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001 - Front Matter
Benzel’s Spine SurgeryTechniques, Complication Avoidance,and Management
002 - Copyright
Copyright
003 - Dedication
Dedication
004 - List of Contributors
List of Contributors
005 - Preface
Preface
005 -Contents -
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006 - Chapter 1 - History of Spine Surgery
1 - History of Spine Surgery
Antique Period and Spine Surgery
Medieval Period and Spine Surgery
Renaissance and Spine Surgery
Early Modern Period and Spine Surgery
Spinal Decompression and the Early Modern Period
Birth and Development of the Laminectomy
HJ Cline, Jr. and the Argument Against Spine Surgery
AG Smith and the First Successful Laminectomy
Laminectomy for Extramedullary Spinal Tumors
Laminectomy for Intramedullary Spinal Tumor
Variations in Laminectomy Technique
Charles A Elsberg: The Laminectomy in Stride
Laminectomy for Intervertebral Disc Herniation. Intervertebral disc pathology was first described by Rudolph Virchow54 in 1857 (...
Laminectomy for Cervical Disc Herniation. In 1905 Watson and Paul66 performed a negative exploration for cervical spinal cord tu...
Laminectomy for Spinal Stenosis. Unlike the herniated intervertebral disc, the stenotic spinal canal was described comparatively...
Approaches to the Spine
Dorsolateral Approaches to the Spine
Ménard’s Costotransversectomy
Capener’s Lateral Rhachotomy
Larson’s Lateral Extracavitary Approach
Spinal Stabilization and Deformity Correction
Birth and Development of Spinal Fusion and Spinal Instrumentation
Spinal Fusion
Interbody Cages
Spinal Instrumentation and Clinical Biomechanics
FW Holdsworth
Paul Harrington and the Birth of Modern Surgical Stabilization
Ventral Approaches to the Spine
Ventral Decompression and Stabilization
W Müller
BH Burns
Ito and Others
Hodgson and Stock
Ventral Deformity Reduction and the Development of Ventral Instrumentation
AF Dwyer
Laminoplasty
Minimally Invasive Spine Surgery, Robotics, and Navigation
Spine Imaging
Summary
007 - Chapter 2 - History of Spine Biomechanics
2 - History of Spine Biomechanics
Classical Antiquity
Mythological Period
Scientific Period
History of Spine Biomechanics
Pythagoras (580–500 bce)
Hippocrates (460–377 bce)
Plato (427–347 bce)
Aristotle (384–322 bce)
Herophilus of Chalcedon (335–280 bce)
Archimedes (287–212 bce)
Galen of Pergamon (130–200 ce)
Middle Ages (330–1453 ce)
Paulus of Aegina (625–690 ce)
Haly Abbas (930–994 ce)
Avicenna (981–1037 ce)
Albucasis (936–1013 ce)
The Renaissance and the Premodern Era
Leonardo da Vinci (1452–1519)
Andreas Vesalius (1514–1564)
Galileo Galilei (1564–1642)
René Descartes (1596–1650)
Giovanni Alfonso Borelli (1608–1679)
Robert Hooke (1635–1703)
Isaac Newton (1642–1727)
Leonard Euler (1707–1783)
Thomas Young (1773–1829)
Weber Brothers (1795–1891)
Etienne Jules Marey (1838–1904)
Christian Wilhelm Braune (1831–1892) and Otto Fischer (1861–1917)
Karl Culmann and Herman von Meyer
Julius Wolff (1836–1902)
Emergence of Modern Biomechanics in the 20th Century
In vivo Human Biomechanical Studies
Finite Element Analysis
Clinical Studies
Organizations and Publications
008 - Chapter 3 - History of Spinal Instrumentation_ The Modern Era
3 - History of Spinal Instrumentation: The Modern Era
The Harrington Rod Area
The Birth of Segmental Spinal Fixation
The Comeback of Hook-Rod Systems and the Rod Rotation Revolution
Pedicle Screws
Development of Dynamic Stabilization Systems
Interspinous Devices
Ventral Thoracolumbar Instrumentation
Dorsal Cervical Instrumentation
Ventral Cervical Instrumentation
Development of Dynamic Systems for Anterior Cervical Instrumentation
Total Disc Arthroplasty: Cervical and Lumbar
Cage Technology: Horizontal and Vertical
Minimally Invasive Approaches Using Instrumentation
Image Guidance and Robotics
Summary
009 - Chapter 4 - Functional Anatomy of the Spine
4 - Functional Anatomy of the Spine
Spinal Curvature
Vertebra
Atlas (C1) and Axis (C2)
Subaxial Cervical Vertebrae (C3‒C7)
Thoracic Vertebrae
Lumbar Vertebrae
Sacrum and Coccyx
Intervertebral Discs
Spinal Ligaments
Spinal Musculature
Spinal Cord
010 - Chapter 5 - Biomechanical Modeling of the Spine
5 - Biomechanical Modeling of the Spine
Biomechanics of Deformity Correction
Biomechanical Modeling of the Spine
Computational Biomechanical Modeling of the Spine
Applications of Biomechanical Models of the Spine
Biomechanical Modeling and Analysis of Pedicle Screw Patterns in Adolescent Idiopathic Scoliosis Instrumentation
Biomechanical Analysis of Adolescent Idiopathic Scoliosis Instrumentation Using Concave Rod Translation First Versus Convex Rod ...
Biomechanical Analysis of Adolescent Idiopathic Scoliosis Instrumentation Using Superelastic Nickel–Titanium Shape-Memory Alloy ...
Biomechanical Analysis of Multirod Constructs in Adult Spinal Instrumentation
Biomechanical Analysis of Transforaminal Lumbar Interbody Fusion
Verification, Validation, and Uncertainty Quantification
Conclusion
011 - Chapter 6 - The Intervertebral Disc_ Anatomy, Pathophysiology, and Aging
6 - The Intervertebral Disc: Anatomy, Pathophysiology, and Aging
Intervertebral Disc
Nucleus Pulposus
Annulus Fibrosus
The Intervertebral Disc: Anatomy, Pathophysiology, and Aging
Vascular Supply
Innervation
Physiology
Extracellular Matrix
Metabolic Balance
Disc Nutrition
Biomechanics
Aging
Extracellular Matrix Changes
Structural and Functional Changes
Summary
012 - 7 – Muscles and the Spine_ Dynamic Stabilization
7 - Muscles and the Spine: Dynamic Stabilization
Anatomic Considerations
Microanatomy
Structure
Classification of Muscle Type
Quantitative Studies of Muscle Architecture
Gross Anatomy
Erector Spinae (Divided by Motion Segment Control Arm)
Long Polysegmental Muscles
Shorter, Robust Polysegmental
Short (Deep) Intersegmental Muscles
Regional Special Muscles (Multiple Use or Axial and Limb)
Lumbopelvic
Cervicohumural
Functional-Postural Considerations
Conclusion
013 - Chapter 8 - Bone Physiology and Osteoporosis
8 - Bone Physiology and Osteoporosis
Function
Structure
Physiology
Bone Physiology and Osteoporosis
Bone Density, Quality, and Strength
Pathological Conditions
Osteoporosis
Osteomalacia
Osteopetrosis
Paget disease
Epidemiology of Osteoporosis
Prevalence
Incidence of Fragility Fractures
Future
Risk Factors
Morbidity
Mortality
Assessment of Bone Status
Bone Mineral Density
Fracture Risk Assessment Tool and Fracture Risk Prediction
Adjuncts to Dual Energy X-Ray Absorptiometry
Opportunistic Computed Tomography
Bone Health in Spine Patients
Vitamin D Deficiency
Osteoporosis in Spine Surgery Patients
Consequences of Osteoporosis in Spine Patients
Bone-Related Complications
Adjacent Segment Disease
Proximal Junctional Failure
Pseudoarthrosis
Iatrogenic Spondylolisthesis
Revision Surgery
Association With Poor Outcomes
Options Available for Salvage
Bone Health Optimization
Secondary Fracture Prevention
Conclusion
014 - Chapter 9 - Applied Anatomy of the Thoracolumbar Spine
9 - Applied Anatomy of the Thoracolumbar Spine
Vertebrae and Ligaments
Vertebral Body
Intervertebral Disc and Vertebral End Plate
Anterior Longitudinal Ligament
Posterior Longitudinal Ligament
Pedicle
Facet and Pars Interarticularis
Transverse Process
Rib Articulations of the Thoracic Spine
Lamina and Spinous Process
Ligamentum Flavum
Interspinous and Supraspinous Ligaments
Spinal Canal
Paraspinal Musculature
Neural Anatomy
Spinal Segmentation
Spinal Cord
Intradural Roots and the Cauda Equina
Lateral Recess, the Neural Foramen, and the Intraforaminal Root
Extraforaminal Spinal Nerve
Innervation of the Spine
Anomalous Root Anatomy
Vascular Anatomy
Upper Thoracic Spine Arterial Supply
Middle Thoracic, Lower Thoracic, and Lumbar Arterial Supply: The Segmental System
Spinal Cord Arterial Supply
Artery of Adamkiewicz
Nerve Root and Cauda Equina Arterial Supply
Venous Drainage of the Spinal Cord and Cauda Equina
Anatomic Variation and Surgical Localization
015 - Chapter 10 - Fundamentals of Spinal Alignment and Balance
10 - Fundamentals of Spinal Alignment and Balance
The Concept of the Spinal Organ and the Chain of Balance
Fundamentals of Spinal Alignment and Balance
The Importance of Pelvic Anatomy and its Parameters Upon Spine Alignment
Consequences
Practical Applications for Spinal Evaluation and Surgery
016 - Chapter 11 - Applied Anatomy of the Spinal Cord
11 - Applied Anatomy of the Spinal Cord
Functional Spinal Segment
Functional Anatomy of the Gray Matter
Functional Anatomy of the White Matter
Descending Tracts
Pyramidal Tracts
Extrapyramidal Tracts
Ascending Tracts
Dorsal Column–Medial Lemniscus Pathway
Anterolateral System (Spinothalamic Tracts)
Spinocerebellar Tracts
Clinical Correlations
Central Cord Syndrome
Spinal Cord Control of Visceral Organs
Autonomic Nervous System
Cardiovascular Function
The Spinal Cord and Respiratory Function
Spinal Cord and Bladder Control
Conclusion
017 - Chapter 12 - Molecular and Anatomic Mechanisms of Nerve Root, Spinal Nerve, and Peripheral Nerve Injury
12 - Molecular and Anatomic Mechanisms of Nerve Root, Spinal Nerve, and Peripheral Nerve Injury
Oligodendrocytes
Schwann Cells
Obersteiner–Redlich Zone
Motor Exit Point Glia
Transition From Dura to Perineurium
Apoptosis
Molecular and Anatomic Mechanisms of Nerve Root, Spinal Nerve, and Peripheral Nerve Injury
Necrosis
Anatomic Considerations and Mechanisms of Injury
Spinal Anatomy: Brief Review
Central Canal
Lateral Recess
Pedicles
Neural Foramen
Neural Structures
Dorsal Root Ganglion: Marking the Transition
Nerve Compression
Nerve Injury and Operative Implications
Degenerative Disease, Instability, and Spinal Misalignment
Iatrogenic Injury
Stretch Injuries
Double Crush Phenomenon
Familial Propensity to Compressive Neuropathy
Molecular Response to Injury and Putative Theraputic Options
Neuropathic Pain Considerations
Conclusion
018 - Chapter 13 - Spine Fusion_ Biology and Biomechanics
13 - Spine Fusion: Biology and Biomechanics
Histological Components
Spine Fusion: Biology and Biomechanics
Biology of Bone Graft Incorporation
Osteoinduction, Osteoconduction, and Osteogenicity
Graft Material
Autograft
Demineralized Bone Matrix
Allograft
Xenograft
Ceramics
Growth Factors and Cytokines
Host Immune Response and Incorporation of Autograft and Allograft in Spine Fusion
Cancellous and Cortical Bone Graft Incorporation
Temporal Profile of Graft Incorporation
Systemic Factors
Nicotine
Drugs
Osteoporosis
Hormones
Biomechanics of Fusion
Biomechanics of Graft Incorporation
Axis of Rotation and Spine Fusion
Modeling and Remodeling Associated With Spine Fusion
Load Sharing
Stress Shielding
Conclusion
019 - Chapter 14 - Implant Attributes_ Cantilever Beam Fixation
14 - Implant Attributes: Cantilever Beam Fixation
Cantilevers in Spinal Instrumentation
Bone–Screw Cantilever
Resistance to Shear Stress
Implant Attributes: Cantilever Beam Fixation
Resistance to Bending Moment
Other Forces and Moments at the Bone–Screw Interface
Screw–Rod Interface
Clinical Modes of Failure and Strategies to Reduce Their Incidence
Bone–Screw Interface Failure
Strategies to Increase the Resistive Moment
Strategies to Decrease the Applied Moment
Screw–Rod Interface Failure
Strategies to Reduce the Incidence of Implant Failure at the Screw–Rod Interface
Conclusion
020 - Chapter 15 - Biomechanics and Implant Materials_ The Anterior Column
15 - Biomechanics and Implant Materials: The Anterior Column
Interbody Fusion
Biomechanics and Implant Materials: The Anterior Column
Biomechanics
Cage Material and Design
Subsidence
Factors Affecting Construct Rigidity
Summary
021 - Chapter 16 - Biomechanics of Motion Preservation Techniques
16 - Biomechanics of Motion Preservation Techniques
Physical Principles
Biomechanics of Motion Preservation Techniques
Intervertebral Disc
Biomechanics of Intervertebral Disc Degeneration
Adjacent-Segment Degeneration
Biomechanics of Motion-Sparing Implants
Total Disc Arthroplasty
Clinical Performance
Ideal Total Disc Arthroplasty
Other Motion-Sparing Devices
Conclusion
Disclaimer
022 - Chapter 17 - Complications in Spine Surgery_ Expected Rates and Classification
17 - Complications in Spine Surgery: Expected Rates and Classification
Complications in Spine Surgery: Expected Rates and Classification
Complication Risk Factors
Operative Complications
Postoperative Complications
Complication Classification
Conclusion
023 - Chapter 18 - Spinal Cord Dysraphism and Myelodysplasia
18 - Spinal Cord Dysraphism and Myelodysplasia
Embryology
Spina Bifida Aperta––Open Neural Tube Defects
Myeloschisis
Myelomeningocele and Meningocele
Surgical Treatment
Fetal Myelomeningocele Repair
Outcomes
Spina Bifida Occulta––Closed Neural Tube Defects
Dermal Sinus Tract
Fatty Filum
Lipoma and Lipomyelomeningocele
Split Cord Malformation
Neurenteric Fistula or Cysts
Anterior Sacral Meningocele
Conclusion
024 - Chapter 19 - Congenital Spinal Deformity
19 - Congenital Spinal Deformity
Congenital Spinal Deformity
Associated Anomalies, Evaluation, Imaging
Classification
Natural History and Observation
Surgical Indications, Imaging, Intraspinal Anomalies
Surgical Options, Timing of Intervention, Global Versus Local Treatment
Common Contemporary Surgical Options
Conclusion
025 - Chapter 20 - Early-Onset Scoliosis
20 - Early-Onset Scoliosis
Classification
Initial Evaluation of the Child With Early-Onset Scoliosis
Consequences of Curve Progression: Pulmonary Development, Spinal Growth, and Thoracic Insufficiency Syndrome
Nonoperative Treatment of Early-Onset Scoliosis
Brace Treatment of Early-Onset Scoliosis
Cast Treatment of Early-Onset Scoliosis
Role of Halo-Gravity Traction in the Management of Early-Onset Scoliosis
Operative Treatment
Surgical Treatment of Isolated Hemivertebrae
Distraction-Based Treatment
Traditional Growing Rods and Rib-Based Distraction
Magnetically Controlled Growing Rods
Shilla
Complications
Conclusion
026 - Chapter 21 - Late-Onset Idiopathic Scoliosis
21 - Late-Onset Idiopathic Scoliosis
Curve Patterns/Progression
Late-Onset Idiopathic Scoliosis
Thoracic Curves
Lumbar Curves
Thoracolumbar Curves
Double-Major Curves
Skeletal Maturity/Progression
Summary
Cardiopulmonary Concerns
Restrictive/Obstructive Lung Disease
Mortality/Summary
Back Pain/Disability
Psychosocial Concerns
Pregnancy/Marriage
Body Image/Body Satisfaction/Cosmesis
Mental Health
Summary
027 - Chapter 22 - Scheuermann Disease
22 - Scheuermann Disease
History
Nomenclature
Clinically Relevant Embryology of the Vertebral Column
Postnatal Development of the Vertebral Column
Sagittal Spinal Alignment and Deformity
Epidemiology
Prevalence
Incidence
Gender Ratio
Associated Conditions
Age
Location
Classification
Genetics
Etiopathogenesis
Genetic Background
Disorganized Endochondral Ossification
Mechanical Factors
Repetitive Strain
Stature of the Sternum
Osteoporosis
Height and Body Mass Index
Pathophysiology
Vertebral Body Wedging
Thickening of the Anterior Longitudinal Ligament
Irregular Vertebral End Plate and Schmorl’s Nodes
Impaired Ring Apophysis
Disc Impairment
Pathology/Histopathology
Clinical Features
History
Onset
Progressive Deformity
Pain
Neurological Compromise
Cardiopulmonary Complaints
Cosmetic Issues
Physical Examination
Radiographic Features
Magnetic Resonance Imaging Features
Natural History
Presentation
Deformity Progression and Pain
Mechanics of Pulmonary Function
Cardiac Function
Thoracolumbar Disc Herniation
Neurological Sequelae
Diagnosis
The Berlin Criteria
Differential Diagnosis
Treatment
Approach Considerations
Nonoperative Treatment
Advice and Observation
Antiinflammatory Medications
Rehabilitation Exercises, Bracing, and Casting
Surgical Treatment
Surgical Indications
Goals of Surgical Correction
Preoperative Workup
Biomechanical Principles of Kyphosis Correction
Surgical Techniques
Literature Review/Current Controversies
What Techniques of Posterior Correction Should be Used
Postoperative Care
Patient-Reported Surgical Outcomes
Prognosis
Complications
Surgical Complications
Junctional Kyphosis
Conclusion
028 - Chapter 23 - Developmental Spondylolisthesis
23 - Developmental Spondylolisthesis
Developmental Spondylolisthesis
Pathophysiology
Hip–Spinopelvic Balance and Morphology
Postural Compensation Mechanisms in Developmental Spondylolisthesis
Spondylolisthesis Classification
Method for Classifying a Patient Using the Spinal Deformity Study Group Classification System
Slip Severity
Sacropelvic Balance
Spinopelvic Balance (If High-Grade With Unbalanced Sacropelvis)
Implications for Surgical Treatment
Treatment Algorithm Using the Spinal Deformity Study Group Classification System
029 - Chapter 24 - Craniovertebral Junction Deformities
24 - Craniovertebral Junction Deformities
Rotatory Atlantoaxial Dislocation
Vertical Atlantoaxial Dislocation
Lateral Atlantoaxial Dislocation
Goel Classification of Atlantoaxial Dislocation
Craniovertebral Junction Deformities
Surgery for Atlantoaxial Dislocation
Biomechanical Issues Regarding Stabilization
Atlantoaxial Fixation Techniques
Goel and Laheri Technique of Lateral Mass Plate and Screw Fixation. (see Figs. 24.1 to 24.4)
Alternative Sites of C2 Screw Insertion
Complications
Surgical Issues With Bleeding in the Region
Other Techniques of Atlantoaxial Fixation
C1–C2 Wiring Techniques
Occipitocervical Fixation
Irreducible or Fixed Atlantoaxial Dislocation
Basilar Invagination
Evolution of Personal Understanding
Reversibility of Musculoskeletal and Neural Alterations
Goel’s Clinical Grading System
Surgical Management
Atlantoaxial Fixation for Group A and B Basilar Invagination (Figs. 24.6 and 24.7)
Chiari Formation and Syringomyelia (Fig. 24.8)
Idiopathic Syringomyelia
Central Atlantoaxial Dislocation in Association With Cervical Myelopathy Related to Multisegmental Cervical Spondylosis, Ossific...
030 - Chapter 25 - Developmental Deformity in the Cervical Spine
25 - Developmental Deformity in the Cervical Spine
Developmental Deformity in the Cervical Spine
Occipitocervical Synostosis
Congenital Atlas Anomalies
Odontoid Anomalies
Posterior Arch Defects
Congenital Muscular Torticollis
Klippel–Feil Syndrome
Laxity of the Transverse Atlantal Ligament
Other Disorders With Common Cervical Spine Involvement
031 - Chapter 26 - Tarlov Cysts
26 - Tarlov Cysts
Histopathology
Clinical Findings
Tarlov Cysts
Radiological Features
Pathogenesis
Differential Diagnosis
Surgical Treatment
Patient Selection
Diagnostic Cyst Aspiration
Needle Aspiration and Fibrin Glue Injection
Surgical Extirpation of the Tarlov Cyst
Summary
032 - Chapter 27 - Dural and Meningeal Pathologies
27 - Dural and Meningeal Pathologies
Epidemiology
Pathophysiology
Dural and Meningeal Pathologies
Presentation
Imaging
Treatment and Outcome
Spinal Cord Herniation
Epidemiology
Pathophysiology
Presentation
Imaging
Treatment and Outcome
Cerebrospinal Fluid Leaks and Spontaneous Intracranial Hypotension
Epidemiology
Pathophysiology
Presentation
Imaging
Treatment and Outcomes
Segmental Amyotrophy Secondary to Dural Defect–Related Extraarachnoid Fluid Collections
Epidemiology
Pathophysiology
Presentation
Imaging
Treatment and Outcomes
033 - Chapter 28 - Chiari Malformations and Syringomyelia
28 - Chiari Malformations and Syringomyelia
Signs, Symptoms, and Imaging: Pathological Features
Chiari I
Chiari Malformations and Syringomyelia
Chiari II
Chiari III
Chiari IV
Chiari 1.5
Chiari 0
Pathophysiology
Patient Selection and Surgical Management
Diagnostic Imaging
Surgical Indications
Chiari I
Chiari II
Surgical Technique (Video 28.1)
Anesthetic and Positioning Considerations
Exposure
Dural and Arachnoid Opening
Graft Selection and Dural Closure
Postoperative Care and Complications
Prognosis
Chiari I
Chiari II
Summary
034 - Chapter 29 - Pathophysiology of Cervical Spondylosis, Radiculopathy, and Myelopathy
29 - Pathophysiology of Cervical Spondylosis, Radiculopathy, and Myelopathy
Cervical Spondylosis
Pathology
Cervical Spondylosis and Axial Neck Pain
Cervical Radiculopathy
Anatomy
Presentation
Etiology
Cervical Myelopathy
Pathophysiology
Biomechanics
Histopathology
Spinal Cord Ischemia and Cervical Spondylotic Myelopathy
Summary
035 - Chapter 30 - Pathophysiology of Thoracic Spondylosis, Radiculopathy, and Myelopathy
30 - Pathophysiology of Thoracic Spondylosis, Radiculopathy, and Myelopathy
Anatomic Consideration of the Thoracic Spine
Specific Pathologies
Ossification of the Ligamentum Flavum
Ossification of the Posterior Longitudinal Ligament
Ankylosing Spondylitis
Diffuse Idiopathic Skeletal Hyperostosis
Thoracic Myelopathy
Thoracic Disc Herniations
Disc Degeneration
Fractures
Management of Thoracic Spine Pathologies
036 - Chapter 31 - Pathophysiology of Intervertebral Disc Degeneration and Pain
31 - Pathophysiology of Intervertebral Disc Degeneration and Pain
Anatomy
Extracellular Matrix
Cells
Nutrition
Innervation
Function
The Degenerative Cascade
Physiological Degeneration
Pathological Degeneration
Degeneration Risk Factors
Age
Sex
Physical Loading
Smoking
Overweight or Obesity
Diabetes
Genetics
Diagnostics
Current and Future Diagnostic Methods With Magnetic Resonance Imaging
Summary and Obstacles to Improved Understanding and Clinical Translation
037 - Chapter 32 - Deformity in the Cervical Spine
32 - Deformity in the Cervical Spine
Background
Pathophysiology
Congenital Cervical Scoliosis
Idiopathic Scoliosis
Traumatic/Iatrogenic Scoliosis
Preoperative Evaluation
Clinical Evaluation
Radiographic Evaluation
Surgical Management
Anterior Subaxial Correction
Posterior Subaxial Correction
Combined Correction Techniques
Surgical Outcomes
Conclusion
038 - Chapter 33 - Adult Degenerative Scoliosis
33 - Adult Degenerative Scoliosis
Clinical Evaluation of the Adult Patient with Spinal Deformity
Diagnostic Imaging
Conventional Radiography
Advanced Imaging
Classification
Current Classification of Adult Spinal Deformity
Future Directions
Management of Adult Degenerative Scoliosis
Nonoperative Treatment Versus Surgical Approach
Optimizing the Patient Before Surgery
Conclusion
039 - Chapter 34 - Lumbar Spondylolisthesis
34 - Lumbar Spondylolisthesis
Isthmic Spondylolisthesis
Degenerative Lumbar Spondylolisthesis
Natural History
Management
Lumbar Spondylolisthesis
Transforaminal Lumbar Interbody Fusion
Anterior Lumbar Interbody Fusion
Lateral Lumbar Interbody Fusion
Oblique Lumbar Interbody Fusion
Surgery for Spondylolisthesis in the Elderly
Management of Osteoporosis
Surgical Considerations for Patients With Osteoporosis
Cost Effectiveness
Guidelines
Surgical Treatment
Conclusion
040 - Chapter 35 - Occipitocervical Injuries
35 - Occipitocervical Injuries
General Principles
Diagnosis and Management
C0––Occipital Condyle Fractures
C0–C1––Atlantooccipital Dislocations
C1 Fracture
Transverse Ligament Injuries
Rotatory C1–C2 Subluxations
C2 Fractures
Odontoid Fractures
C2 Body Fractures
C2 Pars/Pedicle Fractures (Hangman Fractures)
Combination Occipitocervical Junction Injuries
Surgical Procedures
General Principles
Preoperative Care
Intraoperative Care
Postoperative Care
Occipitocervical Junction Fusions
Dorsal C1–C2 and C1–C3 Fixation
Odontoid Screw Fixation
Ventral C1–C2 Fixation
Ventral C2–C3 Fixation
Dorsal Occipital Cervical Fusion
Summary
041 - Chapter 36 - Subaxial Cervical Spine Injuries
36 - Subaxial Cervical Spine Injuries
Anatomy
Clinical Assessment
Radiographic Assessment
Injury Classification
Subaxial Injury and Classification
AOSpine Classification System
Management
Prehospital Immobilization and Transportation
Initial Reduction
Acute Cardiopulmonary Management
Intensive Care Unit Status
Pulmonary Care
Cardiovascular Factors
Pharmacological Therapy
Acute Central Cord Syndrome
Spinal Cord Injury Without Radiological Abnormality
Treatment by Fracture Type
Simple Compression Fractures
Burst Compression Fractures
Teardrop Fractures
Simple Posterior Element Fractures
Facet Fractures
Facet Dislocations/Severe Flexion Distraction Injuries
Severe Hyperextension Injuries
Fracture Dislocations
Associated Vertebral Artery Injury
Prognosis
Conclusion
042 - Chapter 37 - Thoracic and Lumbar Spine Injuries
37 - Thoracic and Lumbar Spine Injuries
Evaluation and Diagnosis
Assessment in the Emergency Department
Imaging
Classification of Thoracolumbar Fractures
Denis Three-Column Classification System
Magerl AO Classification System
Thoracolumbar Injury Classification and Severity Score
AOSpine Thoracolumbar Injury Classification System
Management of Thoracolumbar Fractures
Nonoperative Management
Operative Management
Timing of Surgery
Postoperative Management
Management of Specific Thoracolumbar Injuries
Compression Fractures
Burst Fractures
Flexion-Distraction Injuries
Fracture-Dislocations
Conclusion
043 - Chapter 38 - Peripheral Nerve Injury
38 - Peripheral Nerve Injury
Anatomy and Physiology of the Peripheral Nervous System
Biology of Nerve Injury and Repair
The Nerve Cell Body and Proinflammatory Response in the Nerve Injury Zone
The Proximal Stump
The Interstump Gap
The Distal Stump
The Role of Neurotrophic Factors in Regeneration
Schwann Cells and Injury Outcomes
Central Nervous System Versus Peripheral Nervous System Regeneration
Nerve Injury Grading and Prognosis
Nerve Injury Mechanisms
Direct Nerve Injury (Trauma)
Medium- to High-Energy
Low-Energy
Indirect Nerve Injury (Complex Nerve Injuries)
Electrical
Thermal
Irradiation
Current and Future Surgical Nerve Repair Concepts
Innovative Current and Future Directions
Cauda Equina Syndrome
Definition and Significance
Pathophysiology
Neurogenic Bladder
Cauda Equina Syndrome Secondary to Disc Herniation
Clinical Syndrome
Clinical Course
Diagnostic Imaging
Timing of Surgical Intervention
044 - Chapter 39 - Spinal Cord Injury
39 - Spinal Cord Injury
Mechanisms of Spinal Cord Injury
Pathophysiology
Primary Injury
Secondary Cascade
Spinal Cord Injury
Clinical Manifestations of Spinal Cord Injury
American Spinal Injury Association Classification
Patterns of Incomplete Spinal Cord Injury
Central Cord Syndrome
Anterior Cord Syndrome
Posterior Cord Syndrome
Brown–Séquard Syndrome
Conus Medullaris Injury
Cauda Equina Syndrome
Special Considerations
Cervicomedullary Injury
Penetrating Cord Injuries
Conclusion
045 - Chapter 40 - Spinal Injuries in Sports
40 - Spinal Injuries in Sports
Sport-Specific Spinal Injuries
American Football
Baseball and Softball
Spinal Injuries in Sports
Basketball
Cycling
Equestrian Sports
Gymnastics
Ice Hockey
Mixed Martial Arts
Rugby
Water Sports
Wrestling
Cervical Spine and Brachial Plexus
Cervical Sprains, Strains, and Contusions
Brachial Plexus Neurapraxia
Central Cord Syndrome
Cervical Cord Neurapraxia and Transient Quadriplegia
Traumatic Intervertebral Disc Herniation
Minor Cervical Fractures
Compression Fractures
Spinous Process Fractures
Isolated Laminar Fractures/Facet Fractures
Catastrophic Cervical Spine Injury
Upper Cervical Spine Injury
Lower Cervical Spine Injury
On-Site Evaluation and Management of Spinal Cord Injury
Primum non Nocere
On-Site Management
Off-the-Field Management
Thoracic Spine
Lumbosacral Spine
Disc Herniation
Facet Syndrome
Pars Interarticularis Injury
Impending Spondylolysis or Impending Pars Defect
Spondylolysis and Spondylolisthesis
Summary
046 - Chapter 41 - Rheumatoid Arthritis
41 - Rheumatoid Arthritis
Pathophysiology
Clinical Manifestations
Radiological Evaluation
Operative Indications
Specific Regions of the Spine
Cervical Spine
Upper Cervical Spine
Lower Cervical Spine
Thoracic and Lumbar Spine
Surgical Management of the Rheumatoid Spine
Surgical Techniques
C1–C2 Stabilization
Dorsal Techniques
Screw Fixation
Occipitocervical Fusion
Transoral Surgery
Subaxial Cervical, Thoracic, and Lumbar Surgery
Postoperative External Orthoses
Postoperative Results
Neurological Outcome
Fusion Outcome
Mortality
Medical Adjuncts
Summary
047 - Chapter 42 - Ankylosing Spondylitis and Related Disorders
42 - Ankylosing Spondylitis and Related Disorders
Introduction and Epidemiology
Pathophysiology
Clinical Manifestations and Diagnosis
Laboratory Findings
Radiographic Findings
Nonoperative Treatment Modalities
Operative Interventions: Fractures
Deformity
Preoperative Planning
Osteotomy: Cervical
Osteotomy: Thoracolumbar
Cervical Pedicle Subtraction Osteotomy: C7 Osteotomy Technique
Complications
Conclusion
048 - Chapter 43 - Ossification of the Posterior Longitudinal Ligament
43 - Ossification of the Posterior Longitudinal Ligament
Natural History
Progression of Ossification
Progression of Myelopathy
Ossification of the Posterior Longitudinal Ligament
Genetic Expression and Biomarkers
Symptoms and Diagnosis
Imaging Evaluation and Classification
Diagnosis of Ossification of the Posterior Longitudinal Ligament
Dural Ossification
Intramedullary Signal Change on Magnetic Resonance Imaging
Systematic Ossification in Patients With Ossification of the Posterior Longitudinal Ligament
Nonoperative Treatment for Ossification of the Posterior Longitudinal Ligament
Surgical Treatment for Cervical Ossification of the Posterior Longitudinal Ligament
Surgical Selection for Cervical Ossification of the Posterior Longitudinal Ligament
Anterior Decompression and Fusion
Laminoplasty
Posterior Decompression With Fusion
Anterior Versus Posterior Surgery
Posterior Laminectomy With Fusion Versus Laminoplasty
Summary of Surgical Procedures for Cervical Ossification of the Posterior Longitudinal Ligament
Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament
Surgical Complications of Thoracic Ossification of the Posterior Longitudinal Ligament
Conclusion
049 - Chapter 44 - Primary Infections of the Spine
44 - Primary Infections of the Spine
Definition and Clinical Significance
Primary Infections of the Spine
Epidemiology
Etiology
Pathophysiology
Clinical Presentation and Course
Clinical Symptoms
Clinical Signs
Differential Diagnosis
Diagnostic Modalities and Imaging
Blood Investigations
Radiological Imaging
Nuclear Scans
Culture/Sensitivity and Molecular Diagnostics
Classification System
Treatment
Nonoperative Treatment
Surgical Therapy
Spinal Epidural Abscess
Modic Changes and Subclinical Infections
Clinical Outcome, Treatment Failure, and Relapse
Tubercular Spondylodiscitis
History and Background
Epidemiology
Etiopathogenesis
Histopathology of Tubercular Lesions
Pathogenesis of Vertebral Destruction and Deformity
Pathogenesis of Deformity Progression in Adults Versus Children
Clinical Presentation
Pain
Cold Abscesses
Spinal Deformity
Neurological Deficit
Atypical Presentations141
Diagnostic Investigations
Laboratory Investigations
Immunological Tests
Imaging
Nuclear Scans
Tissue Sampling
Treatment
Nonoperative Treatment
Surgical Treatment
General Principles of Surgical Management in Healed Tuberculosis
Other Granulomatous Spinal Lesions
Brucellosis
Fungal Infections
Conclusion
050 - Chapter 45 - Secondary Infections of the Spine
45 - Secondary Infections of the Spine
Secondary Infections of the Spine
Prevention
Clinical Presentation
Diagnostic Workup
Management
Conclusion
051 - Chapter 46 - Primary Tumors of the Spine
46 - Primary Tumors of the Spine
Symptoms
Radiological Evaluation
Management
Biopsy
Medical Staging
Surgical Staging and Classification
Treatment
Medical Therapy
Surgery
Complications
Radiotherapy
Primary Lesions
Benign Primary Tumors
Osteochondroma
Hemangioma
Eosinophilic Granuloma
Aneurysmal Bone Cyst
Osteoid Osteoma
Osteoblastoma
Chondroma and Enchondroma
Locally Aggressive (Benign) Tumors
Giant Cell Tumor
Chordoma
Malignant Primary Tumors
Multiple Myeloma and Plasmacytoma
Ewing Sarcoma
Osteosarcoma
Chondrosarcoma
Future Directions
Conclusion
052 - Chapter 47 - Metastatic Tumors of the Spine
47 - Metastatic Tumors of the Spine
Imaging Findings
Metastatic Tumors of the Spine
Evaluation
Neurological Function
Oncological Status
Mechanical Instability
Systemic Considerations
Management
Surgical Approaches
Cervical Spine
Thoracic Spine
Lumbar
Sacrum
Minimally Invasive Surgery
Vertebroplasty and Kyphoplasty
Conclusion
053 - Chapter 48 - Intradural Extramedullary Spine Tumors
48 - Intradural Extramedullary Spine Tumors
Patient Presentation
Intradural Extramedullary Spine Tumors
Nerve Sheath Tumors
Neurofibroma
Background
Schwannoma
Background
Treatment
Outcomes
Meningioma
Treatment
Outcomes
Myxopapillary Ependymoma
Imaging
Outcome
Other Histological Subtypes
Surgical Considerations
Radiation Therapy and Stereotactic Radiosurgery
Conclusion
054 - Chapter 49 - Intramedullary Spinal Cord Lesions
49 - Intramedullary Spinal Cord Lesions
Patient Selection
Intramedullary Spinal Cord Lesions
Surgical Objectives
Surgical Technique
Advances in Surgical Approaches
Postoperative Management
A Note on Differential Diagnosis
Summary
055 - Chapter 50 - Brachial Plexus Tumors Extending Into the Cervicothoracic Spine
50 - Brachial Plexus Tumors Extending Into the Cervicothoracic Spine
Brachial Plexus Tumors Extending Into the Cervicothoracic Spine
Surgical Approaches
Surgical Considerations for Brachial Plexus Tumors Extending Into the Cervical and Upper Thoracic Spine
Dorsal Approach
Ventral Supraclavicular Approach
Dorsal Subscapular Approach
Conclusion
056 - Chapter 51 - Spinal Disorders Associated With Connective Tissue Disorders
51 - Spinal Disorders Associated With Connective Tissue Disorders
General Considerations
Atlantoaxial Instability
Basilar Invagination
Cervical Failure of Segmentation
Congenital Scoliosis
Dystrophic Scoliosis
Kyphosis
Dural Ectasia
Thoracic Dystrophy
Spinal Deformity From Soft Tissue Contractures
Spinal Stenosis
Spondylolisthesis
Spinal Angiomas
Summary
057 - Chapter 52 - Osteoporosis, Osteomalacia, and Metabolic Bone Disease
52 - Osteoporosis, Osteomalacia, and Metabolic Bone Disease
Osteoporosis
Definition
Diagnosis of Osteoporosis
Prevalence and Costs
Pathophysiology
Risk Assessment
Morbidity and Mortality
Prevention of Osteoporosis
Hormone Replacement Therapy
Nutrition
Exercise
Who Should be Treated
Pharmacological Therapy
Osteomalacia
Clinical Features/Diagnosis
Treatment
Paget Disease of the Bone
Definition, Epidemiology, and Pathophysiology
History and Clinical Presentation
Diagnosis
Radiographic Findings
Laboratory Manifestations
Treatment
Surgical Considerations in Metabolic Bone Disease
Management of Fractures of the Spine Attributed to Osteoporosis
Fixation Strategies in Osteoporotic Bone
Spinal Mobilization with Osteotomies: Limitations of Minimally Invasive Surgery
Surgical Considerations in Paget Disease of the Spine
Surgical Considerations in Osteomalacia of the Spine
Preoperative Evaluation and Management of Osteoporosis in Spinal Fusion Surgery
Screening
058 - Chapter 53 - Vascular Malformations of the Spine
53 - Vascular Malformations of the Spine
History and Nomenclature
Embryology and Vascular Anatomy
Imaging Techniques
Extradural Arteriovenous Fistulas
Demographics
Pathogenesis
Management
Outcomes
Type 1 Dural Arteriovenous Fistulas
Demographics
Pathophysiology
Management
Outcomes
Type II Glomus Arteriovenous Malformations
Pathophysiology
Demographics
Management
Type III Juvenile Extradural-Intradural Arteriovenous Malformations
Pathophysiology
Demographics
Management
Outcome
Type IV Intradural Perimedullary Arteriovenous Fistula
Pathophysiology
Demographics
Management
Outcomes
Conus Arteriovenous Malformations
Spinal Aneurysms
Demographics and Pathophysiology
Management
Outcomes
Cavernous Angiomas
Demographics
Management
059 - Chapter 54 - Neuromuscular Disorders in the Pediatric Spine
54 - Neuromuscular Disorders in the Pediatric Spine
Classification of Neuromuscular Scoliosis
General Considerations for Patients With Neuromuscular Scoliosis
Natural History of Neuromuscular Scoliosis
General Goals of Treatment in the Neuromuscular Population
General Preoperative Considerations
General Goals of Surgery in the Neuromuscular Population
General Intraoperative Considerations
General Postoperative Considerations in Patients With Neuromuscular Scoliosis
Neuromuscular Scoliosis Secondary to Cerebral Palsy
Nonoperative Management
Specific Preoperative Considerations for Patients With Cerebral Palsy
Outcomes of Corrective Scoliosis Surgery in Patients With Cerebral Palsy
Neuromuscular Scoliosis Secondary to Myelodysplasia
Specific Preoperative Considerations in Patients With Scoliosis Because of Myelomeningocele
Intraoperative Considerations for Patients With Myelomeningocele
Outcomes in Patients With Scoliosis Secondary to Myelomeningocele
Neuromuscular Deformity in the Adult
Management of Neuromuscular Deformity in the Adult
Summary
060 - Chapter 55 - Neuromuscular Disorders in the Adult Spine
55 - Neuromuscular Disorders in the Adult Spine
Pathophysiology
Classification and Evaluation
Parkinson Disease
Management
Nonoperative Interventions
Surgical Intervention
Primary Myopathies
Management
Immunomodulatory Disorders (Multiple Sclerosis)
Management
Conclusion
061 - Chapter 56 - Postoperative Spinal Disorders—Cervical
56 - Postoperative Spinal Disorders—Cervical
Background
Anterior Cervical Spine Surgery
Anterior Surgery Biomechanics
Short-Term Complications
Pseudoarthrosis After Anterior Cervical Spine Surgery
Adjacent Segment Disease After Anterior Cervical Spine Surgery
Posterior Cervical Spine Surgery
Posterior Surgery Biomechanics
Early Postoperative Complications in Posterior Cervical Spine Surgery
Postlaminectomy Kyphosis in Posterior Cervical Spine Surgery
Pseudoarthrosis in Posterior Cervical Spine Surgery
Fusion Choices in Posterior Cervical Spine Surgery
Avoiding Iatrogenic Destabilization
Conclusion
062 - Chapter 57 - Postoperative Spinal Deformity
57 - Postoperative Spinal Deformity
Pathophysiology: Prevalence and Impact
Cervical Spine Alignment
Lumbar Degenerative Alignment
Thoracolumbar Deformity Alignment
Avoiding Fusion of the Spine in Malalignment
Treatment of Postoperative Malalignment of the Spine
Conclusion
063 - Chapter 58 - Adjacent Segment Degeneration and Disease of the Cervical Spine
58 - Adjacent Segment Degeneration and Disease of the Cervical Spine
Biomechanics of Adjacent Segment Pathology
Adjacent Segment Degeneration and Disease of the Cervical Spine
Adjacent Segment Degeneration (Radiographic Adjacent Segment Pathology)
Adjacent Segment Disease (Clinical Adjacent Segment Pathology)
Prevention of Adjacent Segment Pathology
Minimize Disruption of Surrounding Soft Tissue
Patient/Level Selection
Sagittal Alignment
Authors’ Perspective
064 - Chapter 59 - Adjacent Segment Degeneration and Disease of the Lumbar Spine
59 - Adjacent Segment Degeneration and Disease of the Lumbar Spine
Epidemiology
Risk Factors
Adjacent Segment Degeneration and Disease of the Lumbar Spine
Surgical Strategies to Avoid Adjacent Segment Disease
Surgical Strategies to Manage Adjacent Segment Disease
Outcomes and Complications
Conclusion
065 - Chapter 60 - Proximal and Distal Junctional Kyphosis and Failure
60 - Proximal and Distal Junctional Kyphosis and Failure
Adolescent Idiopathic Scoliosis
Proximal and Distal Junctional Kyphosis and Failure
Adult Spinal Deformity
Scheuermann Kyphosis
Impact of Proximal Junctional Kyphosis and Distal Junctional Kyphosis
Strategies for Prevention
Conclusion
066 - Chapter 61 - Physical and Neurological Examination
61 - Physical and Neurological Examination
Taking a Medical History
General Physical Examination
Spine Examination
Posture
Palpation and Range of Motion Testing of the Spine
Cervical Spine
Thoracic Spine
Lumbar Spine
Neurological Examination
Motor Examination
Cervical Spine
Lumbar Spine
Gait and Coordination Testing
Deep Tendon and Superficial Reflexes
Other Pathological Reflexes
Sensory Examination
Provocative Nerve Root or Nerve Testing
Cervical Spine and Arm Provocative Examination Maneuvers
Lumbar Spine and Leg Provocative Examination Maneuvers
Differentiating Spinal Cord and Peripheral Nerve Pathology From Bony or Soft Tissue Pathology
Cervical Radiculopathy Versus Upper Extremity Pathology
Shoulder
Elbow
Sacroiliac Joint
Hip Joint
Video-Telemedicine Spine Evaluation During the COVID-19 Pandemic
067 - Chapter 62 - Sagittal Spinal Alignment_ An Evolutionary Perspective
62 - Sagittal Spinal Alignment: An Evolutionary Perspective
Sagittal Spinal Alignment: An Evolutionary Perspective
The Anatomical Transition From Quadrupeds to Bipeds
The Establishment of Spinal Parameters
Radiographic Measurement of Global Spinal Alignment
Clinical Relevance of the Spinopelvic Relationship
The Contribution of Pelvic Anatomy to Global Alignment
The Relevance of Sagittal Balance to Spinal Surgery Planning
Conclusion
068 - 63 – Spinal Alignment_ Significance and Preoperative Planning
63 - Spinal Alignment: Significance and Preoperative Planning
Clinical and Radiographic Evaluation
Etiology of Sagittal Malalignment
Exhaustion of Nonsurgical Management
Surgical Management
Conclusion
069 - Chapter 64 - Overview of Imaging Procedures Available for Spinal Diagnosis
64 - Overview of Imaging Procedures Available for Spinal Diagnosis
Plain Radiography
Myelography
Fluoroscopy
Nuclear Scans
Computed Tomography
Ultrasonography
Discography
Magnetic Resonance Imaging
Diffusion Tensor Imaging
Conclusion
070 - Chapter 65 - Electrodiagnostic Studies
65 - Electrodiagnostic Studies
Key Anatomy for Electrodiagnosis
Nerve Fiber Injury Types and Relevance
Components of the Electrodiagnostic Examination
Nerve Conduction Studies
Motor Conduction Studies
Sensory Conduction Studies
Needle Electrode Examination
Late Responses
Electrodiagnostic Localization of Spinal Disorders
Radiculopathy
Case Studies
Polyradiculopathy
Cervical Root Avulsion
Lumbar Canal Stenosis
Postoperative Electrodiagnostic Examination
Recommendations for the Referring Physician
071 - Chapter 66 - Differential Diagnosis of Surgical Disorders of the Spine
66 - Differential Diagnosis of Surgical Disorders of the Spine
Degenerative Disease of the Cervical Spine
Degenerative Disease of the Lumbar Spine
Trauma
Posttraumatic Syringomyelia
Charcot Spine
Spinal Infection
Spondylodiscitis
Spinal Epidural Abscess
Neoplastic Disease
Inflammatory Disease of the Spine
Rheumatoid Arthritis
Ankylosing Spondylitis
Vascular Lesions Affecting the Spinal Cord
Spinal Cord Infarct
Vascular Malformations
Neurological Conditions of the Spinal Cord and Spinal Nerves
Multiple Sclerosis
Amyotrophic Lateral Sclerosis
Guillain–Barré Syndrome
Masqueraders of Spinal Pathology
Musculoskeletal System
Shoulder
Hip
Nervous System
Compression Neuropathy
Upper Extremity Compression Neuropathies
Lower Extremity Compression Neuropathies
Metabolic Neuropathy: Diabetic Neuropathy
Visceral Organs and Related Systems
Cardiovascular System
Pulmonary System: Pancoast Tumor
Gastrointestinal System
Genitourinary System
Gynecological System
Summary
072 - Chapter 67 - Patient Selection for Spine Surgery_ Preoperative Optimization
67 - Patient Selection for Spine Surgery: Preoperative Optimization
Diabetes Mellitus
Patient Selection for Spine Surgery: Preoperative Optimization
Tobacco Abuse
Obesity
Anemia
Osteoporosis
Psychosocial Factors
Conclusion
073 - Chapter 68 - Evaluation of the Aging Patient
68 - Evaluation of the Aging Patient
Evaluation of the Aging Patient
Osteoporosis
Functional Assessment
Age-Related Risk Factors
Summary
074 - 69 - Preoperative Evaluation of Psychosocial Aspects and Work-Related Issues
69 - Preoperative Evaluation of Psychosocial Aspects and Work-Related Issues
Preoperative Evaluation of Psychosocial Aspects and Work-Related Issues
Work-Related Issues
Conclusion
075 - Chapter 70 - Preoperative Evaluation of Patients With Tumors Affecting the Spine
70 - Preoperative Evaluation of Patients With Tumors Affecting the Spine
Diagnostic Imaging
Plain Radiographs
Preoperative Evaluation of Patients With Tumors Affecting the Spine
Bone Scan
Computed Tomography
Magnetic Resonance Imaging
Angiography
Laboratory Tests and Inflammatory Markers
Consideration of Spine Surgery in Metastatic Cancer
The NOMS Criteria
Neurological
Oncological
Mechanical Instability
Systemic
Prognostic Scoring Systems
Conclusion
076 - Chapter 71 - Measuring Preoperative Health-Related Quality of Life_ What Metrics Matter
71 - Measuring Preoperative Health-Related Quality of Life: What Metrics Matter
Key Characteristics of Health-Related Quality of Life Tools
Measuring Preoperative Health-Related Quality of Life: What Metrics Matter
Reliability, Validity, and Responsiveness
Reliability
Validity
Floor and Ceiling Effects
Responsiveness
Clinically Important Differences
Some Commonly Used Health-Related Quality of Life Tools in Spine Care (Table 71.1)
Static
Dynamic
Choice of Health-Related Quality of Life Tools: Potential Considerations
Conclusion
077 - Chapter 72 - Rehabilitation and Interventions in Management of Spinal Disorders
72 - Rehabilitation and Interventions in Management of Spinal Disorders
Etiology of Back and Neck Pain
Medical Treatment Options
Prevention
Initial Management
Exercise and Physical Therapy
Nonpharmacological Treatments
Manipulation
Massage
Traction
Superficial Heat or Cold
Low-Level Laser Therapy
Transcutaneous Electrical Nerve Stimulation, Ultrasound, Taping
Summary: An Evidence-Informed Approach to Nonsurgical Management of Back and Neck Pain
Acute Pain (<4 Weeks)
Acute to Subacute Pain (Subacute Pain = 4‒12 Weeks)
Chronic Pain (>12 Weeks)
078 - Chapter 73 - Spine Injections
73 - Spine Injections
Epidural Injection
Anatomy
Spine Injections
Cervical Epidural Steroid Injections
Thoracic Epidural Steroid Injections
Lumbar Epidural Steroid Injections
Caudal Epidural Steroid Injection
Medications
Complications
Contraindications
Interlaminar Versus Transforaminal Approach
Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks
Indications
Anatomy
Technique
Cervical Technique
Lumbar Technique
Sacral Technique
Thoracic Technique
Complications
Facet Joint Injections, Medial Branch Nerve Blocks, and Radiofrequency Denervation
Introduction
Anatomy
Facet Injections
Atlantoaxial (C1‒C2) Facet Injection
Cervical Intraarticular Facet Injection
Cervical Medial Branch Block and Radiofrequency Treatment
Thoracic Intraarticular Facet Injection
Thoracic Medial Branch Block and Radiofrequency Treatment
Lumbar Intraarticular Facet Injection
Lumbar Medial Branch Block and Radiofrequency Treatment
Complications
Sympathetic Blocks
Indications for Stellate Ganglion Blocks
Anatomy of the Stellate Ganglion
Technique of the Stellate Ganglion Block
Fluoroscopic Technique
Ultrasound Technique
Complications of Stellate Ganglion Block
Indications for Lumbar Sympathetic Block
Anatomy of the Lumbar Sympathetic Chain
Technique of the Lumbar Sympathetic Block
Complications of the Lumbar Sympathetic Block
Diagnostic Block Considerations
Conclusion
079 - Chapter 74 - Cognitive Behavioral Therapy and Back Pain
74 - Cognitive Behavioral Therapy and Back Pain
Key Components and Goals of Treatment for Chronic Pain and Chronic Low Back Pain
Cognitive Behavioral Therapy and Back Pain
Theoretical Foundation for Cognitive Behavioral Therapy for Pain
Cognitive Behavioral Therapy: In-Depth Application to Chronic Pain
Key Components of Clinical Intervention
Pain Science Education
Psychophysiological Relaxation
Cognitive Restructuring
Activity Pacing
Case Example of the Cognitive Behavioral Therapy Model
Cognitive Behavioral Therapy Adaptations: New Directions for Cognitive Behavioral Therapy and Pain
Acceptance and Commitment Therapy
Mindfulness-Based Stress Reduction
Emotional Awareness and Expression Therapy
Empirical Support for Cognitive Behavioral Therapy for Chronic Low Back Pain
Cognitive Behavioral Therapy is Effective for Patients with Chronic Pain
Cognitive Behavioral Therapy is Effective for Patients with Chronic Low Back Pain
Treatment Format, Duration, and Intensity
Brief Cognitive Behavioral Therapy for Pain. In recent years there have been efforts to develop and evaluate brief interventions...
Digital Cognitive Behavioral Therapy for Pain. Darnall and colleagues adapted the abovementioned single-session pain psychology ...
Special Subgroups: Efficacy of Cognitive Behavioral Therapy for Pain in Spine Surgery
Special Subgroups: Efficacy of Cognitive Behavioral Therapy for Pain for Subacute Low Back Pain
Treatment Moderators: Who Benefits Most From Cognitive Behavioral Therapy for Pain
Conclusion
080 - Chapter 75 - Regenerative Strategies and Intervertebral Disc Degeneration
75 - Regenerative Strategies and Intervertebral Disc Degeneration
Background
Anatomy and Pathophysiology of the Intervertebral Disc
Biological Therapy
Cell-Based Therapy
Indications for Disc Degeneration and Discogenic Pain
Conclusion
081 - Chapter 76 - Neuromodulation and Rehabilitative Interventions for the Spine
76 - Neuromodulation and Rehabilitative Interventions for the Spine
Past: Spinal Stimulation for Pain Control
Present: Advances in Neuromodulation
New Targets for Neuromodulation: Multifidus Stimulation
Spinal Epidural Stimulation for Chronic Paralysis
Future: The Spine as a Platform for Clinical Neuromodulation
Treatment of Spasticity Related to Cerebral Palsy
Advanced Spinal Imaging
Spine Machine Interfaces
Conclusion
082 - Chapter 77 - Pain Management_ Opioids and Alternatives
77 - Pain Management: Opioids and Alternatives
Acetaminophen
Nonsteroidal Antiinflammatory Drugs
Oral Steroids
Antidepressants
Opioids
Muscle Relaxants
Anticonvulsants
Topicals
Cannabinoids
Conclusion
083 - Chapter 78 - Fundamentals of Spine Surgery
78 - Fundamentals of Spine Surgery
The Decision-Making Process
Patient Selection
Consent for Surgery
Informed Consent
Beyond Informed Consent
Surgical Considerations
Spinal Anatomy and Biomechanics
Technology and the Spine
Economics
Conclusion
084 - Chapter 79 - Perioperative Management Protocols_ Enhanced Recovery After Surgery
79 - Perioperative Management Protocols: Enhanced Recovery After Surgery
Brief History of Enhanced Recovery After Surgery in Other Surgical Specialties
Perioperative Management Protocols: Enhanced Recovery After Surgery
Physiological Foundation for Enhanced Recovery After Surgery
Need for Enhanced Recovery After Surgery Programs in Spinal Surgery
Phases of Enhanced Recovery After Surgery in Spinal Surgery
Preoperative Phase
Intraoperative Phase
Postoperative Phase
University of Miami Spinal Enhanced Recovery After Surgery Experience
Awake Endoscopic Transforaminal Lumbar Interbody Fusion
Enhanced Recovery After Surgery Following Traditional Lumbar Fusion
Literature Review of Established Spinal Enhanced Recovery After Surgery Programs
Enhanced Recovery After Surgery and Degenerative Lumbar Surgery
Enhanced Recovery After Surgery Lumbar Laminectomy and Discectomy
Enhanced Recovery After Surgery Lumbar Fusion
Enhance Recovery After Surgery in Degenerative Cervical Surgery
Enhanced Recovery After Surgery and Combined Spinal Pathologies
Enhanced Recovery After Surgery and Spinal Deformity Surgery
Enhanced Recovery After Surgery in Spinal Oncology
Conclusion and Future Direction
085 - Chapter 80 - Surgical Incisions, Positioning, and Retraction
80 - Surgical Incisions, Positioning, and Retraction
Sitting Position
Ventral Cervical Operations
Lateral Approaches
Retractors
Transoral Retractors
Ventral Cervical Retractors
Surgical Incisions, Positioning, and Retraction
Ventral Thoracic and Lumbar Retractors
Dorsolateral Thoracic and Lumbar Retractors
Tube Retractors
Approaches
Dorsal Approaches to the Upper Cervical Spine
Midline Dorsal Approach
Lateral Transcondylar Approach
Ventral Approaches to the Upper Cervical Spine
Transoral Approach
Endoscopic Approach
Median Labiomandibular Glossotomy
Bilateral Sagittal Split Mandibular Osteotomies
Transthyroid Approach
Ventrolateral Retropharyngeal Approach
Lateral Cervical Approach
Dorsal Approaches to the Subaxial Cervical Spine
Laminectomy and Laminoplasty
Laminoforaminotomy for Cervical Disc Disease
Ventral Approaches to the Subaxial Cervical Spine
Ventromedial Approach
Ventrolateral Approach
Ventral Approaches to the Cervicothoracic Junction
Lower Ventromedial Cervical Approach
Transsternal Approach
Transmanubrial Approach
Transverse Supraclavicular Approach
Transclavicular Approach
Transaxillary Extrapleural Approach
Lateral Parascapular Extrapleural Approach
Transpleural Transthoracic Approach
Trapdoor Approach
Combined Anterior-Posterior Approach in the Sitting Position
Dorsal Approaches to the Thoracic and Thoracolumbar Spine Junction
Thoracic Laminectomy
Transpedicular Approach
Costotransversectomy
Lateral Extracavitary Approach
Dorsal En Bloc Total Spondylectomy
Ventral Approaches to the Thoracic and Thoracolumbar Spine Junction
Transpleural Thoracotomy
Extrapleural Thoracotomy
Transdiaphragmatic Approach
Ventrolateral Retroperitoneal Approach
Simultaneous Ventral-Dorsal Approach
Dorsal Approaches to the Lumbar and Lumbosacral Spine
Lumbar Laminectomy and Laminotomy
Paraspinal Approach
Mini-Open Pedicle Subtraction Osteotomy
Lateral Extracavitary Approach
Ventral Approaches to the Lumbar and Lumbosacral Spine
Lateral Transpsoas Approach
Pelvic Brim Extraperitoneal Approach
Transperitoneal Approach
Dorsal Approaches to the Sacrum
Ventral Approaches to the Sacrum
Retroperitoneal Approach
Transperitoneal Approach
Combined Abdominosacral Approach
086 - Chapter 81 - Intraoperative Imaging Protocols
81 - Intraoperative Imaging Protocols
Intraoperative Imaging Protocols
Plain Film Radiography
Fluoroscopy
Image-Guided Navigation
Components of Image-Guided Navigation Systems
Navigation Techniques
Clinical Applications
Robot-Assisted Spinal Instrumentation
Case Illustration
Conclusion
087 - Chapter 82 - Anesthesia for Spine Surgery and the Prevention of Complications
82 - Anesthesia for Spine Surgery and the Prevention of Complications
National Surgical Quality Improvement Program Database Risk Model
Revised Cardiac Risk Index
Anesthesia for Spine Surgery and the Prevention of Complications
Biomarkers
Ankle Brachial Index
Movement of the Cervical Spine With Intubation
Manual In-Line Stabilization and Cricoid Pressure
Central Cord Syndrome and Direct Laryngoscopy
Pathophysiological Changes With Prone Position
Cardiovascular Changes
Hemodynamic and Fluid Management during Spine Surgery in the Prone Position
Important Functions of the Glycocalyx
Perioperative Fluid Management and Glycocalyx
Suitable and Practical Techniques for Goal-Directed Fluid Therapy and Perfusion Pressure During Spine Surgery
Commonly Used Colloids During Spine Surgeries
Albumin
Hydroxyethyl Starch
In Conclusion
Changes in Respiratory Physiology
Poisson Effect and Prone Position
Intraoperative Neurophysiological Monitoring
Mechanisms and Pathophysiology of Spinal Monitoring Changes
Somatosensory-Evoked Potentials
Limitations of Somatosensory-Evoked Potentials
Motor-Evoked Potentials
Spinal Versus Myogenic Motor-Evoked Potentials
Myogenic Motor-Evoked Potentials After Multiple Stimulation
Effects of Neuromuscular Blockade on Myogenic Motor-Evoked Potentials
Effect of Temperature on Evoked Potentials
Electromyography
Effects of Anesthetics on Evoked Potentials
Intravenous Anesthetics
Treatment of Surgical Pain After Spine Surgeries
Chronic Postsurgical Pain
Postoperative Visual Loss After Spine Surgery
Retinal Perfusion Pressure
Arterial Blood Pressure
Intraocular Pressure
Types of Visual Loss and Impairment Associated With Spine Surgery
Ischemic Optic Neuropathy
Cortical Blindness
Central Retinal Artery Occlusion
Central Retinal Vein Occlusion
Factors Contributing to Vision Loss and Impairment After Spine Surgery
Head Position and Compartment Syndrome
Effect of α2-Adrenergic Agonists on the Eye During Spine Surgery
Other Complications
Excessive Blood Loss and Inadequate Fluid Resuscitation
Brachial Plexus Injuries
Rhabdomyolysis
Postoperative Neurocognitive Dysfunction After Spine Surgery
Medicolegal Concerns
088 - Chapter 83 - Intraoperative Monitoring in Routine and Complex Surgery
83 - Intraoperative Monitoring in Routine and Complex Surgery
Somatosensory-Evoked Potentials
Electrode Placement
System Settings
Intraoperative Somatosensory-Evoked Potential Monitoring Assessment
Motor-Evoked Potentials
Electrode Placement
Intraoperative Motor-Evoked Potential Monitoring Assessment
Electromyography
Free-Running Electromyography
Triggered Electromyography
Anesthesia
Significant Changes in Neuromonitoring
Conclusion
089 - Chapter 84 - Blood Management and Complex Spine Surgery
84 - Blood Management and Complex Spine Surgery
Preoperative Evaluation
Blood Management and Complex Spine Surgery
Medication History
Preoperative Estimation of Blood Loss
Autologous Blood Use
Allogenic Blood Product Use
Transfusion Risks and Counseling
Anesthetic Techniques for Lessening Intraoperative Blood Loss
Operative Team Management
Surgical Techniques for Reducing Blood Loss
Local Agents for the Reduction of Blood Loss
Fibrin Glue
Positioning
Intraoperative Blood Transfusion
Intraoperative and Postoperative Blood Salvage
Postoperative Drugs and Blood Loss
Treatment and Diagnosis of Diffuse Intraoperative and Postoperative Bleeding
Summary
090 - Chapter 85 - Intraoperative Crisis Management in Spine Surgery_ What to Do When Things Go Bad
85 - Intraoperative Crisis Management in Spine Surgery: What to Do When Things Go Bad
Cardiac Arrest
Vascular Injuries
Anterior Cervical Approach
Intraoperative Crisis Management in Spine Surgery: What to Do When Things Go Bad
Posterior Cervical Approach
Posterior Lumbar Approaches
Anterior Lumbar Approaches
Pedicle Screw Placement (Thoracic/Lumbar Spine)
Iliac Crest Bone Graft Harvest
Visceral Injuries
Facet Reduction
Electrophysiological Spinal Cord Monitoring
Neurological Injuries
Perioperative Emergent Complications
Site-Specific Neurological Emergencies
Spinal Cord Injury
Conclusion
091 - Chapter 86 - Biologics in Spine Fusion Surgery
86 - Biologics in Spine Fusion Surgery
Autograft
Iliac Crest Bone Graft
Local Bone Graft
Bone Marrow Concentrates
Allograft
Demineralized Bone Matrix
Cellular-Based Allograft
Synthetic (Ceramic-Based) Bone Substitutes
Recombinant Human Bone Morphogenetic Protein–2
Conclusion
092 - Chapter 87 - Osteointegration_ The Bone and Implant Interface
87 - Osteointegration: The Bone and Implant Interface
Materials
Osteointegration: The Bone and Implant Interface
Surface Topography
Surface Chemistry
Hydroxyapatite Coating
Porosity
Conclusion
093 - Chapter 88 - Common Complications in Spine Surgery_ Pseudoarthrosis
88 - Common Complications in Spine Surgery: Pseudoarthrosis
Biology of Bone Healing
Diagnosis of Pseudoarthrosis
Standard Radiography
Dynamic Radiography
Computed Tomography
Magnetic Resonance Imaging
Bone Scan
Radiological Assessment of Bone Substitutes
Risk Factors for Pseudoarthrosis
Smoking
Age and Race
Osteoporosis and Nutrition
Use of Nonsteroidal Antiinflammatories
Radiation Therapy
Alignment
Incidence and Treatment
Cervical Spine
Thoracic and Lumbar Spine
Thoracolumbar Pseudoarthrosis
Lumbosacral Pseudoarthrosis
Three-Column Osteotomy
Interbody Fusion
Augmentation of Fusion With Graft, Biologics, and Other Factors
Autograft
Osteoinductive Agents
Osteoconductive Agents
Summary
094 - Chapter 89 - Postoperative Medical Complications
89 - Postoperative Medical Complications
Postoperative Medical Complications
Pulmonary and Thromboembolic Complications
Deep Venous Thrombosis
Pulmonary Embolism
Other Pulmonary Complications
Cardiac Complications
Renal Complications
Gastrointestinal Complications
Miscellaneous Complications
Delirium
Vision Loss
Decubitus Ulceration
Impact on Length of Stay
Conclusion
095 - Chapter 90 - Preventing Postoperative Infections_ An Evidence-Based Approach
90 - Preventing Postoperative Infections: An Evidence-Based Approach
Nutrition
Antiseptic Shower
Preventing Postoperative Infections: An Evidence-Based Approach
Mupirocin Nasal Ointment
Hair Removal
Skin Preparation
Handwashing
Intraoperative Factors
Surgical Gowns
Double Gloving
Antimicrobial Adhesive Drapes
Antibiotic Prophylaxis
Core Body Temperature
Intraoperative Hyperoxygenation
Surgical Drains
Vancomycin Powder in the Surgical Bed
Operating Room Hygiene
Postoperative Factors
Glucose Control
Summary of the 2017 Centers for Disease Control Guidelines
Summary
096 - Chapter 91 - Neurological Complications of Common Spine Operations
91 - Neurological Complications of Common Spine Operations
Anterior Cervical
Neurological Complications of Common Spine Operations
Posterior Cervical
Thoracic Spine
Lumbar Spine
Posterior Lumbar
Anterior and Lateral Lumbar
Conclusion
097 - Chapter 92 - Cerebrospinal Fluid Leak_ Repair and Outcomes
92 - Cerebrospinal Fluid Leak: Repair and Outcomes
Cerebrospinal Fluid Leak: Repair and Outcomes
Pathophysiology
Clinical Features
Diagnostic Studies
Conservative Management
Surgical Management
Conclusion
098 - Chapter 93 - Arachnoiditis
93 - Arachnoiditis
Pathogenesis
Etiology
Arachnoiditis
Clinical Features
Radiographic Features
Spinal Epidural Fibrosis
Treatment
Summary
099 - Chapter 94 - Arachnoiditis and Syringomyelia
94 - Arachnoiditis and Syringomyelia
Arachnoiditis and Syringomyelia
Pathophysiology of Arachnoiditis-Associated Syringomyelia
Arachnoiditis
Syringomyelia Formation
Radiographic Findings of Arachnoiditis
Clinical Presentation and Clinical Course
Treatment and Outcomes
Nonsurgical Treatment
Surgical Techniques to Minimize Development of Arachnoiditis
Surgical Management of Lumbar Arachnoiditis
Surgical Management of Syringomyelia
Arachnoiditis Ossificans
Summary
100 - Chapter 95 - Posttraumatic and Idiopathic Syringomyelia
95 - Posttraumatic and Idiopathic Syringomyelia
Classification
Posttraumatic and Idiopathic Syringomyelia
Etiology
Clinical Presentation
Diagnosis
Management
Conclusions
101 - Chapter 96 - Vascular and Soft Tissue Complications
96 - Vascular and Soft Tissue Complications
Complications in the Subaxial Spine
Vascular and Soft Tissue Complications
Recurrent Laryngeal Nerve Injury
Esophageal Injury
Esophageal Repair
Laryngotracheal Injuries
Carotid and Vertebral Artery Injury
Complications at the Cervicothoracic Junction and in the Thoracic Spine
Thoracic Duct Injuries
Vascular Injuries
Pulmonary Complications
Thoracolumbar Junction and Lumbar Spine
Splenic and Vascular Injury
Ureteral Injury
Bowel Injury
Transabdominal Approaches to the Lumbosacral Spine
Vascular Injury
Lymphocele After the Anterior Approach to the Spine
Complications of Posterior Lumbar Discectomy
Complications of Minimally Invasive Thoracolumbar Discectomy and Fusion
Complications Related to Thoracoscopy and Transthoracic Discectomy
Vascular Injury
Other Visceral Injury
Instrumentation Complications
Complications of Vertebral Cement Augmentation
Summary
102 - Chapter 97 - Postoperative Spinal Deformities
97 - Postoperative Spinal Deformities
Postoperative Spinal Deformities
Decompression-Related Postoperative Spinal Deformities
Posterior Decompression
Clinical Presentation
Instrumentation-Related Postoperative Deformities
Adjacent Segment Disease
Proximal Junctional Failures
Surgical Correction of Postsurgical Deformity
Conclusion
103 - Chapter 98 - Implant Wear, Degradation, and Breakage
98 - Implant Wear, Degradation, and Breakage
Implant Wear, Degradation, and Breakage
Wear Debris
Particulate Characterization
Quantifying and Characterizing Wear Debris
Gravimetric Mass
Morphological Characterization of Particulate
Penetration Rate
Ionic Concentrations
Corrosion
General Corrosion
Fretting Corrosion
Pitting Corrosion
Crevice Corrosion
Galvanic Corrosion
Conclusion
104 - Chapter 99 - Spine Readmissions and Reoperations
99 - Spine Readmissions and Reoperations
Definition and Prevalence
Rates in Spine Surgery
Risk Factors
Spine Readmissions and Reoperations
Cervical Spine
Persistent Radiculopathy or Myelopathy
Postoperative Cervical Instability
Thoracolumbar Spine
Persistent or Recurrent Neural Compression
Postoperative Thoracolumbar Instability
Postoperative Cauda Equina Syndrome
Cerebrospinal Fluid Leakage
Postoperative Infection
Postoperative Hematoma
Conclusion
105 - Chapter 100 - Cervical Spine Construct Design
100 - Cervical Spine Construct Design
Fundamental Concepts
Indications for Cervical Construct Application
Clinical Instability
Maintenance of Alignment
Pain Management
Construct Selection
General Considerations
Modes of Application
Simple Distraction
Tension-Band Fixation
Three-Point Bending
Cantilever Beam Fixation
Construct Materials
Bone Grafts
Implants
Construct Application
Ventral Constructs
Interbody Strut Graft
Ventral Cervical Plate and Screw Constructs
Hybrid Fusion Constructs
Dorsal Constructs
Wire Constructs
Interlaminar Clamps
Lateral Mass Rod Fixation
Anterior-Posterior Constructs
Economic Considerations
Supplementary External Immobilization
106 - Chapter 101 - Occipitocervical Spine Approaches for Decompression
101 - Occipitocervical Spine Approaches for Decompression
Pathology
Surgical Anatomy
Dorsal Surgical Anatomy of the Occipitocervical Region
Occipitocervical Spine Approaches for Decompression
Vertebral Artery
Atlantooccipital Joint
Approaches to the Occipitocervical Region
Dorsal Approach to the Occipitocervical Region
Ventral Approaches
Ventral Retropharyngeal Approach
Open Transoral Approach
Endoscopic Approaches
Endoscopic Transoral (Endooral) Approach
Endoscopic Transnasal Approach
Transcervical Approach
Extended Approaches to the Craniocervical Junction
Extended Maxillotomy
Bilateral Sagittal Split Mandibular Osteotomy
Transcondylar Approach to Craniovertebral Junction (Extreme Radial Craniocervical Approach)
Avoidance of Complications
Summary
Acknowledgment
107 - Chapter 102 - Occipitocervical Spine Posterior Approaches for Fusion
102 - Occipitocervical Spine Posterior Approaches for Fusion
Anesthetic Considerations
Occipitocervical Spine Posterior Approaches for Fusion
Ventral Approaches
Indications
Direct Odontoid Screw Fixation
Contraindications
Patient Positioning
Operative Technique
Controversies
One-Screw Versus Two-Screw Constructs. Theoretically, with one screw the odontoid process could rotate on C2, although the inter...
Screw Size and Type. Biomechanical data suggest that cannulated screws are only about 5% to 10% weaker than solid screws.33 Scre...
Results
Ventral C1‒C2 Transarticular Screw Fixation
Other Ventral Techniques
Dorsal Approaches
Transarticular Screw Fixation
Indications
Contraindications
Patient Positioning
Operative Technique
C1‒C2 Screw/Rod Constructs
Bone Grafting
Lasso Technique
Screws
Postoperative Care
Results and Complications
Occipitocervical Fusion
Patient-Reported Outcomes
Summary
108 - Chapter 103 - Endoscopic and Transnasal Approaches to the Craniocervical Junction
103 - Endoscopic and Transnasal Approaches to the Craniocervical Junction
Endoscopic Transnasal Surgical Technique
Operating Room Setup, Patient Positioning, and Equipment
Endoscopic and Transnasal Approaches to the Craniocervical Junction
Anesthetic Considerations
Nasal Approach
Endoscopic Transnasal Transclival Approach
Endoscopic Transnasal Odontoidectomy Approach
Reconstruction
Postoperative Care
Discussion
Clinical Outcomes: Advantages and Limitations
Conclusion
109 - Chapter 104 - Cervical Spine and Cervicothoracic Junction—Posterior
104 - Cervical Spine and Cervicothoracic Junction—Posterior
Surface Anatomy
Posterior Triangle of the Neck
Spinal Anatomy
Cervical Spine and Cervicothoracic Junction—Posterior
Discs
Ligaments
Ligamentum Nuchea
Intravertebral Foramen
Blood Supply
Posterior Subaxial Cervical Spine and Cervicothoracic Junction Pathology
Degenerative Cervical Myelopathy
Subaxial Cervical Spine and Cervicothoracic Junction Trauma
Other Pathologies of the Subaxial Cervical Spine and the Cervicothoracic Junction
Posterior Surgical Approaches
Laminectomy and Fusion
Laminoplasty
Posterior Keyhole Laminotomy/Foraminotomy
Transpedicular
Costotransversectomy and the Lateral Extracavitary Approach
Minimally Invasive Posterior Approach
Acknowledgment
110 - Chapter 105 - Posterior Cervical Decompressions_ Cervical Laminectomy and Laminoforaminotomy
105 - Posterior Cervical Decompressions: Cervical Laminectomy and Laminoforaminotomy
Technique
Positioning
Anesthetic Concerns
Incision and Dissection
Laminectomy
Foraminotomy
Summary
111 - Chapter 106 - Cervical Laminoplasty
106 - Cervical Laminoplasty
Background of the Development of Laminoplasty
Surgical Indication
Surgical Technique used for Laminoplasty
Surgical Results
Complications
Closure of Expanded Lamina
Segmental Motor Paralysis (C5 Palsy)
Axial Pain
Conclusions
112 - Chapter 107 - Dorsal Subaxial Cervical Instrumentation Techniques
107 - Dorsal Subaxial Cervical Instrumentation Techniques
Etiologies
Indications for Surgery
Trauma
Tumor
Degenerative Disorders
Surgical Exposure
Bony Fusion
Techniques
Lateral Mass Screw Fixation
Cervical Pedicle Screw Fixation
Minimally Invasive Intrafacet Fusion
Decision to Cross the C7–T1 junction
Postoperative Care
Complication Management
Neurological and Vascular Complications
Spinal Complications
Wound Complications
Summary
113 - Chapter 108 - Posterior Percutaneous and Minimally Invasive Approaches to Decompression and Arthrodesis of the Cervical Spine
108 - Posterior Percutaneous and Minimally Invasive Approaches to Decompression and Arthrodesis of the Cervical Spine
Posterior Percutaneous and Minimally Invasive Approaches to Decompression and Arthrodesis of the Cervical Spine
Indications
Preoperative Evaluation
Operative Setup
Positioning
Surgical Approach
Laminotomy/Foraminotomy/Discectomy
Decompression for Stenosis
Posterior Cervical Transfacet Fusion Cages
Lateral Mass Fixation
Closure and Postoperative Care
Outcomes and Results
Complications
Summary
114 - Chapter 109 - Cervical Spine and Cervicothoracic Junction—Anterior Approach
109 - Cervical Spine and Cervicothoracic Junction—Anterior Approach
Cervical Spine Pathology and Indications for Surgery
Degenerative Disease
Goals of Surgery
Surgical Consideration
Neoplasm
Surgical Considerations
Infection
Goals of Surgery
Surgical Considerations
Trauma
Surgical Considerations
Surgical Approaches
Subaxial Cervical Spine
Patient Positioning
Surgical Exposure: Anterior
Surgical Exposure: Anterolateral
Cervicothoracic Junction
Positioning
Surgical Exposure: Supracalvicular
Surgical Exposure: Transmanubrial-Transclavicular
Surgical Exposure: Transsternal
Discectomy
Corpectomy
Fusion and Instrumentation
Bone Graft
Titanium Graft
Polyetheretherketone Graft
Cervical Disc Arthroplasty
Cervicothoracic Junction
Complications
Esophageal Injury
Recurrent Laryngeal Nerve Injury
Vertebral Artery Injury
Cerebrospinal Fluid Leak
115 - Chapter 110 - Anterior Cervical Discectomy and Corpectomy
110 - Anterior Cervical Discectomy and Corpectomy
Anterior Cervical Pathologies
Approach and Limitations
Preoperative Planning
Positioning
Complication Avoidance
Exposure
Complication Avoidance
High Dissections (C4 and Above)
Complication Avoidance
Low Dissections (C7 and Below)
Complication Avoidance
Retractor and Distracting Pin Placement
Discectomy
Complication Avoidance
Corpectomy
Complication Avoidance
Spinal Reconstruction
Complication Avoidance
Discectomy Versus Corpectomy
Conclusion
116 - Chapter 111 - Management of Soft Cervical Disc Herniation_ Controversies and Complication Avoidance
111 - Management of Soft Cervical Disc Herniation: Controversies and Complication Avoidance
Approach to Surgical Decision Making
Surgical Options for Soft Disc Herniation
Anterior Approaches
Anterior cervical discectomy and fusion
Cervical total disc replacement
Cervical corpectomy
Posterior Approaches
Posterior cervical laminoforaminotomy
Approach Decision
Common Complications and Avoidance
Vascular Injury
Esophageal and Tracheal Injury
Dural Tear and Cerebrospinal Fluid Leak
Neurological Injury
Airway Compromise
Complications and Complication Avoidance Unique to Cervical Total Disc Replacement
Complications and Complication Avoidance Unique to Posterior Cervical Laminoforaminotomy
Conclusion
117 - Chapter 112 - Anterior Subaxial Cervical Fixation and Fusion Techniques
112 - Anterior Subaxial Cervical Fixation and Fusion Techniques
Background
Anterior Instrumentation
Rigid and Dynamic Anterior Plating Systems
Interbody Options for Anterior Subaxial Fixation
Anterior Interbody Pseudarthrosis and Subsidence
Additional Techniques for Anterior Subaxial Fixation and Fusion
Skip Corpectomy
Floating Corpectomy
Anterior Controllable Antedisplacement Fusion
Conclusion
118 - Chapter 113 - Cervical Total Disc Arthroplasty
113 - Cervical Total Disc Arthroplasty
Rationale for Cervical Arthroplasty
Nomenclature, Biomaterials, and Biomechanics
Indications and Contraindications
Cervical Arthroplasty: The Clinical Evidence
Effect of Cervical Disc Replacement on Adjacent Segment Disease
Potential Complications and Complication Avoidance
Conclusion
119 - Chapter 114 - Combined Ventral-Dorsal Surgery
114 - Combined Ventral-Dorsal Surgery
ACUTE CERVICAL SPINE INJURY
Kyphotic Deformity
Neoplasms
Ankylosing Spondylitis
Cervical Spondylotic Myelopathy
Complications and Avoidance
Summary
120 - 115 - Thoracic and Lumbar Spine Construct Design
115 - Thoracic and Lumbar Spine Construct Design
Nomenclature
Indications for Spinal Instrumentation
Construct Types (Modes of Force Application)
Development of a Construct Blueprint
Line Drawing of Proposed Construct
Level of Lesion and Level of Fusion
Depiction of Implant Components
Mechanical Attributes of Spinal Implants: Construct Type
Construct Design Strategies
Bony Integrity
Location of the Unstable Spinal Segment
Implant Length
Instrumentation Fusion Mismatch (“Rod Long, Fuse Short”)
Short-Segment Fixation
Cross Fixation
Axial Loadbearing Capacity of the Instrumented Spine
Finite Element Spinal Surgical Simulator
Nature of Instability
Kyphotic Deformity
Translational Deformity
Axial Loading Deformity (Burst Fracture)
Flexion-Distraction (Seat Belt) Deformity
Scoliotic Deformity
Need for Decompression
Armamentarium of the Surgeon
121 - Chapter 116 - Posterior Approaches to the Thoracic Spine
116 - Posterior Approaches to the Thoracic Spine
ANATOMY
Thoracic Spine
Approaches
Selecting an Approach
Midline Approach
Indications and Contraindications
Advantages and Disadvantages
Technique
Transpedicular Approach
Indications and Contraindications
Advantages and Disadvantages
Technique
Costotransversectomy
Indications and Contraindications
Advantages and Disadvantages
Technique
Lateral Extracavitary Approach
Indications and Contraindications
Advantages and Disadvantages
Technique
Summary
122 - 117Chapter - Anterior and Lateral Approaches to the Thoracic Spine
117 - Anterior and Lateral Approaches to the Thoracic Spine
Transpedicular Approach
Overview
Operative Planning
Surgical Technique
Postoperative Care and Follow-Up
Costotransversectomy and Lateral Extracavitary
Mini-Open Extracavitary Transpedicular Corpectomy
Overview
Operative Planning
Surgical Technique
Postoperative Care and Follow-Up
Retropleural Thoracotomy
Overview
Surgical Technique
Postoperative Care and Follow-Up
Minimally Invasive Retropleural Approach
Transpleural Thoracotomy
Endoscopic Transpleural Thoracotomy
Direct Anterior Thoracic Approaches
Summary
123 - Chapter 118 - Minimally Invasive Lateral Thoracic Decompression
118 - Minimally Invasive Lateral Thoracic Decompression
Indications for Operative Intervention
Neoplasm
Trauma
Infection
Deformity and Degenerative Conditions
Minimally Invasive Surgical Approaches for Thoracic Decompression
Minimally Invasive Transthoracic Approach
Thoracoscopic-Assisted Minimally Invasive Approach
Minimally Invasive Extracavitary Approach
Minimally Invasive Retropleural Approach
Minimally Invasive Retropleural Approach to the Thoracolumbar Spine
Conclusion
124 - Chapter 119 - Thoracoscopic Corpectomy and Reconstruction
119 - Thoracoscopic Corpectomy and Reconstruction
Advantages and Disadvantages
Indications and Contraindications
Preoperative Assessment and Planning
Radiographic and Diagnostic Evaluation
Planning of Approach
Planning of Resection and Reconstruction
Operative Technique
Thoracoscopic Instruments and Instrumentation Systems
Anesthesia
Patient Positioning
Localization
Access
Dissection and Exposure
Vertebral Body Screw Instrumentation
Vertebral Body Resection and Spinal Canal Decompression
Vertebral Body Reconstruction and Completion of Instrumentation
Chest Tube Placement and Wound Closure
Technical Tips
Outcomes
Conclusion
125 - 120 - Posterolateral Thoracolumbar Fusion
120 - Posterolateral Thoracolumbar Fusion
Surgical Technique
Graft Materials
Bone Morphogenetic Proteins
Postoperative Bracing
Other Nonunion Risks
Instrumentation
Spondylolisthesis as an Indication for Posterolateral Fusion
Cost Effectiveness
Summary
126 - 121 – Posterior Thoracic and Lumbar Universal Spine Instrumentation
121 - Posterior Thoracic and Lumbar Universal Spine Instrumentation
HISTORY
Surgical Indications
Distraction
Tension Band Fixation
Three-Point Bending
Cantilever Beam Constructs
Biomechanical Properties Of Universal Spine Instrumentation Systems
Metallurgy
Polyetheretherketone
Hook Design
Pedicle Screws
Longitudinal Members
Component–Component Junctions
Polyaxial Pedicle Screws
Technical Aspects of Implant Application
Pedicle Screw Insertion
Laminar Hook Insertion
Pedicle Hooks
Transverse Process Hook Insertion
Cross-Fixation
Complication Avoidance and Management
Complications of Hook Fixation
Complications of Transpedicular Fixation
Summary
127 - Chapter 122 - Midline Lumbar Interbody Fusion With Cortical Bone Trajectory Pedicle Screw Placement
122 - Midline Lumbar Interbody Fusion With Cortical Bone Trajectory Pedicle Screw Placement
Surgical Indications and Contraindications
Surgical Technique
Positioning
Fluoroscopy
Exposure
Laminectomy and Facetectomy
Disc Preparation and Interbody Placement
Cortical Bone Screw Placement
Closure
Postoperative Care
Complications
128 - Chapter 123 - Transforaminal Lumbar Interbody Fusion
123 - Transforaminal Lumbar Interbody Fusion
Indications
Preoperative Radiographic Studies
Overview of the Procedure
Surgical Technique
Patient Positioning
Planning the Incision
Phase I: Access Port Docking, Exposure, and Pedicle Screw Placement
Phase II: Osteotomies and Decompression of the Segment
Phase III: End Plate Preparation, Trial, and Interbody Placement
Complication Avoidance
Surgical
Early Postoperative Phase
Late Postoperative Phase
Conclusion
129 - Chapter 124 - Dorsal Semirigid Stabilization
124 - Dorsal Semirigid Stabilization
Adjacent Segment Pathology
Semirigid System Rationale
Neutral Semirigid Systems
Dynamic Screw Systems
Semirigid Rod Systems
Compressive Semirigid Systems
Artificial Ligament Systems
Distractive Semirigid Systems, Interspinous Process Spacers
Wallis
X-Stop
Device for Intervertebral Assisted Motion
Coflex System
Superion
Total Facet Replacement Systems
Total Facet Arthroplasty System
ACADIA
TOPSTM Posterior Arthroplasty System
Facet Joint Resurfacing
Disadvantages and Complications
Conclusion
130 - 125 – Lumbar Total Disc Arthroplasty
125 - Lumbar Total Disc Arthroplasty
BACKGROUND
INDICATIONS
CURRENT DESIGNS
LUMBAR TDR DEVICES AVAILABLE IN THE UNITED STATES
LUMBAR TDR DEVICES AVAILABLE OUTSIDE THE UNITED STATES
TWO-LEVEL LUMBAR TDR
MID- AND LONG-TERM OUTCOMES
HYBRID RECONSTRUCTION
ADJACENT SEGMENT DEGENERATION
COMPLICATIONS
COST AND INSURANCE COVERAGE
FUTURE DIRECTIONS AND CONCLUSIONS
131 - Chapter 126 - Minimally Invasive Spinal Decompression and Stabilization Techniques I_ Philosophy and Rationale
126 - Minimally Invasive Spinal Decompression and Stabilization Techniques I: Philosophy and Rationale
EVOLUTION OF MINIMALLY INVASIVE SPINE SURGERY
Lumbar Spine
Minimally Invasive Lumbar Discectomy
Percutaneous Endoscopic Lumbar Laminectomy
Endoscopic Lumbar Foraminotomy
Percutaneous Translaminar Facet Screw Fixation
Transforaminal Lumbar Interbody Fusion
Mini-Open Retroperitoneal Interbody Fusion
Minimally Invasive Lateral Approach for Lumbar Interbody Fusion
Minimally Invasive Oblique Approach for Lumbar Interbody Fusion
Midline Lumbar Fusion With Cortical Bone Trajectory Screws
Thoracic Spine
Cervical Spine
Anterior Cervical Spine Decompression
Posterior Cervical Decompression
Conclusion
132 - Chapter 127 - Posterior Approaches to the Lumbar Spine_ Minimally Invasive Decompression
127 - Posterior Approaches to the Lumbar Spine: Minimally Invasive Decompression
POSTERIOR MINIMALLY INVASIVE APPROACHES TO THE LUMBAR SPINE
Indications
Preoperative Evaluation
Operative Setup
Positioning
Surgical Technique
Minimally Invasive Lumbar Foraminotomy
Minimally Invasive Lumbar Discectomy
Minimally Invasive Posterior Lumbar Decompression
Closure and Postoperative Care
Outcomes and Results
Complications
Summary
133 - Chapter 128 - Endoscopic Approaches to the Cervical Spine
128 - Endoscopic Approaches to the Cervical Spine
POSTERIOR CERVICAL UNILATERAL LAMINECTOMY FOR BILATERAL DECOMPRESSION
Indications
Surgical Technique
Posterior Cervical Foraminotomy
Indications
Surgical Technique
Anterior Endoscopic Cervical Discectomy
Indications
Surgical Technique
Anterior Cervical Transcorporal Discectomy
Indications
Surgical Technique
Discussion
134 - Chapter 129 - Endoscopic Surgical Approaches to the Lumbar Spine
129 - Endoscopic Surgical Approaches to the Lumbar Spine
ENDOSCOPIC LUMBAR DISCECTOMY
Transforaminal Discectomy11
Interlaminar Discectomy14
Patient Selection
Technical Considerations
Outcome
Endoscopic Lumbar Fusion
Patient Selection for Endoscopic Lumbar Fusion
Technique
Technical Considerations
Outcome
Conclusion
Endoscopic Revision of Lumbar Spinal Fusions
Complications Associated With Endoscopic Spine Surgery
Neural Injury and Dural Tears
Injury to Vascular Structures and Postoperative Hematoma
Injury to Abdominal Contents
Incomplete Decompression and Recurrence of the Disc Herniation
Future Trends
135 - Chapter 130 - Posterior Approaches to the Lumbar Spine_ Minimally Invasive Fusion
130 - Posterior Approaches to the Lumbar Spine: Minimally Invasive Fusion
Midline Lumbar Interbody Fusion
Minimally Invasive Posterior Lumbar Interbody Fusion
Minimally Invasive Transforaminal Lumbar Interbody Fusion
Endoscopic Transforaminal Lumbar Interbody Fusion
Comparison With Open Techniques
Biomechanics
Complications and Clinical Results
Infection
Cost Benefit
Conclusion
136 - Chapter 131 - Anterior Lumbar Interbody Fusion
131 - Anterior Lumbar Interbody Fusion
HISTORY
Preoperative Considerations
Patient Selection
Medical Considerations
Imaging
Intraoperative Considerations
Positioning
Incision
Exposure
Retraction
Discectomy
Distraction
Bone Graft Harvest
Bone Morphogenetic Protein
Fusion
Plating
Dorsal Supplementation
Postoperative Complications
Specific Issues Related to the Lower Lumbar Anterior Lumbar Interbody Fusion and the Relationship to Sagittal Balance
Multilevel Anterior Lumbar Interbody Fusion
Summary
137 - Chapter 132 - Anterior and Anterolateral Lumbar Spine Decompression and Fusion_ Minimally Invasive Surgery Approaches
132 - Anterior and Anterolateral Lumbar Spine Decompression and Fusion: Minimally Invasive Surgery Approaches
REGIONAL ANATOMY
Lumbar Plexus
Safety Zones
Vascular Anatomy
Applications of Anterolateral Approaches
Surgical Technique
Preoperative Planning
Lateral Positioning
Operative Procedure
Lateral Plate
Complications
Numbness, Paresthesia, and Weakness
Abdominal Wall Paresis
Subsidence
Prespoas Versus Transpsoas Approaches
Anterior Approach
Conclusion and Key Points
138 - Chapter 133 - Complex Lumbosacropelvic Fixation Techniques
133 - Complex Lumbosacropelvic Fixation Techniques
Anatomic and Biomechanical Considerations
Sacrum
Structures Adjacent to the Sacrum
Sacroiliac Joint
Muscular Interactions
Indications for Lumbosacropelvic Fixation
Lumbosacral Pivot Point
Complex Techniques of Sacral Fixation
Fixation with Sublaminar Devices
Fixation With Screws
Devices for Sacral Fixation With Multiple Screws
Fixation Across the Sacroiliac Joint
Complications of Complex Lumbopelvic Fixation
Revision Surgery
Summary
139 - Spinal Augmentation for Vertebral Compression Fractures
134 - Spinal Augmentation for Vertebral Compression Fractures
Workup for Vertebral Compression Fractures
Vertebroplasty
Surgical Technique
Case Example
Lumbar Spine Compression Fracture
Outcomes
Kyphoplasty
Surgical Technique
Outcomes
Vertebral Augmentation with Expandable Metal Implants
Complications of Vertebroplasty and Kyphoplasty
Conclusion
140 - Chapter 135 - Indications for Spine Fusion for Axial Pain
135 - Indications for Spine Fusion for Axial Pain
Pathophysiology
Diagnosis
Plain Radiographs
Discography
Magnetic Resonance Imaging
Nonsurgical Treatment
Surgical Treatment
Lumbar Fusion
Outcomes of Lumbar Fusion
Patient Predictors of Treatment Outcome
Conclusion
141 - Chapter 136 - Cervical Disc Herniation
136 - Cervical Disc Herniation
Background
Pathophysiology and Diagnosis
Case Example
Management
Surgical Approach
Posterior Cervical Foraminotomy
Anterior Cervical Discectomy and Fusion
Cervical Disc Arthroplasty
Complications
Preoperative Considerations
Dysphagia
Recurrent Laryngeal Nerve Injury
Durotomy
Surgical Site Infection
Esophageal Perforation
Airway Compromise
Vertebral Artery Injury
Case Examples
Case 1
Case 2
142 - Chapter 137 - Lumbar Intervertebral Disc Herniation
137 - Lumbar Intervertebral Disc Herniation
RISK FACTORS FOR RECURRENT DISC HERNIATIONS
Evaluation of Recurrent Disc Herniation
Management of Recurrent Disc Herniation
Conclusion
143 - Chapter 138 - Thoracic Discectomy
138 - Thoracic Discectomy
CLINICAL PRESENTATIONS
Indications for Surgery
Preoperative Planning and Imaging
Surgical Strategies
Posterior Approach
Laminectomy
Posterolateral Approaches
Transpedicular Approach
Transfacet Pedicle-Sparing Approach
Oblique Paraspinal Approach with a Tubular Retractor
Lateral Approaches
Lateral Extracavitary Approach
Lateral Parascapular Extrapleural Approach
Costotransversectomy
Ventrolateral Approaches
Transthoracic thoracotomy
Mini-Open Thoracotomy Approach
Transthoracic Thoracoscopy
Transsternal Approach
Transforaminal Endoscopic Approach
Special Considerations
Postoperative Management
Complications
Case Examples
144 - Chapter 139 - Degenerative Spondylolisthesis
139 - Degenerative Spondylolisthesis
Classification
Clinical Presentation
Imaging
Nonsurgical Treatment
Surgical Treatment
Decompression Alone Versus Decompression and Fusion
Use of Interbody Fusion
Sagittal Alignment
Complications
Conclusion
145 - Chapter 140 - Sacroiliac Joint Pain
140 - Sacroiliac Joint Pain
ANATOMY AND PATHOPHYSIOLOGY OF THE SACROILIAC JOINT
Diagnosis of Sacroiliac Joint Pain
Physical Examination of the Sacroiliac Joint
Diagnostic Injection of the Sacroiliac Joint
Nonoperative Treatment of Sacroiliac Joint Pain
Surgical Treatment of Sacroiliac Joint Pain
Surgical Approaches for Sacroiliac Joint Fusion
Minimally Invasive Sacroiliac Joint Fusion
Minimally Invasive Transiliac Approach
Open Sacroiliac Joint Fusion
Conclusion
146 - Chapter 141 - Surgical Principles for Spinal Deformity
141 - Surgical Principles for Spinal Deformity
Indications for Surgery
Patient Selection
Mitigating Surgical Risk
General Terms
Preoperative Planning and Radiographic Analysis
Measurements in the Coronal Plane
Measurements in the Sagittal Plane
Causes of Spinal Deformity
Congenital Deformities
Neuromuscular Scoliosis
Adolescent Idiopathic Scoliosis
Scheuermann Kyphosis
Degenerative Deformities
Iatrogenic Deformities
Principles of Deformity Surgery
Obtaining Flexibility
Ventral Releases
Posterior Osteotomies
Obtaining Correction
Cantilever Forces
In Situ Rod Contouring
Compression and Distraction
Derotation
Obtaining Fixation
Pedicle Screw Placement
Sacroiliac Fixation
Summary
147 - Chapter 142 - An Approach for Treatment of Complex Adult Spinal Deformity
142 - An Approach for Treatment of Complex Adult Spinal Deformity
Define the Problem
Goals
Osteoporosis
Options
Decompression Alone
Fusion Without Instrumentation
Limited Fusion
Instrumented Correction and Fusion
Instrumentation in Osteoporosis
Interspinous Spacers
Anterior Column Reconstruction
Osteotomies
Vertebral Column Resection
Plans
Outcomes of Complex Surgery for Adult Deformity
Conclusion
148 - Chapter 143 - An Approach for Treatment of Complex Pediatric Spinal Deformity
143 - An Approach for Treatment of Complex Pediatric Spinal Deformity
GROWTH OF THE SPINE
Evaluation
Clinical Evaluation
Imaging Evaluation
Idiopathic Scoliosis: Early Onset and Adolescent Onset
Adolescent Idiopathic Scoliosis
Clinical Features
Classification
Treatment
Early-Onset Scoliosis
Clinical Features
Treatment
Congenital Disorders
Congenital Scoliosis
Dysplastic Spondylolisthesis
Congenital Lordosis
Congenital Kyphosis
Neuromuscular Disorders
Cerebral Palsy
Neuromuscular Dystrophies and Myopathies
Conclusion
149 - Chapter 144 - Cervicothoracic Deformity_ The Role of Anterior Surgery
144 - Cervicothoracic Deformity: The Role of Anterior Surgery
Clinical Evaluation of Cervicothoracic Junction Deformity Patients
Anatomical Considerations
Anatomy of Anterior Access
Etiologies of Deformity
Surgical Management of Cervicothoracic Junction Deformity
Surgical Access Approaches
Smith–Robinson
Sternal Splitting
Manubriotomy
T Incision
Interaortocaval Subinnominate Window
Approach Algorithm
Complications
Case Presentations
Case 1
Case 2
Conclusion
150 - Chapter 145 - Cervical and Cervicothoracic Deformity Correction_ Posterior-Based Osteotomies
145 - Cervical and Cervicothoracic Deformity Correction: Posterior-Based Osteotomies
Preoperative Evaluation
Cervical Alignment Parameters and Quality of Life Outcomes
Surgical Strategies for the Correction of Cervical and Cervicothoracic Deformities
Posterior-Based Osteotomies
Grade 1 Osteotomy
Grade 2 Osteotomy
Smith-Petersen Osteotomy
Grade 5 Osteotomy
Grade 6 Osteotomy
Grade 7 Osteotomy
Perioperative and Mechanical Complications
Case Presentations
Smith-Petersen Osteotomy
Pedicle Subtraction Osteotomy
Conclusion
151 - Chapter 146 - The Role of Anterior Surgery for Thoracolumbar Deformity
146 - The Role of Anterior Surgery for Thoracolumbar Deformity
ANTERIOR VERSUS POSTERIOR APPROACHES TO SPINAL DEFORMITY
Advantages of the Anterior Approach to the Spine
Surgical Approaches to the Anterior Thoracolumbar Spine
Paramedian approach to L3‒S1
Anterior Approaches to the Lumbar Spine in the Lateral Position
Complications and Complication Avoidance in Anterior Spine Surgery
Anterior Surgery
Lateral Approaches to the Lumbar Interbody Space
Anterior Approaches for Spinal Deformity: Case Examples
Postlaminectomy Deformity
Anterior Spinal Fusion for the Lenke 5C Deformity in Children and Adults
Fractional Deformity Correction
Conclusion
152 - Chapter 147 - Anterior Column Release in Deformity
147 - Anterior Column Release in Deformity
Preoperative Evaluation
Lordosis
Procedural Contraindications
Surgical Considerations
Side of Approach
Approach
Anterior Column Release Anatomy
Surgical Technique
Posterior Fixation
Complications
Vascular Injuries
Neurological Injury
Proximal Junctional Kyphosis
Conclusion
153 - Chapter 148 - Posterior-Based Management of Spinal Deformity
148 - Posterior-Based Management of Spinal Deformity
POSTERIOR OSTEOTOMIES FOR SPINAL MOBILIZATION
Partial Facet Joint Resection
Complete Facet Joint Resection
Pedicle Subtraction Osteotomy
Conclusion
154 - Chapter 149 - Minimally Invasive Approaches to Spinal Deformity
149 - Minimally Invasive Approaches to Spinal Deformity
GOALS OF MINIMALLY INVASIVE TECHNIQUES FOR SPINAL DEFORMITY
Correct Sagittal Imbalance (Sagittal Vertical Axis >5 cm)
Correct Coronal Curvature
Restore Pelvic Incidence and Lumbar Lordosis Harmony
Minimally Invasive Surgery Deformity Algorithm
Minimally Invasive Surgical Approaches
Anterior Lumbar Interbody Fusion
Lateral Lumbar Interbody Fusion
Transpsoas Approach
Prepsoas/Antepsoas Approach
Anterior Column Release
Posterior Approaches for Stabilization and Fusion
Expandable Transforaminal Lumbar Interbody Fusion With Facetectomies
Percutaneous Thoracolumbar Pedicle Screw Fixation
Percutaneous Sacropelvic Fixation
Rod Contouring, Passage, and Connection
Navigation and Robotics in Minimally Invasive Surgery
Complications and Complication Avoidance
Conclusion
155 - Chapter 150 - Surgical Management of High-Grade Dysplastic Spondylolisthesis
150 - Surgical Management of High-Grade Dysplastic Spondylolisthesis
Clinical Presentation of High-Grade Dysplastic Spondylolisthesis
Management of High-Grade Dysplastic Spondylolisthesis
Operative Versus Nonoperative Management of High-Grade Dysplastic Olisthesis
Specific Surgical Approaches for the Management of High-Grade Dysplastic Olisthesis
In Situ Fixation and Partial Reduction and In Situ Fixation for Spondylolisthesis
Posterior-Based Reduction of High-Grade Dysplastic Spondylolisthesis
Anterior and Posterior Approach to High-Grade Dysplastic Spondylolisthesis
Conclusion
156 - Chapter 151 - Deformity Surgery for Ankylosing Spondylitis
151 - Deformity Surgery for Ankylosing Spondylitis
CLINICAL PRESENTATION
Clinical Management
Principles of Medication Management for Ankylosing Spondylitis Patients
Complications of Ankylosing Spondylitis
Surgical Management
General Principles
Surgical Correction
Smith-Petersen Osteotomy
Polysegmental Wedge Osteotomy
Pedicle Subtraction Osteotomy
Anesthesia, Neuromonitoring, and Intraoperative Care
Internal Fixation
Complications
Navigation
Summary
157 - Chapter 152 - Failed Back Surgery Syndrome
152 - Failed Back Surgery Syndrome
Risk Factors for Failed Back Surgical Syndrome
Preoperative Factors
Operative and Perioperative Risk Factors
Pathophysiology of Failed Back Surgical Syndrome
Diagnosis
History and Physical
Imaging
Medical Treatment
Pharmacological Therapies
Other Conservative Treatments
Invasive Procedures and Surgical Treatment
Injections
Adhesiolysis
Rhizotomy
Spinal Cord Stimulation
Revision Surgery
Intrathecal Pump
Case Presentations
Case 1
Case 2
Conclusion
158 - Chapter 153 - Oncological Approaches, and Outcomes for Primary Spine Tumors
153 - Oncological Approaches, and Outcomes for Primary Spine Tumors
Preoperative Planning
Clinical Features and Evaluation
Biopsy for Histopathological Diagnosis
Oncological Staging
Surgical Staging
Oncological Surgical Approaches
General Concepts
Level-Specific Challenges
Craniocervical Junction, Subaxial Cervical Spine, and Cervicothoracic Junction
Thoracic Spine
Lumbar Spine
Sacrum
Complications
Outcomes of Primary Spine Tumors
Benign Tumors
Malignant Tumors
Summary
159 - Chapter 154 - Staging, Classification, and Oncological Approaches for Metastatic Tumors Involving the Spine
154 - Staging, Classification, and Oncological Approaches for Metastatic Tumors Involving the Spine
DECISION FRAMEWORKS
Presentation
Staging and Classification
Imaging
Metabolic and Physiological Issues
Estimating Tumor Burden in Other Regions
Pain Control
Treatment
Antitumor Systemic Therapy
Steroids
Bisphosphonates and Denosumab
Treatment Decisions
Radiosensitive Tumors
Radioresistant Tumors
Surgery
Systemic Disease Assessment
Treatment Decision Making
Case Presentations
Case 1: Mechanical Back Pain Requiring Posterolateral Decompression
Case 2: Biological Pain Treated With Image-Guided Intensity-Modulated Radiation Therapy
Case 3: Mechanical Instability
Conclusion
160 - Chapter 155 - Tumors at the Foramen Magnum and Craniocervical Junction
155 - Tumors at the Foramen Magnum and Craniocervical Junction
Pathology and Epidemiology
Intradural Intramedullary Tumors
Intradural Extramedullary Tumors
Extradural Tumors
Differential Considerations
Clinical Presentation
Surgical Anatomy
Osseous Structures
Muscles
Neural Structures
Vascular Structures
Imaging of Tumors
Alteration of Anatomy by the Tumor
Surgical Approach Selection and Considerations
Dorsal Approach
Far Lateral Approach
Transoral Approach
Endoscopic Approaches
Complications
Neurological Complications
Vascular Injury
Infections
Cerebrospinal Fluid Leak
Systemic Complications
Summary
161 - Chapter 156 - Cervicothoracic Junction Tumors
156 - Cervicothoracic Junction Tumors
PRESENTATION AND TREATMENT
Radiation and Stereotactic Radiosurgery
Surgical Treatment
Surgical Indications
Preoperative Evaluation
Ventral Approach
Operative Technique
Advantages and Risks
Lateral Parascapular Extrapleural Approach
Operative Technique
Advantages and Risks
Dorsal Approach
Operative Technique
Cervicothoracic Junction Challenges: Biomechanical Considerations
Cervicothoracic Junction Tumors: Instrumentation
Outcomes and Complications Following Surgical Treatment
Summary
162 - Chapter 157 - Thoracic and Thoracolumbar Spinal Tumors_ Regional Challenges
157 - Thoracic and Thoracolumbar Spinal Tumors: Regional Challenges
Primary Spinal Tumors
Metastatic Spinal Tumors
Surgical Margins
Spine Stability
Neurological Stability
Surgical Considerations for Patients Undergoing Radiation Therapy
Technical Aspects of the Surgical Approach
Preoperative Embolization in Surgical Treatment
Dorsal Approach
Ventral Approach
Dorsolateral Approach
Separation Surgery
Minimally Invasive Approach
New Horizons in the Treatment of Thoracic and Thoracolumbar Spinal Tumors
Complications
Summary
163 - Chapter 158 - Sacral Tumors_ Regional Challenges
158 - Sacral Tumors: Regional Challenges
TUMOR CLASSIFICATION
Metastatic Tumors
Congenital Lesions
Primary Osseous Tumors
Primary Neurogenic Tumors
Diagnosis
Clinical Presentation
Diagnostic Imaging
Diagnostic Biopsy
Surgical Approaches
Preoperative Planning
Sacral Laminectomy
Dorsal Approach for Sacrectomy
Combined Ventral and Dorsal Sacral Resection
Reconstruction After Sacrectomy
Postoperative Management and Complications
Summary
164 - Chapter 159 - Radiosurgery for Spinal Tumors
159 - Radiosurgery for Spinal Tumors
Benefits of Spine Radiosurgery
Spine Radiosurgery as Primary and Definitive Therapy
Radiosurgery as a Postsurgical Adjuvant Treatment
Radiosurgery in the Setting of Reirradiation
Radiosurgery Combined with Minimally Invasive Techniques and High-Grade Compression
Oligometastatic Disease
Complications of Spine Radiosurgery
Benign Tumors and Future Applications
Summary
165 - Chapter 160 - The Acute Management of Traumatic Spinal Cord Injury and Polytrauma
160 - The Acute Management of Traumatic Spinal Cord Injury and Polytrauma
Overview of Acute Management of Spinal Cord Injury
Prehospital Care
Clinical Assessment
Initial Resuscitation and Blood Pressure Management
Radiographic Assessment
Injury Classification and Surgical Decision Making
Timing of Surgery
Considerations for Polytrauma
Conclusion
166 - Chapter 161 - Timing of Surgery Following Traumatic Spinal Cord Injury
161 - Timing of Surgery Following Traumatic Spinal Cord Injury
Classifying Spinal Cord Injury
Cervical Traumatic Spinal Cord Injury
Central Cord Syndrome
Thoracic and Thoracolumbar Traumatic Spinal Cord Injury
Ultra-Early Surgery in Traumatic Spinal Cord Injury
Limitations and Future Directions
Case Illustration
Conclusion
167 - Chapter 162 - Medical Management of Adult and Pediatric Spinal Cord Injury
162 - Medical Management of Adult and Pediatric Spinal Cord Injury
Pathophysiology
Primary Injury
Secondary Injury
Systemic Consequences of Spinal Cord Injury
Acute Medical Management
Airway Protection and Ventilation
Intubation
Circulatory Support
Bradycardia and Other Arrhythmias
Transfer
Administration of Neuroprotective and Neuroregenerative Agents
Neuroprotection
Corticosteroid Administration
Minocycline
Granulocyte Colony-Stimulating Factor
Riluzole
BA-210
Magnesium
Monosialotetrahexosylganglioside
Therapeutic Hypothermia
Neuroregeneration
Anti-Nogo Antibody
Neural Stem/Precursor Cells
Mesenchymal Stem Cells
Polymer Scaffolds and Hydrogels
Medical Management of Subacute and Chronic Complications
Venous Thromboembolic Prophylaxis
Gastrointestinal Complications and Nutrition
Respiratory Complications
Orthostatic Hypotension
Autonomic Dysreflexia
Conclusion
168 - Chapter 163 - Spinal Traction
163 - Spinal Traction
Indications for Use
Head Halter Traction
Gardner–Wells Tongs
Cranial Halo
Cervical Spine
Lumbar Spine
Pediatric Considerations
Case Report
169 - Chapter 164 - Medical Management of Fractures Without Spinal Cord Injury
164 - Medical Management of Fractures Without Spinal Cord Injury
AT THE SCENE
At the Hospital
Imaging Studies
Closed Reduction of the Cervical Spine
Reduction Techniques
Definitive Treatment
Timing of Surgical Intervention
Upper Cervical Injuries
Subaxial Injuries
Thoracic and Thoracolumbar Fractures
Burst Fractures
Multilevel and Noncontiguous Injuries
Kinetic Therapy
Neurological Complete Cord Injuries
Penetrating Injuries and Gunshot Wounds
Osteoporosis Fractures
Orthoses
Cervical Orthoses and Occipital-Mandibular-Cervical Orthoses
Occipital-Mandibular High-Thoracic Orthoses
Occipital-Mandibular Low-Thoracic Orthoses
Thoracolumbosacral Orthoses
Lumbosacral Orthoses
Sacroiliac Orthoses
Halo Skeletal Fixation
Complications of Spinal Bracing
Keys to Nonoperative Care
170 - Chapter 165 - Anterior Surgery for Cervical Trauma
165 - Anterior Surgery for Cervical Trauma
INITIAL EVALUATION
Advantages of Surgical Management and the Anterior Approach
Overview of Common Anterior Approaches and Complication Avoidance
Lateral Retropharyngeal (Whitesides) Approach to the Upper Cervical Spine
Smith–Robinson Approach: C2‒T1
Accessing the Cervicothoracic Junction
Upper Cervical Spine Traumatic Injuries with Anterior Management Approaches
Relevant Anatomy
C1 (Atlas) Fractures
Odontoid Fractures
Subaxial Cervical Spine Traumatic Injuries with Anterior Management Approaches
Classification and Management of Subaxial Cervical Spine Injuries
Type A: Compression Injuries
Type B: Tension Band Injuries
Type C: Translation Injuries
Type F: Facet Joint Injuries
Conclusion
171 - Chapter 166 - Posterior Surgery for Cervical Trauma
166 - Posterior Surgery for Cervical Trauma
UPPER CERVICAL SPINE INJURIES
Occipitocervical Injury
Occipitocervical Fusion
Preparation/Positioning
Occipital Instrumentation
Cervical Spine Instrumentation
Atlas/C1 Injury
Atlas Fracture
Traumatic Transverse Atlantal Ligament Avulsion
C1‒C2 Fusion
C1 Instrumentation
C2 Instrumentation
C1‒C2 Wiring
Transarticular Fixation
Axis/C2 Injury
Odontoid Fracture
Traumatic Spondylolisthesis of the Axis (Hangman Fracture)
Subaxial Cervical Spine Injuries
Classification of Subaxial Cervical Spine Injuries
Nonoperative Techniques for Distracted Facet Injuries
Operative Techniques for Posterior Reduction and Fixation
Cervical Spondyloptosis
Case Examples
Case Presentation 1
Case Presentation 2
Case Presentation 3
172 - Chapter 167 - Surgical Approaches to Thoracolumbar Trauma
167 - Surgical Approaches to Thoracolumbar Trauma
Anatomy
Thoracic Spine
Thoracolumbar Junction
Imaging
Computed Tomography
Magnetic Resonance Imaging
Biomechanics
Concurrent Injuries
Thoracic Spine Fractures
Thoracolumbar Junction Fractures
Classification
Treatment Options and Strategies
Nonoperative Strategies
Operative Strategies
Ventral Versus Dorsal Approaches
Surgical Stabilization Methods
Neurological Decompression for Incomplete Injuries
Additional Operative Considerations
Summary
173 - Chapter 168 - Surgical Approaches for Sacral Fractures and Sacropelvic Injuries
168 - Surgical Approaches for Sacral Fractures and Sacropelvic Injuries
Anatomy
Epidemiology
Clinical Presentation and Diagnosis
Classification Schemes (Table 168.1)
Management and Outcomes
Surgical Techniques
Illustrative Case
Conclusion
174 - Chapter 169 - Rehabilitation and Recovery After Spinal Cord Injury
169 - Rehabilitation and Recovery After Spinal Cord Injury
Rehabilitation and the Role of the Spinal Cord Injury Specialty and Therapist Consult in Setting the Stage for Rehabilitation
Rehabilitation Process
Classification of Spinal Cord Injury: International Standards for Neurological Classification of Spinal Cord Injury and Internat...
The International Standards for Neurological Classification of Spinal Cord Injury
Motor Examination
Sensory Examination
Scoring
International Standards to Document Remaining Autonomic Function After Spinal Cord Injury
Prognosis and Outcome Measures
Outcome Measures
Prevention of Complications
Pressure Injuries
Neurogenic Bowel
Bowel Management Program
Oral Medication Management
Advanced Management
Acute Abdomen
Neurogenic Bladder
Management in the Acute Phase
Postacute Management
Muscle Spasticity
Measuring Spasticity
Conservative Management of Spasticity
Chemodenervation and Neurolysis
Surgical Management and Intrathecal Baclofen
Nutrition
Calcium Metabolism
Thyroid Function
Adrenal Function
Sodium Metabolism
Bracing and Prosthetics
Electrical Neuromodulation in Rehabilitation
Peripheral Nerve Neuromodulation
Functional Electrical Stimulation Devices for Upper Extremity Function
Functional Electrical Stimulation Devices for Lower Extremity Function
Spinal Cord Neuromodulation
Future of Neuromodulation
Conclusion
175 - Chapter 170 - Harvest of Autograft for Spinal Fusion
170 - Harvest of Autograft for Spinal Fusion
Overview: Historical and Current AUTOGENOUS Bone Graft Harvest
Iliac Crest Bone Graft: Harvest Techniques
Complications of Iliac Crest Harvesting
Comparing AUTOGENOUS Grafts: Local Bone Versus Iliac Crest Bone Graft
Conclusion
176 - Chapter 171 - Vascularized Bone Grafts in Spine Surgery
171 - Vascularized Bone Grafts in Spine Surgery
Bone Grafts in Spine Surgery
Vascularized Bone Grafts
Indications and Principles
Surgical Technique
Preoperative Planning
Fibula
Iliac Crest
Rib
Results
Complications
Case Example
Summary
177 - Chapter 172 - Spinal Wound Closure
172 - Spinal Wound Closure
SOFT TISSUE ANATOMY OF THE BACK
Primary Closure
Nonhealing Spinal Wounds
Debridement
Vacuum-Assisted Closure
Hyperbaric Oxygen Therapy
Skin Grafts
Flaps
Paraspinous Muscle Flaps
Trapezius Flaps
Latissimus Flaps
Gluteus Maximus Flaps
Perforator Flaps
Free Flaps and Other Wound Closure Techniques
Summary
178 - Chapter 173 - Big Data in Healthcare
173 - Big Data in Healthcare
Introduction to Big Data in Medicine
The Law of Large Numbers
The Centrality of Predictions in Medicine
Why Big Data Now
Applications
Decision Support Systems
Patient Care Monitoring and Coordination
Image Processing
Electronic Health Record Management
Reimbursement and Claims Management
Drug and Bio Discovery
Omics
Device Design and Manufacturing
Enabling Tools
Data-Gathering Tools
Preprocessing and Cleaning Tools
Big Data Analysis Tools
Data Visualization Tools
Asking Why
Data Privacy and Overreliance on Correlative Data
Putting Big Data In Medicine In Context
The Chudnovsky Brothers
Pi
Biological Data is Transcendental
Patient Age and Geographic Location of Treatment Impact Satisfaction With Outpatient Orthopedic Procedures
Seeking Patterns and Predictability
Squaring the Biological Circle
Age and Location Determine Treatment Outcomes
179 - 174 - Spine Registries
174 - Spine Registries
CLINICAL DATA SYSTEMS IN THE CONTEXT OF VALUE-BASED CARE
Clinical Registries
Registry Design
Current Status: Defining High-Quality Registries
Highlights of Notable Registries
Evaluating Cost Effectiveness Using Registry Data
Subspecialty Registries
Future Trends/Areas for Improvement
Conclusion
180 - Chapter 175 - Conflicts of Interest in Spine Surgery
175 - Conflicts of Interest in Spine Surgery
Surgeon–Industry Collaboration
Importance of Disclosure
Publication Bias
Case Study: Bone Morphogenetic Protein–2
Case Study: Lumbar Artificial Disc Replacement
Scott’s Parabola
Consequences
Conclusion
181 - Chapter 176 - Art of the Clinical Trial
176 - Art of the Clinical Trial
COMPARATIVE EFFECTIVENESS
Prospective Studies
Randomized Controlled Trials
Informational Bias
Research Question
Patient Population
Influence
Feasibility
Pilot Studies
Cost
Summary
182 - Chapter 177 - Meaningful Retrospective Analysis
177 - Meaningful Retrospective Analysis
Retrospective Clinical Studies
Limitations of Randomized Clinical Trial Methodologies
Advantages of Retrospective Methodology
Limitations of Retrospective Methodology
Administrative Databases
Complication and Cost Outcomes Using Administrative Databases
Clinical Registries
Summary
183 - Chapter 178 - Art and Science of Guideline Formation
178 - Art and Science of Guideline Formation
Author Group
Question Formation
Literature Search
Evidence Grading
Creation of Recommendations
Final Caveats
Beyond Recommendations: Implementation and Review
Summary
184 - Chapter 179 - Appropriate Use Criteria in Spine Surgery
179 - Appropriate Use Criteria in Spine Surgery
RAND Corporation/University of California Los Angeles Appropriateness Method
Existing Appropriate Use Criteria In Spine Surgery
Cervical Fusion
Lumbar Laminectomy
Degenerative Lumbar Scoliosis
Degenerative Lumbar Spondylolisthesis
Vertebral Fragility Fractures
Persistent Pain After Spine Surgery
Imaging Appropriate Use Criteria Program
Criticism of the Appropriateness Method
185 - Chapter 180 - Precision Medicine_ Artificial Intelligence Applied to Evaluation and Management of Spinal Disorders
180 - Precision Medicine: Artificial Intelligence Applied to Evaluation and Management of Spinal Disorders
ARTIFICIAL INTELLIGENCE, MACHINE LEARNING, AND DEEP LEARNING
Application of Artificial Intelligence to the Evaluation of Spinal Disorders
Automated Segmentation and Measurement of Spinal Images
Diagnosing Conditions Using Automated Methods
Automated Fracture Identification and Grading
Application of Artificial Intelligence to the Management of Spinal Disorders
Prediction of Surgical Outcomes and Complications
Predicting Trajectory of Disorder
Pitfalls and Limitations of Artificial Intelligence Models
Conclusions and Future Applications of Artificial Intelligence for Spinal Disorders
186 - Chapter 181 - Healthcare Reform and Spine Surgery
181 - Healthcare Reform and Spine Surgery
Expenditures and Spinal Disorders
Payment Models in Spine Surgery
Managed Care and Managed Competition
The Patient Protection and Affordable Care Act
Value-Based Care Models and Spine Surgery
Accountable Care Organizations
Episode-Based Care With Bundled Payments
Integrated Practice Units With Centers of Excellence
Shared Savings Approaches: Merit-Based Incentive Payment System and Medicare Access and CHIP Reauthorization Act
Summary and Conclusions
187 - Chapter 182 - Development of New Technologies in Spine Surgery
182 - Development of New Technologies in Spine Surgery
HISTORY OF INNOVATION IN SPINAL SURGERY
Development of Surgical Techniques
Development of Surgical Technologies
Development of Pedicle Fixation
Acceleration of Spinal Technology Development
Classification of Surgical Innovations and Technology Development
Fundamentals of Surgical Innovation and Development
Intellectual Property Protection
Idea Development and Refinement
Pathways to Commercialization of New Technology
Ethical and Regulatory Considerations
Industry’s Role in Advancing Innovation
U.S. Food and Drug Administration Clearance
Adoption of Surgical Technology
Conclusion
Index -
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