BOOK
Surgical Anatomy and Techniques to the Spine E-Book
Daniel H. Kim | Alexander R. Vaccaro | Curtis A. Dickman | Dosang Cho | SangKook Lee | Ilsup Kim
(2013)
Additional Information
Book Details
Abstract
Featuring an expanded focus on in-demand endoscopic and minimally invasive spine procedures, Surgical Anatomy and Techniques to the Spine, 2nd Edition pairs new anatomic photographs and radiographic images with expertly rendered color illustrations and clear, step-by-step descriptions to help you effectively perform all of the latest and most effective spine surgery techniques. A multidisciplinary approach makes this medical reference book relevant and informative to all surgeons regardless of their specialty or level of surgical experience with the spine.
- Proceed with confidence. An atlas-style format featuring clear, concise, step-by-step descriptions of the anatomy and procedures along with clinical hints and pearls, tables, and management algorithms provideing swift answers and trusted guidance.
- Sharpen your surgical acumen with a deeper understanding of the anatomy of the surgical target and related anatomy. Comprehensive information on cervical, cervical/thoracic, thoracic/lumbar, lumbar spine, lumbar/pelvis, and other surgical locations ensures the best approaches to spine surgery and results.
- Understand the spine from all angles with multiple-viewpoint, full-color photographs, and illustrations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| ExpertConsult Page | IFC1 | ||
| Surgical Anatomy and Techniques to the Spine | i | ||
| Copyright page | iv | ||
| Associate Editors | v | ||
| Dedications | vii | ||
| Acknowledgments | viii | ||
| Preface | ix | ||
| Contributors | x | ||
| Table of Contents | xix | ||
| A Craniovertebral Junction and Upper Cervical Spine | 1 | ||
| 1 Surgical Anatomy and Biomechanics of the Craniovertebral Junction | 2 | ||
| Overview | 2 | ||
| Embryology of the Craniovertebral Junction | 2 | ||
| Normal Developmental Embryology of the Craniovertebral Junction | 2 | ||
| Developmental Anomalies of the Craniovertebral Junction | 3 | ||
| Surgical Anatomy of the Craniovertebral Junction | 4 | ||
| Bony Structures of the Craniovertebral Junction | 4 | ||
| Foramen Magnum and Occipital Condyle | 4 | ||
| Occipital Condyle. | 4 | ||
| The Atlas (C1) | 5 | ||
| Axis (C2) | 7 | ||
| Ligamentous and Membranous Structures of the Craniovertebral Junction | 10 | ||
| Neuroradiology of the Craniovertebral Junction | 11 | ||
| Skull Base and Atlantoaxial Morphometry | 11 | ||
| Indices for Skull Base and Craniocervical Junction on a Lateral (Sagittal) View (Table 1-1). | 11 | ||
| Indices for Skull Base and Craniocervical Junction on an Anteroposterior (Coronal) View (Table 1-2). | 13 | ||
| Indices for Atlantoaxial Instability (Table 1-3). | 13 | ||
| Biomechanics of the Craniovertebral Junction | 14 | ||
| Occ–C1 Complex | 14 | ||
| Atlantoaxial Complex | 15 | ||
| Conclusions | 15 | ||
| Acknowlegment | 15 | ||
| References | 15 | ||
| 2 Transoral Approach to the Craniocervical Junction and Upper Cervical Spine | 17 | ||
| Overview | 17 | ||
| Anatomy | 17 | ||
| Ventral Pathology of the Craniocervical Junction | 21 | ||
| Indications | 21 | ||
| Relative Contraindications | 21 | ||
| Surgical Technique | 22 | ||
| Preparation and Positioning | 22 | ||
| Surgical Procedure | 22 | ||
| Conclusion | 29 | ||
| References | 29 | ||
| 3 Transmaxillary and Transmandibular Approaches to the Clivus and Upper Cervical Spine | 30 | ||
| Overview | 30 | ||
| Anatomy Review | 30 | ||
| Bony and Ligamentous Anatomy | 30 | ||
| Muscular Anatomy | 31 | ||
| Relevant Neurovascular Anatomy | 31 | ||
| Indications and Contraindications | 31 | ||
| Operative Technique | 34 | ||
| Unilateral Le Fort I Osteotomy with Palatal Split | 34 | ||
| Bilateral Le Fort I Osteotomies with Downfracture of the Maxilla | 34 | ||
| Bilateral Le Fort I Osteotomies with Palatal Split | 34 | ||
| Mandibulotomy | 34 | ||
| Mandibulotomy with Midline Glossotomy | 34 | ||
| Mandibular Swing-Transcervical | 36 | ||
| Complications | 36 | ||
| References | 37 | ||
| 4 High Cervical Retropharyngeal Approach to the Craniocervical Junction | 38 | ||
| Overview | 38 | ||
| Medial Retropharyngeal Approach (Anterior Retropharyngeal Approach) | 38 | ||
| Lateral Retropharyngeal Approach | 42 | ||
| Summary | 46 | ||
| 5 Approaches to the Craniocervical Junction: | 47 | ||
| Overview | 47 | ||
| Posterior Approaches | 47 | ||
| Anatomy | 47 | ||
| Positioning | 48 | ||
| Surgical Technique | 48 | ||
| Lateral Approaches | 50 | ||
| B Mid and Lower Cervical Spine | 119 | ||
| 13 Surgical Anatomy and Biomechanics in the Mid and Lower Cervical Spine | 120 | ||
| Overview | 120 | ||
| Surface Anatomy | 120 | ||
| Vertebral Column | 120 | ||
| Vertebral Body | 120 | ||
| End Plates | 120 | ||
| Uncal Process | 120 | ||
| Transverse Process | 121 | ||
| Neural Foramen | 121 | ||
| Anterior and Posterior Tubercles | 121 | ||
| Pedicles | 121 | ||
| Spinal Canal | 122 | ||
| Lateral Mass | 122 | ||
| Facet Joint | 122 | ||
| Lamina and Spinous Processes | 123 | ||
| Intervertebral Disk Space | 123 | ||
| Disk Space | 123 | ||
| Intervertebral Disk | 123 | ||
| Annulus Fibrosus | 123 | ||
| Nucleus Pulposus | 123 | ||
| Spinal Cord | 123 | ||
| Spinal Cord and Nerve Roots | 123 | ||
| Spinal Cord Blood Supply | 124 | ||
| Neurovascular Structures | 124 | ||
| Carotid Sheath | 124 | ||
| Superior Laryngeal Nerve | 125 | ||
| Inferior (Recurrent) Laryngeal Nerve | 125 | ||
| Hypoglossal Nerve | 125 | ||
| Sympathetic Chain | 125 | ||
| Vertebral Artery | 125 | ||
| Viscera | 126 | ||
| Ligaments | 126 | ||
| Anterior Longitudinal Ligament | 127 | ||
| Posterior Longitudinal Ligament | 127 | ||
| Ligamenta Flava | 127 | ||
| Capsular Ligaments | 127 | ||
| Ligamentum Nuchae | 127 | ||
| Intertransverse Ligaments | 127 | ||
| Fascia and Musculature | 127 | ||
| Fascia | 127 | ||
| Investing Layer | 127 | ||
| Pretracheal (Visceral) Layer | 127 | ||
| Prevertebral Layer | 128 | ||
| Ventral Musculature | 128 | ||
| C Cervicothoracic Junction and Thoracic Spine | 242 | ||
| 25 Surgical Anatomy and Biomechanics in the Cervicothoracic Junction and Thoracic Spine | 243 | ||
| Overview | 243 | ||
| Surgical Anatomy | 243 | ||
| Anterior Approaches | 243 | ||
| Anterolateral Transthoracic Approaches | 245 | ||
| Posterolateral Approaches | 247 | ||
| Biomechanics | 247 | ||
| Anatomic Considerations | 247 | ||
| Instrumentation | 248 | ||
| References | 248 | ||
| 26 Anterior Approaches to the Cervicothoracic Junction | 249 | ||
| Overview | 249 | ||
| Anatomy | 249 | ||
| Thoracic Inlet | 249 | ||
| Vascular and Visceral Compartments of the Superior Mediastinum | 249 | ||
| Fascial Layers | 249 | ||
| Venous Structures | 249 | ||
| Arterial Structures | 249 | ||
| Retropharyngeal and Retromediastinal Spaces | 250 | ||
| Operative Techniques | 250 | ||
| Low-Cervical Approach | 250 | ||
| Supraclavicular Approach | 251 | ||
| Transmanubrial-Transclavicular Approach | 251 | ||
| Transsternal-Transthoracic Approach | 252 | ||
| 27 Posterolateral Approaches to the Cervicothoracic Junction: | 254 | ||
| Overview | 254 | ||
| Anatomy | 254 | ||
| Muscles of the Scapular and Parascapular Region | 254 | ||
| Superficial Muscle Group (Fig. 27-1) | 254 | ||
| Trapezius | 254 | ||
| Rhomboid Major | 254 | ||
| Rhomboid Minor | 254 | ||
| Levator Scapulae | 254 | ||
| Intermediate Muscle Group | 255 | ||
| Serratus Posterior | 255 | ||
| Splenius Capitis | 255 | ||
| Spenius Cervicis | 255 | ||
| Deep Muscle Group | 255 | ||
| Erector Spinae | 255 | ||
| Iliocostalis | 255 | ||
| Longissimus | 255 | ||
| Spinalis | 255 | ||
| Transversospinalis | 255 | ||
| Semispinalis | 256 | ||
| Multifidus | 256 | ||
| Rotares | 256 | ||
| Posterior Thoracic Cage (Fig. 27-3) | 256 | ||
| Vertebral Body and Rib Articulation | 256 | ||
| Ligaments of Rib Articulation | 257 | ||
| Rib Interconnection | 257 | ||
| Retromediastinal Space | 257 | ||
| Neural structures (Fig. 27-7): | 258 | ||
| Surgical Approaches | 258 | ||
| Laminectomy | 258 | ||
| Indications and Advantages | 258 | ||
| Contraindications and Disadvantages | 259 | ||
| Patient Positioning and Preparation (Fig. 27-9) | 259 | ||
| Operation | 259 | ||
| Closure | 259 | ||
| Posterolateral Approaches | 259 | ||
| Transpedicular Approach | 259 | ||
| Indications and Advantages. | 259 | ||
| Contraindications and Disadvantages. | 260 | ||
| Patient Positioning and Preparation. | 260 | ||
| Operation | 261 | ||
| Closure. | 261 | ||
| Costotransversectomy | 261 | ||
| Indications and Advantages. | 261 | ||
| Contraindications and Disadvantages. | 261 | ||
| Patient Positioning and Preparation. | 262 | ||
| Operation | 262 | ||
| Closure | 263 | ||
| Lateral Extracavitary Parascapular Extrapleural Approach | 263 | ||
| Indications and Advantages. | 263 | ||
| Contraindication and Disadvantages. | 263 | ||
| Patient Positioning and Preparation. | 263 | ||
| Operation | 264 | ||
| Closure | 266 | ||
| Summary | 266 | ||
| References | 266 | ||
| 28 Anterolateral Transthoracic Approaches to the Thoracic Spine | 267 | ||
| Overview | 267 | ||
| Anatomic Considerations | 267 | ||
| Superficial (Extrapleural) | 267 | ||
| Deep (Intrapleural) | 267 | ||
| Indications | 268 | ||
| Contraindications | 268 | ||
| Operative Technique | 268 | ||
| Disk Lesions | 270 | ||
| Foraminal Decompression | 270 | ||
| Corpectomy | 271 | ||
| Postoperative Care | 271 | ||
| Considerations Specific to the Proximal Thoracic Spine Approach | 271 | ||
| Considerations Specific to the Thoracolumbar Junction Approach | 272 | ||
| Complications | 272 | ||
| Decreased Pulmonary Function | 272 | ||
| Infection | 272 | ||
| Chyle Leak | 272 | ||
| Dural Tear/Cerebrospinal Fluid Leak | 273 | ||
| Conclusion | 273 | ||
| References | 273 | ||
| 29 Anterior and Posterior Cervicothoracic Junction Stabilization Techniques | 274 | ||
| Overview | 274 | ||
| Operative Anatomy | 274 | ||
| Surgical Approaches | 274 | ||
| Anterior Surgical Approaches to the Cervicothoracic Junction | 274 | ||
| Positioning | 275 | ||
| Technique | 275 | ||
| Low Cervical Approach | 275 | ||
| Transsternal-Transmanubrial Approach | 276 | ||
| Thoracotomy | 276 | ||
| Posterior Approach | 276 | ||
| Posterior Surgical Approaches to the Cervicothoracic Junction | 278 | ||
| Lateral Mass Screws | 278 | ||
| Positioning | 278 | ||
| D Thoracolumbar and Lumbar Spines | 324 | ||
| 34 Surgical Anatomy and Posterior Approach to the Thoracic and Thoracolumbar Spine | 325 | ||
| Overview | 325 | ||
| Muscular Anatomy | 325 | ||
| Posterior Thoracic Cage | 326 | ||
| Posterior Mediastinal Space and Neurovascular Structure | 328 | ||
| Lateral Extracavitary Approach | 329 | ||
| Positioning and Incision | 329 | ||
| Muscle Dissection | 329 | ||
| Rib Resection | 330 | ||
| Identification of the Neural Foramen | 330 | ||
| Corpectomy or Disketomy | 330 | ||
| Vertebral Body Reconstruction | 331 | ||
| Wound Closure | 331 | ||
| Transcostovertebral Approach | 331 | ||
| Costotransversectomy | 331 | ||
| Positioning and Incision | 332 | ||
| Muscle Dissection | 332 | ||
| Rib Resection | 332 | ||
| Exposure of Vertebral Bodies and Spinal Cord | 333 | ||
| Wound Closure | 334 | ||
| Total En Bloc Spondylectomy: Thoracic Spine | 334 | ||
| Indications | 334 | ||
| Surgical Technique | 334 | ||
| Step 1. En Bloc Resection of the Posterior Element of the Vertebra by Posterior Approach | 334 | ||
| Exposure. | 334 | ||
| Introduction of the T-Saw Guide. | 335 | ||
| Cutting the Pedicles and Resection of the Posterior Element. | 335 | ||
| Step 2. En Bloc Corpectomy by Posterior Approach | 335 | ||
| Posterior Ligamentous Release of the Vertebral Body. | 335 | ||
| Dissection of the Spinal Cord and Removal of the Vertebra. | 336 | ||
| Corpectomy with Anterior Approach | 336 | ||
| Anterior Reconstruction and Posterior Instrumentation | 337 | ||
| Postoperative Management | 337 | ||
| Staged Operation of Thoracic Spine Tumors with Involvement of the Ribs | 337 | ||
| Indications | 337 | ||
| Incision and Positioning | 338 | ||
| Single-Stage Posterolateral Transpedicular Approach for Spondylectomy and Epidural Decompression | 339 | ||
| References | 343 | ||
| 35 Thoracoabdominal Approach to the Thoracolumbar Junction | 344 | ||
| Overview | 344 | ||
| Transthoracic Approach to the Midthoracic Level | 344 | ||
| Positioning and Incision | 344 | ||
| Muscle Dissection | 344 | ||
| Rib Removal | 344 | ||
| Exposure of Vertebral Body (Transpleural) | 344 | ||
| Vertebral Body Resection | 346 | ||
| Exposure of the Vertebral Body (Extrapleural) | 346 | ||
| Bilateral Segmental Vessel Ligation | 347 | ||
| Anterior Approach to Thoracolumbar Junction (Transpleural-Transdiaphragmatic Approach with Tenth Rib Resection) | 348 | ||
| Positioning and Incision | 348 | ||
| Soft Tissue Dissection | 348 | ||
| Rib Removal | 348 | ||
| Diaphragm Incision | 349 | ||
| Exposure of Each Vertebral Body | 350 | ||
| Closure | 350 | ||
| Transpleural-Retroperitoneal Approach (Diaphragm Detach) to the Thoracolumbar Junction | 352 | ||
| Identification of the Insertion Point of the Crus | 352 | ||
| Incision of the Diaphragm Insertion | 352 | ||
| Psoas Muscle Dissection | 353 | ||
| Extrapleural-Retroperitoneal Approach to Thoracolumbar Junction with Eleventh Rib Resection | 353 | ||
| Positioning and Incision | 353 | ||
| Muscle Incision and Rib Removal | 353 | ||
| Retroperitoneal Space Dissection | 353 | ||
| Costal Cartilage Splitting | 354 | ||
| Extrapleural Space Dissection | 354 | ||
| Diaphragm Release from the Insertion to the Twelfth Rib | 354 | ||
| Vertebral Body Exposure | 355 | ||
| Widening of Vertebral Body Exposure | 355 | ||
| Wound Closure | 355 | ||
| Minithoracotomy-Transdiaphragmatic Approach (Mini-TTA) | 356 | ||
| Diaphragmatic and Relevant Anatomy | 356 | ||
| Anesthesia | 358 | ||
| Positioning | 358 | ||
| Technique | 358 | ||
| Prevertebral Dissection and Diaphragm Detachment | 359 | ||
| Corpectomy and Decompression of the Spinal Canal | 360 | ||
| Bone Grafting, Cage Placement, and Instrumentation | 361 | ||
| Closure | 361 | ||
| Postoperative Care | 361 | ||
| Complication Rates | 361 | ||
| Advantages of Mini-TTA versus Traditional Thoracoabdominal Approach | 361 | ||
| Advantages of Mini-TTA versus Thoracoscopic Surgery | 363 | ||
| Familiar Three-Dimensional View | 363 | ||
| Whole-Lung Ventilation | 363 | ||
| Simplicity in Equipment and Assistance | 363 | ||
| Low Rate of Surgery-Induced Rib Intercostal Neuralgia | 364 | ||
| References | 364 | ||
| 36 Surgical Stabilization Techniques for Thoracolumbar Fractures | 365 | ||
| Classifications of Spinal Fractures | 365 | ||
| Historical Review | 365 | ||
| The Iowa Classification System and Algorithm | 366 | ||
| Stabilization Techniques | 366 | ||
| Anterolateral Approach to the Thoracolumbar Spine (T11–L4) | 366 | ||
| Posterolateral Transpedicular Approach with Vertebral Body Reconstruction | 369 | ||
| Posterior Minimally Invasive Techniques | 370 | ||
| Screw Placement | 371 | ||
| Rod Insertion | 372 | ||
| References | 373 | ||
| 37 Anterior Retroperitoneal Approach to the Lumbar Spine | 375 | ||
| Overview | 375 | ||
| Anatomy Review | 375 | ||
| General Indications | 377 | ||
| Anterior Approach | 377 | ||
| Thoracoabdominal/Flank Approach | 377 | ||
| Direct Lateral (Minimally Invasive) Approach | 377 | ||
| Contraindications | 378 | ||
| E Lumbar Sacral Pelvic Junction | 482 | ||
| 50 Surgical Anatomy, Approaches, and Biomechanics in the Lumbosacral Pelvic Junction | 483 | ||
| Overview | 483 | ||
| Anatomy | 483 | ||
| Surface Anatomy | 483 | ||
| Bony Antatomy of the Lumbosacral Junction | 483 | ||
| Biomechanics of Lumbosacral Junction | 486 | ||
| Vascular Anatomy | 487 | ||
| Neural Anatomy | 488 | ||
| Approaches to the Lumbosacral Junction | 489 | ||
| Anterior Versus Posterior Pathology-Guided Approach | 489 | ||
| Anterior Approach to the Lumbosacral Junction | 489 | ||
| Midline Transperitoneal Approach | 490 | ||
| Positioning. | 490 | ||
| Incision and Soft Tissue Dissection. | 490 | ||
| Intraperitoneal Dissection. | 490 | ||
| Retroperitoneal Dissection. | 490 | ||
| Diskectomy/Osteophytectomy. | 490 | ||
| Closure. | 490 | ||
| Complications. | 490 | ||
| Retroperitoneal Approach | 491 | ||
| Anterior Retroperitoneal Midline Approach | 491 | ||
| positioning. | 491 | ||
| incision. | 491 | ||
| soft tissue dissection. | 491 | ||
| retroperitoneal dissection. | 491 | ||
| diskectomy/osteophytectomy. | 492 | ||
| closure. | 492 | ||
| complications. | 492 | ||
| Anterior Retroperitoneal Flank Approach | 492 | ||
| lateral decubitus positioning. | 492 | ||
| lateral decubitus incision. | 492 | ||
| soft tissue dissection. | 492 | ||
| retroperitoneal dissection. | 493 | ||
| closure. | 493 | ||
| complications. | 493 | ||
| Posterior Approaches to the Lumbosacral Junction | 493 | ||
| Posterior Positioning | 494 | ||
| Posterior Incision: Midline, T-Shaped, Paramedian, or Transverse (Fig. 50-17) | 494 | ||
| Posterior Midline Approach | 494 | ||
| Posterior Paramedian Approach | 495 | ||
| Posterior Transverse Approach | 496 | ||
| Bony Work and Tumor Resection | 496 | ||
| Closure | 496 | ||
| Complications | 496 | ||
| References | 496 | ||
| 51 Surgical Management of Sacral Fractures | 497 | ||
| Overview | 497 | ||
| Anatomy | 497 | ||
| Diagnosis | 497 | ||
| Classification: Sacral Fractures | 497 | ||
| Denis Classification | 498 | ||
| Roy-Camille Subclassification and Strange-Vognsen and Lebech Modification | 498 | ||
| Isler Classification of Lumbosacral Injuries | 500 | ||
| Surgical Management | 500 | ||
| Surgical Timing | 500 | ||
| Approach to Surgical Stabilization | 501 | ||
| Posterior Stabilization Techniques | 501 | ||
| Lumbopelvic Stabilization | 501 | ||
| Indications | 501 | ||
| Operative Setup and Equipment | 501 | ||
| Surgical Technique: Open Lumbopelvic Stabilization | 501 | ||
| Minimally Invasive Approaches. | 502 | ||
| Open Reduction Internal Fixation | 502 | ||
| F Spinal Deformity | 545 | ||
| 56 Surgical Approaches to Cervical Kyphosis and Deformity | 546 | ||
| Overview | 546 | ||
| Etiology | 546 | ||
| Clinical Presentation | 546 | ||
| Clinical Evaluation | 547 | ||
| Surgical Indications | 548 | ||
| Surgical Approach: Anterior, Posterior, or Combined? | 548 | ||
| Surgical Techniques | 548 | ||
| Anterior Approach | 548 | ||
| Anterior Surgical Technique | 548 | ||
| Results | 549 | ||
| Complications | 550 | ||
| Current Practice | 551 | ||
| Combined Anterior-Posterior Approach | 551 | ||
| Anterior-Posterior Surgical Technique | 551 | ||
| Results | 553 | ||
| Complications | 553 | ||
| Posterior Approach | 553 | ||
| Posterior Surgical Technique | 553 | ||
| Results | 554 | ||
| Complications | 554 | ||
| Conclusion | 557 | ||
| References | 557 | ||
| 57 Surgical Management of Scheuermann Kyphosis | 558 | ||
| Overview | 558 | ||
| Indications and Contraindications | 558 | ||
| Indications | 558 | ||
| Contraindications | 558 | ||
| Operative Technique | 558 | ||
| Equipment | 558 | ||
| Patient Positioning | 558 | ||
| Location of Incision | 558 | ||
| Incision and Soft Tissue Dissection | 559 | ||
| Exposure of the Vertebrae | 559 | ||
| Retractor Placement | 559 | ||
| Instrumentation | 559 | ||
| Correction | 560 | ||
| Bone Graft | 561 | ||
| Closure | 561 | ||
| Postoperative Care | 561 | ||
| Complications | 562 | ||
| References | 563 | ||
| 58 Surgical Approach to Posttraumatic Thoracic Kyphosis | 564 | ||
| Background | 564 | ||
| Normal Sagittal Balance | 564 | ||
| Impact of Spinal Column Trauma on Alignment | 564 | ||
| Presenting Symptoms of Thoracic Kyphosis | 564 | ||
| Correction of Thoracic Kyphosis | 565 | ||
| Complications Associated with Osteotomies | 566 | ||
| Summary | 567 | ||
| 59 Anterior Release and Fusion Techniques for Scoliosis | 568 | ||
| Overview | 568 | ||
| Indications | 568 | ||
| Relative Indications | 568 | ||
| Endoscopic Contraindications | 568 | ||
| Relative Contraindications | 568 | ||
| Selection of Level of Fusion | 569 | ||
| Equipment | 569 | ||
| Open | 569 | ||
| Additional Endoscopic Equipment | 569 | ||
| Preoperative and Perioperative Considerations | 569 | ||
| Positioning | 569 | ||
| Lateral Decubitus (Endoscopic or Open) | 569 | ||
| Prone (Anterior Release Only) | 570 | ||
| Operative Technique | 571 | ||
| Incision/Exposure | 571 | ||
| Upper Thoracic Access (T1–T4) | 571 | ||
| Single and Double Thoracotomy: Convex | 571 | ||
| Endoscopic Access | 572 | ||
| Thoracolumbar (T10–L4) Access | 572 | ||
| Dissection of Pleura | 573 | ||
| Remove Disk/Vertebrae | 573 | ||
| Rib Head Removal | 574 | ||
| Graft Placement | 574 | ||
| Internal Thoracoplasty | 574 | ||
| Segmental Vessels | 574 | ||
| Screw Placement and Staples | 574 | ||
| Rod Reduction/Cantilever | 575 | ||
| Rod Derotation | 575 | ||
| Direct Vertebral Body Derotation | 575 | ||
| Compression | 575 | ||
| In Situ Bending | 575 | ||
| Closure | 576 | ||
| Outcomes | 576 | ||
| Conclusion | 577 | ||
| References | 577 | ||
| 60 Anterior and Posterior Treatment for Thoracolumbar and Lumbar Scoliosis | 578 | ||
| Overview | 578 | ||
| Anterior Approaches | 578 | ||
| Thoracic Curves | 578 | ||
| Thoracolumbar Spine | 578 | ||
| Lumbar Spine | 578 | ||
| Posterior Approach | 579 | ||
| Lumbar Decompression | 579 | ||
| Posterior Release | 579 | ||
| Posterior Instrumentation | 579 | ||
| Posterior-Only Approach | 581 | ||
| Adolescent Idiopathic Scoliosis | 582 | ||
| Neuromuscular Scoliosis | 583 | ||
| Adult Spinal Deformity | 583 | ||
| Degenerative Scoliosis | 584 | ||
| References | 586 | ||
| 61 Surgical Treatment of Adolescent Idiopathic Scoliosis: | 587 | ||
| Overview | 587 | ||
| Classification | 587 | ||
| Type I | 587 | ||
| Type 2 | 587 | ||
| Type 3 | 587 | ||
| Type 4 | 588 | ||
| Type 5 | 588 | ||
| Type 6 | 588 | ||
| Indications/Contraindications | 589 | ||
| Operative Technique | 592 | ||
| Equipment | 592 | ||
| Positioning | 592 | ||
| Approach | 592 | ||
| Osteotomies | 595 | ||
| Freehand Pedicle Screw Placement | 595 | ||
| Reduction Techniques | 598 | ||
| Derotation Maneuver | 599 | ||
| Decortication/Grafting | 599 | ||
| Closure | 599 | ||
| Postoperative Care | 600 | ||
| 62 Surgical Treatment of Flat Back Deformity | 601 | ||
| Overview | 601 | ||
| Etiology | 601 | ||
| Clinical Presentation | 602 | ||
| Radiographic Workup and Evaluation | 603 | ||
| Conservative Management | 604 | ||
| Operative Management | 604 | ||
| Smith-Peterson Osteotomy | 604 | ||
| Surgical Technique | 605 | ||
| Pedicle Subtraction Osteotomy | 606 | ||
| Surgical Technique | 607 | ||
| Anterior Surgery | 607 | ||
| Patient Outcomes | 608 | ||
| Summary | 608 | ||
| References | 608 | ||
| 63 Surgical Management of Degenerative Lumbar Scoliosis | 610 | ||
| Overview | 610 | ||
| Natural History | 610 | ||
| History and Physical Examination | 610 | ||
| Radiologic Evaluation | 611 | ||
| Nonoperative Management | 612 | ||
| Operative Care | 613 | ||
| Risks | 613 | ||
| Preoperative Planning | 613 | ||
| Sagittal Alignment | 615 | ||
| Staging | 616 | ||
| Our Preferences | 618 | ||
| References | 619 | ||
| G Spinal Tumors and Vascular Lesions | 621 | ||
| 64 Primary Malignant and Benign Tumors of the Spine | 622 | ||
| Overview | 622 | ||
| Presentation | 622 | ||
| Evaluation | 622 | ||
| Management | 622 | ||
| Malignant Tumors | 624 | ||
| Multiple Myeloma and Plasmacytoma | 624 | ||
| Ewing Sarcoma | 624 | ||
| Chondrosarcoma | 625 | ||
| Osteosarcoma | 625 | ||
| Chordoma | 625 | ||
| Benign Tumors | 626 | ||
| Hemangioma | 626 | ||
| Osteoid Osteoma and Osteoblastoma | 628 | ||
| Giant Cell Tumors | 628 | ||
| Chondroma, Enchondroma, and Osteochondroma | 629 | ||
| Aneurysmal Bone Cyst | 630 | ||
| Conclusion | 630 | ||
| References | 630 | ||
| 65 Secondary Metastatic Tumors of the Spine | 633 | ||
| Overview | 633 | ||
| Clinical Presentation | 633 | ||
| Evaluation | 633 | ||
| Management | 633 | ||
| Surgical Management “Pearls” | 636 | ||
| Conclusion | 637 | ||
| References | 637 | ||
| 66 Surgical Technique for Resection of Intradural Tumors | 639 | ||
| Overview | 639 | ||
| Indications and Contraindications | 639 | ||
| Indications | 639 | ||
| Relative Contraindications | 639 | ||
| Surgical Technique | 639 | ||
| Equipment | 639 | ||
| Patient Positioning | 639 | ||
| Exposure | 639 | ||
| Dural Opening | 640 | ||
| Approach to Intradural- Extramedullary Tumor | 641 | ||
| Approach to Intramedullary Tumor | 642 | ||
| Hemostasis | 643 | ||
| Closure | 644 | ||
| Postoperative Care | 644 | ||
| Complications | 645 | ||
| Conclusion | 645 | ||
| References | 645 | ||
| 67 Vascular Lesions of the Spinal Cord | 646 | ||
| Overview | 646 | ||
| Normal Vascular Anatomy of the Spinal Cord | 646 | ||
| Anterior Spinal Artery | 646 | ||
| Posterior Spinal Artery | 646 | ||
| Pial Arterial Plexus | 646 | ||
| Radicular Arteries | 646 | ||
| Central Arteries | 646 | ||
| Veins of the Spinal Cord | 647 | ||
| Capillaries of the Spinal Cord | 647 | ||
| Hemangioblastoma | 647 | ||
| Genetics | 647 | ||
| Epidemiology | 648 | ||
| Pathology | 648 | ||
| Imaging | 648 | ||
| Surgical Considerations | 649 | ||
| Surgical Technique | 649 | ||
| Outcomes | 650 | ||
| Spinal Cord Cavernous Malformations | 650 | ||
| Genetics | 650 | ||
| Epidemiology | 650 | ||
| Clinical Presentation and Natural History | 650 | ||
| Pathology | 651 | ||
| Imaging | 651 | ||
| Surgical Considerations | 651 | ||
| Surgical Technique | 651 | ||
| Dorsally Located Lesions (Fig. 67-5) | 651 | ||
| Ventrally Located Lesions | 652 | ||
| Outcomes | 653 | ||
| Spinal Cord Arteriovenous Malformations | 653 | ||
| Genetics | 653 | ||
| Classification | 653 | ||
| Epidemiology and Natural History | 653 | ||
| Extradural Arteriovenous Fistulas | 653 | ||
| Intradural Dorsal Arteriovenous Fistulas | 654 | ||
| Intradural Ventral Arteriovenous Fistulas | 654 | ||
| Extradural-Intradural Arteriovenous Malformations | 655 | ||
| Intramedullary Arteriovenous Malformations | 655 | ||
| Conus Arteriovenous Malformations | 656 | ||
| Pathophysiology | 656 | ||
| Imaging | 656 | ||
| Surgical Considerations | 657 | ||
| Surgical Technique | 657 | ||
| Extradural Arteriovenous Fistulas | 657 | ||
| Intradural Dorsal Arteriovenous Fistulas | 657 | ||
| Intradural Ventral Arteriovenous Fistulas | 657 | ||
| Extradural-Intradural Arteriovenous Malformations | 658 | ||
| Intramedullary Arteriovenous Malformations | 658 | ||
| Conus Arteriovenous Malformations | 658 | ||
| Spinal Cord Aneurysms | 658 | ||
| References | 659 | ||
| H Inflammatory Disease | 661 | ||
| 68 Ankylosing Spondylitis: | 662 | ||
| Overview | 662 | ||
| Osteotomy for Correction of Kyphotic Deformity of Ankylosing Spondylitis | 662 | ||
| Indications | 662 | ||
| Contraindications | 662 | ||
| Posterior Cervical Osteotomy for Correction of Kyphotic Deformity of Ankylosing Spondylitis | 663 | ||
| Advantages | 663 | ||
| Disadvantages | 663 | ||
| Preoperative Evaluation | 663 | ||
| Intraoperative Technique | 664 | ||
| Postoperative Management | 667 | ||
| Complications | 667 | ||
| Pedicle Subtraction Osteotomy for Kyphotic Deformity of the Thoracolumbar Spine | 668 | ||
| Advantages | 668 | ||
| Disadvantages | 668 | ||
| Preoperative Evaluation | 668 | ||
| Location of Osteotomy | 668 | ||
| Operative Technique | 668 | ||
| Equipment | 668 | ||
| Patient Positioning. | 668 | ||
| Location of Incision. | 669 | ||
| Intraoperative Technique. | 669 | ||
| Postoperative Care | 670 | ||
| Complications | 670 | ||
| Conclusion | 670 | ||
| I Spinal Infection | 671 | ||
| 69 Bacterial, Fungal, and Tuberculosis Diskitis and Osteomyelitis of the Cervical, Thoracic, and Lumbar Spine | 672 | ||
| Overview | 672 | ||
| Indications and Contraindications for Surgical Management of Spinal Infection | 672 | ||
| Indications | 672 | ||
| Contraindications | 672 | ||
| Operative Technique | 672 | ||
| General Considerations | 672 | ||
| Cervical Diskitis and Osteomyelitis | 673 | ||
| Positioning | 673 | ||
| Approach | 673 | ||
| Débridement and Decompression | 673 | ||
| Reconstruction | 674 | ||
| Strut Graft Without Anterior Instrumentation | 674 | ||
| Strut Graft with Anterior Instrumentation. | 674 | ||
| Posterior Instrumentation | 675 | ||
| Thoracic Diskitis and Osteomyelitis | 676 | ||
| Anesthesia | 676 | ||
| Patient Positioning | 676 | ||
| Localization | 676 | ||
| Surgical Approach | 676 | ||
| Decompression and Reconstruction | 676 | ||
| Supine Position | 676 | ||
| Lateral Decubitus | 677 | ||
| Anterior Instrumentation | 678 | ||
| Posterior Instrumentation | 679 | ||
| Lumbar Diskitis and Osteomyelitis | 680 | ||
| Positioning and Anesthesia | 680 | ||
| Exposure | 680 | ||
| Débridement and Decompression | 681 | ||
| Anterior Reconstruction | 681 | ||
| Posterior Stabilization | 682 | ||
| Tuberculosis and Fungal Infections of the Spine | 683 | ||
| Epidural Abscess | 684 | ||
| Postoperative Care | 684 | ||
| Complications | 684 | ||
| References | 684 | ||
| J Miscellaneous | 685 | ||
| 70 Surgical Management of Gunshot Wounds to the Spine | 686 | ||
| Overview | 686 | ||
| Epidemiology | 686 | ||
| Mechanisms of Injury | 686 | ||
| Prehospital and Emergency Room Management | 686 | ||
| Neurologic Evaluation | 687 | ||
| Radiologic Evaluation | 687 | ||
| Indications for Surgical Intervention | 687 | ||
| Cerebrospinal Fluid Fistula | 687 | ||
| Spinal Instability | 687 | ||
| Neurologic Deficit | 688 | ||
| Special Indications | 688 | ||
| Disk Herniation | 688 | ||
| Lead Toxicity | 688 | ||
| Bullet Migration | 688 | ||
| Late Complications | 688 | ||
| Louisiana State University–New Orleans Experience | 689 | ||
| Summary | 692 | ||
| References | 693 | ||
| 71 Vertebroplasty and Kyphoplasty | 694 | ||
| Overview | 694 | ||
| Treatment Objectives | 694 | ||
| Indications | 694 | ||
| Contraindications | 694 | ||
| Complications | 694 | ||
| Preoperative Preparation | 694 | ||
| Radiologic Anatomy for Kyphoplasty and Vertebroplasty | 695 | ||
| Equipment for Vertebroplasty and Kyphoplasty | 696 | ||
| Procedure | 696 | ||
| Inserting Tools into the Fractured Vertebral Body | 696 | ||
| Unipedicular Posterolateral Approach | 696 | ||
| Transpedicular Approach | 697 | ||
| Extrapedicular Approach | 697 | ||
| Placing and Inflating the Bone Tamp (Balloon Kyphoplasty) | 698 | ||
| Mixing the Cement and Filling the Void | 699 | ||
| Postoperative Management | 702 | ||
| Potential Adverse Results | 702 | ||
| References | 703 | ||
| 72 Bone Graft Harvesting Techniques | 704 | ||
| Overview | 704 | ||
| Selecting a Bone Graft | 704 | ||
| Techniques of Bone Graft Harvest | 704 | ||
| Anterior Iliac Crest Grafts | 704 | ||
| Posterior Iliac Grafts | 705 | ||
| Alternative Autologous Sites | 706 | ||
| Allograft and Fusion Supplements | 708 | ||
| Conclusion | 709 | ||
| References | 709 | ||
| 73 Dural Tears | 710 | ||
| Overview | 710 | ||
| Anatomy Review | 710 | ||
| Clinical Diagnosis | 710 | ||
| Conservative and Nonsurgical Treatment of Dural Tears | 711 | ||
| Intraoperative Surgical Repair | 712 | ||
| Surgical Methods and Materials | 712 | ||
| Suture | 712 | ||
| Dural Substitutes | 713 | ||
| Allografts. | 713 | ||
| Autogenous Dural Substitutes. | 714 | ||
| Synthetic or Chemically Modified Materials. | 714 | ||
| Dural Sealants | 714 | ||
| Other Dural Tear Surgical Solutions | 715 | ||
| Postoperative Surgical Repair | 716 | ||
| Summary | 716 | ||
| References | 716 | ||
| Index | 719 | ||
| A | 719 | ||
| B | 720 | ||
| C | 720 | ||
| D | 722 | ||
| E | 723 | ||
| F | 723 | ||
| G | 724 | ||
| H | 724 | ||
| I | 725 | ||
| J | 725 | ||
| K | 725 | ||
| L | 726 | ||
| M | 727 | ||
| N | 727 | ||
| O | 728 | ||
| P | 728 | ||
| Q | 730 | ||
| R | 730 | ||
| S | 730 | ||
| T | 732 | ||
| U | 734 | ||
| V | 734 | ||
| W | 734 | ||
| Z | 734 | ||
| Clinical Key ad | IBC1 |