WFNS Spine Committee Textbook on Thoracic Spine PS Ramani, Marcos Masini, Jung Keun Suh, Abbas Amirjamshidi, A Bambang Darwono, David TF Sun
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1WFNS Spine Committee Textbook on THORACIC SPINE2
3WFNS Spine Committee Textbook on THORACIC SPINE
Editor-in-Chief PS Ramani MD MSc DSc Senior Consultant Neurosurgeon, Lilavati Hospital and Research Centre Mumbai, Maharashtra, India Retired Professor and Head, Department of Neuro Spinal Surgery, University of Mumbai Founder and Honoray President, Neuro Spinal Surgeons’ Association of India Founder and Past President, Neurotrauma Society of India Past Chairman, World Federation of Neurosurgical Societies – Spine Committee Founder Member, Asian Young Neurosurgeons’ Forum Executive Committee Member, Asia-Pacific Non Fusion Society Past International President, Lumbar Fusion Society Past President, Bombay Neurosciences Association Member, WFNS Neurotrauma Executive Committee Founder and Past Editor-in-Chief, Journal of Spinal Surgery Editor-in-Chief, Indian Edition of American Journal – Spine Co-editors Marcos Masini MD School of Medicine FAMEPLAC - UNIPLAC Department of Neurosurgery do Hospital Lago Sul and Clinica Queops Millennium, Brasilia, DF, Brazil Jung Keun Suh MD Professor Department of Neurosurgery Korea University Hospital, Seoul, Korea Abbas Amirjamshidi MD MPH Professor Department of Neurosurgery Sina Hospital, Tehran University of Medical Sciences Tehran, Iran A Bambang Darwono MD Division of Orthopedic and Spine Gading-Pluit Hospital Boulevard Timur Raya, Kelapa Gading Jakarta Utara 14250, Indonesia David TF Sun MD Associate Consultant Department of Neuro and Spinal Surgery Prince of Wales Hospital Chinese University of Hong Kong Shatin, NT, Hong Kong, China Forewords Abdul Hafid Bajamal Abd-Elhafiz Shehab-Eldien
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WFNS Spine Committee Textbook on Thoracic Spine
First Edition: 2016
9789352500079
Printed at
5Dedicated to
All my students spread around the world who during the last 44 years thronged in large numbers for my cadaver workshops, hands on models practice, lecture courses, conferences and patients teaching rounds, inspiring me to do more and more and develop operative techniques, invent instruments, teach and write more and more books and textbooks.
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7Contributors
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13Foreword
It is a great pleasure for me to write this foreword. This is the third textbook that Prof Ramani is bringing out for WFNS Spine Committee during his tenure as President of a very active Spine Committee in the WFNS.
With advance in medicine, Neuro Spinal surgery has progressed very rapidly to a point where it is recognized as one of the most popular branches in Neurosurgery all over the world. The rapid progress has created a void and we see lack of enough neuro and spinal surgeons to cope with the demand of growing clinical material.
Fast pace and competitive spirit in day-to-day work has helped to increase alarmingly the degenerative process in the spine and we see a lot of ailments related to degenerative disorders in the spine. The new batch of Neuro Spinal surgeons are eager to learn through textbooks, e-learning, cadaver workshops, live operative workshops and lectures. This is one book on thoracic spine where postgraduate students, junior consultants and even senior practicing neurosurgeons can look upon to gain in-depth knowledge on several conditions associated with the thoracic spine.
This textbook provides a complete review of surgical management in thoracic spine and begins with a discussion of the anatomy of the thoracic spine. The description of the various surgical techniques is lucidly elaborated with several examples of patients. To me, this book exemplifies the ability of the author, Professor PS Ramani in compiling a textbook. By now, he has published several textbooks and his Textbook on Spinal Surgery in 2 volumes has become so popular that it is running into several editions.
It is my conviction that this textbook will be useful as a guide to all surgeons involved in the specialty and others who wish to learn more in Neuro spinal surgery. Professor PS Ramani is not only known for his Textbooks but indeed he is a real “Guru”, who never seems to be tired to propagate the knowledge of spine surgery by regularly traveling to various countries in greatest need and he actively organizes various symposiums and workshops both operative and cadaveric. Professor PS Ramani has proven himself as a figure who should be a role model for the generations of spinal surgeons in the future
Abdul Hafid Bajamal MD PhD
Professor of Neurosurgery
Department of Neurosurgery
Medical Faculty of Airlangga University
Dr Sutomo General Hospital
President Elect of Indonesian Neurosurgery Society
Member—WFNS Spine Committee
President of 11th ACNS
Surabaya, Indonesia14
15Foreword
Advances in the field of the spinal surgery are rapidly evolving in the last decades that include the basic sciences, the available tools, the techniques, in addition to accumulated surgical skills and experience. Continuous and meticulous updates of the scientific sources are mandatory to maintain the standard of practice at the level of knowledge. Professor Ramani has a huge experience in the field. He tried in this textbook to provide the readers with an adequate cover for the basic relevant knowledge that included the history, applied anatomy, biomechanics, stability and instability issues, relevant basic investigations and current surgical standards. The care of the patient is greatly influenced by the experience of his physician. The experience of spine surgeon should never depend of a single tutor. By reading this text, the experience of all contributors is introduced to you in a practical point of view enriching you knowledge and improving the level of care of your patients. Essential topics are well covered too, that include congenital anomalies, trauma, tumors, infections, and degenerative spinal diseases. Re-stabilization issues that include both of fusion and instrumentation aspects, in addition to minimally invasive approaches have been focused on too.
Each section provides the reader with well-balanced discussions on the disease pathology, clinical features, and treatment modalities. Special attention is given for complications that represent a major impact even for the experienced spinal surgeons.
The author is very precise, thoughtful, broad-minded with a good vision. He has a wide research, clinical, surgical and teaching experience in the field. He expressed his preferred methods of performing specific operations that reflects fine points of a proven value. This has been added to the current state-of-the art advances in spine surgery into one beautifully integrated comprehensive text. The book is designed to serve as a guide for spine surgeons who strive to enhance their clinical skills and ability to provide excellent care to patients suffering from spinal diseases. The editor performs this work with the aims of making it as a valued and useful source for the practicing spinal surgeons and young spinal surgeons as an important reference book. I believe that this textbook will provide sufficient knowledge that allows each to approach the various spinal problems through the right corridor.
It is my source of happiness to get the opportunity to write the foreword of this valuable textbook. I congratulate the authors for providing it for the readers who are searching for comprehensive reference source, new information, and original concepts with adequate insight. It is perfectly fit to the needs of the personal libraries of spinal surgeons, spine sections and to institutional libraries.
Abd-Elhafiz Shehab-Eldien
Professor of Neurosurgery
Chief of Neurosurgery Center
Elsahil Teaching Hospital, Cairo, Egypt
President of the Middle East Spine Society16
17Preface
While writing this preface, my heart is filled with pride, accomplishment, content and sense of achievement for the faith WFNS (World Federation of Neurosurgical Societies) has in me and for the pleasure of love and confidence that innumerable luminaries round the world who cooperated with me to compile this textbook without any hassle.
It gave me an in-depth understanding of my friendship with these brilliant personalities from most corners of the world. These feelings are shared unanimously by all my colleagues who are co-editors of this textbook.
Having successfully published two textbooks earlier, one on cervical spine and one on lumbar spine, this is the third textbook in the series that is being published for WFNS by its Spine Committee with me as Editor-in-Chief.
The understanding and development of spinal biomechanics and surgery started with lumbar spine. It took several decades before the interest was focused on the cervical spine and the surgical techniques on thoracic spine were last to be developed but with the advent of MISS (Minimally Invasive Spine Surgery) and mesmerizing advance in technology the surgical techniques on thoracic spine were developed and are being practiced in leaps and bounds. Today thoracic spine forms an important contribution to the day-to-day surgical procedures of any senior spinal surgeon all over the world. It was thus felt necessary to bring out such a book encompassing all the knowledge that is available together so that it can give a comprehensive knowledge to the readers.
To approach the anterior surface of thoracic spine had remained a big challenge as it involved opening the chest and working behind the heart and its great vessels pulsating all the time and distracting the attention. Today with advance in technology the approach to the anterior surface of thoracic spine has become as easy and within the reach of younger spinal surgeons as doing a microdiscectomy in the lumbar spine.
Being a new branch the cumulative experience may not be rich but the developments have been so vast that it has attracted the attention of spinal surgeons very quickly and procedures like, endoscopic thoracic discectomy, robot-assisted thoracic discectomy, endo micro approach to the anterior thoracic spine using VITOM and 360 degrees excision and reconstruction of the spine in the thoracic region has become a reality.
Developments in thoracic spinal stabilization has helped immensely to achieve progress in deformity reconstruction surgery which has not become an established discipline in thoracic spinal surgery.
Me and my colleagues feel immensely satisfied with the outcome as the contributions have been as per our plan and outline of the book. We feel confident that it will be well received by the readers and particularly the younger generation of spinal surgeons all over the world.
PS Ramani18
19Acknowledgments
It has been a great pleasure for me to prepare this vast textbook on thoracic spine much with the prompt cooperation of leaders in the field spread round the world. I gratefully acknowledge the willing cooperation from all the contributors who have taken pains to send the chapter before the dead line that I had set. Their great enthusiasm has heightened my spirits resulting in my convincing the publisher to prepare the book for publication in our NSSA Annual Conference – Spine 2015 in Goa, India in September 2015.
I sincerely thank my friends and co-editors of the textbook for willing agreeing to be a part of this illustrious book.
The cooperation of my assistant colleague Dr Sumeet Pawar has been astounding and without whose help it would have been impossible for me to compile this book. I am indeed indebted to him.
My computer secretaries Priya and Swati were prompt and up to the mark with their work and coordination. My other staff, Dr Sudhendoo, Dr Arjun, Dr Apurva Prasad, Santosh and Ajit never let me down even in stressful circumstances. I thank them from the bottom of my heart.
The cooperation of Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), Ms Sunita Katla (Publishing Manager), and Mr KK Raman (Production Manager) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, is well appreciated. I take this opportunity to sincerely thank Ms Samina Khan (Executive Assistant to Director–Publishing) from the organization who corresponded with me all the time. She was prompt and courteous. I am also thankful to Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Designer), Mr Laxmidhar Padhiary (Proofreader) and Mr Kapil Dev Sharma (DTP Operator) for their dedicated work.20