Expert Techniques in Spine Surgery Alexander R Vaccaro, Arjun Sebastian
INDEX
Page numbers followed by f indicate figures.
A
Acquired immunodeficiency syndrome 20
Adhesions, removing 60
Adjacent segment disease 85, 91, 95f
Adjacent vertebral bodies, superior and inferior 62
Adolescent idiopathic scoliosis, treatment of 97
Allograft strut 28f
American Spinal Injury Association score 47
Angular kyphosis 59
severe 61
Ankylosing spondylitis 97
Aorta, arch of 19
Arterial thrombosis 93
Articular facet, superior 61
Articular process
inferior 5, 55f
removal of 46
superior 4
Atlanto-dens articulation 10
Avascular structure 11
B
Back pain 57
Bipolar cautery 47
Bipolar sealers 45
Blood loss 102
during exposure 67f
limiting 45
Blood volume, circulating 64
Body mass index 10
Bone
allograft material 82
graft 46f
mineral density, evaluation of 102
remove 68f
Bony
bridge 27
compression, removal of 17f
defect 42f
endplate structure 21
resection 36
resection proceeds 14f
vertebrae 12
Bupivacaine hydrochloride 82
Burr, high-speed 46, 37f, 62
Burst fracture, C7 17f, 47
C
Cage in situ 51
Cannulated pedicle screws 82
Cardiac arrest 47
Carotid
artery 12
pulse 12
sheath 12, 13f
Caspar pin 21f, 22
distraction 21
placement 24f
Cauda equina compression 94f
Caudal
lamina 73
levels 8f
pedicle, anatomic landmarks for 40f
vertebra 21
Cement augmentation 102
Central canal stenosis, evidence of severe 94f
Central laminectomy and facet resection 101f
Cephalad trajectory 86
Cerebrospinal fluid
leakage 49, 77
pressure 5
Cervial decompression and fusion, anterior 19
Cervical arthroplasty, implanted C5-6 25f
Cervical corpectomy 10
anatomy 10
and fusion, anterior 11
case presentation 16
complications 15
indications 11
technique 11
Cervical curettes 13
Cervical disc 22
arthroplasty 19
herniation, cross-sectional anatomy of 3f
replacement 23
Cervical discectomy and fusion, anterior 5, 11
Cervical foraminotomy: posterior 3, 7
anatomy 3
complications 7
indications 4
pearls 7
technique 5
Cervical laminae 27
Cervical laminoplasty 27
anatomy 27
case presentation 29
complications 29
for myelopathy 29
indications 27
positioning for 28
technique 28
Cervical level 20
Cervical malalignment, correction of 11
Cervical pedicles 27
Cervical radiculopathy, treatment of 4
Cervical spinal cord compression, severe multilevel 30f
Cervical spinal, range of motion 23
Cervical spine 19, 29, 30f
C3–C7, lower 27
left to right of 29
radiographs 23, 23f
subaxial 10
upper 10
Cervical spondylosis 29
multilevel 11, 29
Cervical sympathetic chain 12
Cervical total disc arthroplasty 19
case presentation 23
complications 22
surgical
indications 19
technique 20
Cervical vertebrae 3
Cervical vertebral level 12
Chiari malformations 60
Cobb
angle 47, 59, 98f
elevator 5, 74, 76, 99
Complex regional pain syndrome 49
Contoured rods in situ 69f
Cord compression 51f
causing 42f
evidence of 8
multilevel 30
Cord signal
change 25f
intensity, increased 16f
Coronal deformity 55
Corpectomy 13
C5 16
C7 17f
process 13
Cortical screw placement 86
concept of 85
Costal demi-facets, inferior 35
Costal facets 53
Costotransversectomy 38
bilateral 50
posterior 38, 40
Costovertebral joint 39f
Cranial
and caudal dissection 20
lamina 73
nerve 12
vertebra 15f, 21
Cranial vertebra for graft placement 14f
Craniocaudal direction 73
Cricoid cartilage 20
Cricothyroid ligament 11
D
Debridement 47
Decompression 6
unilateral 45
Deep cervical fascia 12
Deep vein thrombosis 45, 101
Deformity
cantilever correction of 69f
cases 47
congenital 59
correction of 57f, 91
Degenerative
changes, moderate multilevel 86f
disc disease 12, 92
kyphoscoliosis 93
neural foraminal, bilateral 94f
scoliosis 81, 92
spondylolisthesis 81, 91
Demi-facet
inferiorly 35
superiorly 35
Diabetes mellitus, type 2 49
Diffuse spondylotic disease 5
Disc excision 13
Disc fragment 42f
Disc height restoration 91
Disc herniation 44
acute, right-sided 23f
central and paracentral 42
recurrent 81
Disc prep instruments 82
Disc space 39f
dense packing of 88f
Discectomy and cage placement 92
Discitis 44
Distal junctional
failure, incidence of 54
kyphosis 56
Dorsal soft tissue preservation 102
Dural
ectasia 66f
sac 63
tear 85
Dysphagia 15, 22
incidence of 22
severe 22
Dysphonia 12, 22
E
Eggshell procedure 47
Epidural
compression, high-grade 45
disease 50f
extension of tumor, bilateral 50
fat 60
hematomas 49
hemostasis 62
metastatic spine tumors 49
tumor 47
Epinephrine 82
Esophageal injury 22
Estimated blood loss 64
Extracavitary approach, lateral 38, 40
Extradural mass tumor, removal of 50
Extrapleural fashion 38
F
Facet capsules 28
Facet joint 27, 44, 73, 82
bilateral 54
change 44
degeneration 20
violation 85
Facetectomies, inferior 62
Fibrocartilaginous intervertebral discs 19
Fibrous tissue 60
Flank incision 90
Fluoroscopy 5, 54, 74, 82
intraoperative 95f
use of 91
Food and Drug Administration 20
Foramina stenosis
bilateral 25f
decompression of 91
severe 81
Foraminotomy 6
Forced expiratory volume 64
Forced vital capacity 64
Free ribs 35
Free-run electromyography 93
G
Gardner-wells tongs 5, 12, 14, 61
Gently tap 21
Giant disc herniations, treated for 40
Graft failure 16
Guide wires 82
H
Hanging traction, course of 67f
Hardware malposition 85
Hematoma 49
Hepatitis
B 20
C 20
Herniated disc material, remove 40f
Herniated nucleus pulposus 27
Herniation, type of 39
Hip flexion, bilateral 49
Horner's syndrome 22
Human immunodeficiency virus 20
Hypertension, medical history of 41
Hypertrophied ligamentum flavum 5
I
Iatrogenic
neurologic injury 14
vertebral artery injury 19
Iliac crest 14, 91
autograft 55
Iliac spines, anterior superior 82
Iliocostalis laterally 73
Iliohypogastric nerve 92
Ilioinguinal nerve 92
Impingement 63
Incision and dissection 92
Inflammatory
medications 23
spine 97
Instability, evidence of 8f
Instrumentation, unilateral 42f
Instrumented vertebra, upper 56, 102
Insulin-dependent diabetes 20
Interbody grafting 84f
Interlaminar space 27
Interspinous ligament 27, 55
Intervertebral
cage, placement of 95f
discs, integrity of 81
foraminal space 90
Intramuscular planes, advantage of 81
Ipsilateral
erector spinae muscles 45
lamina 82
J
Jackson table 82
Jamshidi needle 82
Japanese Orthopaedic Association scores 29
Jugular vein
external 12
internal 12
K
Kambin's triangle 81, 83, 91
Kerrison rongeur 5, 13, 14f, 21, 28, 37f, 46, 55, 63, 75, 83
Kyphoscoliosis 59
deformities 61
Kyphosis 29, 44, 47, 48
correction 56, 58f, 69f,
Kyphotic deformity 11, 57
causes 45
distal 49
surgery for 48
treatment of 56
L
Lamina 27
Laminae converge 27
Laminar mobilization 28
Laminectomy 46
abandonment of 41
C3 32f
defect 69f
kyphosis 27
T8 through –T12 42
unilateral 39
use of 39
Laminoplasty 29
C4–6 30
several disadvantages of 29
technique 27, 28f
Laryngeal nerve injury, recurrent 12, 15, 22
Leksell rongeur 14f, 55
Lhermitte's phenomenon, positive 29
Life-threatening complication 22
Ligamentous stabilizers 27
Ligamentum flavum 6, 75
expose 87f
spans 27
superficial 75
Ligamentum nuchae 5
Ligamentum, superficial 73
Longissimus 73
Longitudinal ligament 10
posterior 6, 10, 47
Longus colli muscle 12, 13, 19
Lordosis 97, 102
alignment 44
loss of 97
preservation of 23f
Lordotic sagittal cervical alignment 27
Lumbar corpectomy, anterior 91
Lumbar degenerative disc disease 91
Lumbar interbody fusion
anterior 90
lateral 90
anatomy 90
case presentation 93
complications 93
indications 91
techniques 91
anterior to psoas approach 92
transpsoas approach 91
posterior 90
Lumbar lordosis
calculation of 98f
improvement of 103
Lumbar nerve 3
roots 47
Lumbar paraspinal muscles 81
Lumbar plexus
migrates 91
nerves 91
Lumbar spinal stenosis 74
surgical management of 77
Lumbar spine 44, 61
anterior 90
deformities of 90
Luque instrumentation 48
M
Magnetic resonance imaging 42, 50
Matchstick burr 46
Mean arterial pressure 11, 45, 60
Metabolic
bone disease 20
disease 50f
renal cell, cases of 45
spinal tumors 48
Minimal
bony resection 8f, 25f, 39
small tissue trauma 39
spondylosis 23f
uncovertebral arthrosis 24f
Minimally invasive decompression 77
Minimally invasive lumbar decompression for stenosis 79
Minimally invasive spine surgery 90
anatomy 73
case presentation 77
complications 77
goals of 73
indications 74
technique 74
contralateral decompression 75
incision
and docking 74
localization 74
ipsilateral decompression 75
tube
closure 77
withdrawal 77
Minimally-invasive
approaches 39
techniques 73
Motion, absence of 20
Motion, range of 28
Motor and sensory examinations 50f
Motor-evoked potentials 11
Multiaxial reduction screws 61
Multiaxial screws 61
Musculoskeletal procedures 85
Myelomalacia 8, 16f
Myelomalacial changes 29
Myelopathy
clinical symptoms of 28
symptoms 36
treatment of 27
Myocardial infarction 77
N
Neck disability index 22
Neck pain 27
Neck posterior, musculature of 4
Nerve 3
block agent 82
root injuries 22, 85
Neural
foramen 6, 19
structures 19
Neurogenic mixed evoked potentials 54, 60
Neurologic
deficit 45, 48, 102
impairment 48
injury 16
worsening 22
Neuromonitoring, intraoperative 11, 54
Neuropathy, central and peripheral 81
Neurovascular injury, causes 85
Neutral lordosis 20
Nonsteroidal anti-inflammatory drugs 4, 77
Nuchal pain, rates of 29
O
Obesity 20
Oblique layer, internal 91
Obturator oblique, outlet 101f
Operative instrumentation 11
Osteomyelitis 44
Osteopenia 20
diagnosis of 102
Osteophytes 5
Osteoporosis 20
diagnosis of 102
severe 91
Osteotomies, multiple levels of 54
Osteotomy 47
Oswestry disability index 84, 92, 102
P
Paget's disease 20
Pain
back 92
buttock 92
leg 92
postoperative 92
resolution of 95
Paraspinal
muscles 45
musculature 3, 38
Pedicle medial, aspect of 47
Pedicle screw 46, 55, 61
placed free-hand 67f
placement 62
trajectory 86f
Pedicle subtraction 47
Pedicle subtraction osteotomy 97
case presentation 103
complications 102
etiology 97
evaluation 98
indications 99
technique 99
Pedicular resection 39f
of posterior body 63f
Pelvic instrumentation 103
Persistent neurologic deficits, existence of 36
Pituitary rongeurs 13, 47
Plating and fixation, anterior 14
Platysma retraction 12
Pneumonia 49, 77
Polyetheretherketone 51
Polymethylmethacrylate 45
Ponte osteotomy
multilevel for thoracic kyphosis 53
technique 54
Proximal junctional
failure 102
kyphosis 56
Proximal lumbar hyperlordosis 97
Proximal thoracic spine 44
Pseudarthrosis 48, 55, 81, 55, 91, 102
debridement 49
Pseudoaneurysm 93
Psoas
hematoma 93
muscle 92
Pulmonary
embolism 49
function testing 64
R
Radicular pain 36
improvement in 41
Radiofrequency, bipolar hemostatic sealer 102
Radiolucent table 45, 54
Renal failure 20
Residual kyphosis 14
Retroperitoneal
blood vessels 91
space 91
Retropharyngeal hematoma 22
Retrovertebral compression 16
Rheumatoid arthritis 20, 41
Rib head 35, 36, 59
medial 37
Rigid fixation techniques 55
Rigid thoracic kyphosis 55
common cause of 53
Rod passer 82
Roland-Morris questionnaire scores 93
S
Sacral vertical line, posterior 54f
Scheuermann's kyphosis 53
Scoliosis Research Society 56, 64, 102
Scoliosis, severe 59
Selective nerve root injections 4
Sensory innervation 10
Sepsis 47
Shingles 41
Signs of cauda equine syndrome 81
Single lung ventilation 38, 45
Smith-Petersen osteotomy 99
Smith- Peterson's
type 61
original technique 54
Smith-Robinson, anterior cervical approach 13f
Soft tissue
edema 22
stabilizer 27
Somatosensory evoked potentials 11, 45, 54, 60
Spasticity 49
Spinal canal 49f
Spinal column 61
Spinal cord 3, 14, 22, 27, 35
compression 47, 49
severe 29
impingement 66f
injury 11
signal change 30f
tethering and traction 41
Spinal deformity 56
severe 70
surgery 60
Spinal epidural abscesses 44
Spinal needle 5
Spinal nerve runs 3
Spinal stenosis 91
congenital 27
Spinal tuberculosis 44
cases of 46
Spinal tumors
primary 44
secondary 44
Spine patient outcomes research trial 77
Spinous process 4, 5, 27, 78f
inferior 55
Spondylolisthesis 92
high-grade 91
Spondylosis 27, 31f
Stenosis
central canal 91
lateral 91
severe central canal 91
Sternocleidomastoid 13, 20
muscle 11
Sternohyoid 12
muscles 12
Stout interspinous 27
Strap muscles 13
Stroke 49
Strut-graft 47
placement 14, 15f
preparation 14
Sublaminar contralateral decompression 83
Supraspinous ligaments 27
Surgical
loupes 82
site infection 102
T
Temporary concave rod 68f
Thoracic disc herniation 35, 39
anatomy 35
case presentation 41
complications 41
indications 35
surgical treatment of 35
technique 36
transpedicular approach for 40f
treated using different approaches 41
Thoracic discectomy 39
complications of 41
Thoracic facet joints 53
Thoracic herniated nucleus pulposus 35
, diagnosis of 35
Thoracic kyphosis 35, 57f
amount of 44
correction of 56
treatment of 53
Thoracic motion 35
Thoracic spine 35, 44
anatomy of 44, 53
articulations 44
lower 44
motion in 53
Thoracic transpedicular decompression 44
case presentation 49
complications 48
indications 44
technique 45
Thoracic vertebrae 35
Thoracolumbar
burst fractures, unstable 48
degenerative spondylolisthesis 91
junctions 44
transpedicular decompression 47
Thoracoscopic, anterior approach 38, 40
Thoracotomy 37f, 38
anterior approach 36, 40
Thyroid cartilage 11, 20
superior aspect of 11
Thyroid tumors 45
Tracheoesophageal groove 19
Tranexamic acid, use of 60
Transcranial motor evoked potentials 54, 60
Transforaminal interbody fusion 90
minimally invasive surgery 81
Transforaminal lumbar interbody fusion 61, 81
case presentation 86
complications 85
contraindications 81
cortical screw technique 85
indications 81
technique 82
closure 83
discectomy 83
guide wire placement 82
incision and exposure 82
instruments 82
interbody device insertion 83
laminectomy/facetectomy 82
pedicle screw placement 83
postoperative protocol 83
tubular retractor placement 82
Transient reflex sympathetic dystrophy 49
Transpedicular
approach 48
unilateral 45
corpectomy 47
decompression 44, 50, 50f
single-stage 47
posterior 39, 41
procedures 47
vertebrectomy 47
Transpsoas approach 90
Transversalis fascia 92
Transverse process
aspect of 45
exposure of 39f
Trapezoidal 75
Trendelenburg 5f
Tricompartmental stenosis, moderate-to-severe 86f
Tube
docking 87f
retractor system 82
U
Uncinate process 19
Unstable thoracic burst fractures 44
V
Vagus nerve 12
Vancomycin powder 45
Vasculature 4
Venous
laceration 93
thromboembolism 77
Ventral
and dorsal roots, pair of 3
spine 47
thoracic spine, pathology of 44
Vertebra
index curve 59
stable 54
Vertebrae, T1-T10 35
Vertebral artery 4, 10, 27
injury 16
Vertebral body 3, 14f, 21f, 35, 62
deficiency 20
osteolysis, case reports of 22
pathologic fractures 44
resection 61, 68f
T8 and T9 49, 50f
Vertebral column
distal 59
resection 59, 69f, 99
anatomy 59
case presentation 65
complications 64
neurologic 64
non-neurologic 65
indications 59
surgical technique 60
anesthesia considerations 60
procedure 61
spinal cord monitoring 60
Vertebral corpectomy 13
Vertebral discs, removal of 13
Vertebral wedging, severe 66f
Video-assisted thoracoscopic surgery techniques 38
Visceral complications 93
Visual analog scale 22
Visual analog score 84, 92
Vocal cords, evaluation of 12
Voice hoarseness 12
W
Water-electrolyte imbalance 49
Woodson dental instrument 46
Wound
closure 15
complications 29
dehiscence 49
Z
Zygapophyseal articulation functions 27
Zygapophyseal joints 10
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