Chapter
A Craniovertebral Junction and Upper Cervical Spine
1 Surgical Anatomy and Biomechanics of the Craniovertebral Junction
Embryology of the Craniovertebral Junction
Normal Developmental Embryology of the Craniovertebral Junction
Developmental Anomalies of the Craniovertebral Junction
Surgical Anatomy of the Craniovertebral Junction
Bony Structures of the Craniovertebral Junction
Foramen Magnum and Occipital Condyle
Ligamentous and Membranous Structures of the Craniovertebral Junction
Neuroradiology of the Craniovertebral Junction
Skull Base and Atlantoaxial Morphometry
Indices for Skull Base and Craniocervical Junction on a Lateral (Sagittal) View (Table 1-1).
Indices for Skull Base and Craniocervical Junction on an Anteroposterior (Coronal) View (Table 1-2).
Indices for Atlantoaxial Instability (Table 1-3).
Biomechanics of the Craniovertebral Junction
2 Transoral Approach to the Craniocervical Junction and Upper Cervical Spine
Ventral Pathology of the Craniocervical Junction
Relative Contraindications
Preparation and Positioning
3 Transmaxillary and Transmandibular Approaches to the Clivus and Upper Cervical Spine
Bony and Ligamentous Anatomy
Relevant Neurovascular Anatomy
Indications and Contraindications
Unilateral Le Fort I Osteotomy with Palatal Split
Bilateral Le Fort I Osteotomies with Downfracture of the Maxilla
Bilateral Le Fort I Osteotomies with Palatal Split
Mandibulotomy with Midline Glossotomy
Mandibular Swing-Transcervical
4 High Cervical Retropharyngeal Approach to the Craniocervical Junction
Medial Retropharyngeal Approach (Anterior Retropharyngeal Approach)
Lateral Retropharyngeal Approach
5 Approaches to the Craniocervical Junction:
Lateral Retropharyngeal Approach
6 Posterior and Far-Lateral Approaches to the Craniovertebral Junction:
Extramedullary, Intradural
Relative Contraindications
Magnetic Resonance Imaging
7 Endoscopic Approaches to the Craniovertebral Junction
Endoscopic Endonasal Approach
Endoscopic Transoral Approach
Endoscopic Transcervical Approach
Endoscopic Endonasal Approach
Preparation and Positioning
Endoscopic Transoral Robotic Surgery
Preparation and Positioning
Transcervical Endoscopic Approach
Preparation and Positioning
8 Surgical Approaches to Craniovertebral Junction Congenital Malformations, Chiari Malformations, and Cranial Settling (Invagination)
Surgical Anatomy of the Craniocervical Junction
Indications for Surgical Treatment
Anterior Surgical Approaches
Transoral-Transpalatopharyngeal Approach
Advantages and Disadvantages of the Anterior Approaches
Occipital Screw Technique
C1 Lateral Mass Screw Technique
C1–C2 Transarticular Screw Technique
C2 Pars/Pedicle Screw Technique
Translaminar Screw Technique
C3–C7 Lateral Mass Screw Technique
Advantages and Disadvantages of the Posterior Approaches
Endoscopic Endonasal Approach
Advantages and Disadvantages of Endoscopic Approaches
9 Surgical Approaches to the Craniovertebral Junction in Rheumatoid Arthritis
Atlantoaxial Rotatory Subluxation
Indications and Relative Contraindications
Extended Transoral Procedures
Median Mandibulotomy and Glossotomy
Endoscopic-Assisted Anterior Approach
Combined Anterior and Posterior Approach
10 Craniovertebral Junction Instabilities and Surgical Fixation Techniques
Occipital Bolt or “Inside-Out” Technique
Occipitocervical Wiring: Historic Technique Useful in Some Circumstances
Biomechanical Complications
11 Odontoid Fractures and Screw Fixation
Incision and Soft Tissue Dissection
Placement of K-Wire and Drill Guide System
12 C1–C2 Trauma Injuries and Stabilization Techniques
General Operative Techniques for Posterior Atlantoaxial Fixation
C1–C2 Lateral Mass–Pars Interarticularis Screw Fixation
C1–C2 Lateral Mass–Pedicle Screw Fixation
Atlantoaxial Transarticular Fixation
Atlantoaxial Translaminar Fixation
Atlantoaxial Wiring Techniques
Indications for Posterior Fixation and Fusion of the Upper Cervical Spine
Anterior Approaches for Upper Cervical Spine Instability After Trauma
Indications and Techniques
Anterior Atlantoaxial Facet Screw Fixation
B Mid and Lower Cervical Spine
13 Surgical Anatomy and Biomechanics in the Mid and Lower Cervical Spine
Anterior and Posterior Tubercles
Lamina and Spinous Processes
Intervertebral Disk Space
Spinal Cord and Nerve Roots
Inferior (Recurrent) Laryngeal Nerve
Anterior Longitudinal Ligament
Posterior Longitudinal Ligament
Intertransverse Ligaments
Pretracheal (Visceral) Layer
14 Anterior Cervical Diskectomy and Fusion
Incision and Soft Tissue Dissection
Diskectomy and Foramenotomy
15 Endoscopic Anterior Cervical Foraminotomy (Jho Procedure)
Surgical Indications for Anterior Cervical Foraminotomy (Jho Procedure)
Surgical Tools and Techniques
Endoscopic Surgical Instruments
Surgical Exposure of the Uncovertebral Juncture
Original Description of Microsurgical Anterior Cervical Foraminotomy
Evolution of Anterior Cervical Foraminotomy (Jho Procedure)
Type 1: Transuncal Approach
Type 2: Upper Vertebral Transcorporeal Approach
Type 3: Lower Vertebral Transcorporeal Approach
Type 4: Anterior Cervical Foraminoplasty
Spinal Cord Decompression via Anterior Cervical Foraminotomy
16 Anterior and Posterior Endoscopic Approaches to the Cervical Spine
Surgical Indications and Relative Contraindications
Instruments and Equipment
Instruments for the Anterior Approach
Instruments for Posterior Approach
Surgical Preparations and Techniques
Anterior Approaching Technique
17 Cervical Corpectomy, Fusion, and Vertebral Restoration Techniques
Nervous System Structures
Indications and Contraindications
Contraindications (Relative)
Vertebral Body Restoration Technologies
Bone Grafts: Autograft and Allograft
Polymethylmethacrylate Reconstruction
Titanium Mesh Cages/Harms Cage
Preoperative Considerations
Approach (Figs. 17-16 and 17-17)
Removal of Posterior Longitudinal Ligament
Veterbral Replacement Preparation
Polymethylmethacrylate (see Fig. 17-10)
Titanium Nonexpandable Cages (see Fig. 17-11)
Modular Cages (see Fig. 17-12)
Expandable Cages (see Fig. 17-13)
Supplemental Instrumentation
Anterior Plating (Figs. 17-21 and 17-22)
Adjunct Posterior Instrumentation
Graft Complications (Fig. 17-23)
18 Anterior Cervical Instrumentation Techniques
Relative Contraindications
Technique for Approaching the Cervical Spine
Technique for Approaching the Upper Cervical Spine
Cage Placement and Instrumentation
19 Cervical Disk Arthroplasty Techniques
Indications and Contraindications
Potential Disadvantages of Cervical Artificial Disk Replacement
Preoperative Radiologic Evaluation
Incision, Soft Tissue Dissection, and Exposure of the Vertebra
Sequential Identification and Dissection of Important Anatomic Structures
Anterior Cervical Diskectomy
Artificial Disk Replacement
Postoperative Radiologic Assessment
Complications and Adverse Outcomes of Cervical Artificial Disk Replacement
Adjacent-Segment Disease after Cervical Artificial Disk Replacement
20 Cervical Microforaminotomy and Decompressive Laminectomy
Indications and Contraindications
Posterior Cervical Microforaminotomy
Relative Contraindications
Minimally Invasive Approach
Cervical Microforaminotomy
Decompressive Laminectomy
Indications and Contraindications
Advantages and Disadvantages
Posterior Arch Reconstruction using Graft or Plating
22 Posterior Cervical Stabilization Techniques:
Cervical Pedicle Screw Fixation
Patient Positioning and Incision
Subaxial Pedicle Screw Insertion
Lateral Mass Screw Fixation
Insertion Point and Trajectory
Drilling and Screw Placement
Posterior Wiring of the Subaxial Spine
Procedures and Wiring Techniques
Interspinous Wiring (Bohlman’s Triple-Wire Technique).
Facet Wiring Technique (Fig. 22-9).
23 Facet Dislocation Injuries and Surgical Management
24 Ossification of the Posterior Longitudinal Ligament
Clinical Presentation and Natural Course
Diagnostics and Radiographic Findings
Surgical Options and Outcomes
Combined Anterior and Posterior Approaches
Indications and Contraindications for Laminoplasty
Relative Contraindications
Operative Technique: Open-Door Laminoplasty
Patient Positioning and Intubation
Incision and Soft Tissue Dissection
Bone Graft and Instrumentation
C Cervicothoracic Junction and Thoracic Spine
25 Surgical Anatomy and Biomechanics in the Cervicothoracic Junction and Thoracic Spine
Anterolateral Transthoracic Approaches
Posterolateral Approaches
26 Anterior Approaches to the Cervicothoracic Junction
Vascular and Visceral Compartments of the Superior Mediastinum
Retropharyngeal and Retromediastinal Spaces
Transmanubrial-Transclavicular Approach
Transsternal-Transthoracic Approach
27 Posterolateral Approaches to the Cervicothoracic Junction:
Muscles of the Scapular and Parascapular Region
Superficial Muscle Group (Fig. 27-1)
Intermediate Muscle Group
Posterior Thoracic Cage (Fig. 27-3)
Vertebral Body and Rib Articulation
Ligaments of Rib Articulation
Neural structures (Fig. 27-7):
Indications and Advantages
Contraindications and Disadvantages
Patient Positioning and Preparation (Fig. 27-9)
Posterolateral Approaches
Indications and Advantages.
Contraindications and Disadvantages.
Patient Positioning and Preparation.
Indications and Advantages.
Contraindications and Disadvantages.
Patient Positioning and Preparation.
Lateral Extracavitary Parascapular Extrapleural Approach
Indications and Advantages.
Contraindication and Disadvantages.
Patient Positioning and Preparation.
28 Anterolateral Transthoracic Approaches to the Thoracic Spine
Superficial (Extrapleural)
Considerations Specific to the Proximal Thoracic Spine Approach
Considerations Specific to the Thoracolumbar Junction Approach
Decreased Pulmonary Function
Dural Tear/Cerebrospinal Fluid Leak
29 Anterior and Posterior Cervicothoracic Junction Stabilization Techniques
Anterior Surgical Approaches to the Cervicothoracic Junction
Transsternal-Transmanubrial Approach
Posterior Surgical Approaches to the Cervicothoracic Junction
Anterior-Posterior Approach
Posterior-Anterior- Posterior Approach
30 Thoracic Microdiskectomy:
Prevelance and Presentation
Incision, Dissection, and Diskectomy
Minimally Invasive Considerations
Incision, Dissection, and Diskectomy
Lateral Extracavitary Approach
Incision, Dissection, and Diskectomy
Minimally Invasive Considerations
Posterolateral Approaches
Incision, Dissection, and Diskectomy
Minimally Invasive Considerations
Incision, Dissection, and Diskectomy
Minimally Invasive Considerations
31 Thoracoscopic and Posterior Endoscopic Approaches to the Thoracic Spine
Prevertebral Dissection and Diaphragm Detachment
Posterior Endoscopic Approach
Procedures of C-Arm–Guided PETD using Rigid Working-Channel Scope
Procedures of Real-Time CT-Guided PETA Using LASE
32 Surgical Decompression and Stabilization Techniques in Thoracic Trauma
Indications and Contraindications
33 Surgical Approaches to Thoracic Primary and Secondary Tumors
Incidence of Primary and Secondary Tumors of the Thoracic Spine
Clinical Presentation and Evaluation
Radiographic Studies and Preoperative Diagnosis
Surgical Decision Making and Patient Expectations
Patients with Primary Osseous Lesions
Patients with Metastatic Disease
Preoperative Embolization
Approaches to the Thoracic Spine (Fig. 33-1)
Transpedicular Approach and Costotransversectomy
Lateral Extracavitary (Parascapular) Approach
Thoracotomy (Transthoracic Approach)
D Thoracolumbar and Lumbar Spines
34 Surgical Anatomy and Posterior Approach to the Thoracic and Thoracolumbar Spine
Posterior Mediastinal Space and Neurovascular Structure
Lateral Extracavitary Approach
Identification of the Neural Foramen
Vertebral Body Reconstruction
Transcostovertebral Approach
Exposure of Vertebral Bodies and Spinal Cord
Total En Bloc Spondylectomy: Thoracic Spine
Step 1. En Bloc Resection of the Posterior Element of the Vertebra by Posterior Approach
Introduction of the T-Saw Guide.
Cutting the Pedicles and Resection of the Posterior Element.
Step 2. En Bloc Corpectomy by Posterior Approach
Posterior Ligamentous Release of the Vertebral Body.
Dissection of the Spinal Cord and Removal of the Vertebra.
Corpectomy with Anterior Approach
Anterior Reconstruction and Posterior Instrumentation
Staged Operation of Thoracic Spine Tumors with Involvement of the Ribs
Single-Stage Posterolateral Transpedicular Approach for Spondylectomy and Epidural Decompression
35 Thoracoabdominal Approach to the Thoracolumbar Junction
Transthoracic Approach to the Midthoracic Level
Exposure of Vertebral Body (Transpleural)
Exposure of the Vertebral Body (Extrapleural)
Bilateral Segmental Vessel Ligation
Anterior Approach to Thoracolumbar Junction (Transpleural-Transdiaphragmatic Approach with Tenth Rib Resection)
Exposure of Each Vertebral Body
Transpleural-Retroperitoneal Approach (Diaphragm Detach) to the Thoracolumbar Junction
Identification of the Insertion Point of the Crus
Incision of the Diaphragm Insertion
Extrapleural-Retroperitoneal Approach to Thoracolumbar Junction with Eleventh Rib Resection
Muscle Incision and Rib Removal
Retroperitoneal Space Dissection
Costal Cartilage Splitting
Extrapleural Space Dissection
Diaphragm Release from the Insertion to the Twelfth Rib
Widening of Vertebral Body Exposure
Minithoracotomy-Transdiaphragmatic Approach (Mini-TTA)
Diaphragmatic and Relevant Anatomy
Prevertebral Dissection and Diaphragm Detachment
Corpectomy and Decompression of the Spinal Canal
Bone Grafting, Cage Placement, and Instrumentation
Advantages of Mini-TTA versus Traditional Thoracoabdominal Approach
Advantages of Mini-TTA versus Thoracoscopic Surgery
Familiar Three-Dimensional View
Simplicity in Equipment and Assistance
Low Rate of Surgery-Induced Rib Intercostal Neuralgia
36 Surgical Stabilization Techniques for Thoracolumbar Fractures
Classifications of Spinal Fractures
The Iowa Classification System and Algorithm
Anterolateral Approach to the Thoracolumbar Spine (T11–L4)
Posterolateral Transpedicular Approach with Vertebral Body Reconstruction
Posterior Minimally Invasive Techniques
37 Anterior Retroperitoneal Approach to the Lumbar Spine
Thoracoabdominal/Flank Approach
Direct Lateral (Minimally Invasive) Approach
Thoracoabdominal/Flank Approach
Direct Lateral (Minimally Invasive) Approach
Thoracoabdominal/Flank Approach
Direct Lateral (Minimally Invasive) Approach
Anterior Approach (Fig. 37-5)
Thoracoabdominal/Flank and Direct Lateral Approaches (Fig. 37-6)
Thoracoabdominal/Flank Approach
Direct Lateral (Minimally Invasive) Approach
38 Posterior and Posterolateral Approaches to the Lumbar Spine
Indications/Contraindications
Special Considerations at L5–S1
39 Surgical Approaches to Lumbar Fractures
Classification of Lumbar Fractures
Radiographic Evaluation of Fractures
Evaluation for Surgical Approach
Adjuncts to Surgical Intervention
Fluoroscopy and Spinal Navigation
Surgical Approaches for Location of Injury
Upper Lumbar Fractures: L1, L2, and L3
Posterior Approach with Anterior Column Stabilization
Lateral Retroperitoneal Approach
Lower Lumbar Fractures: L4 and L5
Intraoperative Complications
Recovery and Rehabilitation
40 Surgical Decompression and Stabilization for Lumbar Lesions:
Lateral Transpedicular-Extracavitary Approach
Lateral Retroperitoneal Approach
Anterior Retroperitoneal Approach
41 Lumbar Microdiskectomy:
Midline Open Lateral Diskectomy
Transmuscular Far-Lateral Diskectomy
Minimally Invasive Tubular Microdiskectomy
42 Percutaneous and Endoscopic Diskectomy
Indications and Contraindications
Soft Lumbar Disk Herniation
Relative Contraindications
Electrosurgical Instruments
Patient Positioning and Operating Room Setup
PELD for Nonmigrated Herniations
step 1. needle insertion.
step 2. chromodiskography.
step 3. instrument placement.
PELD for Migrated Herniations.
Technique of Interlaminar PELD
Step 1. Chromodiskography.
Step 2. Needle Insertion.
Step 3. Instrument Placement.
Techniques to Increase Access for Herniations
Extraforaminal Disk Herniation.
Highly Downmigrated Herniations.
43 Surgical Anatomy and Operative Techniques of Lumbar Stenosis
Surgical Approach/Operative Techniques
Subtotal/Total Laminectomy
Unilateral Hemilaminotomy/Hemilaminectomy
44 Transpedicular Screw Fixation:
Techniques of Transpedicular Screw Insertion
Fluoroscopically Assisted Screw Placement
Image-Guided Navigation-Assisted Screw Placement
Electromyelographic Monitoring
45 Posterior and Transforaminal Lumbar Interbody Fusion
Indications and Contraindications
Posterior Lumbar Interbody Fusion Procedure
Closure and Postoperative Care
Transforaminal Lumbar Interbody Fusion Procedure
Patient Positioning and Pedicle Screw Placement
Unilateral Facetectomy and Contralateral Distraction
Total Diskectomy through a Unilateral Approach
Cancellous Bone and Strut Bone or Cage Graft
Final Assembly of a Rod-and-Screw System and Closure
46 Anterior Lumbar Interbody Fusion
Advantages of an Anterior Approach
Indications and Contraindications
Relative Contraindications
Operative Technique (Mini-Open Approach)
47 Lateral Lumbar Interbody Fusion
Complications and Bailout Strategies
48 Spondylolisthesis Reduction
Evidence-based Decision Making
Low- and High-Grade Slip Treated with Fusion
Formal Reduction Maneuver
High-Grade Slip Treated with Anterior and Posterior Techniques
Anterior Surgical Technique
Posterior Surgical Technique
49 Lumbar Facet Screw Fixation Techniques
Relative Contraindications
Open Technique Direct Facet Screw Placement
Open Translaminar Technique
Percutaneous Translaminar Facet Fixation
Postoperative Regimen and Care
E Lumbar Sacral Pelvic Junction
50 Surgical Anatomy, Approaches, and Biomechanics in the Lumbosacral Pelvic Junction
Bony Antatomy of the Lumbosacral Junction
Biomechanics of Lumbosacral Junction
Approaches to the Lumbosacral Junction
Anterior Versus Posterior Pathology-Guided Approach
Anterior Approach to the Lumbosacral Junction
Midline Transperitoneal Approach
Incision and Soft Tissue Dissection.
Intraperitoneal Dissection.
Retroperitoneal Dissection.
Diskectomy/Osteophytectomy.
Anterior Retroperitoneal Midline Approach
retroperitoneal dissection.
diskectomy/osteophytectomy.
Anterior Retroperitoneal Flank Approach
lateral decubitus positioning.
lateral decubitus incision.
retroperitoneal dissection.
Posterior Approaches to the Lumbosacral Junction
Posterior Incision: Midline, T-Shaped, Paramedian, or Transverse (Fig. 50-17)
Posterior Midline Approach
Posterior Paramedian Approach
Posterior Transverse Approach
Bony Work and Tumor Resection
51 Surgical Management of Sacral Fractures
Classification: Sacral Fractures
Roy-Camille Subclassification and Strange-Vognsen and Lebech Modification
Isler Classification of Lumbosacral Injuries
Approach to Surgical Stabilization
Posterior Stabilization Techniques
Lumbopelvic Stabilization
Operative Setup and Equipment
Surgical Technique: Open Lumbopelvic Stabilization
Minimally Invasive Approaches.
Open Reduction Internal Fixation
Percutaneous Sacroiliac Fixation
Relative Contraindications
52 Axial Lumbar Interbody Fusion
Indications and Contraindications
Patient Preparation and Positioning
53 Sacral Screw Fixation and Plating Techniques
Indications for S1 Pedicle Screws
Relative Contraindications for S1 Pedicle Screws
Jackson Intrasacral Rod Technique
Indications for Jackson Intrasacral Rod
Relative Contraindications for S1 Pedicle Screws
Indications for S2 Alar Screws
Relative Contraindications for S1 Pedicle Screws
Chopin Plate/Colorado II Sacral Plate
Indications for Chopin Plate/ Colorado II Sacral Plate
Relative Contraindications for S1 Pedicle Screws
Patient Positioning and Incision
Connection to the Construct
Intraoperative Complications
Postoperative Complications
55 Surgical Resection of Sacral Tumors/Sacrectomy and Lumbopelvic Reconstruction
Tumors Involving S3 and Below
Tumors Involving Proximal Sacrum (Combined Anterior and Posterior Approach)
Modified Galveston Technique
Double Iliac Screw Fixation with Lumbar Segmental Fixation
Triangular Frame Reconstruction
Posterior Iliosacral Plating
56 Surgical Approaches to Cervical Kyphosis and Deformity
Surgical Approach: Anterior, Posterior, or Combined?
Anterior Surgical Technique
Combined Anterior-Posterior Approach
Anterior-Posterior Surgical Technique
Posterior Surgical Technique
57 Surgical Management of Scheuermann Kyphosis
Indications and Contraindications
Incision and Soft Tissue Dissection
Exposure of the Vertebrae
58 Surgical Approach to Posttraumatic Thoracic Kyphosis
Impact of Spinal Column Trauma on Alignment
Presenting Symptoms of Thoracic Kyphosis
Correction of Thoracic Kyphosis
Complications Associated with Osteotomies
59 Anterior Release and Fusion Techniques for Scoliosis
Endoscopic Contraindications
Relative Contraindications
Selection of Level of Fusion
Additional Endoscopic Equipment
Preoperative and Perioperative Considerations
Lateral Decubitus (Endoscopic or Open)
Prone (Anterior Release Only)
Upper Thoracic Access (T1–T4)
Single and Double Thoracotomy: Convex
Thoracolumbar (T10–L4) Access
Screw Placement and Staples
Direct Vertebral Body Derotation
60 Anterior and Posterior Treatment for Thoracolumbar and Lumbar Scoliosis
Posterior Instrumentation
Adolescent Idiopathic Scoliosis
61 Surgical Treatment of Adolescent Idiopathic Scoliosis:
Indications/Contraindications
Freehand Pedicle Screw Placement
62 Surgical Treatment of Flat Back Deformity
Radiographic Workup and Evaluation
Pedicle Subtraction Osteotomy
63 Surgical Management of Degenerative Lumbar Scoliosis
History and Physical Examination
G Spinal Tumors and Vascular Lesions
64 Primary Malignant and Benign Tumors of the Spine
Multiple Myeloma and Plasmacytoma
Osteoid Osteoma and Osteoblastoma
Chondroma, Enchondroma, and Osteochondroma
65 Secondary Metastatic Tumors of the Spine
Surgical Management “Pearls”
66 Surgical Technique for Resection of Intradural Tumors
Indications and Contraindications
Relative Contraindications
Approach to Intradural- Extramedullary Tumor
Approach to Intramedullary Tumor
67 Vascular Lesions of the Spinal Cord
Normal Vascular Anatomy of the Spinal Cord
Capillaries of the Spinal Cord
Spinal Cord Cavernous Malformations
Clinical Presentation and Natural History
Dorsally Located Lesions (Fig. 67-5)
Ventrally Located Lesions
Spinal Cord Arteriovenous Malformations
Epidemiology and Natural History
Extradural Arteriovenous Fistulas
Intradural Dorsal Arteriovenous Fistulas
Intradural Ventral Arteriovenous Fistulas
Extradural-Intradural Arteriovenous Malformations
Intramedullary Arteriovenous Malformations
Conus Arteriovenous Malformations
Extradural Arteriovenous Fistulas
Intradural Dorsal Arteriovenous Fistulas
Intradural Ventral Arteriovenous Fistulas
Extradural-Intradural Arteriovenous Malformations
Intramedullary Arteriovenous Malformations
Conus Arteriovenous Malformations
68 Ankylosing Spondylitis:
Osteotomy for Correction of Kyphotic Deformity of Ankylosing Spondylitis
Posterior Cervical Osteotomy for Correction of Kyphotic Deformity of Ankylosing Spondylitis
Pedicle Subtraction Osteotomy for Kyphotic Deformity of the Thoracolumbar Spine
Intraoperative Technique.
69 Bacterial, Fungal, and Tuberculosis Diskitis and Osteomyelitis of the Cervical, Thoracic, and Lumbar Spine
Indications and Contraindications for Surgical Management of Spinal Infection
Cervical Diskitis and Osteomyelitis
Débridement and Decompression
Strut Graft Without Anterior Instrumentation
Strut Graft with Anterior Instrumentation.
Posterior Instrumentation
Thoracic Diskitis and Osteomyelitis
Decompression and Reconstruction
Posterior Instrumentation
Lumbar Diskitis and Osteomyelitis
Positioning and Anesthesia
Débridement and Decompression
Tuberculosis and Fungal Infections of the Spine
70 Surgical Management of Gunshot Wounds to the Spine
Prehospital and Emergency Room Management
Indications for Surgical Intervention
Cerebrospinal Fluid Fistula
Louisiana State University–New Orleans Experience
71 Vertebroplasty and Kyphoplasty
Radiologic Anatomy for Kyphoplasty and Vertebroplasty
Equipment for Vertebroplasty and Kyphoplasty
Inserting Tools into the Fractured Vertebral Body
Unipedicular Posterolateral Approach
Placing and Inflating the Bone Tamp (Balloon Kyphoplasty)
Mixing the Cement and Filling the Void
Potential Adverse Results
72 Bone Graft Harvesting Techniques
Techniques of Bone Graft Harvest
Anterior Iliac Crest Grafts
Alternative Autologous Sites
Allograft and Fusion Supplements
Conservative and Nonsurgical Treatment of Dural Tears
Intraoperative Surgical Repair
Surgical Methods and Materials
Autogenous Dural Substitutes.
Synthetic or Chemically Modified Materials.
Other Dural Tear Surgical Solutions
Postoperative Surgical Repair
Surgical Anatomy and Techniques to the Spine
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