Bridwell and DeWald’s Textbook of Spinal Surgery

Title Page......Page 2
Copyright......Page 4
Dedication......Page 6
Contributing Authors......Page 7
Foreword......Page 49
Preface......Page 51
Acknowledgments......Page 53
Contents......Page 54
Introduction A: The Evolution of Pediatric Spine Surgery Since the Third Edition of The Textbook of Spinal Surgery......Page 69
REFERENCES......Page 76
Introduction B: The Evolution of Adult Spine Surgery Since the Third Edition of The Textbook of Spinal Surgery......Page 80
ADULT SPINAL DEFORMITY......Page 82
NEUROPHYSIOLOGIC INTRAOPERATIVE MONITORING......Page 87
CERVICAL SPINE SURGERY......Page 88
SURGICAL TREATMENT OF SPINAL TUMORS......Page 89
REFERENCES......Page 90
1. Evaluation and Optimization of the Adult and Pediatric Spine Patient Preoperatively and Perioperatively to Improve Outcome......Page 97
INTRODUCTION......Page 98
STEP ONE: APPROPRIATENESS......Page 99
FITNESS FOR SURGERY......Page 101
PREOPERATIVE EVALUATION AND OPTIMIZATION—PEDIATRIC......Page 105
PERIOPERATIVE EVALUATION AND OPTIMIZATION—ADULT......Page 108
PERIOPERATIVE EVALUATION AND OPTIMIZATION—PEDIATRIC......Page 111
SYSTEMS APPROACH TO OPTIMIZING PATIENT OUTCOMES......Page 115
CONCLUSIONS......Page 117
REFERENCES......Page 118
2. Normal Spinal Anatomy: Normal Sagittal Plane Alignment......Page 129
DEVELOPMENT, ANATOMY, AND FUNCTION......Page 131
THREE-DIMENSIONAL SPINAL ALIGNMENT......Page 133
TERMINOLOGY OF SPINAL ALIGNMENT......Page 134
THE CONE OF ECONOMY......Page 138
SPINAL BALANCE: THE PLUMB LINE......Page 141
SACROPELVIC AND SPINOPELVIC ALIGNMENT......Page 145
NORMAL LUMBAR LORDOSIS......Page 152
THORACOLUMBAR JUNCTION......Page 154
NORMAL THORACIC KYPHOSIS......Page 155
NORMAL CERVICAL LORDOSIS......Page 157
SUMMARY......Page 158
ACKNOWLEDGMENT......Page 159
REFERENCES......Page 160
3. Spinal Cord and Nerve Root Monitoring......Page 162
INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING APPLICATIONS FOR SPINAL SURGERY......Page 163
SOMATOSENSORY-EVOKED POTENTIALS......Page 165
DESCENDING NEUROGENIC–EVOKED POTENTIALS......Page 172
NERVE ROOT MONITORING......Page 178
MOTOR-EVOKED POTENTIALS......Page 181
H-REFLEXES AND F-RESPONSES......Page 189
REFERENCES......Page 237
4. Bone Grafting and Biologics for Spine Fusion......Page 241
INTRODUCTION......Page 242
BIOLOGY OF SPINAL FUSION......Page 244
SELECTING A GRAFT MATERIAL......Page 249
AUTOLOGOUS BONE GRAFT IN SPINAL FUSION......Page 252
ALLOGRAFT BONE......Page 255
CERAMICS......Page 259
OSTEOINDUCTIVE GROWTH FACTORS......Page 261
RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEINS......Page 262
GENE THERAPY IN SPINAL FUSION......Page 264
OSTEOINDUCTIVE SMALL MOLECULES......Page 266
CONCLUSION......Page 268
REFERENCES......Page 269
5. General Considerations of Biomechanical Testing......Page 274
INTRODUCTION......Page 275
BIOMECHANICAL TERMINOLOGY AND ANALYZED PARAMETERS......Page 276
IN VITRO BIOMECHANICAL TESTING MODELS......Page 282
ASTM STANDARDS......Page 287
NONDESTRUCTIVE MULTISEGMENTAL SPINE TESTING......Page 294
LIMITATIONS OF IN VITRO BIOMECHANICS......Page 301
REFERENCES......Page 303
6. Clinical Biomechanics of the Cervical Spine......Page 306
INTRODUCTION TO THE BIOMECHANICAL PROPERTIES OF THE CERVICAL SPINE......Page 307
ANTERIOR FIXATION IN THE LOWER CERVICAL SPINE......Page 312
POSTERIOR FIXATION......Page 314
INSTABILITY DUE TO INJURY AND IATROGENIC DEFECTS......Page 317
ADJACENT SEGMENT DISEASE AND ARTIFICIAL DISCS......Page 319
ACKNOWLEDGMENT......Page 322
REFERENCES......Page 323
7. Biomechanics of Three-Dimensional Scoliosis Correction......Page 331
THE THREE-DIMENSIONAL ANATOMY OF IDIOPATHIC SCOLIOSIS......Page 332
CORONAL PLANE CORRECTION: AXIAL LOADING VERSUS TRANSVERSE APPROXIMATION......Page 334
MEASUREMENT OF DEFORMITY IN SCOLIOSIS......Page 336
VISUAL ANALYSIS OF AXIAL ROTATION......Page 339
THREE-DIMENSIONAL ASPECTS OF SCOLIOSIS CORRECTION......Page 340
PEDICLE SCREW INSTRUMENTATION......Page 341
SEGMENTAL AXIAL ROTATION ABOUT THE CONCAVE ROD......Page 345
DEROTATION BY TRANSVERSE PLANE TRANSLATION......Page 347
SUMMARY......Page 349
REFERENCES......Page 351
8. Principles and Applications of Spinal Instrumentation: A Clinical Approach......Page 355
CLINICAL CONSIDERATIONS......Page 356
HOOKS......Page 358
WIRES AND TETHERS......Page 365
PEDICLE SCREWS......Page 368
CORTICAL BONE TRAJECTORY SCREWS......Page 372
POSTERIOR LUMBAR INTERBODY FUSION......Page 374
TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 375
ANTERIOR LUMBAR INTERBODY FUSION......Page 376
ANTERIOR TO PSOAS (OBLIQUE LATERAL) APPROACH......Page 377
ADVANTAGES AND DISADVANTAGES OF INTERBODY APPROACHES......Page 378
IMPLANT CONSIDERATIONS......Page 379
PEEK VERSUS TITANIUM......Page 380
INTERBODY DEVICE SHAPE/DESIGN......Page 382
SUMMARY......Page 384
REFERENCES......Page 385
9. Treatment Considerations and Biomechanics of the Lumbosacral Spine......Page 395
INTRODUCTION......Page 396
INDICATIONS/CONTRAINDICATIONS......Page 399
ANATOMIC ZONES......Page 401
ANTERIOR AUGMENTATION WITH INTERBODY FUSION (TABLE 9.2)......Page 408
OUTCOMES/RESULTS FOR TECHNIQUE(S)......Page 411
SUMMARY/CONCLUSION......Page 413
FUTURE CONSIDERATIONS......Page 414
REFERENCES......Page 415
10. Anterior Cervical Approaches......Page 418
INTRODUCTION......Page 419
FASCIAL LAYERS......Page 420
MUSCLES......Page 422
NERVES......Page 423
VASCULAR......Page 425
BONE......Page 426
PATIENT POSITIONING......Page 428
LEFT- VERSUS RIGHT-SIDED APPROACH......Page 429
INCISION......Page 430
DEEP DISSECTION......Page 432
LOCALIZATION OF LEVEL, LONGUS COLLI ELEVATION, AND RETRACTOR PLACEMENT......Page 435
DYSPHAGIA......Page 437
DYSPHONIA......Page 438
ARTERIAL INJURY—VERTEBRAL ARTERIES......Page 439
AIRWAY OBSTRUCTION......Page 440
ESOPHAGEAL INJURY......Page 441
HEMATOMA......Page 442
OTHER NERVE INJURIES—C5 PALSY......Page 443
CONCLUSION......Page 444
REFERENCES......Page 445
11. Surgical Approach to the Posterior Cervical Spine......Page 448
INTRODUCTION......Page 449
INDICATIONS FOR POSTERIOR CERVICAL APPROACH......Page 450
BONE ANATOMY......Page 451
MUSCULATURE ANATOMY......Page 456
MUSCULATURE INNERVATION......Page 459
NUCHAL LIGAMENTS......Page 461
VASCULAR ANATOMY......Page 462
POSITIONING......Page 463
EXPOSURE SUBAXIAL SPINE......Page 466
C1–C2 EXPOSURE......Page 467
WOUND CLOSURE......Page 468
POSTOPERATIVE PAIN AND KYPHOSIS......Page 469
CHIN-ON-CHEST DEFORMITY......Page 470
CONCLUSION......Page 471
REFERENCES......Page 472
12. Jaw-Splitting Approaches to the Upper Cervical Spine......Page 474
INTRODUCTION......Page 475
UPPER NECK EXPOSURE......Page 477
PATHOLOGY......Page 479
TRANSORAL–TRANSPHARYNGEAL......Page 480
TRANSORAL–TRANSPHARYNGEAL PLUS MAXILLARY OSTEOTOMY......Page 485
TECHNIQUE......Page 486
TRANSMANDIBULAR APPROACHES......Page 487
MEDIAN MANDIBULOTOMY WITH GLOSSOTOMY (TROTTER APPROACH)......Page 488
MANDIBULAR SWING TRANSCERVICAL APPROACH......Page 493
TRANSMANDIBULAR–CIRCUMGLOSSAL–RETROPHARYNGEAL APPROACH......Page 497
BILATERAL SAGITTAL SPLIT MANDIBULAR OSTEOTOMIES......Page 498
COMBINED TRANSMAXILLARY AND TRANSMANDIBULAR APPROACHES......Page 499
TRANSCERVICAL ENDOSCOPIC ODONTOIDECTOMY......Page 500
ODONTOID-SPARING TRANSNASAL APPROACH......Page 504
ENDOSCOPIC-ASSISTED LATERAL TRANSATLANTAL APPROACH......Page 505
FAR- VERSUS EXTREME-LATERAL APPROACHES......Page 506
ENDOSCOPIC ENDONASAL......Page 507
SUBMANDIBULAR RETROPHARYNGEAL APPROACH......Page 508
COMPLICATIONS......Page 510
REFERENCES......Page 513
13. The Modified Anterior Approach to the Cervicothoracic Junction......Page 517
INTRODUCTION......Page 518
ANATOMY......Page 519
PREOPERATIVE PLANNING......Page 520
LOW CERVICAL APPROACH......Page 525
FULL STERNOTOMY APPROACH......Page 526
UNILATERAL OR BILATERAL MANUBRIOTOMY......Page 528
MEDIAL CLAVICULAR OSTEOTOMY......Page 529
MINI-OPEN APPROACH......Page 534
COMPLICATIONS......Page 537
DISCUSSION......Page 538
CONCLUSION......Page 540
ACKNOWLEDGMENT......Page 541
REFERENCES......Page 542
14. Transsternal Approaches to the Spine......Page 545
INTRODUCTION......Page 546
MUSCULATURE......Page 547
NERVES......Page 549
TRANSSTERNAL APPROACHES......Page 551
FULL MEDIAN STERNOTOMY......Page 552
PARTIAL MEDIAN STERNOTOMY......Page 554
LATERAL MANUBRIOTOMY......Page 557
MODIFIED PARTIAL LATERAL MANUBRIOTOMY......Page 559
STERNOTOMY PLUS ANTEROLATERAL THORACOTOMY......Page 561
FULL MEDIAN STERNOTOMY AND INTERAORTOCAVAL SUBINNOMINATE APPROACH......Page 565
PRE- AND POSTOPERATIVE MANAGEMENT......Page 569
COMPLICATIONS......Page 571
PARAVERTEBRAL MASSES AND TRANSSTERNAL APPROACHES......Page 573
CASE ILLUSTRATION......Page 574
REFERENCES......Page 579
15. “Microscopic” Approach to the Posterior Lumbar Spine for Decompression......Page 581
INTRODUCTION......Page 582
INDICATIONS/PREOPERATIVE PLANNING......Page 584
POSITIONING AND SETUP......Page 590
OPERATIVE APPROACHES—UNILATERAL......Page 592
BILATERAL DECOMPRESSION......Page 597
EXTRAFORAMINAL DECOMPRESSION......Page 598
COMPLICATIONS......Page 600
OUTCOMES......Page 601
SUMMARY......Page 602
REFERENCES......Page 603
16. Minimal Access Techniques Using Tubular Retractors for Disc Herniations and Stenosis......Page 608
INTRODUCTION......Page 609
INDICATIONS......Page 610
SERIAL DILATION AND TUBULAR RETRACTOR PLACEMENT......Page 612
INITIAL DRILLING......Page 613
TECHNIQUE—LUMBAR DISCECTOMY......Page 614
TECHNIQUE......Page 618
CONSIDERATIONS......Page 621
INTRAOPERATIVE PLANNING AND INCISION......Page 624
PEDICLE SCREW PLACEMENT......Page 625
INTERBODY CAGE......Page 626
ROD INSERTION AND CLOSURE......Page 629
LAMINECTOMY......Page 630
TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 631
ADDITIONAL BENEFITS OF TUBULAR RETRACTORS......Page 635
COMPLICATIONS......Page 638
THE LEARNING CURVE......Page 639
CONCLUSION......Page 641
REFERENCES......Page 642
17. Open Anterior Exposure of the Thoracic, Thoracolumbar, and Lumbar Spines......Page 647
INTRODUCTION......Page 648
HIGH TRANSTHORACIC APPROACH T1–T4......Page 649
INDICATIONS......Page 650
MID AND LOWER TRANSTHORACIC APPROACH T4–T12 INCLUDING DOUBLE THORACOTOMY AND THORACOPHRENOLUMBOTOMY DOWN TO L5–S1......Page 652
INDICATIONS......Page 653
EXPOSURE FOR THORACOLUMBAR/LUMBAR SCOLIOSIS......Page 655
POSTOPERATIVE MANAGEMENT......Page 670
RISKS AND COMPLICATIONS......Page 672
REFERENCES......Page 674
18. Anterior Approaches to the Distal Lumbar Spine and Sacrum......Page 676
INTRODUCTION......Page 677
LAYERS OF THE ABDOMINAL WALL......Page 679
PERITONEAL AND RETROPERITONEAL ANATOMY......Page 681
VASCULATURE......Page 682
LYMPHATIC NETWORK......Page 684
INDICATIONS......Page 686
PREOPERATIVE EVALUATION......Page 691
ADVANTAGE......Page 695
POSITIONING......Page 696
EXPOSURE......Page 697
NEUROVASCULAR DISSECTION......Page 700
LUMBOSACRAL EXPOSURE......Page 703
EXPOSURE......Page 705
NEUROVASCULAR DISSECTION......Page 707
POSTOPERATIVE MANAGEMENT......Page 710
LATERAL INTERBODY FUSION......Page 711
INSTRUMENTATION AND BONE GRAFTING......Page 713
COMPLICATIONS......Page 716
CONCLUSION......Page 720
REFERENCES......Page 721
19. Direct Lateral Approach to the Lumbar Spine......Page 733
INTRODUCTION......Page 734
ANATOMIC CONSIDERATIONS......Page 736
INDICATIONS......Page 739
POSITIONING......Page 740
PROCEDURE......Page 744
CLOSURE......Page 747
COMPLICATIONS......Page 748
CONCLUSIONS......Page 750
REFERENCES......Page 751
20. Cervical: State of the Art......Page 756
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......Page 761
INTRODUCTION......Page 762
INCIDENCE OF AXIAL NECK PAIN......Page 763
NATURAL HISTORY OF NECK PAIN......Page 764
PATHOPHYSIOLOGY OF NECK PAIN......Page 765
DIFFERENTIAL DIAGNOSIS OF NECK PAIN......Page 766
EVALUATION OF PATIENTS WITH NECK PAIN......Page 767
NONOPERATIVE TREATMENT OF ACUTE AND SUBACUTE NECK PAIN......Page 779
NONOPERATIVE TREATMENT OF CHRONIC NECK PAIN......Page 780
NONOPERATIVE TREATMENT OF IATROGENIC NECK PAIN WITH DEFORMITY......Page 781
CERVICAL SPONDYLOLISTHESIS......Page 782
PSEUDOARTHROSIS......Page 783
CERVICAL KYPHOSIS......Page 784
CERVICOGENIC HEADACHE......Page 786
SUMMARY......Page 787
REFERENCES......Page 788
22. Nonoperative Management of Cervical Radiculopathy......Page 792
INTRODUCTION......Page 793
ANATOMY......Page 794
CLINICAL EVALUATION......Page 795
IMAGING EVALUATIONS......Page 799
OTHER EVALUATIONS......Page 801
EPIDEMIOLOGY......Page 802
TREATMENT DECISIONS......Page 803
MEDICATION TREATMENT......Page 804
PHYSICAL THERAPY......Page 806
CERVICAL IMMOBILIZATION......Page 807
CERVICAL MANIPULATION......Page 808
STEROID INJECTION......Page 809
CONCLUSION......Page 812
REFERENCES......Page 813
23. Cervical Spondylosis and Radiculopathy......Page 817
BACKGROUND......Page 818
ANATOMY......Page 819
PATHOANATOMY/PATHOPHYSIOLOGY......Page 820
RADICULOPATHY......Page 823
DIAGNOSIS......Page 824
DIAGNOSTIC STUDIES......Page 831
NATURAL HISTORY......Page 835
ANTERIOR CERVICAL DISCECTOMY AND FUSION......Page 838
POSTERIOR LAMINOFORAMINOTOMY......Page 839
CERVICAL DISC ARTHROPLASTY......Page 840
SUMMARY......Page 841
REFERENCES......Page 842
24. Cervical Myelopathy......Page 846
INTRODUCTION......Page 847
EPIDEMIOLOGY......Page 849
PATHOPHYSIOLOGY......Page 852
HISTORY......Page 854
PHYSICAL EXAMINATION......Page 855
DIAGNOSTIC IMAGING......Page 856
PATIENT-REPORTED OUTCOMES ASSESSMENT......Page 857
NATURAL HISTORY AND NONOPERATIVE TREATMENT......Page 859
EVIDENCE FOR SURGICAL TREATMENT......Page 861
CERVICAL LAMINECTOMY WITHOUT FUSION......Page 862
POSTERIOR CERVICAL DECOMPRESSION AND FUSION (PCF)......Page 863
LAMINOPLASTY......Page 864
ANTERIOR CERVICAL DECOMPRESSION AND FUSION (ACF)......Page 866
COMBINED ANTERIOR AND POSTERIOR SURGERY......Page 869
CONCLUSIONS......Page 870
REFERENCES......Page 872
25. Anterior Decompression, Instrumentation, Fusion Techniques: Discectomy, Foraminotomy, Disc Space Carpentry......Page 878
BACKGROUND DATA......Page 879
ACCEPTED FORMS OF SURGICAL TREATMENT......Page 880
ANESTHESIA......Page 881
NEUROPHYSIOLOGIC MONITORING......Page 882
APPROACH......Page 883
DISCECTOMY......Page 885
END PLATE PREPARATION......Page 887
AUTOGENOUS ILIAC CREST BONE GRAFT......Page 888
INTERBODY GRAFTING......Page 889
INSTRUMENTATION......Page 890
POSTOPERATIVE MANAGEMENT......Page 894
VASCULAR......Page 896
NEURAL......Page 897
VERTEBRAL BODY FRACTURE......Page 898
ACUTE POSTOPERATIVE COMPLICATIONS......Page 899
OUTCOMES......Page 901
FUTURE TRENDS......Page 902
SUMMARY......Page 903
REFERENCES......Page 904
26. Anterior Decompression, Instrumentation, Fusion Techniques: Corpectomy, Strut Grafting......Page 907
INTRODUCTION......Page 908
CLASSIFICATION OF MYELOPATHY......Page 910
NATURAL HISTORY......Page 912
HISTORY AND PHYSICAL EXAMINATION......Page 913
IMAGING STUDIES......Page 914
CONTRAINDICATIONS......Page 919
NEUROPHYSIOLOGIC MONITORING......Page 921
ANESTHETIC CONSIDERATION......Page 922
POSITIONING......Page 923
EXPOSURE......Page 924
INSTRUMENTATION......Page 940
GRAFT SELECTION......Page 941
RESULTS......Page 942
INTRAOPERATIVE COMPLICATIONS......Page 945
POSTOPERATIVE COMPLICATIONS......Page 951
RESPIRATORY DISTRESS......Page 952
PSEUDARTHROSIS......Page 953
SUMMARY......Page 954
REFERENCES......Page 955
27. Anterior Cervical Plating......Page 959
INTRODUCTION......Page 960
HISTORICAL PERSPECTIVE......Page 961
FIRST GENERATION—DYNAMIC NONLOCKING (“UNRESTRICTED BACKOUT”)......Page 963
SECOND GENERATION—STATIC LOCKING (“RESTRICTED BACKOUT”)......Page 964
THIRD GENERATION—DYNAMIC LOCKING (“SEMICONSTRAINED”)......Page 970
FOURTH GENERATION—BIORESORBABLE......Page 976
PLATING TECHNIQUES AND INTRAOPERATIVE CONSIDERATIONS......Page 980
CONCLUSIONS......Page 984
REFERENCES......Page 985
28. Indications and Techniques for Transoral and Foramen Magnum Decompression......Page 992
INTRODUCTION......Page 993
NEURODIAGNOSTIC IMAGING AND TREATMENT ALGORITHMS......Page 995
TRANSORAL APPROACH TO THE VENTRAL CRANIOCERVICAL BORDER......Page 997
PREOPERATIVE ASSESSMENT......Page 1002
OPERATIVE PROCEDURE......Page 1006
INTRADURAL EXPANSION OF TUMOR AND REPAIR OF CSF LEAK......Page 1012
POSTOPERATIVE CARE......Page 1013
MORBIDITY/INFECTION......Page 1014
MORTALITY......Page 1015
POSTEROLATERAL–FAR LATERAL TRANSCONDYLAR APPROACH TO THE VENTRAL FORAMEN MAGNUM AND UPPER CERVICAL CANAL......Page 1016
INDICATIONS......Page 1018
SURGICAL TECHNIQUE......Page 1019
LATERAL TRANSCERVICAL EXTRAPHARYNGEAL APPROACH TO THE UPPER CERVICAL SPINE AND CRANIOCERVICAL JUNCTION......Page 1023
POSTERIOR MIDLINE CRANIECTOMY AND UPPER CERVICAL LAMINECTOMY......Page 1028
CONCLUSION......Page 1030
REFERENCES......Page 1031
29. Occipitocervical and Atlantoaxial Methods of Fusion: Rigid Fixation and Wiring......Page 1036
INTRODUCTION......Page 1037
GRAFT AND CABLE TECHNIQUE......Page 1038
GRAFT AND CLAMP TECHNIQUE......Page 1041
RIGID FIXATION......Page 1042
TRANSARTICULAR SCREW FIXATION......Page 1043
LATERAL MASS SCREWS AND RODS......Page 1046
OCCIPITOCERVICAL FUSION......Page 1054
ROD AND WIRE (CONTOURED LOOP) FIXATION......Page 1057
SCREW/ROD FIXATION......Page 1060
COMPLICATIONS......Page 1066
SUMMARY......Page 1067
REFERENCES......Page 1068
30. Subaxial Posterior Foraminotomy......Page 1072
HISTORY......Page 1073
ANATOMY/BIOMECHANICS......Page 1075
SURGICAL TECHNIQUE OF POSTERIOR FORAMINOTOMY......Page 1078
OPEN POSTERIOR CERVICAL FORAMINOTOMY......Page 1079
MIS POSTERIOR CERVICAL FORAMINOTOMY......Page 1084
POSTERIOR LAMINOFORAMINOTOMY......Page 1089
COMPLICATIONS......Page 1090
OUTCOMES OF MIS POSTERIOR CERVICAL FORAMINOTOMY (MIS PCF)......Page 1092
COST......Page 1093
FULL ENDOSCOPIC POSTERIOR FORAMINOTOMY......Page 1095
REFERENCES......Page 1096
31. Cervical Laminoplasty......Page 1099
INTRODUCTION......Page 1100
BACKGROUND......Page 1101
POSITIONING AND EXPOSURE......Page 1102
BONY DECOMPRESSION AND LAMINOPLASTY STABILIZATION......Page 1103
COMPLETION......Page 1109
POSTOPERATIVE CARE......Page 1111
POSTLAMINOPLASTY KYPHOSIS......Page 1113
RECURRENT STENOSIS......Page 1114
MOTOR ROOT PALSY......Page 1115
RESULTS......Page 1117
CONCLUSION......Page 1119
REFERENCES......Page 1120
32. Subaxial Posterior Decompression and Fusion Techniques......Page 1124
INTRODUCTION......Page 1125
OPERATIVE TECHNIQUE......Page 1131
POSTOPERATIVE CARE......Page 1145
COMPLICATIONS......Page 1147
CONCLUSION......Page 1149
ACKNOWLEDGMENT......Page 1150
REFERENCES......Page 1151
33. Subaxial Posterior Laminoplasty and Laminectomy With Lateral Mass Fixation......Page 1154
INTRODUCTION......Page 1155
SUBAXIAL POSTERIOR LAMINOPLASTY AND LAMINECTOMY......Page 1157
OPERATIVE TECHNIQUE......Page 1158
POSTOPERATIVE CARE......Page 1166
COMPLICATIONS......Page 1168
RESULTS......Page 1170
ANATOMY......Page 1172
BIOMECHANICS......Page 1173
SURGICAL TECHNIQUE......Page 1174
SCREW TECHNIQUES......Page 1175
POSTOPERATIVE MANAGEMENT......Page 1186
MINIMALLY INVASIVE APPROACH......Page 1190
CASE SAMPLES......Page 1191
CONCLUSION......Page 1194
REFERENCES......Page 1195
34. Subaxial Posterior Lateral Mass Fixation......Page 1200
INTRODUCTION......Page 1201
ANATOMY......Page 1202
BIOMECHANICS......Page 1203
INDICATIONS AND CONTRAINDICATIONS......Page 1204
SURGICAL TECHNIQUE......Page 1205
SCREW TECHNIQUES......Page 1206
POSTOPERATIVE MANAGEMENT......Page 1217
OUTCOMES AND COMPLICATIONS......Page 1218
MINIMALLY INVASIVE TECHNIQUE......Page 1220
CASE 2......Page 1221
REFERENCES......Page 1230
35. Subaxial Cervical Pedicle Screw Fixation......Page 1234
INTRODUCTION......Page 1235
CONTRAINDICATION AND LIMITATION......Page 1237
PEDICLE SIZE......Page 1239
ANATOMY OF THE VERTEBRAL ARTERY......Page 1240
OPERATION ROOM SET-UP/POSITIONING......Page 1244
IMPLANTS......Page 1245
PEDICLE SCREW PLACEMENT......Page 1246
COMPLICATIONS DIRECTLY ATTRIBUTABLE TO SCREW INSERTION......Page 1254
COMPLICATIONS NOT DIRECTLY ATTRIBUTABLE TO SCREW INSERTION......Page 1257
A CASE OF SALVAGE SURGERY FOR POSTLAMINECTOMY KYPHOSIS......Page 1259
A CASE OF MULTISEGMENTAL INSTABILITY CAUSED BY SUBAXIAL LESION OF RHEUMATOID ARTHRITIS......Page 1267
SUMMARY......Page 1269
REFERENCES......Page 1270
36. Revision Cervical Spine Surgery......Page 1272
INTRODUCTION......Page 1273
EVALUATION OF THE PATIENT AFTER FAILED CERVICAL SPINE SURGERY......Page 1276
HEMATOMA......Page 1280
RADICULOPATHY AND RECURRENT SYMPTOMS......Page 1281
ADJACENT SEGMENT DISEASE......Page 1283
PSEUDARTHROSIS......Page 1284
POSTSURGICAL MALALIGNMENT......Page 1287
CONCLUSION......Page 1291
REFERENCES......Page 1292
37. Combined Approaches (Anterior-Posterior, Posterior-Anterior-Posterior) to the Correction of Cervical Kyphosis......Page 1299
INTRODUCTION......Page 1300
CLINICAL PRESENTATION AND PHYSICAL EXAMINATION......Page 1302
RADIOGRAPHIC EVALUATION......Page 1303
RESTORATION OF BALANCE AND ALIGNMENT......Page 1306
ACHIEVING A STABLE FUSION CONSTRUCT......Page 1309
DECISION-MAKING ALGORITHM......Page 1310
COMPLICATIONS AFTER COMBINED APPROACHES......Page 1325
REFERENCES......Page 1327
38. Cervical Pedicle Subtraction Osteotomy......Page 1330
INTRODUCTION......Page 1331
INDICATION AND PREOPERATIVE EVALUATION......Page 1333
EXPOSURE......Page 1336
INSTRUMENTATION......Page 1337
PEDICLE SUBTRACTION OSTEOTOMY......Page 1338
OSTEOTOMY CLOSURE......Page 1340
WOUND CLOSURE......Page 1342
CASE 38.1......Page 1343
COMPLICATIONS......Page 1345
CONCLUSION......Page 1346
REFERENCES......Page 1347
39. Cervical Disc Arthroplasty......Page 1348
INTRODUCTION......Page 1349
HISTORY OF CERVICAL DISC ARTHROPLASTY......Page 1352
PROSTHETIC KINEMATICS......Page 1354
MATERIAL CHOICE......Page 1356
CURRENT INDICATIONS AND CONTRAINDICATIONS......Page 1360
EXPANDED INDICATIONS AND FUTURE DIRECTIONS......Page 1362
SINGLE-LEVEL DISEASE......Page 1365
TWO-LEVEL DISEASE......Page 1369
META-ANALYSES OF OUTCOMES......Page 1370
PREVENTION OF ADJACENT SEGMENT DISEASE......Page 1372
COMPLICATIONS SPECIFIC TO CDA......Page 1374
AUTHOR’S PREFERRED SURGICAL TECHNIQUE......Page 1376
REFERENCES......Page 1378
40. Complications of Surgical Treatment of the Cervical Spine......Page 1384
BACKGROUND......Page 1385
DEFINING COMPLICATIONS IN CERVICAL SPINE SURGERY......Page 1387
RISK FACTORS FOR CERVICAL SPINE SURGERY COMPLICATIONS......Page 1388
COMPLICATION RATES IN CERVICAL SPINE SURGERY......Page 1390
IMPORTANT COMPLICATIONS ASSOCIATED WITH ANTERIOR CERVICAL SPINE SURGERY......Page 1391
IMPORTANT COMPLICATIONS ASSOCIATED WITH POSTERIOR CERVICAL SPINE SURGERY......Page 1393
IMPORTANT RADIOGRAPHIC COMPLICATIONS OF CERVICAL SPINE SURGERY......Page 1394
FUTURE DIRECTIONS......Page 1395
REFERENCES......Page 1396
41. Thoracic and Lumbar Degenerative Disorders: State of the Art......Page 1401
REFERENCES......Page 1408
42. Evaluation of Thoracic and Lumbar Axial Back Pain: Who Is a Surgical Candidate and Who Is Not?......Page 1412
INTRODUCTION......Page 1413
DEFINITION OF AXIAL BACK PAIN......Page 1414
ANATOMY, PATHOANATOMY, AND PATHOGENESIS OF AXIAL BACK PAIN......Page 1415
RISK FACTORS OF AXIAL BACK PAIN......Page 1417
CLASSIFICATION OF AXIAL BACK PAIN......Page 1418
NATURAL HISTORY OF AXIAL BACK PAIN......Page 1419
HISTORY AND PHYSICAL EVALUATION OF THE PATIENT WITH AXIAL BACK PAIN......Page 1420
MUSCLE STRAIN......Page 1423
SPONDYLOLYSIS AND SPONDYLOLISTHESIS......Page 1424
SPONDYLOARTHROPATHIES......Page 1425
BENIGN AND MALIGNANT TUMORS......Page 1426
INFECTIONS......Page 1427
METABOLIC BONE DISEASE......Page 1428
NONORGANIC BACK PAIN......Page 1429
PLAIN RADIOGRAPHS......Page 1430
MAGNETIC RESONANCE IMAGING......Page 1431
DISCOGRAPHY......Page 1432
DIAGNOSTIC INJECTIONS......Page 1433
NONOPERATIVE MANAGEMENT OF AXIAL BACK PAIN......Page 1434
OPERATIVE MANAGEMENT OF AXIAL BACK PAIN......Page 1436
CONCLUSION......Page 1441
REFERENCES......Page 1442
43. Surgical Treatment of Lumbar Disc Herniation......Page 1450
INTRODUCTION......Page 1451
SURGICAL TECHNIQUE......Page 1458
EXTRUDED DISC......Page 1467
FORAMINAL DISC HERNIATIONS......Page 1468
FAR-LATERAL EXTRAFORAMINAL HERNIATIONS......Page 1470
POSTOPERATIVE CARE......Page 1474
REFERENCES......Page 1475
44. Surgical Treatment of Lumbar Spinal Stenosis......Page 1477
INTRODUCTION......Page 1478
PATHOGENESIS AND PATHOANATOMY......Page 1481
MANIFESTATIONS OF LUMBAR SPINAL STENOSIS......Page 1483
NATURAL HISTORY OF LUMBAR SPINAL STENOSIS......Page 1484
HISTORY AND PHYSICAL EXAMINATION OF THE PATIENT WITH LUMBAR SPINAL STENOSIS......Page 1485
PLAIN RADIOGRAPHS......Page 1488
MAGNETIC RESONANCE IMAGING (MRI)......Page 1489
MYELOGRAPHY/COMPUTED TOMOGRAPHY MYELOGRAPHY......Page 1490
ELECTRODIAGNOSTIC STUDIES......Page 1491
DIFFERENTIAL DIAGNOSIS OF LUMBAR SPINAL STENOSIS......Page 1493
NONOPERATIVE MANAGEMENT OF LUMBAR SPINAL STENOSIS......Page 1494
SURGICAL MANAGEMENT OF LUMBAR SPINAL STENOSIS......Page 1496
INDICATIONS FOR SURGERY AND REVIEW OF SURGICAL TECHNIQUES......Page 1497
CENTRAL LAMINECTOMY......Page 1498
LAMINECTOMY WITH LATERAL RECESS DECOMPRESSION AND FORAMINOTOMY......Page 1499
LAMINOPLASTY......Page 1500
POSTERIOR SPINAL FUSION WITH AND WITHOUT INSTRUMENTATION......Page 1501
INTERBODY FUSION......Page 1502
INTERSPINOUS PROCESS DEVICE......Page 1504
MINIMALLY INVASIVE SURGICAL TECHNIQUES......Page 1505
LONG-TERM OUTCOMES......Page 1507
CONCLUSION......Page 1508
REFERENCES......Page 1509
45. Revision Laminectomy: Indications and Techniques......Page 1514
INTRODUCTION......Page 1515
EVALUATION AND INDICATIONS......Page 1516
TREATMENT......Page 1527
SURGICAL TECHNIQUES......Page 1528
COMPLICATIONS......Page 1532
CONCLUSION......Page 1534
REFERENCES......Page 1535
46. Minimally Invasive Posterior Surgery for the Lumbar Spine......Page 1537
INTRODUCTION......Page 1538
LIMITATIONS......Page 1540
EXPOSURE......Page 1541
LUMBAR DECOMPRESSION......Page 1542
RESULTS......Page 1543
OVERVIEW......Page 1545
PERCUTANEOUS SPINAL FIXATION......Page 1547
RESULTS......Page 1549
MINIMALLY INVASIVE POSTEROLATERAL FUSION......Page 1550
INTRODUCTION......Page 1551
TECHNIQUE (AUTHORS’ PREFERENCE)......Page 1553
RESULTS......Page 1557
FUTURE DIRECTION OF MINIMALLY INVASIVE SPINE SURGERY......Page 1558
MINIMALLY INVASIVE TWO-LEVEL TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 1559
REFERENCES......Page 1565
47. When to Consider ALIF, TLIF, and PLIF With PSF......Page 1569
INTRODUCTION/BACKGROUND......Page 1570
POSTERIOR LUMBAR INTERBODY FUSION......Page 1571
TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 1573
ANTERIOR LUMBAR INTERBODY FUSION......Page 1574
COMPARISON STUDY BETWEEN PLIF AND TLIF......Page 1577
COMPARISON STUDY BETWEEN TLIF AND ALIF......Page 1578
CONCLUSION......Page 1580
REFERENCES......Page 1581
48. Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion......Page 1584
INDICATIONS......Page 1585
PLIF SURGICAL PROTOCOL......Page 1586
TLIF SURGICAL PROTOCOL......Page 1587
THE IMPORTANCE OF LORDOSIS......Page 1588
OPERATING TABLE......Page 1589
MINIMALLY INVASIVE SURGERY......Page 1590
BILATERAL FACETECTOMIES......Page 1591
STEERABLE CAGES......Page 1595
EXPANDABLE CAGES......Page 1596
INTERPEDICULAR COMPRESSION......Page 1598
UNILATERAL VERSUS BILATERAL PEDICLE SCREWS......Page 1601
CONTRALATERAL RADICULOPATHY......Page 1602
CASE 2......Page 1603
CONCLUSION......Page 1604
REFERENCES......Page 1605
49. Revision Lumbar Spine Surgery......Page 1610
INTRODUCTION......Page 1611
CLINICAL EVALUATION......Page 1612
IMAGING EVALUATION......Page 1615
PATIENTS WITHOUT PRIOR INSTRUMENTATION......Page 1616
PATIENTS WITH PRIOR INSTRUMENTATION AND FUSION......Page 1617
ALIGNMENT EVALUATION......Page 1619
SURGICAL INDICATIONS AND PREOPERATIVE OPTIMIZATION......Page 1620
REVISION DECOMPRESSIONS......Page 1623
ADJACENT SEGMENT DISEASE......Page 1624
PSEUDARTHROSIS......Page 1628
MALALIGNMENT......Page 1630
CONCLUSIONS......Page 1633
REFERENCES......Page 1634
50. Thoracic Disc Herniation: Diagnosis and Management......Page 1647
INTRODUCTION......Page 1648
ANATOMICAL FINDINGS TO CONSIDER IN TDH......Page 1650
LOCATION OF THORACIC DISC HERNIATION......Page 1651
DIAGNOSIS......Page 1653
NONOPERATIVE MANAGEMENT......Page 1654
IDENTIFICATION OF THE CORRECT LEVEL AND PREVENTION OF WRONG-SITE SURGERY......Page 1655
INTRAOPERATIVE NEUROMONITORING......Page 1656
SURGICAL APPROACH—POSTERIOR......Page 1657
TRANSFACET PEDICLE–SPARING APPROACH......Page 1658
ANTEROLATERAL APPROACH TO THE THORACIC SPINE......Page 1659
Neurologic signs......Page 1661
THORACIC MICROSCOPIC DISCECTOMY......Page 1662
MINIMALLY INVASIVE LATERAL APPROACHES TO THORACIC SPINE......Page 1663
CONCLUSION......Page 1664
REFERENCES......Page 1665
51. Thoracic Stenosis......Page 1670
INTRODUCTION......Page 1671
ANATOMY......Page 1672
DIAGNOSIS......Page 1673
PATHOGENESIS......Page 1675
SURGICAL TREATMENT......Page 1676
COMPLICATIONS......Page 1681
POSTOPERATIVE CARE......Page 1684
REFERENCES......Page 1689
52. Treatment of Thoracic Myelopathy......Page 1692
INTRODUCTION......Page 1693
THORACIC DISC HERNIATIONS......Page 1695
THORACIC OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT......Page 1702
THORACIC OSSIFICATION OF YELLOW LIGAMENT......Page 1705
CONCLUSION......Page 1711
REFERENCES......Page 1712
53. Current State of Lumbar Total Disc Replacement: Concepts/Design Strategy/Indications/Contraindications/Complications......Page 1716
CONCEPTS......Page 1717
DESIGN STRATEGY......Page 1719
INDICATIONS......Page 1722
CONTRAINDICATIONS......Page 1723
PHYSICAL EXAMINATION......Page 1726
RADIOGRAPHIC ANALYSIS......Page 1727
PATIENT POSITIONING......Page 1728
COMPLICATIONS......Page 1732
IMPLANTS......Page 1737
EVIDENCE-BASED OUTCOMES......Page 1739
SUMMARY......Page 1741
REFERENCES......Page 1742
54. Sacroiliac Joint Dysfunction......Page 1746
INTRODUCTION......Page 1747
SI JOINT DYSFUNCTION AND LOW BACK PAIN......Page 1749
ANATOMY AND BIOMECHANICS......Page 1750
PATHOLOGY AND PATHOMECHANICS......Page 1756
CLINICAL HISTORY......Page 1759
PHYSICAL EXAMINATION......Page 1761
IMAGING EVALUATION......Page 1762
DIAGNOSTIC INJECTION......Page 1763
NONSURGICAL TREATMENT......Page 1766
TRADITIONAL OPEN SURGERY......Page 1768
MINIMALLY INVASIVE SURGERY......Page 1770
MINIMALLY INVASIVE SURGICAL TECHNIQUE......Page 1771
MIS SURGICAL OUTCOMES......Page 1775
COMPLICATIONS......Page 1783
CONCLUSION......Page 1785
REFERENCES......Page 1787
55. The Future: Disc Regeneration and Other Technologies......Page 1793
INTRODUCTION......Page 1794
GROWTH FACTORS......Page 1795
ANTI-INFLAMMATORY PROTEINS......Page 1796
CONCLUSION......Page 1798
SMALL MOLECULAR THERAPIES......Page 1799
CONCLUSION......Page 1800
DISC CELLS......Page 1802
STEM CELLS......Page 1803
DERMAL FIBROBLASTS......Page 1804
CONCLUSIONS......Page 1805
ANNULUS FIBROSUS TISSUE ENGINEERING......Page 1806
WHOLE INTERVERTEBRAL DISC ENGINEERING......Page 1807
CONCLUSIONS......Page 1808
CONCLUSIONS......Page 1809
REFERENCES......Page 1810
56. Complications of Lumbosacral Spine Surgery......Page 1821
INTRODUCTION......Page 1822
INSTRUMENTATION AND FUSION COMPLICATIONS......Page 1824
PSEUDARTHROSIS......Page 1830
VASCULAR AND BLEEDING–RELATED COMPLICATIONS......Page 1838
MUSCLE COMPLICATIONS......Page 1847
INFECTION......Page 1851
NEUROLOGIC COMPLICATIONS......Page 1857
SAGITTAL ALIGNMENT AND BALANCE COMPLICATIONS......Page 1862
COST EFFECTIVENESS OF LUMBAR SPINE SURGERY......Page 1864
CONCLUSION......Page 1867
REFERENCES......Page 1869
57. Wiltse and Marchetti–Bartolozzi Classifications of Spondylolisthesis: Guidelines for Treatment......Page 1878
TYPE 2 (ISTHMIC)......Page 1881
TYPE 5 (PATHOLOGIC)......Page 1882
MARCHETTI–BARTOLOZZI CLASSIFICATION......Page 1883
PROGRESSION OF DEFORMITY......Page 1887
ACQUIRED......Page 1890
MEYERDING GRADING SCALE......Page 1895
TREATMENT......Page 1897
REFERENCES......Page 1903
58. Sagittal Alignment and the Spinal Deformity Study Group Classification......Page 1905
INTRODUCTION......Page 1906
LOCAL ALIGNMENT: SLIP GRADE AND LUMBOSACRAL KYPHOSIS......Page 1908
REGIONAL ALIGNMENT: SACROPELVIC MORPHOLOGY, PELVIC BALANCE, AND PROXIMAL FEMORAL ANGLE......Page 1911
GLOBAL ALIGNMENT: SPINAL BALANCE......Page 1922
SPINAL DEFORMITY STUDY GROUP CLASSIFICATION......Page 1926
PROPOSED SURGICAL TREATMENT......Page 1930
REFERENCES......Page 1934
59. Natural History of Spondylolisthesis......Page 1937
INTRODUCTION......Page 1938
L5–SACRUM RELATIONSHIP......Page 1939
GLOBAL ANATOMICAL CLASSIFICATION......Page 1941
SPINAL DEFORMITY STUDY GROUP (SDSG AND MAC-THIONG) CLASSIFICATION......Page 1947
NATURAL HISTORY: PROPOSAL FOR A NEW CLASSIFICATION INTEGRATING THE TIME-SCALE DIMENSION......Page 1949
CONCLUSION......Page 1956
REFERENCES......Page 1957
60. Pars Interarticularis Repair......Page 1960
INTRODUCTION......Page 1961
REVIEW OF LITERATURE......Page 1962
INDICATIONS......Page 1963
PREOPERATIVE PLANNING......Page 1969
AUTHORS’ PREFERRED METHOD......Page 1970
POSTOPERATIVE CARE......Page 1972
AUTHORS’ SERIES......Page 1973
DISCUSSION AND CONCLUSION......Page 1978
REFERENCES......Page 1979
61. Low-Grade Spondylolisthesis in Children and Adolescents......Page 1981
INTRODUCTION......Page 1982
TREATMENT......Page 1986
COMPLICATIONS......Page 1991
SUMMARY......Page 1994
REFERENCES......Page 1995
62. Adult Degenerative Spondylolisthesis......Page 1998
ANATOMY AND BIOMECHANICS......Page 1999
NATURAL HISTORY AND EPIDEMIOLOGY......Page 2000
IMAGING STUDIES AND WORKUP......Page 2001
LEVEL-1 EVIDENCE FOR DECOMPRESSION ALONE VERSUS DECOMPRESSION WITH FUSION......Page 2006
POSTEROLATERAL FUSION......Page 2007
POSTEROLATERAL FUSION WITH PEDICLE SCREW INSTRUMENTATION......Page 2008
SURGICAL TECHNIQUES......Page 2015
REFERENCES......Page 2044
63. High-Grade Spondylolisthesis: Decision Making and Fusion Reduction......Page 2052
INTRODUCTION......Page 2053
ALIGNMENT......Page 2054
DECISION MAKING: TO REDUCE OR NOT TO REDUCE......Page 2056
IN SITU FUSION......Page 2057
REDUCTION......Page 2058
CASE ILLUSTRATIONS......Page 2063
CONCLUSION......Page 2072
REFERENCES......Page 2074
64. High-Grade Spondylolisthesis: Partial Reduction......Page 2077
DEFINITION......Page 2078
EFFECT OF THE POSITION OF L5 ON THE LUMBAR LORDOSIS......Page 2080
UNBALANCED HGS......Page 2081
L4–L5 COUPLING......Page 2084
FLAT VERSUS DOME-SHAPED SACRAL ENDPLATE......Page 2085
IS PARTIAL REDUCTION OF L5 A GOOD OPTION IN BALANCED HGS?......Page 2086
SURGICAL TECHNIQUE......Page 2088
SACRAL FIXATION......Page 2089
LUMBAR FIXATION......Page 2090
FUSION......Page 2091
ADJUSTING THE REDUCTION OF L5......Page 2092
NEUROLOGIC EXAMINATION......Page 2093
BRACING......Page 2094
EVALUATION OF THE WIDTH OF L5–S1 DISC SPACE......Page 2098
NO PAIN......Page 2100
LOSS OF REDUCTION......Page 2102
INSTRUMENTATION BULKINESS......Page 2104
CONCLUSION......Page 2106
REFERENCES......Page 2107
65. High-Grade Spondylolisthesis: Posterior Decompression and Spanning/Dowel Fibula......Page 2109
BACKGROUND......Page 2110
TREATMENT......Page 2112
PREOPERATIVE PLANNING......Page 2114
POSTERIOR APPROACH......Page 2120
ANTERIOR–POSTERIOR APPROACH......Page 2123
POSTOPERATIVE CARE......Page 2126
RESULTS......Page 2127
COMPLICATIONS......Page 2129
CASE 1......Page 2131
CASE 2......Page 2140
CONCLUSIONS......Page 2150
REFERENCES......Page 2151
66. High Dysplastic Spondylolisthesis: Anatomic Reduction Harms/Shufflebarger Technique......Page 2154
INTRODUCTION......Page 2155
PATHOMECHANICS OF SPONDYLOLISTHESIS......Page 2156
RATIONALE FOR REDUCTION OF SPONDYLOLISTHESIS......Page 2162
SURGICAL TECHNIQUE OF SPONDYLOLISTHESIS REDUCTION......Page 2163
COMPLICATIONS......Page 2172
RESULTS AND OUTCOMES......Page 2173
REFERENCES......Page 2174
67. Reduction of High-Grade Spondylolisthesis: The Edwards Technique......Page 2176
INTRODUCTION......Page 2177
PATHOMECHANICS OF SPONDYLOLISTHESIS......Page 2178
ADVANTAGES OF REDUCTION......Page 2182
IMPROVES FUSION RATE......Page 2184
STOPS SLIP PROGRESSION......Page 2185
RESTORES POSTURE AND MECHANICS......Page 2186
IMPROVES APPEARANCE AND SELF-IMAGE......Page 2187
TRACTION-CAST REDUCTION......Page 2188
POSTERIOR DISTRACTION INSTRUMENTATION......Page 2189
ANTEROPOSTERIOR RESECTION REDUCTIONS......Page 2190
VERTEBRECTOMY......Page 2191
PEDICLE SCREW LEVERED REDUCTION......Page 2192
SAGITTAL DECOMPENSATION......Page 2194
HIGH RISK OF SLIP PROGRESSION......Page 2195
EXCESS LUMBOSACRAL MOBILITY......Page 2196
TWO-POINT DISTAL FIXATION......Page 2198
ANATOMIC ALIGNMENT......Page 2199
EDWARDS GRADUAL REDUCTION TECHNIQUE......Page 2201
PREOPERATIVE PLANNING......Page 2202
ROOT LENGTHENING LIMIT......Page 2204
MONITORING NERVE FUNCTION......Page 2206
ALAR DISTRACTION RODS......Page 2207
L5 ROOT DECOMPRESSION......Page 2209
THE SPONDYLO CONSTRUCT: SCREW FIXATION......Page 2211
S1 SCREW OPTIONS......Page 2212
DISTAL SCREW OPTIONS......Page 2213
SPONDYLO CONSTRUCT: ASSEMBLY......Page 2215
GRADUAL INSTRUMENTED REDUCTION......Page 2216
GRAFTING......Page 2218
POSTOPERATIVE BRACING......Page 2219
SPECIAL SITUATIONS......Page 2220
CLINICAL RESULTS......Page 2223
REFERENCES......Page 2227
68. L5 Vertebrectomy for High-Grade Spondylolisthesis: Anterior–Posterior and Posterior-Only Approaches......Page 2230
INTRODUCTION......Page 2231
ETIOLOGY OF SPONDYLOPTOSIS......Page 2234
CLINICAL FEATURES......Page 2236
FIRST-STAGE PROCEDURE: ANTERIOR APPROACH (FIG. 68.3)......Page 2239
SECOND-STAGE PROCEDURE: POSTERIOR APPROACH (FIG. 68.6)......Page 2242
SURGICAL PROCEDURE: POSTERIOR-ONLY APPROACH (SENIOR AUTHOR’S TECHNIQUE)......Page 2245
STAGED ANTERIOR–POSTERIOR TECHNIQUE......Page 2255
POSTERIOR-ONLY TECHNIQUE......Page 2260
CONCLUSION......Page 2262
ACKNOWLEDGMENT......Page 2263
REFERENCES......Page 2264
69. Complications of Spondylolysis/Spondylolisthesis Surgery......Page 2268
INTRODUCTION......Page 2269
NEUROLOGIC COMPLICATIONS......Page 2270
PSEUDARTHROSIS......Page 2276
SLIP PROGRESSION......Page 2279
INSTRUMENTATION FAILURE......Page 2281
VASCULAR COMPLICATIONS......Page 2285
INFECTION......Page 2287
SUMMARY......Page 2289
REFERENCES......Page 2290
70. Natural History Including Measures of Maturity......Page 2293
INTRODUCTION......Page 2294
PREVALENCE AND INCIDENCE......Page 2295
TYPES OF IDIOPATHIC SCOLIOSIS......Page 2296
AGE OF ONSET......Page 2297
CURVE EVOLUTION—PROGRESSION DURING IMMATURITY......Page 2298
INFANTILE......Page 2300
JUVENILE......Page 2302
ADOLESCENT......Page 2303
PROGRESSION IN BRACED PATIENTS......Page 2304
ASSESSING PHYSICAL MATURITY......Page 2305
CURVE PROGRESSION AFTER MATURITY......Page 2311
WHY CURVES PROGRESS......Page 2313
INFLUENCE OF SPINAL DEFORMITY ON THE LUNGS......Page 2314
THORACIC INSUFFICIENCY SYNDROME......Page 2315
BACK PAIN......Page 2316
PREGNANCY......Page 2317
FUNCTION......Page 2318
EPILOGUE......Page 2320
REFERENCES......Page 2322
71. Clinical Assessment and Parent–Patient Expectations......Page 2329
PATIENT HISTORY......Page 2330
PHYSICAL EXAMINATION......Page 2333
PARENT AND PATIENT PERSPECTIVES......Page 2342
CONCLUSIONS......Page 2346
REFERENCES......Page 2347
72. Spinal Deformity Outcomes Measurement......Page 2350
INTRODUCTION......Page 2351
CHOOSING OUTCOME MEASURES......Page 2353
SRS INSTRUMENT......Page 2354
GENERIC AND SPINAL DISORDER–SPECIFIC OUTCOMES......Page 2356
STATISTICAL VALIDATION OF AN INSTRUMENT......Page 2357
CROSS-CULTURAL ADAPTATION......Page 2358
PATIENT-REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM......Page 2360
HEALTH ECONOMICS......Page 2361
FUTURE PERSPECTIVE......Page 2363
CONCLUSION......Page 2365
REFERENCES......Page 2366
73. Radiographic Classification Scheme: Lenke Classification......Page 2374
INTRODUCTION......Page 2375
RADIOGRAPHIC COMPONENTS OF THE CLASSIFICATION SYSTEM......Page 2376
CURVE TYPES......Page 2379
SUMMARY......Page 2394
CASE EXAMPLES......Page 2396
REFERENCES......Page 2416
74. Fusionless Surgery and Growing-Rod Techniques for Idiopathic Early-Onset Scoliosis......Page 2419
INTRODUCTION......Page 2420
PATIENT EVALUATION......Page 2421
IMAGING ASSESSMENT......Page 2423
MANAGEMENT THEMES......Page 2426
FUSIONLESS SURGERY OR GROWING-ROD EVOLUTION......Page 2428
TRADITIONAL DUAL GROWING RODS......Page 2431
LENGTHENING OF TRADITIONAL GROWING RODS......Page 2435
GRADUATION......Page 2438
MAGNETICALLY CONTROLLED GROWING RODS......Page 2439
SUMMARY......Page 2455
REFERENCES......Page 2456
75. Anterior and Posterior Scoliosis Correction Techniques Without Fusion......Page 2464
INTRODUCTION......Page 2465
VERTEBRAL BODY STAPLING......Page 2467
VBS INDICATIONS......Page 2469
VBS TECHNIQUE......Page 2470
VBS COMPLICATIONS......Page 2472
VERTEBRAL BODY TETHERING......Page 2474
VBT INDICATIONS......Page 2475
VBT TECHNIQUE......Page 2476
VBT COMPLICATIONS......Page 2483
POSTERIOR DYNAMIC CONCAVE DISTRACTION (ApiFix)......Page 2485
POSTERIOR DYNAMIC CONCAVE DISTRACTION TECHNIQUE......Page 2490
POSTERIOR DYNAMIC CONCAVE DISTRACTION COMPLICATIONS......Page 2492
SUMMARY......Page 2494
REFERENCES......Page 2495
76. Shilla Technique......Page 2500
INTRODUCTION......Page 2501
PATIENT SELECTION AND PREOPERATIVE PLANNING......Page 2503
OSTEOTOMIES AND INSTRUMENTATION......Page 2506
DEFORMITY CORRECTION......Page 2509
SURGICAL PEARLS......Page 2510
POSTOPERATIVE CARE......Page 2512
REVISION STRATEGIES......Page 2513
COMPLICATIONS......Page 2514
DEFINITIVE TREATMENT......Page 2516
COST EFFECTIVENESS......Page 2517
CASE STUDY......Page 2519
REFERENCES......Page 2523
77. Open and Thoracoscopic Anterior Thoracic Surgery......Page 2526
ANTERIOR THORACIC SURGERY......Page 2527
HISTORICAL PERSPECTIVE AND RECENT ADVANCEMENTS......Page 2528
GOALS OF ANTERIOR THORACIC SURGERY......Page 2530
INDICATIONS FOR ANTERIOR THORACIC SURGERY......Page 2532
CONTRAINDICATIONS FOR ANTERIOR THORACIC SURGERY......Page 2535
SURGICAL TECHNIQUE: OPEN ANTERIOR THORACOTOMY WITH DISC EXCISION AND INSTRUMENTATION......Page 2537
SURGICAL TECHNIQUE: THORACOSCOPIC ANTERIOR RELEASE AND INSTRUMENTATION......Page 2541
RADIOGRAPHIC AND CLINICAL OUTCOMES......Page 2551
CONCLUSIONS......Page 2554
REFERENCES......Page 2560
78. Thoracoplasty......Page 2564
BACKGROUND DATA......Page 2565
TECHNIQUE......Page 2570
POSTOPERATIVE MANAGEMENT......Page 2576
COMPLICATIONS......Page 2577
SUMMARY......Page 2584
REFERENCES......Page 2585
79. Evolution of Instrumentation for Adolescent Idiopathic Scoliosis......Page 2587
NATURAL HISTORY OF SCOLIOSIS......Page 2588
INITIAL TREATMENTS......Page 2589
POSTERIOR INSTRUMENTED FUSION......Page 2592
ANTERIOR INSTRUMENTATION......Page 2605
NONFUSION INSTRUMENTATION (GROWTH MODULATION TECHNIQUES)......Page 2611
REFERENCES......Page 2615
80. Posterior Spinal Deformity Correction Techniques......Page 2618
INTRODUCTION......Page 2619
CLINICAL ASSESSMENT......Page 2620
RADIOGRAPHIC EVALUATION......Page 2623
HALO-GRAVITY TRACTION......Page 2625
PHYSIOLOGIC ASSESSMENT......Page 2627
INTRAOPERATIVE POSITIONING......Page 2628
IMPLANT CONSIDERATIONS......Page 2629
SOFT TISSUE RELEASES AND OSTEOTOMIES......Page 2635
FACET-BASED OSTEOTOMIES......Page 2638
PEDICLE SUBTRACTION OSTEOTOMY......Page 2640
VERTEBRAL COLUMN RESECTION......Page 2644
CORRECTION TECHNIQUES......Page 2647
POSTEROLATERAL TRANSLATION......Page 2650
VERTEBRAL DEROTATION TECHNIQUES......Page 2651
KYPHOSIS CORRECTION......Page 2658
LORDOTIC CORRECTION......Page 2663
CONCLUSIONS......Page 2667
REFERENCES......Page 2668
81. Anterior Lumbar and Thoracolumbar Correction and Fusion for Adolescent Idiopathic Scoliosis......Page 2671
INTRODUCTION......Page 2672
EVOLUTION OF THE ANTERIOR APPROACH FOR THORACOLUMBAR/LUMBAR SCOLIOSIS......Page 2674
INDICATIONS......Page 2681
FUSION/INSTRUMENTATION LEVELS......Page 2684
SCREW PLACEMENT......Page 2686
DEFORMITY CORRECTION......Page 2690
FRONTAL PLANE CORRECTION......Page 2695
DEROTATION......Page 2696
COMPARISON WITH THE POSTERIOR APPROACH......Page 2700
PSEUDARTHROSIS......Page 2703
DECOMPENSATION......Page 2704
UNUSUAL COMPLICATIONS......Page 2705
CONCLUSION......Page 2706
REFERENCES......Page 2707
82. Strategies in the Management of Severe and Neglected Deformities......Page 2713
INTRODUCTION......Page 2714
PREVALENCE OF UNTREATED SPINE DEFORMITY......Page 2715
CLINICAL PRESENTATION......Page 2717
DIAGNOSTIC INVESTIGATIONS......Page 2723
NONSURGICAL TREATMENT......Page 2726
POSTERIOR APPROACHES......Page 2728
SURGICAL TECHNIQUE......Page 2733
POSTOPERATIVE MEDICAL MANAGEMENT......Page 2735
PAIN CONTROL......Page 2736
SUMMARY......Page 2737
REFERENCES......Page 2738
83. Complications Associated With Adolescent Idiopathic Scoliosis Surgery......Page 2740
INTRODUCTION......Page 2741
INFECTION......Page 2743
ACUTE DEEP WOUND INFECTIONS......Page 2744
DELAYED DEEP WOUND INFECTION......Page 2746
POSTOPERATIVE EPIDURAL ABSCESS......Page 2747
ANTIBIOTIC PROPHYLAXIS FOR SURGICAL PROCEDURES IN THE SETTING OF SPINAL IMPLANTS......Page 2748
SPINAL CORD INJURY......Page 2750
ROOT AND PLEXUS INJURIES......Page 2754
PSEUDARTHROSIS......Page 2756
SYMPTOMATIC IMPLANTS, BREAKAGE, AND DISLODGEMENT......Page 2759
COMPLICATIONS OF THORACIC VERTEBRAL BODY SCREWS......Page 2763
COMPLICATIONS OF PEDICLE SCREWS......Page 2764
THORACOSCOPIC APPROACH......Page 2767
SAGITTAL PLANE IMBALANCE (IATROGENIC FLATBACK)......Page 2769
CRANKSHAFT AND “ADDING ON”......Page 2770
SHOULDER ASYMMETRY......Page 2771
DEATH......Page 2772
VISUAL IMPAIRMENT OR LOSS......Page 2773
COMPRESSION INJURY OF NERVES......Page 2774
SUPERIOR MESENTERIC ARTERY SYNDROME......Page 2776
LONG-TERM OUTCOME OF THE INSTRUMENTED ADOLESCENT SPINE......Page 2777
CONCLUSION......Page 2778
REFERENCES......Page 2779
84. Adult Spinal Deformity: Introduction/State of the Art......Page 2788
85. Adult Spinal Deformity Classification......Page 2794
INTRODUCTION......Page 2795
CLASSIFICATION EFFORTS TO DATE......Page 2796
SRS SCHWAB ASD CLASSIFICATION......Page 2800
CLASSIFICATION......Page 2802
CLASSIFICATION AND TREATMENT......Page 2805
SURGICAL OUTCOME AND THE CLASSIFICATION......Page 2808
CONCLUSION......Page 2814
REFERENCES......Page 2817
86. De Novo Scoliosis......Page 2820
INTRODUCTION......Page 2821
DEFINITION OF BALANCE......Page 2823
THE AGING SPINE......Page 2825
CLINICAL EVALUATION......Page 2829
RADIOLOGIC EVALUATION......Page 2831
CORONAL EVALUATION......Page 2832
SAGITTAL EVALUATION......Page 2835
NONOPERATIVE TREATMENT......Page 2839
SURGICAL MANAGEMENT......Page 2841
THE ROLE OF MINIMALLY INVASIVE TECHNIQUES......Page 2850
OUTCOMES......Page 2852
CONCLUSION......Page 2854
REFERENCES......Page 2855
87. Sagittal Imbalance......Page 2860
BACKGROUND......Page 2861
C7 SAGITTAL VERTICAL ANGLE......Page 2863
T1 PELVIC ANGLE......Page 2865
SPINO-PELVIC ALIGNMENT......Page 2866
PELVIC INCIDENCE......Page 2868
PELVIC TILT AND SACRAL SLOPE......Page 2869
SPINAL COMPENSATION......Page 2870
LOWER EXTREMITY ALIGNMENT......Page 2872
REFERENCES......Page 2873
88. Fixed Coronal Malalignment of the Spine: Clinical Significance and Operative Management......Page 2877
SPINAL DEFORMITY AND HRQOL......Page 2878
THE PATHOGENESIS OF FIXED CORONAL PLANE DEFORMITY......Page 2879
CLINICAL EVALUATION OF CORONAL MALALIGNMENT......Page 2880
RADIOGRAPHIC EVALUATION OF CORONAL MALALIGNMENT......Page 2885
INDICATIONS FOR SURGICAL CARE......Page 2890
NONSURGICAL MANAGEMENT OF FIXED CORONAL MALALIGNMENT......Page 2894
SURGICAL MANAGEMENT OF FIXED CORONAL MALALIGNMENT......Page 2895
SPECIFIC CURVE TYPES......Page 2897
DECISION MAKING AND AN ALGORITHM FOR CARE......Page 2905
POSTOPERATIVE MANAGEMENT......Page 2910
REFERENCES......Page 2912
89. Spinal Deformity in the Older Patient With Kyphosis......Page 2915
PATHOGENESIS......Page 2917
ADVERSE HEALTH EFFECTS......Page 2919
VERTEBROPLASTY/KYPHOPLASTY......Page 2920
SURGERY......Page 2921
POSTERIOR COLUMN OSTEOTOMY TECHNIQUE......Page 2922
PEDICLE SUBTRACTION OSTEOTOMY......Page 2923
PSO TECHNIQUE......Page 2924
VERTEBRAL COLUMN RESECTION......Page 2927
VCR TECHNIQUE......Page 2928
SURGICAL OUTCOMES......Page 2930
CONCLUSIONS......Page 2935
REFERENCES......Page 2936
90. Decision Making in Treatment of Adult Spinal Deformity......Page 2940
INTRODUCTION......Page 2941
DECISION MAKING REGARDING TREATMENT FOR ADULT SCOLIOSIS......Page 2942
PRESENTATION OF ADULT SCOLIOSIS......Page 2946
SURGICAL TREATMENT OF ADULT SCOLIOSIS......Page 2949
SPECTRUM OF PRESENTATIONS OF ADULT SCOLIOSIS......Page 2953
RESULTS OF NIH STUDY ON QUALITY OF LIFE IN ADULT SCOLIOSIS......Page 2955
OPERATIVE FACTORS THAT MAY IMPACT OUTCOME IN ADULT SCOLIOSIS......Page 2962
TREATMENT OF FIXED SAGITTAL IMBALANCE/LUMBAR KYPHOSIS......Page 2963
SUMMARY/CONCLUSION......Page 2970
REFERENCES......Page 2975
91. Smith-Petersen Osteotomy of the Spine......Page 2977
INTRODUCTION......Page 2978
HISTORY......Page 2980
TECHNIQUE......Page 2981
RESULTS—ANKYLOSING SPONDYLITIS......Page 2984
RESULTS—ADULT SPINAL DEFORMITY......Page 2986
SUMMARY......Page 2988
REFERENCES......Page 2989
92. Pedicle Subtraction Procedures for Complex Spinal Deformity......Page 2993
INTRODUCTION......Page 2994
COMPLEX SPINAL DEFORMITY AND ASSOCIATED DISABILITY......Page 2995
SURGICAL TECHNIQUE......Page 2997
ADULT THORACOLUMBAR DEFORMITY......Page 2999
ADULT CERVICAL DEFORMITY......Page 3003
COMPLICATIONS......Page 3005
CONCLUSIONS......Page 3008
REFERENCES......Page 3009
93. Vertebral Column Resection for Complex Spinal Deformity: Posterior Approach......Page 3016
AUTHORS’ PREFERRED SURGICAL TECHNIQUE......Page 3020
CORRECTION OF SCOLIOSIS DEFORMITY......Page 3023
CORRECTION OF KYPHOSCOLIOSIS......Page 3026
CORRECTION OF KYPHOSIS......Page 3027
CORRECTION OF THORACIC LORDOSIS/LORDOSCOLIOSIS......Page 3028
CORRECTION OF SEVERE RIGID PELVIC OBLIQUITY IN NEGLECTED CONGENITAL SCOLIOSIS WITH INTRASPINAL ANOMALY AND PREVIOUS SURGERY WITH PVCR......Page 3034
AFTERCARE......Page 3035
INTRAOPERATIVE COMPLICATIONS......Page 3036
INTRAOPERATIVE BLOOD LOSS......Page 3041
NEUROLOGIC COMPLICATIONS......Page 3044
POSTOPERATIVE COMPLICATIONS......Page 3048
INFECTION......Page 3049
IMPLANT FAILURE AND PSEUDARTHROSIS......Page 3050
CONCLUSION......Page 3052
REFERENCES......Page 3053
94. Vertebral Column Resection for Complex Spinal Deformity: Combined Anterior and Posterior Approach......Page 3056
INTRODUCTION AND BACKGROUND......Page 3057
SPINAL SHORTENING PROCEDURES......Page 3059
INDICATIONS FOR VERTEBRAL COLUMN RESECTION......Page 3063
PREOPERATIVE CONSIDERATIONS......Page 3064
PREOPERATIVE EVALUATION......Page 3066
IMAGING......Page 3069
ANTERIOR STAGE......Page 3072
POSTERIOR STAGE......Page 3074
POSTOPERATIVE CARE......Page 3075
CONCLUSIONS......Page 3078
REFERENCES......Page 3079
95. Fusion to the Sacrum and Fixation Techniques of the Sacropelvic Junction......Page 3082
INTRODUCTION......Page 3083
HISTORICAL OVERVIEW......Page 3085
ANATOMIC AND BIOMECHANICAL CONSIDERATIONS......Page 3090
S1 SCREW PLACEMENT......Page 3101
ILIAC SCREWS WITH PSIS ENTRY......Page 3103
S2-ALAR-ILIAC APPROACH......Page 3113
TRADITIONAL GALVESTON TECHNIQUE......Page 3116
TRANSDISCAL SCREWS......Page 3120
OUTCOMES......Page 3122
SUMMARY......Page 3130
REFERENCES......Page 3132
96. Structural Grafting for Adult Spinal Deformity......Page 3140
INTRODUCTION......Page 3141
INDICATIONS FOR STRUCTURAL GRAFTING......Page 3143
ANTERIOR, LATERAL, AND POSTERIOR APPROACHES......Page 3146
ALLOGRAFT......Page 3149
TITANIUM......Page 3150
EXPANDABLE DEVICES......Page 3151
COMPLICATIONS......Page 3153
CONCLUSION......Page 3154
REFERENCES......Page 3160
97. Revision Surgeries for Adult Spinal Deformity......Page 3162
INTRODUCTION......Page 3163
COMORBIDITIES......Page 3165
PHYSICAL EXAMINATION......Page 3166
RADIOGRAPHIC EVALUATION......Page 3167
LIMITING BLOOD LOSS......Page 3169
INSTRUMENTATION......Page 3170
DEFORMITY CORRECTION......Page 3171
FUSION......Page 3172
OUTCOMES AND COMPLICATIONS......Page 3174
CONCLUSION......Page 3177
REFERENCES......Page 3178
98. Minimally Invasive Deformity Surgery: Future Directions......Page 3184
INTRODUCTION......Page 3185
PREOPERATIVE ASSESSMENT......Page 3187
STAGE 1: INTERBODY FUSION......Page 3188
STAGE 2: POSTERIOR INSTRUMENTATION AND FUSION......Page 3195
PITFALLS......Page 3198
CASE EXAMPLE......Page 3199
CONCLUSION......Page 3200
REFERENCES......Page 3202
99. ACR and Minimally Invasive Surgery for Sagittal Plane Deformities......Page 3203
INTRODUCTION......Page 3204
INDICATIONS/CONTRAINDICATIONS......Page 3205
ALIGNMENT......Page 3206
COMPUTED TOMOGRAPHY......Page 3209
MAGNETIC RESONANCE IMAGING......Page 3210
APPROACH SIDE......Page 3211
APPROACH......Page 3213
ACR ANATOMY......Page 3215
TECHNIQUE......Page 3216
POSTERIOR CONSTRUCT......Page 3217
MOTOR/NEUROLOGIC DEFICIT......Page 3220
SYMPATHETIC PLEXUS INJURY......Page 3221
PROXIMAL JUNCTIONAL KYPHOSIS......Page 3222
OUTCOMES......Page 3223
CONCLUSION......Page 3225
REFERENCES......Page 3226
100. Introduction/State of the Art in the Care of Dysplastic and Congenital Spine Deformities......Page 3231
INTRODUCTION......Page 3232
DIAGNOSIS......Page 3233
IMAGING......Page 3234
CLASSIFICATION......Page 3236
NONOPERATIVE TREATMENT......Page 3237
SURGICAL TREATMENT......Page 3238
CONCLUSION......Page 3241
REFERENCES......Page 3242
101. Dysplastic Scoliosis: Neurofibromatosis Spinal Pathology......Page 3246
INTRODUCTION......Page 3247
GENETICS......Page 3248
DIAGNOSIS......Page 3251
SPINAL DEFORMITIES, GENERAL......Page 3253
IMAGING......Page 3256
CERVICAL DEFORMITY MANAGEMENT......Page 3258
SCOLIOSIS......Page 3267
KYPHOSCOLIOSIS......Page 3277
LORDOSCOLIOSIS......Page 3286
SACRUM AND SPONDYLOLISTHESIS......Page 3287
DURAL ECTASIA......Page 3288
ENLARGED VASCULAR CHANNELS......Page 3290
SUMMARY REMARKS......Page 3292
REFERENCES......Page 3293
102. Spinal Deformity in Skeletal Dysplasia Conditions: Diagnosis and Presentation......Page 3301
SPONDYLOEPIPHYSEAL DYSPLASIA CONGENITA......Page 3304
KNIEST DYSPLASIA, SPONDYLOEPIPHYSEAL METAPHYSEAL DYSPLASIA (STRUDWICK), AND STICKLER SYNDROME......Page 3306
OSTEOGENESIS IMPERFECTA......Page 3308
ACHONDROPLASIA/HYPOCHONDROPLASIA......Page 3311
CONRADI–HUNERMANN SYNDROME (X-LINKED CHONDRODYSPLASIA PUNCTATA 2)......Page 3314
METATROPIC DYSPLASIA......Page 3316
LARSON SYNDROME/ATELOSTEOGENESIS TYPE III......Page 3317
DIASTROPHIC DYSPLASIA......Page 3319
MUCOPOLYSACCHARIDOSES......Page 3322
SUMMARY......Page 3326
REFERENCES......Page 3327
103. Surgical Management of Spinal Deformity in Skeletal Dysplasias......Page 3334
INTRODUCTION......Page 3335
PREOPERATIVE MANAGEMENT......Page 3336
SPINAL INSTRUMENTATION......Page 3337
POSTOPERATIVE MANAGEMENT AND COMPLICATIONS......Page 3338
FORAMEN MAGNUM STENOSIS......Page 3341
ODONTOID HYPOPLASIA AND ATLANTOAXIAL INSTABILITY......Page 3344
CERVICAL KYPHOSIS......Page 3346
THORACIC AND THORACOLUMBAR KYPHOSIS......Page 3349
SCOLIOSIS AND KYPHOSCOLIOSIS......Page 3352
SPINAL STENOSIS......Page 3354
CONCLUSIONS......Page 3360
REFERENCES......Page 3361
104. The Spine in Osteogenesis Imperfecta......Page 3366
INTRODUCTION......Page 3367
BASILAR INVAGINATION......Page 3368
BONE DENSITY IN OSTEOGENESIS IMPERFECTA......Page 3372
SPONDYLOLYSIS AND SPONDYLOLISTHESIS IN OSTEOGENESIS IMPERFECTA......Page 3374
PROGRESSION OF SCOLIOSIS IN OSTEOGENESIS IMPERFECTA......Page 3378
TREATMENT......Page 3380
UNANSWERED QUESTIONS REMAIN......Page 3384
REFERENCES......Page 3386
105. Spinal Deformity in Familial Dysautonomia......Page 3390
INTRODUCTION......Page 3391
ETIOLOGY AND GENETICS......Page 3392
DIAGNOSIS......Page 3393
MEDICAL MANIFESTATIONS......Page 3394
ONSET AND CURVE BEHAVIOR......Page 3396
NONOPERATIVE TREATMENT......Page 3397
SURGICAL TREATMENT......Page 3398
SURGICAL MANAGEMENT......Page 3399
NEUROGENIC MONITORING/INTRAOPERATIVE CONCERNS......Page 3401
POSTOPERATIVE PERIOD......Page 3402
OTHER TYPES OF HSAN......Page 3404
SUMMARY......Page 3405
REFERENCES......Page 3413
106. Congenital Intraspinal Anomalies: Spinal Dysraphism—Embryology, Pathology, and Treatment......Page 3415
SPINAL DYSRAPHISM—EMBRYOLOGY, PATHOLOGY, AND TREATMENT......Page 3416
FOLIC ACID SUPPLEMENTATION AND OPEN NEURAL TUBE DEFECTS......Page 3418
ROLE OF GENETICS IN OPEN NEURAL TUBE DEFECTS......Page 3421
EPIDEMIOLOGY OF SPINA BIFIDA OCCULTA......Page 3423
EMBRYOLOGY......Page 3424
EMBRYOLOGY......Page 3432
ANTENATAL EVALUATION AND TREATMENT—FETAL SURGERY FOR MYELOMENINGOCELE......Page 3433
POSTNATAL PRESENTATION AND EVALUATION......Page 3434
POSTNATAL REPAIR OF MYELOMENINGOCELE......Page 3436
MONITORING FOR HYDROCEPHALUS AFTER MYELOMENINGOCELE REPAIR......Page 3441
TETHERED CORD SYNDROME......Page 3443
LIPOMYELOMENINGOCELE......Page 3446
SPLIT CORD MALFORMATIONS......Page 3456
DIASTEMATOMYELIA......Page 3457
DERMAL SINUS TRACT......Page 3466
MENINGOCELES......Page 3468
ALTERED CAUDAL DEVELOPMENT......Page 3472
TIGHT FILUM TERMINALE SYNDROME......Page 3473
TERMINAL MYELOCYSTOCELE......Page 3475
DYSRAPHISM ASSOCIATED WITH ANORECTAL MALFORMATION......Page 3476
CHIARI MALFORMATIONS......Page 3478
SYRINGOMYELIA......Page 3485
ASSOCIATED CARE ISSUES IN SPINAL DYSRAPHISM......Page 3488
RETETHERING AND REOPERATION......Page 3489
LONG-TERM CARE......Page 3492
SUMMARY......Page 3495
REFERENCES......Page 3496
107. Congenital Scoliosis and Kyphosis......Page 3504
INTRODUCTION......Page 3505
CHEST......Page 3507
CLASSIFICATION AND NATURAL HISTORY......Page 3510
FULLY SEGMENTED HEMIVERTEBRA......Page 3512
INCARCERATED HEMIVERTEBRA......Page 3515
UNILATERAL UNSEGMENTED BAR......Page 3516
UNILATERAL UNSEGMENTED BAR WITH CONTRALATERAL HEMIVERTEBRAE......Page 3517
COMPLEX MIXED VERTEBRAL ANOMALIES......Page 3518
CONGENITAL RIB AND CHEST WALL ANOMALIES......Page 3519
SECONDARY DEFORMING FEATURES REQUIRING TREATMENT......Page 3520
PROGNOSIS......Page 3522
SPINE......Page 3524
INTRASPINAL ANOMALIES......Page 3525
OTHER ASSOCIATED CONGENITAL ANOMALIES......Page 3528
SURGICAL TREATMENT......Page 3531
CONVEX GROWTH ARREST (HEMIEPIPHYSIODESIS)......Page 3536
EXCISION OF A HEMIVERTEBRA......Page 3537
IN SITU FUSION......Page 3544
GROWTH ROD......Page 3547
RIB EXPANSION SURGERY......Page 3552
MAGNETICALLY CONTROLLED GROWING RODS......Page 3558
CORRECTION AND SPINAL FUSION WITH INSTRUMENTATION......Page 3559
VERTEBRAL COLUMN RESECTION, CORRECTION, AND ARTHRODESIS......Page 3562
CONGENITAL KYPHOSIS AND KYPHOSCOLIOSIS......Page 3567
CLASSIFICATION AND NATURAL HISTORY......Page 3569
TREATMENT OF CONGENITAL KYPHOSIS......Page 3572
REFERENCES......Page 3574
108. Hemivertebra Resection......Page 3579
INTRODUCTION......Page 3580
SURGICAL PROCEDURES......Page 3581
SURGICAL PROCEDURE......Page 3584
COMPLICATION MANAGEMENT......Page 3592
RESULTS......Page 3599
TEMPORARY INSTRUMENTATIONS......Page 3603
COMPLICATIONS AND ADDITIONAL OPERATIONS......Page 3604
TRANSPEDICULAR INSTRUMENTATION AND SPINAL GROWTH......Page 3605
CONCLUSIONS......Page 3606
FUTURE DEVELOPMENTS......Page 3609
HEMIVERTEBRA RESECTION IN THE CERVICAL SPINE......Page 3612
REFERENCES......Page 3613
109. Thoracic Insufficiency Syndrome......Page 3616
INTRODUCTION......Page 3617
PREOPERATIVE PLANNING......Page 3624
THE EXPOSURE......Page 3630
IMPLANTATION OF THE SUPERIOR RIB CRADLE......Page 3634
THE OPENING WEDGE THORACOSTOMY......Page 3635
IMPLANTATION OF A HYBRID VEPTR......Page 3637
IMPLANTATION OF THE SECOND VEPTR: RIB-TO-RIB CONSTRUCT......Page 3639
CLOSURE......Page 3641
VEPTR OUTPATIENT EXPANSION......Page 3644
VEPTR REPLACEMENT PROCEDURE......Page 3645
COMPLICATIONS......Page 3647
THE FUTURE TREATMENT OF TIS......Page 3649
ACKNOWLEDGMENT......Page 3652
REFERENCES......Page 3653
110. Congenital Anomalies of the Cervical Spine in Children: Management of Segmental Instability and Spinal Canal Encroachment......Page 3656
INTRODUCTION......Page 3657
EMBRYOLOGY OF THE PROXIMAL CERVICAL SPINE (OCCIPUT TO C2–C3 DISC SPACE)......Page 3658
EMBRYOLOGY OF THE DISTAL CERVICAL SPINE (C3–C7)......Page 3659
DEVELOPMENTAL ANATOMY OF THE IMMATURE CERVICAL SPINE......Page 3661
THE ATLAS......Page 3662
THE AXIS......Page 3663
THE SUBAXIAL SPINE......Page 3664
BIOMECHANICS......Page 3666
DIAGNOSING ENCROACHMENT......Page 3667
SPINAL INSTABILITY......Page 3668
DEFINITIONS AND MEASUREMENTS OF INSTABILITY......Page 3669
CONGENITAL CAUSES OF CERVICAL SPINAL INSTABILITY......Page 3672
UPPER CERVICAL SPINE: (OCCIPUT TO C2–C3 DISC SPACE)......Page 3673
KLIPPEL–FEIL SYNDROME......Page 3680
22q11.2 DELETION SYNDROME (DIGEORGE SYNDROME)......Page 3681
HALO VEST IMMOBILIZATION......Page 3682
ANTERIOR SURGICAL APPROACHES......Page 3684
POSTERIOR SURGICAL APPROACHES......Page 3685
CONCLUSION......Page 3699
REFERENCES......Page 3700
111. Complications of the Surgical Treatment of Congenital Spinal Deformities......Page 3703
RELATED ANOMALIES CONTRIBUTING TO COMPLICATIONS IN CONGENITAL SCOLIOSIS......Page 3704
PREOPERATIVE TRACTION COMPLICATIONS IN CONGENITAL SCOLIOSIS......Page 3709
COMPLICATIONS FROM THE SURGICAL TREATMENT OF CONGENITAL SCOLIOSIS......Page 3710
CONCLUSION......Page 3720
REFERENCES......Page 3721
112. Considerations in Neuromuscular Spine Deformity......Page 3727
OVERVIEW AND PREVALENCE......Page 3728
INDICATIONS......Page 3729
ETHICAL CONSIDERATIONS......Page 3730
PREOPERATIVE ASSESSMENT......Page 3732
INFECTION......Page 3734
NEED FOR PELVIC FIXATION......Page 3735
BLEEDING......Page 3736
OUTCOMES MEASURES FOR NMS PATIENTS......Page 3737
REFERENCES......Page 3739
113. Preoperative Preparation for Neuromuscular Spine Surgery......Page 3743
DECISION MAKING......Page 3744
MEDICAL PREPARATION......Page 3748
CONSULTATIONS......Page 3749
SURGICAL PREPARATION......Page 3758
CONCLUSION......Page 3763
REFERENCES......Page 3764
114. Surgical Techniques Unique to Neuromuscular Scoliosis......Page 3776
INTRODUCTION......Page 3777
RISK OF COMPLICATIONS......Page 3778
CONCURRENT HIP PATHOLOGY......Page 3779
PRE- AND PERIOPERATIVE TRACTION......Page 3781
PHONE A FRIEND? TWO ATTENDING SURGEONS FOR THE TREATMENT OF NMS......Page 3782
INTRAOPERATIVE NEURAL MONITORING......Page 3784
SPECIAL POSITIONING CONSIDERATIONS......Page 3785
INTRAOPERATIVE TRACTION......Page 3787
WORKING AROUND A BACLOFEN PUMP......Page 3789
DECREASING BLOOD LOSS DURING EXPOSURE......Page 3790
RODS, SCREWS, WIRES, AND BANDS......Page 3794
FUSION TO THE PELVIS......Page 3796
SACRAL–ALAR–ILIAC SCREW INSERTION TECHNIQUE......Page 3799
TECHNIQUES TO CORRECT PELVIC OBLIQUITY AND SPINE DEFORMITY......Page 3803
BARBED SUTURE......Page 3812
ROLE OF PLASTIC SURGEON IN WOUND CLOSURE......Page 3814
CONCLUSION......Page 3815
REFERENCES......Page 3816
115. Pelvic Fixation in Neuromuscular Scoliosis......Page 3823
INTRODUCTION......Page 3824
PELVIC OBLIQUITY......Page 3826
INDICATIONS FOR PELVIC FIXATION......Page 3827
GALVESTON TECHNIQUE WITH UNIT ROD......Page 3829
ILIAC SCREWS......Page 3832
SACRAL–ALAR–ILIAC SCREWS......Page 3834
SUMMARY......Page 3838
REFERENCES......Page 3839
116. Spinal Muscular Atrophy, Duchenne Muscular Dystrophy, and Other Neuromuscular Disorders......Page 3842
CLASSIC NATURAL HISTORY......Page 3845
RECENT MEDICAL ADVANCES......Page 3846
SPINAL DEFORMITY......Page 3847
OUTCOMES......Page 3860
NATURAL HISTORY......Page 3862
RECENT MEDICAL ADVANCES......Page 3863
SPINAL DEFORMITY......Page 3864
SURGICAL CARE......Page 3865
OUTCOMES......Page 3868
CONGENITAL MYOTONIC DYSTROPHY......Page 3869
FRIEDREICH ATAXIA......Page 3871
CHARCOT–MARIE–TOOTH......Page 3872
ACKNOWLEDGMENTS......Page 3874
REFERENCES......Page 3875
117. Spinal Deformity in Patients With Cerebral Palsy and Rett Syndrome......Page 3893
INTRODUCTION......Page 3894
ONSET AND NATURAL HISTORY......Page 3895
CHARACTERISTICS OF SPINAL DEFORMITY IN CEREBRAL PALSY......Page 3896
ONSET AND NATURAL HISTORY......Page 3898
CHARACTERISTICS OF SPINAL DEFORMITY IN RETT SYNDROME......Page 3899
FUNCTIONAL EFFECTS OF NEUROMUSCULAR SPINAL DEFORMITY......Page 3901
NONOPERATIVE MANAGEMENT STRATEGIES......Page 3902
OPERATIVE MANAGEMENT......Page 3903
COMPLICATIONS......Page 3909
OUTCOMES......Page 3910
REFERENCES......Page 3911
118. Surgical Treatment of Spinal Deformity in Myelomeningocele......Page 3918
INTRODUCTION......Page 3920
TREATMENT GUIDELINES......Page 3921
RADIOGRAPHIC IMAGING......Page 3923
PATIENT EVALUATION......Page 3924
SURGICAL PLANNING......Page 3928
SURGICAL TECHNIQUES......Page 3933
WOUND MANAGEMENT......Page 3945
POSTOPERATIVE CARE......Page 3946
REFERENCES......Page 3949
119. Introduction and Current State of the Art......Page 3952
120. Cervical Instability and Kyphosis (Rheumatoid, Dwarfism, Degenerative, Others)......Page 3956
INTRODUCTION......Page 3957
ANATOMY OF THE CERVICAL SPINE......Page 3958
CERVICAL SPINAL STABILITY......Page 3960
PATHOPHYSIOLOGY OF CERVICAL INSTABILITY......Page 3961
EVALUATION AND DIAGNOSIS OF CERVICAL INSTABILITY......Page 3962
RHEUMATOID ARTHRITIS......Page 3968
TREATMENT OF INSTABILITY IN RA......Page 3970
CASE EXAMPLE 120.1: RHEUMATOID PANNUS......Page 3971
CONGENITAL/GENETIC DISORDERS WITH CERVICAL INSTABILITY......Page 3972
CASE EXAMPLE 120.2: OS ODONTOIDEUM......Page 3973
CERVICAL SAGITTAL ALIGNMENT......Page 3976
ETIOLOGY AND EVALUATION OF CERVICAL KYPHOSIS......Page 3982
GENERAL PRINCIPLES IN MANAGING CERVICAL KYPHOSIS......Page 3983
CASE EXAMPLE 120.3: CERVICAL SPONDYLOTIC MYELOPATHY WITH KYPHOSIS......Page 3984
POSTLAMINECTOMY KYPHOSIS......Page 3986
CASE EXAMPLE 120.4: DROPPED HEAD SYNDROME......Page 3990
CONGENITAL AND MISCELLANEOUS CONDITIONS WITH CERVICAL KYPHOSIS......Page 3991
CASE EXAMPLE 120.5: RENAL OSTEODYSTROPHY......Page 3994
ANKYLOSING SPONDYLITIS AND FIXED KYPHOSIS......Page 3995
CASE EXAMPLE 120.6: CERVICAL OSTEOTOMY......Page 3998
CONCLUSION......Page 4002
REFERENCES......Page 4003
121. Surgical Treatment of Scheuermann Kyphosis......Page 4008
INTRODUCTION......Page 4009
CLINICAL EVALUATION......Page 4011
RADIOGRAPHIC EVALUATION......Page 4014
NONOPERATIVE TREATMENT......Page 4016
OPERATIVE TREATMENT......Page 4019
SURGICAL PROCEDURE (SEE TABLE 121.3)......Page 4023
CONCLUSION......Page 4035
CLINICAL CASES 121.1......Page 4037
REFERENCES......Page 4044
122. Delayed Posttraumatic Deformity: Presentation and Management......Page 4047
INTRODUCTION......Page 4048
EPIDEMIOLOGY......Page 4049
PATIENT PRESENTATION......Page 4050
POSTTRAUMATIC SPINAL DEFORMITY......Page 4051
PAIN......Page 4055
NEUROLOGIC DEFICIT......Page 4056
SURGICAL CONSIDERATIONS......Page 4058
OUTCOME......Page 4063
CONCLUSION......Page 4068
REFERENCES......Page 4069
123. Ankylosing Spondylitis/Thoracolumbar Deformities......Page 4072
INTRODUCTION......Page 4073
SPINAL FRACTURE......Page 4075
DISCITIS......Page 4077
PSEUDARTHROSIS......Page 4079
KYPHOSIS......Page 4080
RADIOGRAPHIC FEATURES......Page 4085
EVALUATIONS OF KYPHOSIS......Page 4088
NONSURGICAL TREATMENT......Page 4090
SURGICAL TREATMENT FOR THORACOLUMBAR DEFORMITIES......Page 4091
OPERATIVE TECHNIQUE......Page 4092
OPERATIVE TECHNIQUE......Page 4095
OPERATIVE TECHNIQUE......Page 4098
COMPUTER-BASED SIMULATION: SURGIMAP SOFTWARE......Page 4103
MATHEMATICAL FORMULAS......Page 4104
INTRAOPERATIVE SUBLUXATION OF THE OSTEOTOMIZED VERTEBRA......Page 4106
FRACTURE AND OPENING OF ANTERIOR CORTEX OF THE OSTEOTOMIZED VERTEBRA......Page 4109
PSEUDARTHROSIS ADJACENT TO THE OSTEOTOMY......Page 4110
FLEXIBILITY OF CERVICAL SPINE......Page 4113
SPINAL OSTEOTOMY AND TOTAL HIP REPLACEMENT: WHICH SHOULD BE PERFORMED FIRST?......Page 4114
NEUROLOGIC DAMAGE......Page 4121
SUPERIOR MESENTERIC ARTERY SYNDROME (SMAS)......Page 4122
INTRAOPERATIVE SUBLUXATION......Page 4123
POSTOPERATIVE CARE AND REHABILITATION......Page 4128
CONCLUSIONS......Page 4129
REFERENCES......Page 4130
124. Cervicothoracic Extension Osteotomy for Chin-on-Chest Deformity......Page 4136
ETIOLOGY......Page 4137
RADIOLOGIC PATTERNS OF CHIN-ON-CHEST DEFORMITY......Page 4140
PREOPERATIVE PLANNING......Page 4143
ANESTHESIA AND POSITIONING......Page 4147
SURGICAL TECHNIQUE......Page 4148
COMPLICATION......Page 4153
CONCLUSION......Page 4156
REFERENCES......Page 4159
125. The Role of Osteotomies in the Cervical Spine......Page 4161
INTRODUCTION......Page 4162
HISTORY......Page 4163
PRESENTATION AND INDICATIONS......Page 4167
PREOPERATIVE EVALUATION......Page 4168
ANESTHESIA AND PATIENT POSITIONING......Page 4171
EXPOSURE......Page 4175
HEMOSTASIS......Page 4176
PEDICLE SUBTRACTION OSTEOTOMY FOR ANKYLOSING SPONDYLITIS......Page 4177
IATROGENIC CERVICAL DEFORMITY CORRECTION......Page 4185
BONE GRAFTING......Page 4196
DRAIN AND CLOSURE......Page 4200
POSTOPERATIVE MANAGEMENT......Page 4201
CONCLUSION......Page 4205
REFERENCES......Page 4206
126. Complications of Surgical Treatment of Kyphotic Deformities......Page 4208
INTRODUCTION......Page 4209
ETIOLOGY......Page 4210
SCHEUERMANN KYPHOSIS......Page 4211
NONIDIOPATHIC......Page 4212
PROXIMAL JUNCTIONAL KYPHOSIS AND FAILURE......Page 4214
DISTAL JUNCTIONAL KYPHOSIS AND FAILURE......Page 4216
PREVENTION......Page 4217
TREATMENT OF JUNCTIONAL KYPHOSIS......Page 4219
NEUROLOGIC COMPLICATIONS......Page 4222
CAUSES......Page 4225
PREVENTION......Page 4226
TREATMENT......Page 4228
PSEUDARTHROSIS/IMPLANT FAILURE......Page 4229
VASCULAR/OTHER......Page 4230
THROMBOEMBOLIC DISEASE......Page 4231
REFERENCES......Page 4232
127. Classification of Cervical Spine Injury......Page 4239
INTRODUCTION......Page 4240
HISTORIC CLASSIFICATION SYSTEMS......Page 4242
CERVICAL SPINE INJURY SEVERITY SCORE......Page 4245
SUBAXIAL CERVICAL SPINE CLASSIFICATION......Page 4246
ABCD......Page 4249
AOSPINE......Page 4250
MORPHOLOGY......Page 4252
FACET INJURY......Page 4253
NEUROLOGY......Page 4254
CASE-SPECIFIC MODIFIERS......Page 4255
CONCLUSION......Page 4257
REFERENCES......Page 4261
128. Classification of Thoracic, Lumbar, and Sacral Fractures......Page 4263
INTRODUCTION......Page 4264
DEFINING INSTABILITY......Page 4265
VALIDITY AND RELIABILITY......Page 4266
HISTORICAL OVERVIEW OF THORACOLUMBAR CLASSIFICATION SYSTEMS......Page 4267
MORPHOLOGY: FRACTURE PATTERN......Page 4269
INTEGRITY OF THE POSTERIOR LIGAMENTOUS COMPLEX......Page 4272
NEUROLOGIC STATUS......Page 4273
QUALIFIERS......Page 4274
AOSpine THORACOLUMBAR CLASSIFICATION......Page 4275
AOSpine SACRAL CLASSIFICATION......Page 4278
CONCLUSION......Page 4280
BURST FRACTURE WITH AN INTACT PLC......Page 4281
BURST FRACTURE WITH DISRUPTED PLC......Page 4282
TRANSLATIONAL INJURY WITH PLC DISRUPTION AND CAUDA EQUINA SYNDROME......Page 4284
REFERENCES......Page 4286
129. Surgical Management of Cervical Spine Fractures......Page 4289
INTRODUCTION......Page 4290
CRANIOCERVICAL DISSOCIATION......Page 4291
ODONTOID FRACTURES......Page 4292
C2 TRAUMATIC SPONDYLOLISTHESIS......Page 4297
BURST AND FLEXION–COMPRESSION INJURIES......Page 4298
FLEXION–DISTRACTION/FACET DISLOCATIONS......Page 4299
FACET FRACTURES......Page 4305
LATERAL MASS FRACTURES......Page 4306
EXTENSION–DISTRACTION INJURIES......Page 4307
CONCLUSION......Page 4310
REFERENCES......Page 4311
130. Anterior Decompression and Instrumentation Techniques for Thoracolumbar Fractures......Page 4315
EPIDEMIOLOGY......Page 4316
CLINICAL AND RADIOGRAPHIC ASSESSMENT......Page 4317
THORACOLUMBAR SPINE FRACTURE CLASSIFICATION......Page 4318
INDICATIONS FOR ANTERIOR CORPECTOMY......Page 4324
HIGH THORACIC T1–T5......Page 4327
THORACOLUMBAR APPROACH (T10–L1)......Page 4329
RETROPERITONEAL APPROACH L2–L5......Page 4330
TRANSPERITONEAL APPROACH L3–S1......Page 4331
ADDITIONAL APPROACHES......Page 4333
CORPECTOMY TECHNIQUE......Page 4334
INSTRUMENTATION......Page 4337
COMPLICATION AVOIDANCE AND MANAGEMENT......Page 4340
REFERENCES......Page 4341
131. Surgical Treatment of Thoracolumbar Spine Fractures: Posterior Decompression and Instrumentation Techniques......Page 4343
INTRODUCTION......Page 4344
BACKGROUND......Page 4345
CLASSIFICATION SCHEMES FOR THORACOLUMBAR AND LUMBAR SPINE INJURIES......Page 4346
INDICATIONS FOR SURGICAL TREATMENT OF TL FRACTURES......Page 4353
DISADVANTAGES......Page 4356
POSTERIOR INSTRUMENTATION......Page 4358
THORACIC PEDICLE ANATOMY......Page 4359
BIOMECHANICAL PRINCIPLES......Page 4360
PEDICLE SCREW PLACEMENT......Page 4362
DIRECT DECOMPRESSION......Page 4368
INDIRECT DECOMPRESSION AND REALIGNMENT......Page 4370
ROD PLACEMENT TECHNIQUES......Page 4374
POSTOPERATIVE MANAGEMENT......Page 4375
COMPLICATIONS......Page 4376
OUTCOMES......Page 4377
FUTURE TRENDS......Page 4378
SUMMARY......Page 4379
REFERENCES......Page 4382
132. Minimal Access Techniques for Spine Trauma......Page 4387
INTRODUCTION......Page 4388
PERCUTANEOUS VERTEBRAL CEMENT AUGMENTATION......Page 4390
PERCUTANEOUS PEDICLE SCREW FIXATION......Page 4393
FUSION TECHNIQUES FOR MINIMALLY INVASIVE THORACOLUMBAR TRAUMA......Page 4399
LESS INVASIVE POSTERIOR DECOMPRESSION......Page 4401
MINI-OPEN LATERAL CORPECTOMY......Page 4403
MINIMALLY INVASIVE TREATMENT OF CERVICAL SPINE FRACTURES......Page 4405
SUMMARY......Page 4406
REFERENCES......Page 4408
133. Management of Central Cord Syndrome......Page 4413
BACKGROUND......Page 4414
MEDICAL MANAGEMENT......Page 4417
SURGICAL MANAGEMENT......Page 4421
INDICATIONS......Page 4423
TIMING......Page 4424
OUTCOMES......Page 4425
NONOPERATIVE MANAGEMENT......Page 4427
SUMMARY......Page 4429
REFERENCES......Page 4430
134. Surgical Treatment of Sacral-Pelvic Fractures......Page 4435
INTRODUCTION......Page 4436
SURGICAL ANATOMY......Page 4438
BIOMECHANICS......Page 4442
CLINICAL EXAMINATION......Page 4444
IMAGING TECHNIQUES......Page 4446
ELECTROPHYSIOLOGIC EXAMINATION......Page 4448
INSUFFICIENCY AND STRESS FRACTURES OF THE SACRUM......Page 4449
DENIS AND ISLER CLASSIFICATIONS......Page 4451
TRANSVERSE SACRAL FRACTURE CLASSIFICATIONS......Page 4452
LUMBOSACRAL INJURY CLASSIFICATION SYSTEM......Page 4457
AOSpine SACRAL FRACTURE CLASSIFICATION SYSTEM......Page 4458
GENERAL CONSIDERATIONS......Page 4461
NONOPERATIVE TREATMENT......Page 4462
SURGICAL TREATMENT......Page 4466
PEDIATRIC INJURIES......Page 4483
COMPLICATIONS AND OUTCOMES......Page 4484
SUMMARY......Page 4488
REFERENCES......Page 4489
135. Novel Approaches to Neural Repair and Regeneration After Spinal Cord Injury......Page 4496
INTRODUCTION......Page 4497
EXCITOTOXICITY AND IMPAIRMENT OF IONIC HOMEOSTASIS......Page 4499
INFLAMMATORY/IMMUNOLOGIC RESPONSE......Page 4500
OUTCOMES ASSESSMENT IN ANIMAL MODELS......Page 4502
BLUNT SPINAL CORD INJURY PARADIGMS......Page 4503
PHARMACOLOGIC INTERVENTIONS......Page 4505
BIOLOGIC THERAPIES DIRECTLY APPLIED TO THE SPINAL CORD......Page 4506
CELL-BASED THERAPIES......Page 4509
CONCLUSION—THE TRANSLATION FROM BENCH TO BEDSIDE......Page 4513
REFERENCES......Page 4516
136. Outcomes Measures in Spinal Trauma......Page 4523
INTRODUCTION......Page 4524
MEASUREMENT OF OUTCOMES......Page 4526
CHALLENGES......Page 4528
OUTCOME MEASURES IN SPINAL CORD INJURY......Page 4531
OUTCOME MEASURES IN SPINAL COLUMN INJURY......Page 4534
MOST RECENT DEVELOPMENTS......Page 4536
CONCLUSION......Page 4540
REFERENCES......Page 4541
137. Introduction and State-of-the-Art: Tumors and Osteomyelitis......Page 4546
138. Benign Tumors of the Spine......Page 4549
INTRODUCTION......Page 4550
DIAGNOSIS......Page 4551
STAGING......Page 4552
BIOPSY......Page 4553
SURGICAL TREATMENTS......Page 4554
CHONDROGENIC TUMORS......Page 4558
OSTEOGENIC TUMORS......Page 4561
OSTEOGENIC TUMORS......Page 4563
GIANT CELL–RICH TUMORS......Page 4565
NOTOCHORDAL TUMORS......Page 4569
VASCULAR TUMORS......Page 4572
UNDEFINED TUMORS......Page 4573
UNDEFINED TUMORS......Page 4576
CONCLUSION......Page 4579
ACKNOWLEDGMENT......Page 4580
REFERENCES......Page 4581
139. Primary Malignant Tumors of the Spine......Page 4588
DIAGNOSIS AND STAGING......Page 4589
IMAGING......Page 4590
BIOPSY......Page 4591
STAGING OF MALIGNANT TUMORS......Page 4594
METASTATIC TUMORS......Page 4597
MARGINS AND SURGICAL PLANNING......Page 4598
WBB STAGING SYSTEM......Page 4599
INTRALESIONAL EXCISION......Page 4600
EN BLOC RESECTION......Page 4601
PALLIATIVE PROCEDURE......Page 4602
PLANNING......Page 4604
PLANNING......Page 4609
PLANNING......Page 4613
SINGLE POSTERIOR APPROACH......Page 4614
COMBINATION OF ANTERIOR APPROACH FIRST AND POSTERIOR APPROACH SECOND......Page 4615
FIRST POSTERIOR APPROACH, SECOND CONTEMPORARY ANTERIOR AND POSTERIOR APPROACHES......Page 4617
PITFALLS AND COMPLICATIONS......Page 4619
PITFALLS TO AVOID......Page 4621
ADJUVANT THERAPY......Page 4622
SACRIFICING FUNCTIONAL STRUCTURES......Page 4623
OSTEOSARCOMA......Page 4624
EWING SARCOMA......Page 4626
CHORDOMA......Page 4627
CHONDROSARCOMA......Page 4628
AUTHORS’ PERSPECTIVE—SUMMARY......Page 4630
ACKNOWLEDGMENTS......Page 4632
REFERENCES......Page 4633
140. The Surgical Treatment of Metastatic Spine Disease......Page 4637
INTRODUCTION......Page 4638
DECISION MAKING......Page 4640
SURGICAL APPROACH......Page 4647
RECONSTRUCTION OF MECHANICAL STABILITY......Page 4650
VASCULAR STUDIES AND EMBOLIZATION......Page 4652
ATLANTOAXIAL REGION......Page 4654
SUBAXIAL CERVICAL SPINE......Page 4656
THORACIC AND LUMBAR APPROACHES......Page 4659
CONCLUSION......Page 4662
REFERENCES......Page 4664
141. Intramedullary Spinal Cord Tumors......Page 4668
INTRODUCTION......Page 4669
EPIDEMIOLOGY......Page 4671
CLINICAL PRESENTATION......Page 4672
PHYSICAL EXAMINATION......Page 4673
ANATOMIC CONSIDERATIONS......Page 4674
EPENDYMOMAS......Page 4676
MYXOPAPILLARY EPENDYMOMA......Page 4678
ASTROCYTOMA......Page 4679
HEMANGIOBLASTOMA......Page 4680
CAVERNOUS ANGIOMA......Page 4683
SCHWANNOMA......Page 4685
METASTATIC DISEASE......Page 4687
GERMINOMA......Page 4689
DIAGNOSTIC IMAGING STUDIES......Page 4691
INFECTION......Page 4693
MULTIPLE SCLEROSIS AND TRANSVERSE MYELITIS......Page 4694
SARCOIDOSIS......Page 4696
SPINAL ARTERIOVENOUS FISTULAE......Page 4697
NONSURGICAL MANAGEMENT......Page 4699
SURGICAL TREATMENT......Page 4701
SURGICAL APPROACHES......Page 4703
TUMOR RESECTION......Page 4706
POSTSURGICAL CARE......Page 4710
NEUROLOGIC DEFICITS......Page 4711
POSTOPERATIVE INSTABILITY/DEFORMITY......Page 4712
FOLLOW-UP CARE......Page 4713
CHEMOTHERAPY......Page 4714
CONCLUSION......Page 4716
REFERENCES......Page 4717
142. Intradural Extramedullary Spinal Tumors......Page 4723
OVERVIEW......Page 4724
PRESENTATION......Page 4725
PREOPERATIVE EVALUATION AND IMAGING......Page 4726
NERVE SHEATH TUMORS......Page 4728
MENINGIOMAS......Page 4731
EPENDYMOMAS......Page 4732
PARAGANGLIOMAS......Page 4733
LEPTOMENINGEAL METASTASES......Page 4734
OTHERS......Page 4735
PRINCIPLES OF TREATMENT......Page 4736
APPROACHES......Page 4737
INTRADURAL COMPONENT......Page 4739
CLOSURE AND RECONSTRUCTION......Page 4744
POSTOPERATIVE MANAGEMENT......Page 4750
COMPLICATIONS......Page 4751
OUTCOMES AND FOLLOW-UP......Page 4752
ADJUVANT THERAPY......Page 4754
CONCLUSION......Page 4755
REFERENCES......Page 4756
143. Spinal Vascular Malformations......Page 4759
INTRODUCTION......Page 4760
CAVERNOUS MALFORMATIONS......Page 4762
ARTERIOVENOUS FISTULAS......Page 4763
ARTERIOVENOUS MALFORMATIONS......Page 4767
ARTERIOVENOUS FISTULAS......Page 4770
ARTERIOVENOUS MALFORMATIONS......Page 4773
IMAGING......Page 4774
ARTERIOVENOUS FISTULAS......Page 4775
ARTERIOVENOUS MALFORMATIONS......Page 4777
CAVERNOUS MALFORMATIONS......Page 4779
ARTERIOVENOUS FISTULAS......Page 4780
ARTERIOVENOUS MALFORMATIONS......Page 4784
CONCLUSION......Page 4787
REFERENCES......Page 4788
144. Spinal Infection/Osteomyelitis......Page 4791
BACKGROUND......Page 4792
PATHOPHYSIOLOGY......Page 4793
CLINICAL PRESENTATION......Page 4794
DIAGNOSTIC WORKUP......Page 4797
SURGICAL INDICATIONS......Page 4801
INFECTION PROPHYLAXIS......Page 4807
SURGICAL TREATMENT......Page 4808
CONCLUSION......Page 4814
REFERENCES......Page 4815
145. Sacral Tumors......Page 4822
GENERAL CONSIDERATIONS IN THE EVALUATION OF SACRAL TUMORS......Page 4823
PRIMARY TUMORS WITH A PREDILECTION FOR SACRAL INVOLVEMENT......Page 4827
PRIMARY BONE TUMORS ARISING IN THE SACRUM......Page 4833
METASTATIC/HEMATOPOIETIC SACRAL TUMORS......Page 4837
BENIGN BONE TUMORS......Page 4838
NEUROGENIC TUMORS......Page 4840
SACRAL INVASION FROM VISCERAL MALIGNANCIES......Page 4842
PRINCIPLES OF SACRAL TUMOR RESECTION......Page 4843
ONCOLOGIC OUTCOMES......Page 4852
CONCLUSIONS......Page 4854
REFERENCES......Page 4855
146. Adjuvant Therapy of Spinal Tumors......Page 4860
INTRODUCTION......Page 4861
BIOLOGIC BASIS OF TUMOR RADIATION RESPONSE......Page 4862
RADIATION DELIVERY TECHNOLOGY......Page 4864
TREATMENT PLANNING......Page 4865
TREATMENT DELIVERY......Page 4870
ALTERNATIVE METHODS OF RADIATION DELIVERY......Page 4872
TREATMENT PARADIGMS......Page 4875
OUTCOMES......Page 4876
TOXICITY/TOLERANCE......Page 4879
CONCLUSIONS......Page 4880
REFERENCES......Page 4881
147. Complications of Surgical Treatment of Tumor and Infection......Page 4885
INTRODUCTION......Page 4887
DURAL TEARS......Page 4888
BLOOD LOSS......Page 4889
CAPSULAR VIOLATIONS AND PLANNED SACRIFICE DURING EN-BLOC RESECTIONS......Page 4890
ACUTE/SUBACUTE......Page 4892
DELAYED......Page 4895
CONCLUSIONS......Page 4907
REFERENCES......Page 4908
148. Neurologic Complications in Spine Surgery......Page 4918
INTRODUCTION......Page 4919
PREVALENCE......Page 4920
MECHANISMS OF NEUROLOGIC COMPLICATIONS......Page 4922
PATIENT EVALUATION AND PREOPERATIVE PLANNING......Page 4923
INTRAOPERATIVE PREPARATION......Page 4925
MOTOR EVOKED POTENTIALS......Page 4926
ELECTROMYOGRAPHY......Page 4927
STAGNARA WAKE-UP TEST......Page 4928
MULTIMODALITY INTRAOPERATIVE MONITORING......Page 4930
INTRAOPERATIVE NEUROLOGIC COMPLICATIONS......Page 4931
STAGNARA WAKE-UP TEST......Page 4932
RELEASE OF CORRECTION......Page 4933
STEROID PROTOCOL......Page 4935
POSTOPERATIVE MANAGEMENT......Page 4936
DELAYED POSTOPERATIVE NEUROLOGIC COMPLICATIONS......Page 4937
CHAPTER SUMMARY......Page 4938
REFERENCES......Page 4939
149. Perioperative Spinal Cord Deficits and Myelopathy......Page 4942
INTRODUCTION......Page 4943
PATHOPHYSIOLOGY OF INJURY......Page 4944
PRESURGICAL AND POSTSURGICAL......Page 4945
CERVICAL SPINE......Page 4946
THORACIC AND LUMBAR SPINE......Page 4948
GENERAL MEASURES......Page 4950
NEURONAVIGATION......Page 4951
NEUROMONITORING......Page 4953
INITIAL MANAGEMENT......Page 4955
LATE MANAGEMENT......Page 4956
REFERENCES......Page 4958
150. Reconstruction of Complex Spinal Wounds......Page 4964
SPINAL WOUNDS: INCIDENCE AND ETIOLOGY......Page 4965
RECONSTRUCTIVE LADDER......Page 4967
ANATOMY OF THE PARASPINAL AND ASSOCIATED MUSCULATURE......Page 4970
CERVICAL AND UPPER THORACIC SPINE......Page 4971
TECHNIQUE—TRAPEZIUS MUSCULOCUTANEOUS FLAP......Page 4972
MIDDLE TO LOWER THORACIC SPINE......Page 4974
TECHNIQUE—LATISSIMUS DORSI FLAP......Page 4975
TECHNIQUE—ERECTOR SPINAE FLAP......Page 4977
LUMBAR SPINE......Page 4982
TECHNIQUE—VERTICAL RECTUS ABDOMINIS MUSCLE FLAP......Page 4984
FREE FLAPS......Page 4986
POSTOPERATIVE CARE......Page 4990
SUMMARY......Page 4994
REFERENCES......Page 4995
151. Vascular Complications......Page 4999
INTRODUCTION......Page 5000
ANATOMY......Page 5001
ANTERIOR PROCEDURES......Page 5002
POSTERIOR PROCEDURES......Page 5009
ANTERIOR PROCEDURES......Page 5011
POSTERIOR PROCEDURES......Page 5014
ANATOMY......Page 5017
ANTERIOR PROCEDURES......Page 5018
LATERAL PROCEDURES......Page 5020
POSTERIOR PROCEDURES......Page 5022
VERTEBROPLASTY/KYPHOPLASTY......Page 5025
CONCLUSION......Page 5026
REFERENCES......Page 5027
152. Postoperative Early and Late Wound/Implant Infections......Page 5034
INTRODUCTION......Page 5035
BACKGROUND......Page 5037
DIAGNOSIS......Page 5043
LABORATORY STUDIES......Page 5044
RADIOGRAPHIC STUDIES......Page 5047
TREATMENT AND OUTCOMES......Page 5051
PREVENTION......Page 5057
CONCLUSION......Page 5061
REFERENCES......Page 5062
153. Dural Lacerations, CSF Fistula, Pseudomeningoceles, and Strategies for Repair......Page 5068
INTRODUCTION......Page 5069
IATROGENIC......Page 5071
TRAUMATIC......Page 5072
CONGENITAL......Page 5073
COMPLICATIONS OF CSF LEAKAGE......Page 5074
TREATMENT—DURAL LACERATIONS......Page 5076
SUTURE TYPE AND TECHNIQUE......Page 5077
DURAL SEALANTS......Page 5078
DRAINS......Page 5079
REFRACTORY CSF FISTULA......Page 5080
ANTERIOR CERVICAL......Page 5081
MINIMALLY INVASIVE APPROACHES......Page 5082
TREATMENT—PSEUDOMENINGOCELE......Page 5084
REFERENCES......Page 5086
154. Pseudarthrosis in Spinal Deformity Surgery......Page 5095
INTRODUCTION......Page 5096
DEFINITION......Page 5097
CHARACTERISTICS OF ADULT PSEUDARTHROSIS IN ASD......Page 5099
RADIOGRAPHS......Page 5101
COMPUTED TOMOGRAPHY......Page 5105
BONE SCAN......Page 5106
RISK FACTORS......Page 5108
BIOLOGIC RISK FACTORS......Page 5109
BIOMECHANICAL RISK FACTORS......Page 5111
TREATMENT......Page 5113
APPROACH......Page 5115
INSTRUMENTATION......Page 5116
BONE GRAFT SUBSTITUTE AND OSTEOBIOLOGICS......Page 5122
CONCLUSION......Page 5124
REFERENCES......Page 5125
155. Legal Implications and Strategies......Page 5129
INTRODUCTION......Page 5131
COURT STRUCTURE......Page 5132
STEPS OF A LAWSUIT......Page 5134
NEGLIGENCE......Page 5137
TYPES OF DAMAGES......Page 5140
PLAINTIFF ATTORNEY PERSPECTIVE......Page 5141
THE NATURE AND EXTENT OF THE PATIENT’S INJURIES......Page 5142
SPECIAL ISSUES FOR AN ELDER OR DEPENDENT ADULT......Page 5143
A STRONG CASE......Page 5145
INFORMED CONSENT......Page 5146
PATIENT EDUCATION TOOLS AS ADJUNCTIONS......Page 5149
BATTERY......Page 5150
FRAUD......Page 5151
PROOF THAT MEDICAL RECORDS HAVE BEEN ALTERED......Page 5152
FAILURE TO RECOMMEND AND DOCUMENT SECOND OPINIONS......Page 5153
SOURCES OF SURGEON LIABILITY......Page 5154
PRACTICING WITH INCOMPETENT OR CARELESS PARTNERS IN YOUR MEDICAL GROUP......Page 5155
SURGEON LIABILITY AND ANESTHESIA PROVIDERS......Page 5156
SURGEON LIABILITY, PODS, AND CORPORATE RELATIONSHIPS......Page 5158
OFF-LABEL USE......Page 5160
SPINE MEDICOLEGAL LANDSCAPE......Page 5162
PHYSICIAN’S APOLOGIES......Page 5165
DOCUMENTATION......Page 5167
LEVEL OF SURGERY AND CHANGE OF SURGERY......Page 5168
SURGEON SUBSTITUTION......Page 5170
ALWAYS HAVE ADEQUATE MALPRACTICE INSURANCE......Page 5171
REPORT ALL CLAIMS PROMPTLY......Page 5172
HAVE A GOOD ATTORNEY......Page 5173
GIVE CONSENT TO SETTLE IF A DEMAND IS MADE WITHIN POLICY LIMITS ON A CASE WHERE YOU WERE WRONG......Page 5174
REGULATORY REPORTING......Page 5175
PRE-EVENT RISK REDUCTION STRATEGIES......Page 5177
MEDICAL ERRORS AND DISCLOSURE REQUIREMENTS......Page 5179
TELEMEDICINE......Page 5181
LACK OF LICENSURE JEOPARDIZES PROTECTION......Page 5182
CYBERMEDICINE......Page 5183
ACKNOWLEDGEMENT......Page 5185
BIBLIOGRAPHY......Page 5186
156. Unresolved Postoperative Spine Pain......Page 5194
INTRODUCTION......Page 5195
DIFFERENTIAL DIAGNOSIS/ETIOLOGY......Page 5197
HISTORY......Page 5201
IMAGING STUDIES......Page 5203
DIAGNOSTIC PROCEDURES......Page 5205
PHYSIOTHERAPY......Page 5209
MEDICATIONS......Page 5210
PSYCHOLOGICAL THERAPY......Page 5213
INTERVENTIONAL PROCEDURES......Page 5214
NEUROMODULATION......Page 5216
SURGICAL INDICATIONS......Page 5217
CONCLUSION......Page 5220
REFERENCES......Page 5221
157. Medical Complications Associated With Spinal Surgery......Page 5223
INTRODUCTION......Page 5224
PULMONARY COMPLICATIONS......Page 5226
PNEUMONIA......Page 5227
PNEUMOTHORAX AND HEMOTHORAX......Page 5228
PULMONARY EMBOLISM......Page 5229
CARDIAC COMPLICATIONS......Page 5231
RENAL FAILURE......Page 5232
GASTROINTESTINAL BLEED......Page 5234
PANCREATITIS......Page 5235
SUPERIOR MESENTERIC ARTERY SYNDROME......Page 5236
COLITIS......Page 5237
ALCOHOL WITHDRAWAL SYNDROME......Page 5238
CEREBRAL ISCHEMIA......Page 5239
COAGULOPATHIES......Page 5240
HYPONATREMIA......Page 5242
DECUBITUS ULCERS......Page 5243
CONCLUSIONS......Page 5245
REFERENCES......Page 5246
Index......Page 5250