Foreword by Gending Dang
Foreword by Yan Wang
Acknowledgments
Introduction
Contents
1: Technique and Application of Atlas Internal Fixation
1.1 Atlas Internal Fixation: A Historical Perspective
1.2 Atlas Anatomy
1.3 Key Points of Atlas Lateral Mass Screw Technique
1.3.1 Determining Screw Entry Points in the Lateral Mass of the Atlas
1.3.2 Entry Angle for a C1 Lateral Mass Screw
1.3.3 Depth of C1 Lateral Mass Screws
1.4 Surgical Steps (Method A)
1.5 Imaging Features of Standard Pedicle Screws of the Atlas (Figs. 1.31, 1.32, 1.33, 1.34, and 1.35)
1.6 Pearls and Pitfalls
References
2: C2 Internal Fixation Techniques and Their Applications
2.1 Axis Internal Fixation: A Historical Perspective
2.2 Anatomy of the Axis
2.2.1 The Gross Anatomy of C2 Was Shown Below (Figs. 2.5, 2.6, 2.7, 2.8, and 2.9)
2.2.2 The Vertebral Artery in Relation to the Axis
2.3 Key Points of Axis Pedicle Screw Techniques
2.3.1 Determining Entry Points of C2 Pedicle Screws
2.3.2 Entry Angle of the Pedicle Screw of the Axis
2.3.3 Depth of the Pedicle Screw of the Axis
2.3.4 Surgical Steps
2.4 Imaging Features of Standard Pedicle Screws of the Axis (Figs. 2.24, 2.25, 2.26, 2.27, 2.28, and 2.29)
2.5 Pearls and Pitfalls
References
3: Lateral Mass Screw Fixation Techniques for the Lower Cervical Spine
3.1 Lateral Mass Screws for the Lower Cervical Spine: A Historical Perspective
3.2 Surgical Anatomy of the Lateral Mass of the Lower Cervical Spine
3.2.1 Defining the Lateral Mass Boundaries
3.2.2 Important Neurovascular Structures in Relation to the Lateral Masses
3.2.3 Measured Dimensions of the Lateral Mass of the Cervical Spine (Figs. 3.9 and 3.10; Table 3.1)
3.3 Lateral Mass Screw Techniques for the Lower Cervical Spine
3.3.1 Determining the Screw Entry Points in the Lateral Mass of the Cervical Spine
3.3.2 Entry Angles of Lateral Mass Screws of the Cervical Spine (Figs. 3.12 and 3.13)
3.3.3 Entry Depth of Lateral Mass Screws
3.3.4 Surgical Steps
3.3.5 Imaging Features of Standard Lateral Mass Screws of the Cervical Spine (Figs. 3.15, 3.16, 3.17, and 3.18)
3.3.6 Pearls and Pitfalls
References
4: Surgical Techniques for Pedicle Screw Fixation of the Cervical Spine and Their Applications
4.1 Pedicle Screw Fixation Technique for the Cervical Spine: A Historical Perspective
4.2 Surgical Anatomy of the Pedicles of the Cervical Spine
4.2.1 Gross Anatomy (Figs. 4.5, 4.6, 4.7, and 4.8)
4.3 Data in Relation to the Pedicles of the Cervical Spine
4.4 Key Points of Pedicle Screw Techniques for Fixation of the Cervical Spine
4.4.1 Determining Pedicle Screw Entry Points in the Cervical Spine (Fig. 4.11)
4.4.2 Pedicle Screw Entry Angles in the Cervical Spine (Fig. 4.12)
4.4.3 Entry Depths of Pedicle Screws in the Cervical Spine
4.4.4 Surgical Steps (Insertion of C4 Pedicle Screw Is Used as an Example)
4.5 Imaging Features of Standard Pedicle Screws of the Cervical Spine (Figs. 4.18, 4.19, and 4.20)
4.6 Pearls and Pitfalls
References
5: Anterior Cervical Plate Techniques and Their Applications
5.1 A Historical Review and Anatomic Parameters
5.1.1 A Historical Review of Anterior Cervical Plate Techniques
5.1.2 Anatomic Parameters Related to Cervical Anterior Plates
5.2 Internal Fixation with the ATLANTIS Anterior Cervical Plate System
5.2.1 Surgical Indications and Contraindications
5.2.2 Surgical Steps
5.3 Clinical Cases
5.4 Pearls and Pitfalls
5.5 Postoperative Management
References
6: Artificial Cervical Disc Techniques and Their Applications
6.1 A Historical Review of Artificial Cervical Disc Techniques
6.2 Anatomy of Cervical Intervertebral Discs
6.3 Artificial Cervical Intervertebral Disc Replacement Technique
6.3.1 Standard Location of Artificial Cervical Intervertebral Disc Replacement
6.3.2 Preoperative Planning for Artificial Cervical Intervertebral Disc Replacement and Key Operative Techniques
6.4 Personalized Surgical Plan
6.4.1 Surgical Indications and Contraindications
6.4.1.1 Indications
6.4.1.2 Contraindications
6.5 Surgical Steps
6.5.1 Preoperative Measurement
6.5.2 Patient Positioning
6.5.3 Exposure
6.5.4 Decompression
6.5.5 Endplate Preparation
6.5.6 Selection of Appropriate Implant Sizes
6.5.7 Rail Preparation
6.5.8 Rail Cutting
6.5.9 Implantation
6.5.10 Placement Verification
6.5.11 Bi-level Implantation
6.6 Standard Imaging Features
6.7 Clinical Cases
6.8 Pearls and Pitfalls
6.8.1 The Imaging Features of Undesirable PRESTIGE Artificial Disc Replacement
References
7: The CENTERPIECE™ Posterior Cervical Laminoplasty and Internal Fixation System
7.1 Posterior Cervical Laminoplasty: A Historical Perspective
7.2 Implants
7.3 System Features
7.4 Indications and Contraindications
7.5 Standard Imaging Features of Cervical Spinal Stenosis
7.6 Surgical Procedures
7.6.1 Surgical Exposure
7.6.2 Proper Techniques for Open Door
7.6.2.1 The Open Side and Direction
7.6.2.2 Trough Preparation and Hinge Position
7.6.2.3 Trough and Hinge Shape
7.6.2.4 Tools for Open-Door Laminoplasty
7.6.2.5 Size of the Open Door
7.6.2.6 Extent of the Open Door
7.6.2.7 Methods for Open-Door Laminoplasty
7.6.3 Keeping the Door Open
7.7 Clinical Cases
7.8 Intraoperative Cautions and Clinical Pearls
7.9 Postoperative Management
Reference
8: Surgical Techniques for Pedicle Screw Fixation of the Thoracic Spine
8.1 Pedicle Screw Fixation Technique for the Thoracic Spine: A Historical Perspective
8.2 Surgical Anatomy of the Pedicles of the Thoracic Spine (Figs. 8.5, 8.6, 8.7, and 8.8)
8.3 Data in Relation to the Pedicles of the Thoracic Spine
8.4 Determination of Thoracic Pedicle Screw Entry Points (Fig. 8.14)
8.5 Thoracic Pedicle Screw Entry Angles
8.6 Thoracic Pedicle Screw Entry Depths
8.7 Determination of the Diameters of Thoracic Pedicle Screws
8.8 Surgical Procedures
8.9 Imaging Features of Standard Pedicle Screws (Figs. 8.24, 8.25, 8.26, 8.27, 8.28, 8.29, 8.30, 8.31, 8.32, 8.33, 8.34, 8.35, 8.36, and 8.37)
References
9: Lumbar Pedicle Screw Fixation Techniques and Their Applications
9.1 Unit 1: Lumbar Pedicle Screw Fixation Techniques and Their Applications
9.1.1 A Historical Review and Anatomic Parameters
9.1.1.1 A Historical Review of Lumbar Pedicle Screw Techniques
9.1.1.2 Anatomy of the Lumbar Pedicle
Gross Anatomy
Anatomic Data of the Lumbar Pedicle
9.1.1.3 Lumbar Pedicle Screw Techniques
Determining the Entry Point of Lumbar Pedicle Screws
Entry Angle of Lumbar Pedicle Screws
Entry Depth of Lumbar Pedicle Screws
9.1.1.4 Surgical Steps
Determine Screw Entry Point (Fig. 9.11)
Prepare Screw Trajectory
Screw Insertion
9.2 Unit 2: The CD HORIZON LEGACY Plate Internal Fixation System via a Lumbar Posterior Approach
9.2.1 Implants
9.2.2 Features of the System
9.2.3 Clinical Indications and Contraindications
9.2.3.1 Indications
9.2.3.2 Contraindications
9.2.4 Surgical Techniques
9.2.4.1 CDH SOLERA Degenerative Surgical Technique
9.2.4.2 Rod Contouring and Placement
9.2.4.3 Compression/Distraction
9.2.4.4 Final Tightening and Decortication
9.2.4.5 Graft Placement
9.2.4.6 X10 CROSSLINK Plate Placement
9.2.4.7 In Line Plate Holder Method
9.2.4.8 Implant Positioner Method
9.2.4.9 Forceps Plate Holder Method
9.2.5 Pedicle Screw Surgery for Deformity Correction Using the SOLERA System
9.2.5.1 Hinged Translator
9.2.5.2 Placing the Stabilizing Rod
9.2.5.3 Final Tightening and Decortication
9.2.6 Multi-axial Reduction Screw Techniques
9.2.6.1 Screw/Rod Placement
9.2.6.2 Spondylolisthesis Reduction
9.2.6.3 Final Tightening
9.3 Clinical Cases
9.4 Common Pitfalls in Surgery of Vertebral Scoliosis due to Neurofibromatosis
9.4.1 Pitfall #1
9.4.2 Pitfall #2
9.4.3 Pitfall #3
9.5 Pearls and Pitfalls
9.6 Postoperative Management
References
10: Surgical Techniques for Iliac Screws
10.1 Iliac Screw Fixation Technique: A Historical Perspective
10.2 Data in Relation to the Ilium
10.3 Iliac Screw Techniques
10.3.1 Determination of Screw Entry Points
10.3.2 Screw Entry Angle
10.3.2.1 Entry Angle of a Single Iliac Screw
10.3.2.2 Entry Angle of Double Iliac Screws
10.3.3 Entry Depths of Iliac Screws
10.4 Surgical Procedures
10.4.1 Choosing the Iliac Screw Entry Point (Fig. 10.8)
10.4.2 Completing Iliac Screw Fixation (Fig. 10.9)
10.4.3 The Sectional View of the Iliac Screw Trajectory (Figs. 10.10, 10.11, 10.12, 10.13)
10.5 Imaging Features of Standard Iliac Screws (Fig. 10.14)
References
11: Surgical Techniques for Sacral Pedicle Screws
11.1 Sacral Screw Fixation Technique: A Historical Perspective
11.2 Anatomic Data in Relation to the Sacrum (Figs. 11.4, 11.5, 11.6, 11.7, and 11.8)
11.3 S1 Pedicles
11.4 Determination of S1 Pedicle Screw Entry Points
11.5 Entry Angle of Sacral Pedicle Screws
11.5.1 Entry Angle of S1 Pedicle Screws
11.5.2 Entry Angles of S2 Screws
11.6 Entry Depth of Sacral Pedicle Screws
11.7 Selection of Diameters of Sacral Pedicle Screws
11.8 Surgical Procedures
11.9 Imaging Features of Standard Sacral Pedicle Screws (Figs. 11.17, 11.18, 11.19, 11.20, 11.21, and 11.22)
References
12: Surgical Techniques for Thoracolumbar Anterior Internal Fixation
12.1 Thoracolumbar Anterior Internal Fixation Techniques: A Historical Perspective
12.2 Indications and Contraindications
12.2.1 Indications
12.2.2 Contraindications
12.3 Surgical Procedures (with the VANTAGE System)
12.3.1 Thoracolumbar Anterior Plate Fixation System: The Staple Method
12.3.1.1 Corpectomy
12.3.1.2 Staple Placement
12.3.1.3 Screw Placement
12.3.1.4 Reduction, Graft Length Measurement, and Placement
12.3.1.5 Reduction Methods
12.3.1.6 Plate Measurement and Placement
12.3.1.7 Loading the Nut
12.3.1.8 Compression/Final Tightening
12.3.1.9 Closure/Postoperative Management
12.4 Thoracolumbar Anterior Plate Internal Fixation: The Single Bolt Option
12.4.1 Bolt Insertion
12.4.2 Endoscopic Option
12.4.3 Reduction, Graft Length Measurement, and Placement
12.4.4 Reduction Option
12.4.5 Plate Measurement and Placement
12.4.6 Nut Placement
12.4.7 Compression/Final Tightening
12.4.8 Closure/Postoperative Care
12.5 Clinical Cases
12.5.1 Case No. 1
12.5.2 Case No. 2
12.6 Pearls and Pitfalls
12.7 Postoperative Care
References
13: Spine Minimally Invasive Internal Fixation Techniques and Their Applications
13.1 Implants
13.1.1 Multilevel Rod Inserter (Fig. 13.1)
13.1.2 Screw Retaining Sleeve (Fig. 13.2)
13.1.3 Screw Extenders (Fig. 13.3)
13.1.4 Rod Inserter Arc Arm (Fig. 13.4)
13.1.5 Multilevel Distractor Guide (Fig. 13.5)
13.1.6 Multilevel Stylet Guide (Fig. 13.6)
13.1.7 Rod Template (Fig. 13.7)
13.1.8 Rod Template Pointer (Fig. 13.8)
13.1.9 Multilevel Lucent Guide Clamp (Fig. 13.9)
13.1.10 Hollow Drill Bit (Fig. 13.10)
13.2 Features of the System
13.3 Clinical Indications and Contraindications
13.4 Surgical Procedures
13.4.1 Sextant Fixation Technique
13.4.1.1 Step 1: Preoperative Planning
13.4.1.2 Step 2: Selection of Screw Entry Site
13.4.1.3 Step 3: Anatomic Considerations of the Pedicle
13.4.1.4 Step 4: Using the Navigation System
13.4.1.5 Step 5: Accessing the Pedicle (PAK Needle and Awl/Probe Option)
13.4.1.6 Step 6: Fascia Dilation
13.4.1.7 Step 7: Pedicle Preparation
13.4.1.8 Step 8: Screw Extender Assembly
13.4.1.9 Step 9: Screw Insertion
13.4.1.10 Step 10: Inserting the Second Screw
13.4.1.11 Step 11: Connecting the Screw Extenders
13.4.1.12 Step 12: Connecting the Rod Inserter and Trocar
13.4.1.13 Step 13: Inserting the Trocar
13.4.1.14 Step 14: Rod Measurements
13.4.1.15 Step 15: Passing the Rod
13.4.1.16 Step 16: Final Tightening
13.4.1.17 Step 17: Removal of Screw Assembly
13.4.1.18 Step 18: Closure
13.5 SEXTANT Percutaneous Pedicle Screw System
13.5.1 Alignment
13.5.1.1 Freehand Method for Pedicle Needle Insertion
13.5.1.2 Alignment Guide Method
13.5.2 Connecting the Guide
13.5.2.1 Step 1
13.5.2.2 Step 2
13.5.2.3 Step 3
13.5.2.4 Step 4
13.5.2.5 Step 5
13.5.2.6 Step 6
13.5.2.7 Step 7
13.5.2.8 Step 8
13.6 CD HORIZON SEXTANT Spondylolisthesis Reduction Technique
13.6.1 Instruments and Implants
13.6.2 Screw and Extender Assembly
13.6.3 Instruments and Implants
13.6.4 Measuring Reduction Amount
13.6.5 Screw Insertion
13.6.6 Connecting the Extenders
13.6.7 Trocar Assembly
13.6.8 Connecting the Rod Inserter
13.6.9 Preparation of the Soft Tissue Trajectory
13.6.10 Connecting the Rod Inserter
13.6.11 Verification of Rod Passage
13.6.12 Passing the Rod
13.6.13 Screw Insertion
13.6.14 Spondylolisthesis Reduction
13.6.15 Compression and Distraction
13.6.16 Breaking-Off the Tip of the Screw
13.6.17 Removing the Assembly
13.6.18 Connecting the Extenders
13.6.19 Screw Implantation
13.6.20 Spondylolisthesis Reduction
13.6.21 Internal Fixation
13.6.22 Unilateral Reduction Technique
13.6.23 Bilateral Reduction Technique
13.7 The Multilevel Percutaneous Internal Fixation System
13.7.1 Preoperative Plan
13.7.2 Patient Position
13.7.3 Skin Incision
13.7.4 Entering the Pedicle
13.7.5 Neuromonitoring of Nerve Integrity
13.7.6 Removal of Handle and Needle Stylet
13.7.7 Guidewire Insertion
13.7.8 Advancing the Remaining Guidewire
13.7.9 Dilation of the Muscles
13.7.10 Removal of the Dilators
13.7.11 Pedicle Tapping
13.7.12 Tap Removal
13.7.13 Removal of the Last Dilator
13.7.14 Inserting the Inner Sleeve
13.7.15 The Inner Sleeve Is Adjusted to “LD”
13.7.16 Assembling and Tightening the Screw
13.7.17 Screwdriver Insertion
13.7.18 Insertion of the Screw Extender Assembly into the Pedicle
13.7.19 Placement of the Remaining Screw Extenders
13.7.20 Extender Alignment for Passing the Rod
13.7.21 Measuring the Rod Length
13.7.22 Attaching the Rod to the Rod Inserter
13.7.23 Estimating Rod Entry Site
13.7.24 Passing the Rod Through the First Extender Cephalocaudally
13.7.25 Confirmation of Rod Passing
13.7.26 Passing the Rod Through the Remaining Extenders
13.7.27 Verification of Hanging Rod
13.7.28 Gradual Reduction of Extenders
13.7.29 Passing the Contralateral Rod and Reduction of Extenders
13.7.30 Assembling the Screw
13.7.31 Assembling the Counter Torque Wrench and Break-Off
13.7.32 Compression/Distraction
13.7.33 Compression/Distraction of the Remaining Segments and Final Break-Off of the Screw
13.7.34 Removal of Rod Inserter
13.7.35 Removal of Extenders
13.7.36 Removal of the Remaining Extenders and Wound Closure
13.7.37 Disassembly of Screw Extenders
13.7.38 Implant Explantation
13.8 Clinical Cases
13.8.1 Case No. 1
13.8.2 Case No. 2
13.8.3 Case No. 3
13.8.4 Case No. 4
13.9 Caveats and Lessons
13.9.1 Postoperative Management
References
14: Thoracolumbar Percutaneous Vertebroplasty (PVP) and Percutaneous Kyphoplasty (PKP)
14.1 Percutaneous Kyphoplasty: A Historical Perspective
14.2 Surgical Techniques of PVP and PKP
14.2.1 Anesthesia
14.2.2 Radiographic Visualization
14.2.2.1 PVP
Determination of Puncture Site
Puncture Angle
Puncture Depth
Tailored Adjustment
Surgical Steps
14.2.2.2 PKP Technique
Puncture
Surgical Steps
14.3 Clinical Cases
14.3.1 Case No. 1
14.4 Pearls and Pitfalls
References
15: Internal Fixation Technique and Application in the Osteoporotic Spine
15.1 A Historical Perspective
15.1.1 A Historical Perspective of Osteoporosis Screw Loosening
15.1.2 A Historical Perspective of Expansive Screw
15.1.3 A Historical Perspective of Bone Cement Screw
15.2 Technical Points
15.3 Clinical Cases
15.3.1 Expansive Screw Fixation
15.3.1.1 Case No. 1
15.3.1.2 Case No. 2
15.3.2 Bone Cement-Augmented Screw Fixation
15.3.2.1 Case No. 1
15.3.2.2 Case No. 2
15.4 Pearls and Pitfalls
References
16: Anterior Odontoid Screw Techniques and Application
16.1 Anterior Odontoid Screw Fixation Techniques: A Historical Perspective
16.2 Anatomy of the Odontoid Process (Figs. 16.1, 16.2, 16.3, 16.4, and 16.5; Table 16.1)
16.3 Key Points of the Odontoid Screw Technique
16.3.1 Screw Entry Site
16.3.2 Screw Entry Angle
16.3.3 Screw Length
16.4 Surgical Steps (3D Reconstruction Images)
16.5 Clinical Cases
16.5.1 Case No. 1
16.6 Pearls and Pitfalls
16.7 Postoperative Care
16.8 Clinical Experiences and Cautions
16.8.1 Surgical Indications of Odontoid Screw Fixation Techniques
16.8.2 Treatment Options for Anteroposterior-Posteroinferior (Reverse Oblique Type) Fracture
16.8.3 Number of Screws
References
17: The Interbody Fusion System
17.1 Devices for Cervical Intervertebral Fusion
17.1.1 Implant
17.1.2 Clinical Indications and Contraindications
17.1.3 Surgical Procedures
17.1.4 Clinical Cases
17.1.4.1 Case No. 1
17.1.4.2 Case No. 2
17.2 Titanium Mesh Cage Fusion Device
17.2.1 Implant
17.2.2 Clinical Indications and Contraindications
17.2.3 Surgical Procedures
17.2.4 Clinical Cases
17.2.4.1 Case No. 1
17.2.4.2 Case No. 2
17.2.4.3 Case No. 3
17.3 Pearls and Pitfalls
17.4 Anatomic Lumbar Interbody Fusion Device
17.4.1 Implant (Fig. 17.34)
17.4.2 Clinical Indications and Contraindications
17.4.3 Surgical Procedures
17.5 Clinical Cases
17.5.1 Case No. 1
17.5.2 Case No. 2
17.5.3 Case No. 3
17.6 Pearls and Pitfalls