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Surgical Techniques in Spinal Surgery: Cervical Spine: A Step by Step Approach
PS Ramani
SECTION 1: BASIC KNOWLEDGE OF CERVICAL SPINE
1:
Historical Background of Surgery on Cervical Spine
Early Landmarks
Brief History (Figs 1.6 to 1.9)
2:
Applied Anatomy of Cervical Spine
First Cervical Vertebra
Second Cervical Vertebra
Typical Cervical Vertebra
Uncovertebral Joint
Intervertebral Disc
Nerve Roots
Vertebral Artery
Movements of Cervical Spine
Most Mobile Portion of the Spine
Flexion Extension
Lateral Bending
Rotation
Important Root Lesions
3:
Biomechanics of Cervical Spine
Stability
Motion Segment
Segmental Instability
Ligaments
Factors Influencing Stability of the Spine
SECTION 2: ORIENTATION IN THE OPERATION THEATER
4:
Operation Theater Set-up
Introduction
C-Arm
Ceiling Lamps
Head Lamp
Operating Microscope
Microinstruments
Anesthesia Machine
Unipolar and Bipolar Cautery and High Speed Drills
Operating Table
Soft Gel Headrest
Warming Blanket
Ultrasonic Surgical Aspirator
Navigation System
Position of Operating Team Around the Operating Table
Live Operating Picture
Instrument Sets
Prevention of Deep Vein Thrombosis
Fiberoptic laryngoscope for Nasal intubation
Operating Team
5:
Basic Instrument Set for Spinal Surgery
Introduction
The Instruments
6:
Hemostasis in Spinal Surgery
Introduction
Surgeon
Preoperative Evaluation
Anesthesia
Position of the Patient
During Surgery
Other Agents
Hemostatic Matrix (Surgiflow-Johnson and Johnson)
Conclusion
SECTION 3: TECHNIQUES OF HARVESTING BONE GRAFTS FROM THE ILIAC CREST AND FAMILIARITY WITH THE USE OF SCREWS AND PLATES
7:
Technique of Harvesting Bone Grafts from the Anterior and Posterior Iliac Crest
Anterior Iliac Crest
Introduction
Graft
Posterior iliac crest
Introduction
Graft
Possible Complications
Conclusion
8:
Basic Knowledge of Screws Used in Spinal Surgery
Introduction
Uses of Screws in Cervical Spine
Components of Screw
Types of Screws
Steps of Screw Insertion
Holding Power of Screws
Other Factors Influencing the Holding Power
Pull Out Strength of Screws Depends–
9:
Operative Technique of Screws and Plates Fixation in Anterior Cervical Spine
Introduction
Advantages
Indications
Plates
Screws
Procedure
Bicortical Purchase
Conclusion
10:
Posterior Atlantoaxial Stabilization with Screws in the Lateral Masses
Introduction
Indications
Contraindications
Procedure
Postoperative
Complications
Conclusion
11:
Posterior Atlantoaxial Stabilization with Screws and Plates in the Lateral Masses
Introduction
Position and Procedure
Complications
Occipitocervical Stabilization
Conclusion
12:
Posterior Subaxial Stabilization of the Cervical Spine: Lateral Mass Screws and Plates or Rods
Introduction
Indications
Contraindications
Procedure
Complications
Conclusion
SECTION 4: SURGICAL APPROACHES TO CRANIO-VERTEBRAL JUNCTION
13:
Surgical Technique for Anterior Occipitocervical Decompression and Fusion
Introduction
Indications
Types
Pre-operative Evaluation
Use of Pre-operative Traction
Complications
Conclusion
14:
Transoral Approach to Cranio-vertebral Junction: Basic Principles
Introduction
Indications
Variation in Approach
Basic Anatomy
Advantages
Contraindications
Preoperative Evaluation
Anesthesia
Complications
Conclusion
15:
Anterior Approach to Upper Cervical Spine
Transoral Odontoidectomy
Introduction
Indications
Preoperative Evaluation
Position
Operative Procedure
The Dissection
Postoperative Management
Complications
Extended Transoral Approach
Conclusion
Maxillotomy (Le-Forte-I Osteotomy) for Upward Extension of Transoral Approach
Introduction
Precautions
Advantages
Conclusion
16:
Retropharyngeal Approach to Occipitocervical Junction
Introduction
Indications
Contraindications
Advantages
Surgical Steps
Complications
Conclusion
17:
Surgical Technique of Posterior Exposure of Occiput C1 and C2
Introduction
Indications
Caution
Surgical Steps
Alternative Approaches
Precautions
Conclusion
18:
Posterior Occipitocervical Stabilization Using Contoured Hartshill Ring or Ransford Loop
Introduction
Indications
Advantages
Caution
Surgical Steps
Dr Ramani's Method
Decortication
Fusion
Complications
Conclusion
19:
Posterior Occipitocervical Fusion Using Auto-bone Graft from the Posterior Iliac Crest: Menezes Principle
Introduction
Operative Techniques
Harvesting the Graft
Harvesting Iliac Crest Graft
Postoperative Care
Conclusion
20:
Other Modalities of C1 and C2 Fusion
Introduction
Indications
Methods
21:
Far Out Lateral Transcondylar Approach to Lesions Placed Intradurally Anterior to Cervico-medullary Junction
Introduction
Indications
Contraindications
Advantages
Radiological Evaluation
Surgical Steps
Specific Postoperative Care
Complications
Conclusion
SECTION 5: SURGICAL APPROACHES TO SUBAXIAL ANTERIOR CERVICAL SPINE
22:
Anterior Approach to Subaxial Cervical Spine–Some Considerations
Introduction
Indications
Advantages
Disadvantages
Approach
Vertical or Horizontal Incision
Illumination and Magnification
23:
Surgical Approach to Subaxial Anterior Cervical Spine–Basic Knowledge
Approaches to Lower Cervical Spine can be Divided into Three Broad Groups
Basic Knowledge of Tissues
Conclusion
24:
Step by Step Approach to Anterior Subaxial Cervical Spine
Introduction
Anesthesia
Intubation and Position of the Tube
Difficult Intubation
Position of Anesthesia Machine
Position of the Head
Position of Pelvis
OT Personnel
Operative Steps
Platysma Muscle
Omohyoid Muscle
Blood Vessels and the Hollow Organs
Correct Level
Longus Colli Muscles
Excision of Anterior and Posterior Osteophytes
Recurrent laryngeal nerve
Sympathetic Chain
Conclusion
25:
Anterior Cervical Discectomy and Fusion
Excision of Anterior Osteophytes
Excision of Intervertebral Disc
The Fusion
Implants
Possible Complications
Conclusion
26:
Anterior Cervical Microdiscectomy
Introduction
Indications
Contraindications
Advantages
Disadvantages
Surgical Steps
Postoperative care
Complications
Conclusion
27:
Anterior Cervical Median Corpectomy
Introduction
Indications
Advantages
Disadvantages
Surgical Steps
Steps of Corpectomy
Difficulties
Fusion
Conclusion
28:
Motion Preserving Anterior Cervical Stabilization–Cervical Discoplasty
Introduction
Justification for Dynamic Reconstruction
Theoretical Presumed Benefits from Dynamic Reconstruction
Pre-requisite
Certain Issues
Disadvantages
Surgical Steps
Expected Functioning of the Disc
Complications
Postoperative Management
Some Commonly Available Models
Conclusion
SECTION 6: POSTERIOR APPROACH TO SUBAXIAL CERVICAL SPINE
29:
Posterior Exposure of Subaxial Cervical Spine
Introduction
Advantages
Disadvantages
Basic Knowledge
Anesthesia
Position of the Patient
Exposure
Closure
Controversy
Complications
Mobilization
Conclusion
30:
Cervical Laminectomy
Introduction
Pitfalls
Length of Decompression
Advantages
Disadvantages
Surgical Steps
Tips on High Speed Drilling
Closure
Conclusion
31:
Posterior Cervical Foraminotomy
Introduction
Decompression of the Root
Indications
Contraindications
Advantages
Surgical Technique
Incision
Closure
Complications
Conclusion
32:
Posterior Cervical Microdiscectomy
Introduction
Indications
Contraindications
Advantages
Surgical Technique
Incision
Closure
Postoperative Management
Complications
Conclusion
33:
Cervical Laminoplasty
Introduction
Advantages
Indications
Disadvantages
Laminectomy and Laminoplasty
Laminoplasty
Operative Procedure
Fixation of the laminae
Alternative Useful Method
Possible Complications
Conclusion
SECTION 7: CONGENITAL MALFORMATIONS OF THE NERVOUS TISSUE
34:
Step by Step Surgical Approach to Chiari Malformations
Introduction
Chiari Malformations
Establishment of Diagnosis
Indications for Surgery
Management Protocol for Chiari Malformation
Arachnoid Adhesionlysis
Management of Syringomyelia
Surgical Steps for Foramen Magnum Decompression
Complications
Surgical steps in Syringomyelia shunting
Complications
Syringoperitoneal Shunt
Advantages
Disadvantages
Syringopleural shunt
Drainage of Syrinx
Terminal Ventriculostomy
Results and Prognosis
Conclusion
35:
Cervical Encephalocele
Introduction
Diagnosis
Surgical goals
Contraindications for Surgery
Advantages of Surgery
Precautions
Surgical Steps
Outcome
Conclusion
SECTION 8: SURGICAL MANAGEMENT OF TRAUMA TO THE CERVICAL SPINE
36:
Principles of Management of Trauma to the Occipitocervical Junction
Introduction
Complications
Occipitocervical Dislocations
Transverse Ligament Injuries
Isolated Fractures
Conclusion
37:
Basic Concepts of Surgical Management
Introduction
General Principles of Management
Basic Points in Management
Purpose of Surgery
Anesthesia and Positioning of the Patient
Conclusion
38:
Surgical Techniques for Management of Trauma to the Anterior Cervical Spine
Introduction
Indications
Important Surgical Steps
Conclusion
39:
Surgical Techniques for Management of Trauma to the Posterior Cervical Spine
Introduction
Posterior Stabilization
Cervical Facet Wiring
Cervical Clamp and Hook System
Apofix Cervical Hook System
Interspinous Wiring
Use of Methyl Methacrylate
Use of Hartshill Rectangle for Stabilization of Spine
Combined Anterior and Posterior Stabilization
40:
Bohlman's Triple Wire Concept
Introduction
Indications
Advantages
Contraindications
Surgical Steps
Surgical Steps (Continued)
Complications
Conclusion
41:
Posterior Cervical Stabilization: Use of Metallic Rectangle
Introduction
Indications
Contraindications
Advantages
Disadvantages
Surgical Steps
Facets Stabilization Technique
Metallic Rectangle Stabilization by Sublaminar Wires
Spinous Processes Stabilization of Rectangle using Drummond Wires
Complications
Conclusion
42:
Facet Lock Surgical Release and Stabilization
Introduction
Mechanism of Injury
Philosophy of Treatment
Initial Treatment
Indications
Contraindications
Advantages
Surgical Steps
Reduction of Locked Facet
Stabilization
Stabilization Using Oblique Facet Wiring
Closure
Complications
Conclusion
SECTION 9: TUMORS OF THE CERVICAL SPINE
43:
Classification of Cervical Spine and Spinal Cord Tumors
Introduction
Relevant Applied Anatomy
Group 1: Extradural Tumors
Group 2: Intradural Tumors
Pediatric Tumors
Salient Features in the Diagnosis
Useful Tools
Surgical Technique
Conclusion
44:
Excision of Intramedullary Tumors
Introduction
Indications for Surgery
Approach
Contraindications
Position
Anesthesia
Neurophysiological Monitoring
Surgical Steps
Aim of Surgery
Most Hazardous Lart
Closure
Postoperative Care
Complications
Conclusion
45:
Intradural Extramedullary Cervical Spine Tumors
Introduction
Pitfalls
Positioning and Anesthesia
Exposure
Opening the Dura
Characteristics of Tumors
Complications
Conclusion
INDEX
TOC
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