATOMYELIA
NEURENTERIC CYST
DERMAL SINUS TRACT
MENINGOCELES
ALTERED CAUDAL DEVELOPMENT
TIGHT FILUM TERMINALE SYNDROME
TERMINAL MYELOCYSTOCELE
DYSRAPHISM ASSOCIATED WITH ANORECTAL MALFORMATION
CHIARI MALFORMATIONS AND SYRINGOMYELIA
CHIARI MALFORMATIONS
SYRINGOMYELIA
ASSOCIATED CARE ISSUES IN SPINAL DYSRAPHISM
RETETHERING AND REOPERATION
LONG-TERM CARE
SUMMARY
REFERENCES
107. Congenital Scoliosis and Kyphosis
INTRODUCTION
PATHOGENESIS
SPINE
CHEST
CLASSIFICATION AND NATURAL HISTORY
HEMIVERTEBRA
FULLY SEGMENTED HEMIVERTEBRA
SEMISEGMENTED HEMIVERTEBRA
INCARCERATED HEMIVERTEBRA
UNILATERAL UNSEGMENTED BAR
UNILATERAL UNSEGMENTED BAR WITH CONTRALATERAL HEMIVERTEBRAE
COMPLEX MIXED VERTEBRAL ANOMALIES
CONGENITAL RIB AND CHEST WALL ANOMALIES
SECONDARY DEFORMING FEATURES REQUIRING TREATMENT
PROGNOSIS
PREOPERATIVE ASSESSMENT
SPINE
INTRASPINAL ANOMALIES
RESPIRATORY FUNCTION
OTHER ASSOCIATED CONGENITAL ANOMALIES
THE TREATMENT OF CONGENITAL SCOLIOSIS IS VERY DIFFERENT FROM ALL OTHER TYPES OF SCOLIOSIS
NONOPERATIVE TREATMENT
SURGICAL TREATMENT
PROPHYLACTIC SURGICAL PROCEDURES
CONVEX GROWTH ARREST (HEMIEPIPHYSIODESIS)
EXCISION OF A HEMIVERTEBRA
IN SITU FUSION
GROWTH ROD
RIB EXPANSION SURGERY
MAGNETICALLY CONTROLLED GROWING RODS
CORRECTION AND SPINAL FUSION WITH INSTRUMENTATION
VERTEBRAL COLUMN RESECTION, CORRECTION, AND ARTHRODESIS
SUMMARY
CONGENITAL KYPHOSIS AND KYPHOSCOLIOSIS
CLASSIFICATION AND NATURAL HISTORY
TREATMENT OF CONGENITAL KYPHOSIS
REFERENCES
108. Hemivertebra Resection
INTRODUCTION
INDICATION AND TIME FOR SURGERY
SURGICAL PROCEDURES
TECHNIQUE OF POSTERIOR HEMIVERTEBRA RESECTION
PREOPERATIVE PLANNING
SURGICAL PROCEDURE
POSTOPERATIVE MANAGEMENT
COMPLICATION MANAGEMENT
RESULTS
TEMPORARY INSTRUMENTATIONS
COMPLICATIONS AND ADDITIONAL OPERATIONS
TRANSPEDICULAR INSTRUMENTATION AND SPINAL GROWTH
CONCLUSIONS
FUTURE DEVELOPMENTS
HEMIVERTEBRA RESECTION IN THE CERVICAL SPINE
REFERENCES
109. Thoracic Insufficiency Syndrome
INTRODUCTION
PREOPERATIVE PLANNING
SURGICAL TECHNIQUE
THE EXPOSURE
IMPLANTATION OF THE SUPERIOR RIB CRADLE
THE OPENING WEDGE THORACOSTOMY
IMPLANTATION OF A HYBRID VEPTR
IMPLANTATION OF THE SECOND VEPTR: RIB-TO-RIB CONSTRUCT
CLOSURE
POSTOPERATIVE MANAGEMENT
VEPTR OUTPATIENT EXPANSION
VEPTR REPLACEMENT PROCEDURE
COMPLICATIONS
THE FUTURE TREATMENT OF TIS
ACKNOWLEDGMENT
REFERENCES
110. Congenital Anomalies of the Cervical Spine in Children: Management of Segmental Instability and Spinal Canal Encroachment
INTRODUCTION
EMBRYOLOGY OF THE CERVICAL SPINE
EMBRYOLOGY OF THE PROXIMAL CERVICAL SPINE (OCCIPUT TO C2–C3 DISC SPACE)
EMBRYOLOGY OF THE DISTAL CERVICAL SPINE (C3–C7)
DEVELOPMENTAL ANATOMY OF THE IMMATURE CERVICAL SPINE
THE ATLAS
THE AXIS
THE SUBAXIAL SPINE
BIOMECHANICS
SPINAL CANAL ENCROACHMENT
DIAGNOSING ENCROACHMENT
SPINAL INSTABILITY
DEFINITIONS AND MEASUREMENTS OF INSTABILITY
CONGENITAL CAUSES OF CERVICAL SPINAL INSTABILITY
UPPER CERVICAL SPINE: (OCCIPUT TO C2–C3 DISC SPACE)
SYNDROMES COMMONLY ASSOCIATED WITH CONGENITAL ANOMALIES OF THE CERVICAL SPINE
DOWN SYNDROME
KLIPPEL–FEIL SYNDROME
22q11.2 DELETION SYNDROME (DIGEORGE SYNDROME)
MANAGEMENT AND TREATMENT OF CONGENITAL CERVICAL ANOMALIES IN CHILDREN
GENERAL TREATMENT PRINCIPLES
HALO VEST IMMOBILIZATION
OPERATIVE TREATMENT OF CERVICAL INSTABILITY AND ENCROACHMENT
ANTERIOR SURGICAL APPROACHES
POSTERIOR SURGICAL APPROACHES
CONCLUSION
REFERENCES
111. Complications of the Surgical Treatment of Congenital Spinal Deformities
INTRODUCTION
RELATED ANOMALIES CONTRIBUTING TO COMPLICATIONS IN CONGENITAL SCOLIOSIS
PREOPERATIVE TRACTION COMPLICATIONS IN CONGENITAL SCOLIOSIS
COMPLICATIONS FROM THE SURGICAL TREATMENT OF CONGENITAL SCOLIOSIS
CONCLUSION
REFERENCES
SECTION X: Neuromuscular Spine Deformity
112. Considerations in Neuromuscular Spine Deformity
OVERVIEW AND PREVALENCE
INDICATIONS
ETHICAL CONSIDERATIONS
PREOPERATIVE ASSESSMENT
INFECTION
NEED FOR PELVIC FIXATION
BLEEDING
OUTCOMES MEASURES FOR NMS PATIENTS
REFERENCES
113. Preoperative Preparation for Neuromuscular Spine Surgery
INTRODUCTION
DECISION MAKING
MEDICAL PREPARATION
CONSULTATIONS
SURGICAL PREPARATION
CONCLUSION
REFERENCES
114. Surgical Techniques Unique to Neuromuscular Scoliosis
INTRODUCTION
PREOPERATIVE CONSIDERATIONS
RISK OF COMPLICATIONS
CONCURRENT HIP PATHOLOGY
PRE- AND PERIOPERATIVE TRACTION
WHEN TO CONSIDER AN ANTERIOR RELEASE
PHONE A FRIEND? TWO ATTENDING SURGEONS FOR THE TREATMENT OF NMS
INTRAOPERATIVE CONSIDERATIONS
PERIOPERATIVE ANTIBIOTICS
INTRAOPERATIVE NEURAL MONITORING
SPECIAL POSITIONING CONSIDERATIONS
INTRAOPERATIVE TRACTION
WORKING AROUND A BACLOFEN PUMP
DECREASING BLOOD LOSS DURING EXPOSURE
INTRAOPERATIVE TECHNIQUES UNIQUE TO NMS
RODS, SCREWS, WIRES, AND BANDS
FUSION TO THE PELVIS
SACRAL–ALAR–ILIAC SCREW INSERTION TECHNIQUE
TECHNIQUES TO CORRECT PELVIC OBLIQUITY AND SPINE DEFORMITY
CLOSURE CONSIDERATIONS
ANTIBIOTICS WITHIN THE BONE GRAFT
BARBED SUTURE
ROLE OF PLASTIC SURGEON IN WOUND CLOSURE
CONCLUSION
REFERENCES
115. Pelvic Fixation in Neuromuscular Scoliosis
INTRODUCTION
PELVIC OBLIQUITY
INDICATIONS FOR PELVIC FIXATION
PELVIC FIXATION IMPLANTS AND TECHNIQUES
GALVESTON TECHNIQUE WITH UNIT ROD
ILIAC SCREWS
SACRAL–ALAR–ILIAC SCREWS
SUMMARY
REFERENCES
116. Spinal Muscular Atrophy, Duchenne Muscular Dystrophy, and Other Neuromuscular Disorders
SMA ETIOLOGY
CLASSIC NATURAL HISTORY
RECENT MEDICAL ADVANCES
SPINAL DEFORMITY
OUTCOMES
DMD ETIOLOGY
NATURAL HISTORY
CARDIAC CONSIDERATIONS
RECENT MEDICAL ADVANCES
SPINAL DEFORMITY
SURGICAL CARE
OUTCOMES
OTHER NEUROMUSCULAR DISORDERS
CONGENITAL MUSCULAR DYSTROPHIES
CONGENITAL MYOTONIC DYSTROPHY
FRIEDREICH ATAXIA
CHARCOT–MARIE–TOOTH
ACKNOWLEDGMENTS
REFERENCES
117. Spinal Deformity in Patients With Cerebral Palsy and Rett Syndrome
INTRODUCTION
CEREBRAL PALSY
ONSET AND NATURAL HISTORY
CHARACTERISTICS OF SPINAL DEFORMITY IN CEREBRAL PALSY
RETT SYNDROME
ONSET AND NATURAL HISTORY
CHARACTERISTICS OF SPINAL DEFORMITY IN RETT SYNDROME
FUNCTIONAL EFFECTS OF NEUROMUSCULAR SPINAL DEFORMITY
MANAGEMENT OF SPINAL DEFORMITY ASSOCIATED WITH CEREBRAL PALSY OR RETT SYNDROME
NONOPERATIVE MANAGEMENT STRATEGIES
OPERATIVE MANAGEMENT
COMPLICATIONS
OUTCOMES
REFERENCES
118. Surgical Treatment of Spinal Deformity in Myelomeningocele
INTRODUCTION
TREATMENT GUIDELINES
PREOPERATIVE EVALUATION
RADIOGRAPHIC IMAGING
PATIENT EVALUATION
SURGICAL PLANNING
SURGICAL TECHNIQUES
WOUND MANAGEMENT
POSTOPERATIVE CARE
REFERENCES
SECTION XI: Kyphosis and Postlaminectomy Deformities
119. Introduction and Current State of the Art
120. Cervical Instability and Kyphosis (Rheumatoid, Dwarfism, Degenerative, Others)
INTRODUCTION
ANATOMY OF THE CERVICAL SPINE
CERVICAL SPINAL STABILITY
PATHOPHYSIOLOGY OF CERVICAL INSTABILITY
EVALUATION AND DIAGNOSIS OF CERVICAL INSTABILITY
ETIOLOGIES OF CERVICAL INSTABILITY
RHEUMATOID ARTHRITIS
TREATMENT OF INSTABILITY IN RA
CASE EXAMPLE 120.1: RHEUMATOID PANNUS
CONGENITAL/GENETIC DISORDERS WITH CERVICAL INSTABILITY
CASE EXAMPLE 120.2: OS ODONTOIDEUM
CERVICAL SAGITTAL ALIGNMENT
ETIOLOGY AND EVALUATION OF CERVICAL KYPHOSIS
GENERAL PRINCIPLES IN MANAGING CERVICAL KYPHOSIS
CERVICAL SPONDYLOSIS AND MYELOPATHY
CASE EXAMPLE 120.3: CERVICAL SPONDYLOTIC MYELOPATHY WITH KYPHOSIS
POSTLAMINECTOMY KYPHOSIS
DROPPED HEAD SYNDROME
CASE EXAMPLE 120.4: DROPPED HEAD SYNDROME
CONGENITAL AND MISCELLANEOUS CONDITIONS WITH CERVICAL KYPHOSIS
CASE EXAMPLE 120.5: RENAL OSTEODYSTROPHY
ANKYLOSING SPONDYLITIS AND FIXED KYPHOSIS
CASE EXAMPLE 120.6: CERVICAL OSTEOTOMY
CONCLUSION
REFERENCES
121. Surgical Treatment of Scheuermann Kyphosis
INTRODUCTION
CLINICAL EVALUATION
RADIOGRAPHIC EVALUATION
TREATMENTS
NONOPERATIVE TREATMENT
OPERATIVE TREATMENT
SURGICAL PROCEDURE (SEE TABLE 121.3)
CONCLUSION
CLINICAL CASES 121.1
REFERENCES
122. Delayed Posttraumatic Deformity: Presentation and Management
INTRODUCTION
EPIDEMIOLOGY
PATIENT PRESENTATION
POSTTRAUMATIC SPINAL DEFORMITY
PAIN
NEUROLOGIC DEFICIT
SURGICAL CONSIDERATIONS
OUTCOME
CONCLUSION
REFERENCES
123. Ankylosing Spondylitis/Thoracolumbar Deformities
INTRODUCTION
CLINICAL PRESENTATION
PAIN
SPINAL FRACTURE
DISCITIS
PSEUDARTHROSIS
KYPHOSIS
RADIOGRAPHIC EXAMINATION
RADIOGRAPHIC FEATURES
EVALUATIONS OF KYPHOSIS
TREATMENT
NONSURGICAL TREATMENT
SURGICAL TREATMENT FOR THORACOLUMBAR DEFORMITIES
OPERATIVE TECHNIQUE
OPERATIVE TECHNIQUE
OPERATIVE TECHNIQUE
SURGICAL DECISION MAKING
TRIGONOMETRIC METHOD
COMPUTER-BASED SIMULATION: SURGIMAP SOFTWARE
MATHEMATICAL FORMULAS
INTRAOPERATIVE SUBLUXATION OF THE OSTEOTOMIZED VERTEBRA
FRACTURE AND OPENING OF ANTERIOR CORTEX OF THE OSTEOTOMIZED VERTEBRA
DISC OPENING IN INSTRUMENTATION AREA
PSEUDARTHROSIS ADJACENT TO THE OSTEOTOMY
THE CLOSURE RATIO OF THE UPPER PART TO THE LOWER PART OF THE OSTEOTOMIZED VERTEBRA
FLEXIBILITY OF CERVICAL SPINE
SPINAL OSTEOTOMY AND TOTAL HIP REPLACEMENT: WHICH SHOULD BE PERFORMED FIRST?
PITFALLS AND COMPLICATIONS
NEUROLOGIC DAMAGE
AORTA STRETCHING
SUPERIOR MESENTERIC ARTERY SYNDROME (SMAS)
INTRAOPERATIVE SUBLUXATION
POSTOPERATIVE CARE AND REHABILITATION
CONCLUSIONS
REFERENCES
124. Cervicothoracic Extension Osteotomy for Chin-on-Chest Deformity
INTRODUCTION
DEFINITION
ETIOLOGY
RADIOLOGIC PATTERNS OF CHIN-ON-CHEST DEFORMITY
TREATMENT ALGORITHM
SURGICAL INDICATIONS
PREOPERATIVE PLANNING
ANESTHESIA AND POSITIONING
SURGICAL TECHNIQUE
COMPLICATION
CONCLUSION
REFERENCES
125. The Role of Osteotomies in the Cervical Spine
INTRODUCTION
HISTORY
PREOPERATIVE AND INITIAL OPERATIVE APPROACH
PRESENTATION AND INDICATIONS
PREOPERATIVE EVALUATION
ANESTHESIA AND PATIENT POSITIONING
EXPOSURE
HEMOSTASIS
SPECIFIC OSTEOTOMY TECHNIQUES
PEDICLE SUBTRACTION OSTEOTOMY FOR ANKYLOSING SPONDYLITIS
IATROGENIC CERVICAL DEFORMITY CORRECTION
BONE GRAFTING, WOUND CLOSURE, AND POSTOPERATIVE MANAGEMENT
BONE GRAFTING
DRAIN AND CLOSURE
POSTOPERATIVE MANAGEMENT
CONCLUSION
REFERENCES
126. Complications of Surgical Treatment of Kyphotic Deformities
INTRODUCTION
ETIOLOGY
INCIDENCE
SCHEUERMANN KYPHOSIS
NONIDIOPATHIC
ADJACENT SEGMENT DISEASE
PROXIMAL JUNCTIONAL KYPHOSIS AND FAILURE
DISTAL JUNCTIONAL KYPHOSIS AND FAILURE
PREVENTION
TREATMENT OF JUNCTIONAL KYPHOSIS
NEUROLOGIC COMPLICATIONS
CAUSES
PREVENTION
TREATMENT
PSEUDARTHROSIS/IMPLANT FAILURE
VASCULAR/OTHER
SUPERIOR MESENTERIC ARTERY SYNDROME
THROMBOEMBOLIC DISEASE
REFERENCES
SECTION XII: Trauma
127. Classification of Cervical Spine Injury
INTRODUCTION
HISTORIC CLASSIFICATION SYSTEMS
MODERN CLASSIFICATION SYSTEMS
CERVICAL SPINE INJURY SEVERITY SCORE
SUBAXIAL CERVICAL SPINE CLASSIFICATION
ABCD
AOSPINE
MORPHOLOGY
FACET INJURY
NEUROLOGY
CASE-SPECIFIC MODIFIERS
CONCLUSION
REFERENCES
128. Classification of Thoracic, Lumbar, and Sacral Fractures
INTRODUCTION
DEFINING INSTABILITY
VALIDITY AND RELIABILITY
HISTORICAL OVERVIEW OF THORACOLUMBAR CLASSIFICATION SYSTEMS
FACTORS CRITICAL TO CLINICAL DECISION MAKING
INJURY SEVERITY SCORE
MORPHOLOGY: FRACTURE PATTERN
INTEGRITY OF THE POSTERIOR LIGAMENTOUS COMPLEX
NEUROLOGIC STATUS
QUALIFIERS
SCORING SIGNIFICANCE
AOSpine THORACOLUMBAR CLASSIFICATION
AOSpine SACRAL CLASSIFICATION
CONCLUSION
CASE EXAMPLES
COMPRESSION FRACTURE
BURST FRACTURE WITH AN INTACT PLC
BURST FRACTURE WITH DISRUPTED PLC
TRANSLATIONAL INJURY WITH PLC DISRUPTION AND CAUDA EQUINA SYNDROME
REFERENCES
129. Surgical Management of Cervical Spine Fractures
INTRODUCTION
SURGICAL MANAGEMENT OF CRANIOCERVICAL INJURIES
CRANIOCERVICAL DISSOCIATION
ODONTOID FRACTURES
C2 TRAUMATIC SPONDYLOLISTHESIS
SURGICAL MANAGEMENT OF SUBAXIAL CERVICAL SPINE INJURIES
BURST AND FLEXION–COMPRESSION INJURIES
FLEXION–DISTRACTION/FACET DISLOCATIONS
FACET FRACTURES
LATERAL MASS FRACTURES
EXTENSION–DISTRACTION INJURIES
CONCLUSION
REFERENCES
130. Anterior Decompression and Instrumentation Techniques for Thoracolumbar Fractures
INTRODUCTION
EPIDEMIOLOGY
CLINICAL AND RADIOGRAPHIC ASSESSMENT
THORACOLUMBAR SPINE FRACTURE CLASSIFICATION
INDICATIONS FOR ANTERIOR CORPECTOMY
SURGICAL TECHNIQUES
ANTERIOR CORPECTOMY APPROACH: HIGH THORACIC (T1–T5) AND MIDTHORACIC (T6–T10)
HIGH THORACIC T1–T5
MIDTHORACIC T6–T10
THORACOLUMBAR APPROACH (T10–L1)
RETROPERITONEAL APPROACH L2–L5
TRANSPERITONEAL APPROACH L3–S1
ADDITIONAL APPROACHES
CORPECTOMY TECHNIQUE
INSTRUMENTATION
COMPLICATION AVOIDANCE AND MANAGEMENT
REFERENCES
131. Surgical Treatment of Thoracolumbar Spine Fractures: Posterior Decompression and Instrumentation Techniques
INTRODUCTION
BACKGROUND
CLASSIFICATION SCHEMES FOR THORACOLUMBAR AND LUMBAR SPINE INJURIES
INDICATIONS FOR SURGICAL TREATMENT OF TL FRACTURES
POSTERIOR APPROACH
ADVANTAGES
DISADVANTAGES
PATIENT POSITIONING
APPROACH
POSTERIOR INSTRUMENTATION
RELEVANT ANATOMY
THORACIC PEDICLE ANATOMY
LUMBAR PEDICLE ANATOMY
BIOMECHANICAL PRINCIPLES
SURGICAL TECHNIQUE
STARTING POINT
PEDICLE SCREW PLACEMENT
DECOMPRESSION SURGICAL TECHNIQUE
DIRECT DECOMPRESSION
INDIRECT DECOMPRESSION AND REALIGNMENT
ROD PLACEMENT TECHNIQUES
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
OUTCOMES
FUTURE TRENDS
SUMMARY
REFERENCES
132. Minimal Access Techniques for Spine Trauma
INTRODUCTION
PERCUTANEOUS VERTEBRAL CEMENT AUGMENTATION
PERCUTANEOUS PEDICLE SCREW FIXATION
FUSION TECHNIQUES FOR MINIMALLY INVASIVE THORACOLUMBAR TRAUMA
LESS INVASIVE POSTERIOR DECOMPRESSION
MINI-OPEN LATERAL CORPECTOMY
MINIMALLY INVASIVE TREATMENT OF CERVICAL SPINE FRACTURES
SUMMARY
REFERENCES
133. Management of Central Cord Syndrome
BACKGROUND
MANAGEMENT
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
INDICATIONS
TIMING
PROCEDURES
OUTCOMES
NONOPERATIVE MANAGEMENT
SUMMARY
REFERENCES
134. Surgical Treatment of Sacral-Pelvic Fractures
INTRODUCTION
SURGICAL ANATOMY
BIOMECHANICS
PATIENT EVALUATION AND DIAGNOSTIC APPROACHES (TABLE 134.1)
CLINICAL EXAMINATION
IMAGING TECHNIQUES
ELECTROPHYSIOLOGIC EXAMINATION
INSUFFICIENCY AND STRESS FRACTURES OF THE SACRUM
CLASSIFICATIONS
DENIS AND ISLER CLASSIFICATIONS
TRANSVERSE SACRAL FRACTURE CLASSIFICATIONS
CLASSIFICATION OF NEURAL DEFICITS
LUMBOSACRAL INJURY CLASSIFICATION SYSTEM
AOSpine SACRAL FRACTURE CLASSIFICATION SYSTEM
TREATMENT OPTIONS (TABLE 134.2)
GENERAL CONSIDERATIONS
NONOPERATIVE TREATMENT
SURGICAL TREATMENT
PEDIATRIC INJURIES
COMPLICATIONS AND OUTCOMES
SUMMARY
REFERENCES
135. Novel Approaches to Neural Repair and Regeneration After Spinal Cord Injury
INTRODUCTION
PATHOPHYSIOLOGY OF ACUTE SPINAL CORD INJURY
VASCULAR DISRUPTION AND ISCHEMIA
EXCITOTOXICITY AND IMPAIRMENT OF IONIC HOMEOSTASIS
OXIDATIVE STRESS
INFLAMMATORY/IMMUNOLOGIC RESPONSE
ANIMAL MODELS OF SPINAL CORD INJURY
OUTCOMES ASSESSMENT IN ANIMAL MODELS
BLUNT SPINAL CORD INJURY PARADIGMS
NOVEL TREATMENT APPROACHES
PHARMACOLOGIC INTERVENTIONS
BIOLOGIC THERAPIES DIRECTLY APPLIED TO THE SPINAL CORD
CELL-BASED THERAPIES
CONCLUSION—THE TRANSLATION FROM BENCH TO BEDSIDE
REFERENCES
136. Outcomes Measures in Spinal Trauma
INTRODUCTION
MEASUREMENT OF OUTCOMES
NEED AND CHALLENGES IN SPINE TRAUMA
LONGSTANDING CONTROVERSIES
CHALLENGES
OUTCOME MEASURES IN SPINAL CORD INJURY
OUTCOME MEASURES IN SPINAL COLUMN INJURY
MOST RECENT DEVELOPMENTS
CONCLUSION
REFERENCES
SECTION XIII: Tumor and Osteomyelitis
137. Introduction and State-of-the-Art: Tumors and Osteomyelitis
138. Benign Tumors of the Spine
INTRODUCTION
DIAGNOSIS
STAGING
BIOPSY
SURGICAL TREATMENTS
CLASSIFICATION
CHONDROGENIC TUMORS
OSTEOGENIC TUMORS
OSTEOGENIC TUMORS
GIANT CELL–RICH TUMORS
NOTOCHORDAL TUMORS
VASCULAR TUMORS
VASCULAR TUMORS
UNDEFINED TUMORS
UNDEFINED TUMORS
CONCLUSION
ACKNOWLEDGMENT
REFERENCES
139. Primary Malignant Tumors of the Spine
INTRODUCTION
DIAGNOSIS AND STAGING
CLINICAL MANIFESTATIONS
IMAGING
DIAGNOSTIC STUDIES
BIOPSY
STAGING OF MALIGNANT TUMORS
LOW-GRADE MALIGNANT TUMORS
HIGH-GRADE MALIGNANT TUMORS
METASTATIC TUMORS
PREOPERATIVE PLANNING
ADJUVANT TREATMENT
MARGINS AND SURGICAL PLANNING
WBB STAGING SYSTEM
SURGICAL TECHNIQUES
TERMINOLOGY
INTRALESIONAL EXCISION
EN BLOC RESECTION
MARGINAL DEFINITIONS
PALLIATIVE PROCEDURE
VERTEBRECTOMY (EN BLOC RESECTION OF THE VERTEBRAL BODY)
PLANNING
SAGITTAL RESECTION
PLANNING
POSTERIOR RESECTION
PLANNING
UPDATE IN EN BLOC RESECTION ACCORDING WBB STAGING
SINGLE ANTERIOR APPROACH
SINGLE POSTERIOR APPROACH
COMBINATION OF ANTERIOR APPROACH FIRST AND POSTERIOR APPROACH SECOND
FIRST POSTERIOR APPROACH, SECOND CONTEMPORARY ANTERIOR AND POSTERIOR APPROACHES
PITFALLS AND COMPLICATIONS
PITFALLS TO AVOID
MARGINS
ADJUVANT THERAPY
SACRIFICING FUNCTIONAL STRUCTURES
OVERVIEW OF PRIMARY MALIGNANT TUMORS
OSTEOSARCOMA
EWING SARCOMA
CHORDOMA
CHONDROSARCOMA
AUTHORS’ PERSPECTIVE—SUMMARY
ACKNOWLEDGMENTS
REFERENCES
140. The Surgical Treatment of Metastatic Spine Disease
INTRODUCTION
DECISION MAKING
SURGICAL APPROACH
RECONSTRUCTION OF MECHANICAL STABILITY
VASCULAR STUDIES AND EMBOLIZATION
ATLANTOAXIAL REGION
SUBAXIAL CERVICAL SPINE
THORACIC AND LUMBAR APPROACHES
CONCLUSION
REFERENCES
141. Intramedullary Spinal Cord Tumors
INTRODUCTION
EPIDEMIOLOGY
CLINICAL PRESENTATION
PHYSICAL EXAMINATION
ANATOMIC CONSIDERATIONS
SPECIFIC TUMOR TYPES
EPENDYMOMAS
MYXOPAPILLARY EPENDYMOMA
ASTROCYTOMA
HEMANGIOBLASTOMA
CAVERNOUS ANGIOMA
SCHWANNOMA
LIPOMA
METASTATIC DISEASE
GERMINOMA
DIAGNOSTIC IMAGING STUDIES
NONNEOPLASTIC LESIONS
INFECTION
MULTIPLE SCLEROSIS AND TRANSVERSE MYELITIS
SARCOIDOSIS
SPINAL CORD INFARCTION
SPINAL ARTERIOVENOUS FISTULAE
NONSURGICAL MANAGEMENT
SURGICAL TREATMENT
SURGICAL APPROACHES
TUMOR RESECTION
POSTSURGICAL CARE
COMPLICATIONS
NEUROLOGIC DEFICITS
CSF LEAK
POSTOPERATIVE INSTABILITY/DEFORMITY
FOLLOW-UP CARE
ADJUVANT THERAPIES
RADIOTHERAPY
CHEMOTHERAPY
CONCLUSION
REFERENCES
142. Intradural Extramedullary Spinal Tumors
BACKGROUND
OVERVIEW
EPIDEMIOLOGY
PRESENTATION
PREOPERATIVE EVALUATION AND IMAGING
CLASSIFICATIONS, INDICATIONS, AND CONTRAINDICATIONS
NERVE SHEATH TUMORS
MENINGIOMAS
EPENDYMOMAS
PARAGANGLIOMAS
LEPTOMENINGEAL METASTASES
CONGENITAL TUMORS
OTHERS
PRINCIPLES OF TREATMENT
OPERATIVE TECHNIQUE
APPROACHES
INTRADURAL COMPONENT
CLOSURE AND RECONSTRUCTION
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
OUTCOMES AND FOLLOW-UP
ADJUVANT THERAPY
CONCLUSION
REFERENCES
143. Spinal Vascular Malformations
INTRODUCTION
CLASSIFICATION AND ETIOLOGY
CAVERNOUS MALFORMATIONS
ARTERIOVENOUS FISTULAS
ARTERIOVENOUS MALFORMATIONS
NATURAL HISTORY AND CLINICAL PRESENTATION
CAVERNOUS MALFORMATIONS
ARTERIOVENOUS FISTULAS
ARTERIOVENOUS MALFORMATIONS
IMAGING
CAVERNOUS MALFORMATIONS
ARTERIOVENOUS FISTULAS
ARTERIOVENOUS MALFORMATIONS
TREATMENT AND OUTCOME
CAVERNOUS MALFORMATIONS
ARTERIOVENOUS FISTULAS
ARTERIOVENOUS MALFORMATIONS
CONCLUSION
REFERENCES
144. Spinal Infection/Osteomyelitis
BACKGROUND
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
DIAGNOSTIC WORKUP
SURGICAL INDICATIONS
INFECTION PROPHYLAXIS
SURGICAL TREATMENT
CONCLUSION
REFERENCES
145. Sacral Tumors
INTRODUCTION
GENERAL CONSIDERATIONS IN THE EVALUATION OF SACRAL TUMORS
PRIMARY TUMORS WITH A PREDILECTION FOR SACRAL INVOLVEMENT
PRIMARY BONE TUMORS ARISING IN THE SACRUM
POSTRADIATION SARCOMAS
METASTATIC/HEMATOPOIETIC SACRAL TUMORS
BENIGN BONE TUMORS
NEUROGENIC TUMORS
SACRAL INVASION FROM VISCERAL MALIGNANCIES
PRINCIPLES OF SACRAL TUMOR RESECTION
NEUROLOGIC AND FUNCTIONAL OUTCOMES
ONCOLOGIC OUTCOMES
CONCLUSIONS
REFERENCES
146. Adjuvant Therapy of Spinal Tumors
INTRODUCTION
BIOLOGIC BASIS OF TUMOR RADIATION RESPONSE
RADIATION DELIVERY TECHNOLOGY
TREATMENT PLANNING
TREATMENT DELIVERY
ALTERNATIVE METHODS OF RADIATION DELIVERY
TREATMENT PARADIGMS
OUTCOMES
TOXICITY/TOLERANCE
CONCLUSIONS
REFERENCES
147. Complications of Surgical Treatment of Tumor and Infection
INTRODUCTION
INTRAOPERATIVE COMPLICATIONS
DURAL TEARS
BLOOD LOSS
NEUROLOGIC INJURY
CAPSULAR VIOLATIONS AND PLANNED SACRIFICE DURING EN-BLOC RESECTIONS
POSTOPERATIVE COMPLICATIONS
ACUTE/SUBACUTE
DELAYED
CONCLUSIONS
REFERENCES
SECTION XIV: Complications
148. Neurologic Complications in Spine Surgery
INTRODUCTION
PREVALENCE
MECHANISMS OF NEUROLOGIC COMPLICATIONS
PATIENT EVALUATION AND PREOPERATIVE PLANNING
INTRAOPERATIVE PREPARATION
INTRAOPERATIVE NEUROMONITORING
SOMATOSENSORY EVOKED POTENTIALS
MOTOR EVOKED POTENTIALS
ELECTROMYOGRAPHY
STAGNARA WAKE-UP TEST
MULTIMODALITY INTRAOPERATIVE MONITORING
INTRAOPERATIVE NEUROLOGIC COMPLICATIONS
SPINAL CORD PERFUSION
STAGNARA WAKE-UP TEST
RELEASE OF CORRECTION
STEROID PROTOCOL
POSTOPERATIVE MANAGEMENT
DELAYED POSTOPERATIVE NEUROLOGIC COMPLICATIONS
CHAPTER SUMMARY
REFERENCES
149. Perioperative Spinal Cord Deficits and Myelopathy
INTRODUCTION
PATHOPHYSIOLOGY OF INJURY
RISK FACTORS FOR INJURY
PRESURGICAL AND POSTSURGICAL
CERVICAL SPINE
THORACIC AND LUMBAR SPINE
PREVENTION
GENERAL MEASURES
NEURONAVIGATION
NEUROMONITORING
MANAGEMENT
INITIAL MANAGEMENT
LATE MANAGEMENT
REFERENCES
150. Reconstruction of Complex Spinal Wounds
SPINAL WOUNDS: INCIDENCE AND ETIOLOGY
PRESENTATION AND INITIAL MANAGEMENT
RECONSTRUCTIVE LADDER
RECONSTRUCTIVE OPTIONS BY SPINAL LEVEL
ANATOMY OF THE PARASPINAL AND ASSOCIATED MUSCULATURE
CERVICAL AND UPPER THORACIC SPINE
TECHNIQUE—TRAPEZIUS MUSCULOCUTANEOUS FLAP
MIDDLE TO LOWER THORACIC SPINE
TECHNIQUE—LATISSIMUS DORSI FLAP
TECHNIQUE—ERECTOR SPINAE FLAP
LUMBAR SPINE
TECHNIQUE—VERTICAL RECTUS ABDOMINIS MUSCLE FLAP
FREE FLAPS
POSTOPERATIVE CARE
SUMMARY
REFERENCES
151. Vascular Complications
INTRODUCTION
CERVICAL SPINE
ANATOMY
ANTERIOR PROCEDURES
POSTERIOR PROCEDURES
THORACIC SPINE
ANATOMY
ANTERIOR PROCEDURES
POSTERIOR PROCEDURES
LUMBAR SPINE
ANATOMY
ANTERIOR PROCEDURES
LATERAL PROCEDURES
POSTERIOR PROCEDURES
SPECIAL CONSIDERATIONS
BONE GRAFT HARVEST
VERTEBROPLASTY/KYPHOPLASTY
CONCLUSION
REFERENCES
152. Postoperative Early and Late Wound/Implant Infections
INTRODUCTION
BACKGROUND
DIAGNOSIS
LABORATORY STUDIES
RADIOGRAPHIC STUDIES
TREATMENT AND OUTCOMES
PREVENTION
CONCLUSION
REFERENCES
153. Dural Lacerations, CSF Fistula, Pseudomeningoceles, and Strategies for Repair
INTRODUCTION
ETIOLOGY OF CSF LEAKS
IATROGENIC
TRAUMATIC
CONGENITAL
COMPLICATIONS OF CSF LEAKAGE
TREATMENT—DURAL LACERATIONS
SUTURE TYPE AND TECHNIQUE
DURAL SEALANTS
DRAINS
REFRACTORY CSF FISTULA
SURGICAL TECHNIQUES—SPECIFIC SCENARIOS
ANTERIOR CERVICAL
POSTERIOR CERVICAL
MINIMALLY INVASIVE APPROACHES
TREATMENT—PSEUDOMENINGOCELE
REFERENCES
154. Pseudarthrosis in Spinal Deformity Surgery
INTRODUCTION
DEFINITION
CHARACTERISTICS OF ADULT PSEUDARTHROSIS IN ASD
DIAGNOSIS
RADIOGRAPHS
COMPUTED TOMOGRAPHY
MAGNETIC RESONANCE IMAGING
BONE SCAN
RISK FACTORS
BIOLOGIC RISK FACTORS
BIOMECHANICAL RISK FACTORS
OUTCOMES
PATIENT OUTCOMES
TREATMENT
SURGICAL INTERVENTION FOR PSEUDARTHROSIS
APPROACH
INSTRUMENTATION
BONE GRAFT SUBSTITUTE AND OSTEOBIOLOGICS
CONCLUSION
REFERENCES
155. Legal Implications and Strategies
INTRODUCTION
COURT SYSTEM OVERVIEW
COURT STRUCTURE
STEPS OF A LAWSUIT
NEGLIGENCE
TYPES OF DAMAGES
PLAINTIFF ATTORNEY PERSPECTIVE
HOW DO ATTORNEYS DECIDE
THE NATURE AND EXTENT OF THE PATIENT’S INJURIES
SPECIAL ISSUES FOR AN ELDER OR DEPENDENT ADULT
A STRONG CASE
INFORMED CONSENT
INFORMED CONSENT AND PATIENT EDUCATION
PATIENT EDUCATION TOOLS AS ADJUNCTIONS
DISCLOSURE OF FINANCIAL RELATIONSHIPS
BATTERY
FRAUD
PROOF THAT MEDICAL RECORDS HAVE BEEN ALTERED
INADEQUATE SAFEGUARDS FOR COMMUNICATING TEST RESULTS
FAILURE TO REFER TO A SPECIALIST
FAILURE TO RECOMMEND AND DOCUMENT SECOND OPINIONS
SOURCES OF SURGEON LIABILITY
INCOMPETENT OR INADEQUATELY SUPERVISED STAFF
PRACTICING WITH INCOMPETENT OR CARELESS PARTNERS IN YOUR MEDICAL GROUP
SURGEON LIABILITY AND ANESTHESIA PROVIDERS
SURGEON LIABILITY, PODS, AND CORPORATE RELATIONSHIPS
OFF-LABEL USE
SPINE MEDICOLEGAL LANDSCAPE
DEFENSE ATTORNEY PERSPECTIVE
ENACT AND USE MORE PATIENT SAFETY SYSTEMS
PHYSICIAN’S APOLOGIES
MINIMIZE YOUR EXPOSURE
DOCUMENTATION
DICTATE OR TYPE NOTE IN THE PRESENCE OF THE PATIENT
LEVEL OF SURGERY AND CHANGE OF SURGERY
SURGEON SUBSTITUTION
INSURANCE AND YOUR ATTORNEY
ALWAYS HAVE ADEQUATE MALPRACTICE INSURANCE
REPORT ALL CLAIMS PROMPTLY
CLAIM EVALUATION
HAVE A GOOD ATTORNEY
COOPERATE WITH YOUR DEFENSE
GIVE CONSENT TO SETTLE IF A DEMAND IS MADE WITHIN POLICY LIMITS ON A CASE WHERE YOU WERE WRONG
REGULATORY REPORTING
RISK MANAGEMENT PERSPECTIVE
OVERVIEW OF MEDICAL ERRORS
PRE-EVENT RISK REDUCTION STRATEGIES
MEDICAL ERRORS AND DISCLOSURE REQUIREMENTS
MODERN DAY RISK FACTORS
TELEMEDICINE
PROBLEMS WITH LICENSING AND TELEMEDICINE
LACK OF LICENSURE JEOPARDIZES PROTECTION
CYBERMEDICINE
ACKNOWLEDGEMENT
BIBLIOGRAPHY
156. Unresolved Postoperative Spine Pain
INTRODUCTION
PATIENT EVALUATION
DIFFERENTIAL DIAGNOSIS/ETIOLOGY
HISTORY
IMAGING STUDIES
DIAGNOSTIC PROCEDURES
TREATMENT OPTIONS
PHYSIOTHERAPY
MEDICATIONS
PSYCHOLOGICAL THERAPY
INTERVENTIONAL PROCEDURES
NEUROMODULATION
SURGICAL INDICATIONS
CONCLUSION
REFERENCES
157. Medical Complications Associated With Spinal Surgery
INTRODUCTION
PULMONARY COMPLICATIONS
PNEUMONIA
ACUTE PULMONARY INJURY
PNEUMOTHORAX AND HEMOTHORAX
PULMONARY EMBOLISM
CARDIAC COMPLICATIONS
RENAL AND URINARY COMPLICATIONS
URINARY TRACT INFECTIONS
RENAL FAILURE
GASTROINTESTINAL COMPLICATIONS
ILEUS
CONSTIPATION
GASTROINTESTINAL BLEED
CHOLECYSTITIS
PANCREATITIS
SUPERIOR MESENTERIC ARTERY SYNDROME
COLITIS
NEUROLOGIC COMPLICATIONS FOLLOWING SPINAL SURGERY
DELIRIUM
ALCOHOL WITHDRAWAL SYNDROME
SPINAL CORD ISCHEMIA
CEREBRAL ISCHEMIA
HEMATOLOGIC COMPLICATIONS ASSOCIATED WITH SPINAL SURGERY
ANEMIA
COAGULOPATHIES
MISCELLANEOUS MEDICAL COMPLICATIONS AFTER SPINE SURGERY
BLINDNESS
HYPONATREMIA
RHABDOMYOLYSIS
DECUBITUS ULCERS
CONCLUSIONS
REFERENCES
Index