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Mastering Orthopedic Techniques Spine Surgery
Rajesh Malhotra, Bhavuk Garg
1:
Evolution of Spinal Instrumentation
Introduction
Historical Outline
Anterior Cervical Spine Instrumentation
ANTERIOR CERVICAL PLATING
ANTERIOR CERVICAL CAGES1,10
CERVICAL TOTAL DISK REPLACEMENT
Posterior Cervical Instrumentation
OCCIPITOCERVICAL INSTRUMENTATION
Atlanto-axial Instrumentation
SUBAXIAL CERVICAL INSTRUMENTATION
Posterior Thoracolumbar Instrumentation
Anterior Thoracolumbar Instrumentation
INTERBODY CAGES
LUMBAR DISK REPLACEMENT
Newer Concepts and Designs
Minimally Invasive Spine Surgery
Summary
2:
Injection Techniques in Spine
Introduction
Prerequisites to Performing the Injections
Fluoroscopic Orientation of Spine
Technique for Selective Nerve Root Block (All Lumbar Nerves Except S1)
Special Technique for S1 Block
Facet Joint Block
Medial Branch Block
Transforaminal Discography
Interlaminar Epidural Block
3:
Microendoscopic Discectomy
Introduction
Indications
METRx System (Figs 3.1A to H)
Surgical Technique
POSITION (FIG. 3.2A)
ANESTHESIA
APPROACH
DISCECTOMY STEPS
Illustrative Case
CASE EXAMPLE
Summary
4:
Percutaneous Transforaminal Lumbar Endoscopic Discectomy
Introduction
Indications and Contraindications
Preoperative Planning
Surgical Technique
Risks and Complications
Tips and Pearls
Results
Illustrative Case (Figs 4.18 and 4.19)
CASE 1: UPMIGRATED L4-5 DISK HERNIATION
CASE 2: DOWNMIGRATED LEFT PARACENTRAL L4-5 DISK HERNIATION (FIGS 4.20 TO 4.23)
CASE 3: A LARGE RIGHT SIDED L4-5 EXTRAFORAMINAL DISK HERNIATION IMPINGING THE EXITING L4 NERVE ROOT (FIGS 4.24 AND 4.25)
5:
Anterior Cervical Discectomy and Fusion
Introduction
Indications
Contraindications
Approaches
Procedure
Anterior Cervical Fusion Techniques
SMITH AND ROBINSON TECHNIQUE
CLOWARD TECHNIQUE
BAILEY AND BADGLEY TECHNIQUE
SIMMONS AND BHALLA KEYSTONE TECHNIQUE
Bone Graft Substitutes
Anterior Cervical Plating in Anterior Cervical Discectomy and Fusion
Multilevel ACDF and Anterior Corpectomy and Fusion
Postoperative Treatment
Complications
APPROACH-RELATED COMPLICATIONS
BONE GRAFT RELATED COMPLICATIONS
NONUNION
ADJACENT SEGMENT DEGENERATION
POSTOPERATIVE CERVICAL DEFORMITY
Alternatives to ACDF
Conclusion
6:
Expansive Midline T-saw Double-Door Cervical Laminoplasty
Introduction
Surgical Indications
Contraindications
Selection Criteria for Choosing Anterior vs Posterior Procedure in Cervical Spondylomyelopathy
NUMBER OF LEVELS INVOLVED
SAGITTAL ALIGNMENT OF THE CERVICAL SPINE
DEVELOPMENTAL CANAL STENOSIS
Procedure
POSITIONING (FIG. 6.7)
APPROACH (FIG. 6.8)
LAMINA EXPOSURE (FIG. 6.9)
SPLITTING THE SPINOUS PROCESSES (FIG. 6.11)
FASHIONING THE LATERAL GUTTERS (FIGS 6.12 AND 6.13)
POSTERIOR ARCH RECONSTRUCTION (FIG. 6.14)
Cautions
Postoperative Management
Results
Complications
EXCESSIVE BLOOD LOSS DURING SURGERY
FRACTURE OF THE LAMINA
CSF LEAKS
POSTOPERATIVE HEMATOMA
C5 PALSY
POSTOPERATIVE AXIAL NECK PAIN
FUSION OF THE LAMINA
Illustrative Case
7:
Posterior Cervical Decompression and Instrumentation for Cervical Myelopathy
Introduction
Goals of Surgical Intervention
The factors that influence the choice of approach
SAGITTAL ALIGNMENT OF SPINAL COLUMN
LOCATION OF COMPRESSIVE PATHOLOGY
PRESENCE OF AXIAL NECK PAIN
NUMBER OF INVOLVED SEGMENTS
Posterior Cervical Decompression
PRINCIPLES
PREREQUISITES
Indications of Cervical Instrumentation
Laminoplasty
OPEN-DOOR LAMINOPLASTY
FRENCH-DOOR LAMINOPLASTY
Technique
INTUBATION AND POSITIONING
Posterior Approach
INSTRUMENTATION AND LAMINECTOMY
OPEN DOOR LAMINOPLASTY
FRENCH DOOR LAMINOPLASTY49
Different Techniques for Instrumentation
LATERAL MASS SCREWS
MID-CERVICAL AND LOWER CERVICAL PEDICLE SCREWS
POSTERIOR CERVICAL RODS AND CROSS-LINKS
LAMINOPLASTY IMPLANTS
After Treatment
Complications
DURAL LEAK
NEUROLOGICAL INJURY INCLUDING C5 NERVE ROOT INJURY
CERVICAL KYPHOSIS
POSTOPERATIVE LAMINA CLOSURE
POSTOPERATIVE AXIAL PAIN
Outcomes
LAMINECTOMY
LAMINOPLASTY
LAMINOPLASTY VERSUS LAMINECTOMY
Alternative to Posterior Decompression— Anterior Decompression
Conclusion
8:
Surgical Techniques of Atlantoaxial (C1-C2) Fixation
Introduction and Anatomy
Indications for Atlantoaxial Arthrodesis
Surgical Procedures
Interlaminar Wiring
Transarticular Screw Fixation
Surgical Technique
PREOPERATIVE PLANNING
ANESTHESIA
General Anesthesia
INSTRUMENTATION
TECHNIQUE
Illustrative Case
9:
Lumbar Canal Stenosis
Introduction
Clinical Presentation
Conservative Vs Surgical Management
Indications for Surgery in Lumbar Canal Stenosis
WHEN TO FUSE?
Surgical Treatment
DECOMPRESSIVE LAMINECTOMY (MIDLINE DECOMPRESSION)
Technique
SPINOUS PROCESS OSTEOTOMY
Technique (Figs 9.7A to C)
SPINOUS PROCESS SPLITTING DECOMPRESSION
Technique (Watanabe et al)
MICRODECOMPRESSION
Operative Technique (McCulloch)
EXPANSIVE LAMINOPLASTY
MULTIPLE LAMINOTOMIES
MINIMALLY INVASIVE TECHNIQUES
Postoperative Protocol
Prognostic Factors
10:
Anterior Lumbar Interbody Fusion
Background
Advantages and Indications
Preoperative Workup
Patient Positioning
Approach
Technique
Postoperative Care
Complications
General Recommendations
11:
The Transpsoas Approach for Thoracolumbar Interbody Fusion
Introduction
Indications
Preoperative Planning
Implant
Surgery
Tips and Pearls/Cautions
Postoperative Management
Complications
Illustrative Case
Conclusion
12:
Percutaneous AxiaLIF (Lumbosacral Interbody Fusion)
Introduction
Indications
Implant
Surgery (Single Level Procedure)
Tips and Pearls/Cautions
Complications
Illustrative Case
CASE DESCRIPTION
Conclusion
13:
Low-Grade Spondylolisthesis
Definition
Isthmic Spondylolisthesis (Fig. 13.2)
GROUP A
GROUP B
Degenerative Spondylolisthesis (Fig. 13.3)
Management of Low-Grade Spondylolisthesis
ISTHMIC SPONDYLOLISTHESIS
NONOPERATIVE TREATMENT
NONOPERATIVE VERSUS OPERATIVE TREATMENT
POSTEROLATERAL FUSION—INSTRUMENTED VERSUS NONINSTRUMENTED
ANTERIOR LUMBAR INTERBODY FUSION
Degenerative Spondylolisthesis
NATURAL HISTORY
NONOPERATIVE TREATMENT
SURGICAL TREATMENT
Current Concepts
Use of Instrumentation
Technique of Listhesis Correction
PREOPERATIVE PLANNING
X-rays (Figs 13.4A and B)
CT Scans (Figs 13.6A to C)
MRI (Figs 13.7A and B)
Dynamic X-rays (Figs 13.8A and B)
Positioning of the Patient (Figs 13.9A and B)
Perioperative Imaging (Figs 13.10A and B)
INCISION (FIG. 13.11)
IDENTIFICATION OF PEDICLE ENTRY POINTS FOR CANNULATION (FIG. 13.12)
CANNULATION OF PEDICLES (FIGS 13.13A AND B)
Steps for Pedicle Screw Insertion (Figs 13.14 to 13.20)
Decompression (Fig. 13.21)
DISK SPACE PREPARATION FOR INTERBODY FUSION (FIGS 13.22A TO C AND 13.23)
PLACEMENT OF UNILATERAL ROD (FIGS 13.24A TO D)
DISTRACTION (FIGS 13.25A AND B)
INTERBODY FUSION (FIGS 13.26 AND 13.27)
CONFIRM ADEQUATE DECOMPRESSION (FIG. 13.28)
PLACEMENT OF SECOND ROD AND FINAL COMPRESSION (FIG. 13.29)
Summary
14:
L5 Vertebrectomy with Reduction of L4 onto S1 for the Surgical Reconstruction of Lumbosacral Spondyloptosis
Introduction
Clinical Features
CROUCH GAIT AND STANCE (FIGS 14.1A TO C)
Surgical Procedure4,5
FIRST STAGE PROCEDURE (FIG. 14.2A)
SECOND STAGE PROCEDURE (FIG. 14.2B)
Postoperative Care
Tips and Pearls
STAGE 1
STAGE 2
Illustrative Case (Figs 14.9A to F)
Conclusion
15:
Motion Preservation in Spine Surgery
Introduction
Indications1
PEDICLE SCREW-BASED POSTERIOR DYNAMIC STABILIZATION
INTERSPINOUS PROCESS DISTRACTION
Implants and Classification1
CLASSIFICATION OF DEVICES1
Pedicle Screw-based Posterior Dynamic Stabilization Devices
Interspinous Distraction Devices
Preoperative Planning
Surgery
ANESTHESIA AND POSITIONING
APPROACH/EXPOSURE
CLOSURE AND POSTOPERATIVE MANAGEMENT
ALTERNATE TECHNIQUES – WHERE APPLICABLE
Complications
Tips and Pearls/Cautions
Pearls and Pitfalls
16:
Anterolateral Decompression (D2 to L5)
Introduction
Operative Complications and their Prevention
Postoperative Care
Anterolateral Approach to the Lumbar Spine (Fig. 16.8) (Lumbovertebrotomy, Lumbar-Transverse-Vertebrotomy)
17:
Single Stage Global Decompression and Stabilization Using Posterior Approach for Tubercular Spondylitis
Introduction
Indications
MIDDLE-PATH REGIMEN9,10
RELATIVE INDICATIONS
CONTRAINDICATIONS
Preoperative Planning
Surgical Goals
DECOMPRESSION
POSTERIOR STABILIZATION AND ANTERIOR COLUMN RECONSTRUCTION3–8
Implants and Instrumentation
SURGICAL TECHNIQUE
Closure
Tips and Pearls/ Cautions
Postoperative Management
Complications
Illustrative Case
18:
Surgical Procedures in the Management of Post Tubercular Kyphosis
Introduction
Indications of Surgery in Tubercular Kyphosis
KYPHOSIS IN ACTIVE DISEASE
KYPHOSIS IN HEALED DISEASE14
Concerns Regarding Kyphosis Correction in TB12,15,16
Preoperative Work-up
Surgeries in Kyphosis of Active Disease
SINGLE STAGE TRANSPEDICULAR DECANCELLATION OSTEOTOMY16–18
Technique
COMBINED ANTERIOR AND POSTERIOR SURGERY
Surgical Approach for Anterior Debridement
Surgical Technique of Anterior Debridement
Posterior Procedure
KYPHOSIS CORRECTION BY SINGLE STAGE EXTRAPLEURAL ANTEROLATERAL APPROACH
Technique
Surgeries in Kyphosis of Healed Disease
PEDICLE SUBTRACTION OSTEOTOMY
Technique
SINGLE STAGE CLOSING-OPENING WEDGE OSTEOTOMY
Technique
EN BLOC SPONDYLECTOMY
Technique
Conclusion
19:
The Anterior Approach to Treating Scheuermann's Disease: Short Segment Fusion
Introduction
Surgical Indications
Selection of Operative Levels
Operative Technique
POSITIONING
ANESTHESIA AND NEUROMONITORING
ACCESS
PROCEDURE (TABLE 19.3)
Rib Head Resection and a Complete Discectomy (Fig. 19.2)
Spacers
Instrumentation
Complications
After-care
Illustrative Case (Figs 19.6A to G)
20:
Short Segment ‘Bone-on-Bone’ Fusion for Adolescent Idiopathic Scoliosis
Introduction
Indications (Table 20.1)
Contraindications (Table 20.2)
Preoperative Analysis
Surgical Technique9–11
POSITIONING AND EXPOSURE
RIB HEAD EXCISION AND IDENTIFICATION OF THE INTERVERTEBRAL FORAMEN
DISCECTOMY AND BONE-ON-BONE
Complications
Tips and Tricks for Short Segment Fusion for Scoliosis
Postoperative Care
Illustrative Case (Figs 20.7A to C)
Conclusion
21:
Surgical Treatment of Scoliosis by Vertebral Coplanar Alignment
Introduction
Principles of Vertebral Coplanar Alignment (VCA)
VCA set
Surgical Technique
PREOPERATIVE PLANNING
POSITIONING AND APPROACH
PEDICLE SCREWS
VERTEBRAL COPLANAR ALIGNMENT
DECORTICATION, GRAFTING AND CLOSURE
POSTOPERATIVE TREATMENT
Clinical Results
Discussion
Conclusion
22:
Vertebral Column Resection for Angular Kyphoscoliosis: Posterior Only Correction Technique
Introduction
Indications
Preoperative Evaluation and Planning
PATIENT EVALUATION
RADIOGRAPHIC AND OTHER IMAGING ASSESSMENT
PREOPERATIVE PLANNING
Surgery
ANESTHESIA AND POSITIONING
APPROACH/EXPOSURE
PROCEDURE
REDUCTION TECHNIQUES/CORRECTION MANEUVER
FUSION
CLOSURE
Postoperative Management
Complications
Illustrative Case
CASE 1 (FIG. 22.5)
CASE 2 (FIG. 22.6)
23:
Growing Rod Technique for Early Onset Scoliosis
Introduction
Indication
Preoperative Evaluation
RADIOGRAPHIC ASSESSMENT
Procedure
ANESTHESIA AND POSITIONING
APPROACH/ EXPOSURE
PROCEDURE
CLOSURE
POSTOPERATIVE MANAGEMENT
FINAL FUSION
Complication
Illustrative Cases
CASE 1 (FIG. 23.9)
CASE 2 (FIGS 23.10A AND B)
CASE 3 (FIG. 23.11)
24:
Minimally Invasive Correction for Adolescent Idiopathic Scoliosis
Introduction
Surgical Technique
POSITIONING
INCISION (FIG. 24.1)
FACET PREPARATION
PEDICLE SCREW PLACEMENT
Correction of Scoliosis and Alignment of Screw Extenders (Fig. 24.4)
PASSAGE OF RODS (FIG. 24.5)
FINAL CORRECTION (FIGS 24.6A AND B)
WOUND CLOSURE (FIG. 24.6C)
POSTOPERATIVE PROTOCOL
Illustrative Case
CASE EXAMPLE
25:
Vertebral Augmentation
Background
Indications
Contraindications
Preliminary Assessment
Procedure
GENERAL CONSIDERATIONS: PREOPERATIVE, ANESTHETIC AND NEUROMONITORING
PATIENT POSITIONING AND ROOM SET-UP
TECHNIQUE OF VERTEBROPLASTY
TECHNIQUE OF KYPHOPLASTY
POSTOPERATIVE CONSIDERATIONS
Complications
Results
PAIN RELIEF
HEIGHT RESTORATION / KYPHOSIS IMPROVEMENT
Conclusion
Illustrative Case
CASE EXAMPLE
26:
Controlled Vertebral Augmentation: SpineJack Procedure
Introduction
Indications
Contraindications
Preoperative Planning
Implant Description and Features (Figs 26.1 and 26.2)
Surgical Technique
ANESTHESIA
POSITION–NEED FOR INTRAOPERATIVE IMAGING (FIG. 26.4)
REDUCTION TECHNIQUES (WHERE APPLICABLE)
General Considerations
SPECIFIC CONSIDERATIONS
APPROACH/EXPOSURE
Implant Site Preparation
Insertion and Expansion of Implant
Cement Injection
Complication
DOCUMENTATION
Postoperative Care
Illustrative Case (Figs 26.19 to 26.24)
27:
Management of Thoracolumbar Fractures
Introduction
Classification
Fracture Type and Management
SIMPLE ANTERIOR WEDGE/COMPRESSION FRACTURE
Management
BURST FRACTURES
Management
FLEXION-DISTRACTION INJURY/SEAT BELT INJURY
Management
FRACTURE-DISLOCATION
Management
Summary
28:
Surgical Management of Spinal Tumors
Introduction
Epidemiology of Metastatic Spine
Anatomic Location of Metastatic Spine Disease
PRESENTATION21
WORK-UP
Imaging
Biopsy
PARASPINAL TECHNIQUE (FLUOROSCOPIC OR CT GUIDED)
TRANSPEDICULAR APPROACH (FLUOROSCOPIC OR CT GUIDED)
PERCUTANEOUS TRANSFORAMINODISCAL APPROACH
Medical Management
RADIATION THERAPY (TABLE 28.1)
Types of Radiation Therapy
SURGERY
Case Presentation
Surgical Technique (C7 Transpedicular Decompression)
Case Presentation
Surgical Technique (T12 Transthoracic Corpectomy with Instrumentation)
Kyphoplasty/Vertebroplasty
SCIENTIFIC EVIDENCE ON SURGERY
Factors Affecting Survival
Conclusion
29:
Cervical Disk Replacement
Introduction
History and Development of Cervical Arthroplasty
Wear Analysis
Indications
PRODISC-C IDE STUDY EXCLUSION CRITERIA
Exclusion Criteria (Currently Used)
Preoperative Assessment
Surgical Technique
Complications (Figs 29.10 to 29.12)
Conclusion
INDEX
TOC
Index
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