Bridwell and DeWald’s Textbook of Spinal Surgery

Description

Written by experts from around the world, the latest edition of this leading reference features contributions from both neurosurgeons and orthopaedic surgeons. Presenting the full scope of spinal surgery, chapters discuss anatomy, biomechanics, complications, instrumentation, preoperative and postoperative care, and other core topics for surgeons. And numerous illustrations and clinical video clips provide critical visual context. New chapters detail current surgical techniques for idiopathic scoliosis procedures. Over half of the authors are new—bringing fresh perspectives and approaches to surgical preparation and techniques. Technical procedures are written in an easy-to-follow, step-by-step format. Covers a wide spectrum of spinal deformities, degenerative disorders, injuries, and traumatic conditions. Now with more than 4,000 illustrations—including figures that accurately depict anatomy and procedures, and tables and algorithms for absorbing information quickly. Enrich Your Ebook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech. Title Page......Page 2 Copyright......Page 4 Dedication......Page 6 Contributing Authors......Page 7 Foreword......Page 49 Preface......Page 51 Acknowledgments......Page 53 Contents......Page 54 Introduction A: The Evolution of Pediatric Spine Surgery Since the Third Edition of The Textbook of Spinal Surgery......Page 69 REFERENCES......Page 76 Introduction B: The Evolution of Adult Spine Surgery Since the Third Edition of The Textbook of Spinal Surgery......Page 80 ADULT SPINAL DEFORMITY......Page 82 NEUROPHYSIOLOGIC INTRAOPERATIVE MONITORING......Page 87 CERVICAL SPINE SURGERY......Page 88 SURGICAL TREATMENT OF SPINAL TUMORS......Page 89 REFERENCES......Page 90 1. Evaluation and Optimization of the Adult and Pediatric Spine Patient Preoperatively and Perioperatively to Improve Outcome......Page 97 INTRODUCTION......Page 98 STEP ONE: APPROPRIATENESS......Page 99 FITNESS FOR SURGERY......Page 101 PREOPERATIVE EVALUATION AND OPTIMIZATION—PEDIATRIC......Page 105 PERIOPERATIVE EVALUATION AND OPTIMIZATION—ADULT......Page 108 PERIOPERATIVE EVALUATION AND OPTIMIZATION—PEDIATRIC......Page 111 SYSTEMS APPROACH TO OPTIMIZING PATIENT OUTCOMES......Page 115 CONCLUSIONS......Page 117 REFERENCES......Page 118 2. Normal Spinal Anatomy: Normal Sagittal Plane Alignment......Page 129 DEVELOPMENT, ANATOMY, AND FUNCTION......Page 131 THREE-DIMENSIONAL SPINAL ALIGNMENT......Page 133 TERMINOLOGY OF SPINAL ALIGNMENT......Page 134 THE CONE OF ECONOMY......Page 138 SPINAL BALANCE: THE PLUMB LINE......Page 141 SACROPELVIC AND SPINOPELVIC ALIGNMENT......Page 145 NORMAL LUMBAR LORDOSIS......Page 152 THORACOLUMBAR JUNCTION......Page 154 NORMAL THORACIC KYPHOSIS......Page 155 NORMAL CERVICAL LORDOSIS......Page 157 SUMMARY......Page 158 ACKNOWLEDGMENT......Page 159 REFERENCES......Page 160 3. Spinal Cord and Nerve Root Monitoring......Page 162 INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING APPLICATIONS FOR SPINAL SURGERY......Page 163 SOMATOSENSORY-EVOKED POTENTIALS......Page 165 DESCENDING NEUROGENIC–EVOKED POTENTIALS......Page 172 NERVE ROOT MONITORING......Page 178 MOTOR-EVOKED POTENTIALS......Page 181 H-REFLEXES AND F-RESPONSES......Page 189 REFERENCES......Page 237 4. Bone Grafting and Biologics for Spine Fusion......Page 241 INTRODUCTION......Page 242 BIOLOGY OF SPINAL FUSION......Page 244 SELECTING A GRAFT MATERIAL......Page 249 AUTOLOGOUS BONE GRAFT IN SPINAL FUSION......Page 252 ALLOGRAFT BONE......Page 255 CERAMICS......Page 259 OSTEOINDUCTIVE GROWTH FACTORS......Page 261 RECOMBINANT HUMAN BONE MORPHOGENETIC PROTEINS......Page 262 GENE THERAPY IN SPINAL FUSION......Page 264 OSTEOINDUCTIVE SMALL MOLECULES......Page 266 CONCLUSION......Page 268 REFERENCES......Page 269 5. General Considerations of Biomechanical Testing......Page 274 INTRODUCTION......Page 275 BIOMECHANICAL TERMINOLOGY AND ANALYZED PARAMETERS......Page 276 IN VITRO BIOMECHANICAL TESTING MODELS......Page 282 ASTM STANDARDS......Page 287 NONDESTRUCTIVE MULTISEGMENTAL SPINE TESTING......Page 294 LIMITATIONS OF IN VITRO BIOMECHANICS......Page 301 REFERENCES......Page 303 6. Clinical Biomechanics of the Cervical Spine......Page 306 INTRODUCTION TO THE BIOMECHANICAL PROPERTIES OF THE CERVICAL SPINE......Page 307 ANTERIOR FIXATION IN THE LOWER CERVICAL SPINE......Page 312 POSTERIOR FIXATION......Page 314 INSTABILITY DUE TO INJURY AND IATROGENIC DEFECTS......Page 317 ADJACENT SEGMENT DISEASE AND ARTIFICIAL DISCS......Page 319 ACKNOWLEDGMENT......Page 322 REFERENCES......Page 323 7. Biomechanics of Three-Dimensional Scoliosis Correction......Page 331 THE THREE-DIMENSIONAL ANATOMY OF IDIOPATHIC SCOLIOSIS......Page 332 CORONAL PLANE CORRECTION: AXIAL LOADING VERSUS TRANSVERSE APPROXIMATION......Page 334 MEASUREMENT OF DEFORMITY IN SCOLIOSIS......Page 336 VISUAL ANALYSIS OF AXIAL ROTATION......Page 339 THREE-DIMENSIONAL ASPECTS OF SCOLIOSIS CORRECTION......Page 340 PEDICLE SCREW INSTRUMENTATION......Page 341 SEGMENTAL AXIAL ROTATION ABOUT THE CONCAVE ROD......Page 345 DEROTATION BY TRANSVERSE PLANE TRANSLATION......Page 347 SUMMARY......Page 349 REFERENCES......Page 351 8. Principles and Applications of Spinal Instrumentation: A Clinical Approach......Page 355 CLINICAL CONSIDERATIONS......Page 356 HOOKS......Page 358 WIRES AND TETHERS......Page 365 PEDICLE SCREWS......Page 368 CORTICAL BONE TRAJECTORY SCREWS......Page 372 POSTERIOR LUMBAR INTERBODY FUSION......Page 374 TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 375 ANTERIOR LUMBAR INTERBODY FUSION......Page 376 ANTERIOR TO PSOAS (OBLIQUE LATERAL) APPROACH......Page 377 ADVANTAGES AND DISADVANTAGES OF INTERBODY APPROACHES......Page 378 IMPLANT CONSIDERATIONS......Page 379 PEEK VERSUS TITANIUM......Page 380 INTERBODY DEVICE SHAPE/DESIGN......Page 382 SUMMARY......Page 384 REFERENCES......Page 385 9. Treatment Considerations and Biomechanics of the Lumbosacral Spine......Page 395 INTRODUCTION......Page 396 INDICATIONS/CONTRAINDICATIONS......Page 399 ANATOMIC ZONES......Page 401 ANTERIOR AUGMENTATION WITH INTERBODY FUSION (TABLE 9.2)......Page 408 OUTCOMES/RESULTS FOR TECHNIQUE(S)......Page 411 SUMMARY/CONCLUSION......Page 413 FUTURE CONSIDERATIONS......Page 414 REFERENCES......Page 415 10. Anterior Cervical Approaches......Page 418 INTRODUCTION......Page 419 FASCIAL LAYERS......Page 420 MUSCLES......Page 422 NERVES......Page 423 VASCULAR......Page 425 BONE......Page 426 PATIENT POSITIONING......Page 428 LEFT- VERSUS RIGHT-SIDED APPROACH......Page 429 INCISION......Page 430 DEEP DISSECTION......Page 432 LOCALIZATION OF LEVEL, LONGUS COLLI ELEVATION, AND RETRACTOR PLACEMENT......Page 435 DYSPHAGIA......Page 437 DYSPHONIA......Page 438 ARTERIAL INJURY—VERTEBRAL ARTERIES......Page 439 AIRWAY OBSTRUCTION......Page 440 ESOPHAGEAL INJURY......Page 441 HEMATOMA......Page 442 OTHER NERVE INJURIES—C5 PALSY......Page 443 CONCLUSION......Page 444 REFERENCES......Page 445 11. Surgical Approach to the Posterior Cervical Spine......Page 448 INTRODUCTION......Page 449 INDICATIONS FOR POSTERIOR CERVICAL APPROACH......Page 450 BONE ANATOMY......Page 451 MUSCULATURE ANATOMY......Page 456 MUSCULATURE INNERVATION......Page 459 NUCHAL LIGAMENTS......Page 461 VASCULAR ANATOMY......Page 462 POSITIONING......Page 463 EXPOSURE SUBAXIAL SPINE......Page 466 C1–C2 EXPOSURE......Page 467 WOUND CLOSURE......Page 468 POSTOPERATIVE PAIN AND KYPHOSIS......Page 469 CHIN-ON-CHEST DEFORMITY......Page 470 CONCLUSION......Page 471 REFERENCES......Page 472 12. Jaw-Splitting Approaches to the Upper Cervical Spine......Page 474 INTRODUCTION......Page 475 UPPER NECK EXPOSURE......Page 477 PATHOLOGY......Page 479 TRANSORAL–TRANSPHARYNGEAL......Page 480 TRANSORAL–TRANSPHARYNGEAL PLUS MAXILLARY OSTEOTOMY......Page 485 TECHNIQUE......Page 486 TRANSMANDIBULAR APPROACHES......Page 487 MEDIAN MANDIBULOTOMY WITH GLOSSOTOMY (TROTTER APPROACH)......Page 488 MANDIBULAR SWING TRANSCERVICAL APPROACH......Page 493 TRANSMANDIBULAR–CIRCUMGLOSSAL–RETROPHARYNGEAL APPROACH......Page 497 BILATERAL SAGITTAL SPLIT MANDIBULAR OSTEOTOMIES......Page 498 COMBINED TRANSMAXILLARY AND TRANSMANDIBULAR APPROACHES......Page 499 TRANSCERVICAL ENDOSCOPIC ODONTOIDECTOMY......Page 500 ODONTOID-SPARING TRANSNASAL APPROACH......Page 504 ENDOSCOPIC-ASSISTED LATERAL TRANSATLANTAL APPROACH......Page 505 FAR- VERSUS EXTREME-LATERAL APPROACHES......Page 506 ENDOSCOPIC ENDONASAL......Page 507 SUBMANDIBULAR RETROPHARYNGEAL APPROACH......Page 508 COMPLICATIONS......Page 510 REFERENCES......Page 513 13. The Modified Anterior Approach to the Cervicothoracic Junction......Page 517 INTRODUCTION......Page 518 ANATOMY......Page 519 PREOPERATIVE PLANNING......Page 520 LOW CERVICAL APPROACH......Page 525 FULL STERNOTOMY APPROACH......Page 526 UNILATERAL OR BILATERAL MANUBRIOTOMY......Page 528 MEDIAL CLAVICULAR OSTEOTOMY......Page 529 MINI-OPEN APPROACH......Page 534 COMPLICATIONS......Page 537 DISCUSSION......Page 538 CONCLUSION......Page 540 ACKNOWLEDGMENT......Page 541 REFERENCES......Page 542 14. Transsternal Approaches to the Spine......Page 545 INTRODUCTION......Page 546 MUSCULATURE......Page 547 NERVES......Page 549 TRANSSTERNAL APPROACHES......Page 551 FULL MEDIAN STERNOTOMY......Page 552 PARTIAL MEDIAN STERNOTOMY......Page 554 LATERAL MANUBRIOTOMY......Page 557 MODIFIED PARTIAL LATERAL MANUBRIOTOMY......Page 559 STERNOTOMY PLUS ANTEROLATERAL THORACOTOMY......Page 561 FULL MEDIAN STERNOTOMY AND INTERAORTOCAVAL SUBINNOMINATE APPROACH......Page 565 PRE- AND POSTOPERATIVE MANAGEMENT......Page 569 COMPLICATIONS......Page 571 PARAVERTEBRAL MASSES AND TRANSSTERNAL APPROACHES......Page 573 CASE ILLUSTRATION......Page 574 REFERENCES......Page 579 15. “Microscopic” Approach to the Posterior Lumbar Spine for Decompression......Page 581 INTRODUCTION......Page 582 INDICATIONS/PREOPERATIVE PLANNING......Page 584 POSITIONING AND SETUP......Page 590 OPERATIVE APPROACHES—UNILATERAL......Page 592 BILATERAL DECOMPRESSION......Page 597 EXTRAFORAMINAL DECOMPRESSION......Page 598 COMPLICATIONS......Page 600 OUTCOMES......Page 601 SUMMARY......Page 602 REFERENCES......Page 603 16. Minimal Access Techniques Using Tubular Retractors for Disc Herniations and Stenosis......Page 608 INTRODUCTION......Page 609 INDICATIONS......Page 610 SERIAL DILATION AND TUBULAR RETRACTOR PLACEMENT......Page 612 INITIAL DRILLING......Page 613 TECHNIQUE—LUMBAR DISCECTOMY......Page 614 TECHNIQUE......Page 618 CONSIDERATIONS......Page 621 INTRAOPERATIVE PLANNING AND INCISION......Page 624 PEDICLE SCREW PLACEMENT......Page 625 INTERBODY CAGE......Page 626 ROD INSERTION AND CLOSURE......Page 629 LAMINECTOMY......Page 630 TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 631 ADDITIONAL BENEFITS OF TUBULAR RETRACTORS......Page 635 COMPLICATIONS......Page 638 THE LEARNING CURVE......Page 639 CONCLUSION......Page 641 REFERENCES......Page 642 17. Open Anterior Exposure of the Thoracic, Thoracolumbar, and Lumbar Spines......Page 647 INTRODUCTION......Page 648 HIGH TRANSTHORACIC APPROACH T1–T4......Page 649 INDICATIONS......Page 650 MID AND LOWER TRANSTHORACIC APPROACH T4–T12 INCLUDING DOUBLE THORACOTOMY AND THORACOPHRENOLUMBOTOMY DOWN TO L5–S1......Page 652 INDICATIONS......Page 653 EXPOSURE FOR THORACOLUMBAR/LUMBAR SCOLIOSIS......Page 655 POSTOPERATIVE MANAGEMENT......Page 670 RISKS AND COMPLICATIONS......Page 672 REFERENCES......Page 674 18. Anterior Approaches to the Distal Lumbar Spine and Sacrum......Page 676 INTRODUCTION......Page 677 LAYERS OF THE ABDOMINAL WALL......Page 679 PERITONEAL AND RETROPERITONEAL ANATOMY......Page 681 VASCULATURE......Page 682 LYMPHATIC NETWORK......Page 684 INDICATIONS......Page 686 PREOPERATIVE EVALUATION......Page 691 ADVANTAGE......Page 695 POSITIONING......Page 696 EXPOSURE......Page 697 NEUROVASCULAR DISSECTION......Page 700 LUMBOSACRAL EXPOSURE......Page 703 EXPOSURE......Page 705 NEUROVASCULAR DISSECTION......Page 707 POSTOPERATIVE MANAGEMENT......Page 710 LATERAL INTERBODY FUSION......Page 711 INSTRUMENTATION AND BONE GRAFTING......Page 713 COMPLICATIONS......Page 716 CONCLUSION......Page 720 REFERENCES......Page 721 19. Direct Lateral Approach to the Lumbar Spine......Page 733 INTRODUCTION......Page 734 ANATOMIC CONSIDERATIONS......Page 736 INDICATIONS......Page 739 POSITIONING......Page 740 PROCEDURE......Page 744 CLOSURE......Page 747 COMPLICATIONS......Page 748 CONCLUSIONS......Page 750 REFERENCES......Page 751 20. Cervical: State of the Art......Page 756 21. Evaluation of Axial Neck Pain: Who Is a Surgical Candidate and Who Isn’t: How to Manage the Nonoperative Treatment, How to Work Up the Pathology......Page 761 INTRODUCTION......Page 762 INCIDENCE OF AXIAL NECK PAIN......Page 763 NATURAL HISTORY OF NECK PAIN......Page 764 PATHOPHYSIOLOGY OF NECK PAIN......Page 765 DIFFERENTIAL DIAGNOSIS OF NECK PAIN......Page 766 EVALUATION OF PATIENTS WITH NECK PAIN......Page 767 NONOPERATIVE TREATMENT OF ACUTE AND SUBACUTE NECK PAIN......Page 779 NONOPERATIVE TREATMENT OF CHRONIC NECK PAIN......Page 780 NONOPERATIVE TREATMENT OF IATROGENIC NECK PAIN WITH DEFORMITY......Page 781 CERVICAL SPONDYLOLISTHESIS......Page 782 PSEUDOARTHROSIS......Page 783 CERVICAL KYPHOSIS......Page 784 CERVICOGENIC HEADACHE......Page 786 SUMMARY......Page 787 REFERENCES......Page 788 22. Nonoperative Management of Cervical Radiculopathy......Page 792 INTRODUCTION......Page 793 ANATOMY......Page 794 CLINICAL EVALUATION......Page 795 IMAGING EVALUATIONS......Page 799 OTHER EVALUATIONS......Page 801 EPIDEMIOLOGY......Page 802 TREATMENT DECISIONS......Page 803 MEDICATION TREATMENT......Page 804 PHYSICAL THERAPY......Page 806 CERVICAL IMMOBILIZATION......Page 807 CERVICAL MANIPULATION......Page 808 STEROID INJECTION......Page 809 CONCLUSION......Page 812 REFERENCES......Page 813 23. Cervical Spondylosis and Radiculopathy......Page 817 BACKGROUND......Page 818 ANATOMY......Page 819 PATHOANATOMY/PATHOPHYSIOLOGY......Page 820 RADICULOPATHY......Page 823 DIAGNOSIS......Page 824 DIAGNOSTIC STUDIES......Page 831 NATURAL HISTORY......Page 835 ANTERIOR CERVICAL DISCECTOMY AND FUSION......Page 838 POSTERIOR LAMINOFORAMINOTOMY......Page 839 CERVICAL DISC ARTHROPLASTY......Page 840 SUMMARY......Page 841 REFERENCES......Page 842 24. Cervical Myelopathy......Page 846 INTRODUCTION......Page 847 EPIDEMIOLOGY......Page 849 PATHOPHYSIOLOGY......Page 852 HISTORY......Page 854 PHYSICAL EXAMINATION......Page 855 DIAGNOSTIC IMAGING......Page 856 PATIENT-REPORTED OUTCOMES ASSESSMENT......Page 857 NATURAL HISTORY AND NONOPERATIVE TREATMENT......Page 859 EVIDENCE FOR SURGICAL TREATMENT......Page 861 CERVICAL LAMINECTOMY WITHOUT FUSION......Page 862 POSTERIOR CERVICAL DECOMPRESSION AND FUSION (PCF)......Page 863 LAMINOPLASTY......Page 864 ANTERIOR CERVICAL DECOMPRESSION AND FUSION (ACF)......Page 866 COMBINED ANTERIOR AND POSTERIOR SURGERY......Page 869 CONCLUSIONS......Page 870 REFERENCES......Page 872 25. Anterior Decompression, Instrumentation, Fusion Techniques: Discectomy, Foraminotomy, Disc Space Carpentry......Page 878 BACKGROUND DATA......Page 879 ACCEPTED FORMS OF SURGICAL TREATMENT......Page 880 ANESTHESIA......Page 881 NEUROPHYSIOLOGIC MONITORING......Page 882 APPROACH......Page 883 DISCECTOMY......Page 885 END PLATE PREPARATION......Page 887 AUTOGENOUS ILIAC CREST BONE GRAFT......Page 888 INTERBODY GRAFTING......Page 889 INSTRUMENTATION......Page 890 POSTOPERATIVE MANAGEMENT......Page 894 VASCULAR......Page 896 NEURAL......Page 897 VERTEBRAL BODY FRACTURE......Page 898 ACUTE POSTOPERATIVE COMPLICATIONS......Page 899 OUTCOMES......Page 901 FUTURE TRENDS......Page 902 SUMMARY......Page 903 REFERENCES......Page 904 26. Anterior Decompression, Instrumentation, Fusion Techniques: Corpectomy, Strut Grafting......Page 907 INTRODUCTION......Page 908 CLASSIFICATION OF MYELOPATHY......Page 910 NATURAL HISTORY......Page 912 HISTORY AND PHYSICAL EXAMINATION......Page 913 IMAGING STUDIES......Page 914 CONTRAINDICATIONS......Page 919 NEUROPHYSIOLOGIC MONITORING......Page 921 ANESTHETIC CONSIDERATION......Page 922 POSITIONING......Page 923 EXPOSURE......Page 924 INSTRUMENTATION......Page 940 GRAFT SELECTION......Page 941 RESULTS......Page 942 INTRAOPERATIVE COMPLICATIONS......Page 945 POSTOPERATIVE COMPLICATIONS......Page 951 RESPIRATORY DISTRESS......Page 952 PSEUDARTHROSIS......Page 953 SUMMARY......Page 954 REFERENCES......Page 955 27. Anterior Cervical Plating......Page 959 INTRODUCTION......Page 960 HISTORICAL PERSPECTIVE......Page 961 FIRST GENERATION—DYNAMIC NONLOCKING (“UNRESTRICTED BACKOUT”)......Page 963 SECOND GENERATION—STATIC LOCKING (“RESTRICTED BACKOUT”)......Page 964 THIRD GENERATION—DYNAMIC LOCKING (“SEMICONSTRAINED”)......Page 970 FOURTH GENERATION—BIORESORBABLE......Page 976 PLATING TECHNIQUES AND INTRAOPERATIVE CONSIDERATIONS......Page 980 CONCLUSIONS......Page 984 REFERENCES......Page 985 28. Indications and Techniques for Transoral and Foramen Magnum Decompression......Page 992 INTRODUCTION......Page 993 NEURODIAGNOSTIC IMAGING AND TREATMENT ALGORITHMS......Page 995 TRANSORAL APPROACH TO THE VENTRAL CRANIOCERVICAL BORDER......Page 997 PREOPERATIVE ASSESSMENT......Page 1002 OPERATIVE PROCEDURE......Page 1006 INTRADURAL EXPANSION OF TUMOR AND REPAIR OF CSF LEAK......Page 1012 POSTOPERATIVE CARE......Page 1013 MORBIDITY/INFECTION......Page 1014 MORTALITY......Page 1015 POSTEROLATERAL–FAR LATERAL TRANSCONDYLAR APPROACH TO THE VENTRAL FORAMEN MAGNUM AND UPPER CERVICAL CANAL......Page 1016 INDICATIONS......Page 1018 SURGICAL TECHNIQUE......Page 1019 LATERAL TRANSCERVICAL EXTRAPHARYNGEAL APPROACH TO THE UPPER CERVICAL SPINE AND CRANIOCERVICAL JUNCTION......Page 1023 POSTERIOR MIDLINE CRANIECTOMY AND UPPER CERVICAL LAMINECTOMY......Page 1028 CONCLUSION......Page 1030 REFERENCES......Page 1031 29. Occipitocervical and Atlantoaxial Methods of Fusion: Rigid Fixation and Wiring......Page 1036 INTRODUCTION......Page 1037 GRAFT AND CABLE TECHNIQUE......Page 1038 GRAFT AND CLAMP TECHNIQUE......Page 1041 RIGID FIXATION......Page 1042 TRANSARTICULAR SCREW FIXATION......Page 1043 LATERAL MASS SCREWS AND RODS......Page 1046 OCCIPITOCERVICAL FUSION......Page 1054 ROD AND WIRE (CONTOURED LOOP) FIXATION......Page 1057 SCREW/ROD FIXATION......Page 1060 COMPLICATIONS......Page 1066 SUMMARY......Page 1067 REFERENCES......Page 1068 30. Subaxial Posterior Foraminotomy......Page 1072 HISTORY......Page 1073 ANATOMY/BIOMECHANICS......Page 1075 SURGICAL TECHNIQUE OF POSTERIOR FORAMINOTOMY......Page 1078 OPEN POSTERIOR CERVICAL FORAMINOTOMY......Page 1079 MIS POSTERIOR CERVICAL FORAMINOTOMY......Page 1084 POSTERIOR LAMINOFORAMINOTOMY......Page 1089 COMPLICATIONS......Page 1090 OUTCOMES OF MIS POSTERIOR CERVICAL FORAMINOTOMY (MIS PCF)......Page 1092 COST......Page 1093 FULL ENDOSCOPIC POSTERIOR FORAMINOTOMY......Page 1095 REFERENCES......Page 1096 31. Cervical Laminoplasty......Page 1099 INTRODUCTION......Page 1100 BACKGROUND......Page 1101 POSITIONING AND EXPOSURE......Page 1102 BONY DECOMPRESSION AND LAMINOPLASTY STABILIZATION......Page 1103 COMPLETION......Page 1109 POSTOPERATIVE CARE......Page 1111 POSTLAMINOPLASTY KYPHOSIS......Page 1113 RECURRENT STENOSIS......Page 1114 MOTOR ROOT PALSY......Page 1115 RESULTS......Page 1117 CONCLUSION......Page 1119 REFERENCES......Page 1120 32. Subaxial Posterior Decompression and Fusion Techniques......Page 1124 INTRODUCTION......Page 1125 OPERATIVE TECHNIQUE......Page 1131 POSTOPERATIVE CARE......Page 1145 COMPLICATIONS......Page 1147 CONCLUSION......Page 1149 ACKNOWLEDGMENT......Page 1150 REFERENCES......Page 1151 33. Subaxial Posterior Laminoplasty and Laminectomy With Lateral Mass Fixation......Page 1154 INTRODUCTION......Page 1155 SUBAXIAL POSTERIOR LAMINOPLASTY AND LAMINECTOMY......Page 1157 OPERATIVE TECHNIQUE......Page 1158 POSTOPERATIVE CARE......Page 1166 COMPLICATIONS......Page 1168 RESULTS......Page 1170 ANATOMY......Page 1172 BIOMECHANICS......Page 1173 SURGICAL TECHNIQUE......Page 1174 SCREW TECHNIQUES......Page 1175 POSTOPERATIVE MANAGEMENT......Page 1186 MINIMALLY INVASIVE APPROACH......Page 1190 CASE SAMPLES......Page 1191 CONCLUSION......Page 1194 REFERENCES......Page 1195 34. Subaxial Posterior Lateral Mass Fixation......Page 1200 INTRODUCTION......Page 1201 ANATOMY......Page 1202 BIOMECHANICS......Page 1203 INDICATIONS AND CONTRAINDICATIONS......Page 1204 SURGICAL TECHNIQUE......Page 1205 SCREW TECHNIQUES......Page 1206 POSTOPERATIVE MANAGEMENT......Page 1217 OUTCOMES AND COMPLICATIONS......Page 1218 MINIMALLY INVASIVE TECHNIQUE......Page 1220 CASE 2......Page 1221 REFERENCES......Page 1230 35. Subaxial Cervical Pedicle Screw Fixation......Page 1234 INTRODUCTION......Page 1235 CONTRAINDICATION AND LIMITATION......Page 1237 PEDICLE SIZE......Page 1239 ANATOMY OF THE VERTEBRAL ARTERY......Page 1240 OPERATION ROOM SET-UP/POSITIONING......Page 1244 IMPLANTS......Page 1245 PEDICLE SCREW PLACEMENT......Page 1246 COMPLICATIONS DIRECTLY ATTRIBUTABLE TO SCREW INSERTION......Page 1254 COMPLICATIONS NOT DIRECTLY ATTRIBUTABLE TO SCREW INSERTION......Page 1257 A CASE OF SALVAGE SURGERY FOR POSTLAMINECTOMY KYPHOSIS......Page 1259 A CASE OF MULTISEGMENTAL INSTABILITY CAUSED BY SUBAXIAL LESION OF RHEUMATOID ARTHRITIS......Page 1267 SUMMARY......Page 1269 REFERENCES......Page 1270 36. Revision Cervical Spine Surgery......Page 1272 INTRODUCTION......Page 1273 EVALUATION OF THE PATIENT AFTER FAILED CERVICAL SPINE SURGERY......Page 1276 HEMATOMA......Page 1280 RADICULOPATHY AND RECURRENT SYMPTOMS......Page 1281 ADJACENT SEGMENT DISEASE......Page 1283 PSEUDARTHROSIS......Page 1284 POSTSURGICAL MALALIGNMENT......Page 1287 CONCLUSION......Page 1291 REFERENCES......Page 1292 37. Combined Approaches (Anterior-Posterior, Posterior-Anterior-Posterior) to the Correction of Cervical Kyphosis......Page 1299 INTRODUCTION......Page 1300 CLINICAL PRESENTATION AND PHYSICAL EXAMINATION......Page 1302 RADIOGRAPHIC EVALUATION......Page 1303 RESTORATION OF BALANCE AND ALIGNMENT......Page 1306 ACHIEVING A STABLE FUSION CONSTRUCT......Page 1309 DECISION-MAKING ALGORITHM......Page 1310 COMPLICATIONS AFTER COMBINED APPROACHES......Page 1325 REFERENCES......Page 1327 38. Cervical Pedicle Subtraction Osteotomy......Page 1330 INTRODUCTION......Page 1331 INDICATION AND PREOPERATIVE EVALUATION......Page 1333 EXPOSURE......Page 1336 INSTRUMENTATION......Page 1337 PEDICLE SUBTRACTION OSTEOTOMY......Page 1338 OSTEOTOMY CLOSURE......Page 1340 WOUND CLOSURE......Page 1342 CASE 38.1......Page 1343 COMPLICATIONS......Page 1345 CONCLUSION......Page 1346 REFERENCES......Page 1347 39. Cervical Disc Arthroplasty......Page 1348 INTRODUCTION......Page 1349 HISTORY OF CERVICAL DISC ARTHROPLASTY......Page 1352 PROSTHETIC KINEMATICS......Page 1354 MATERIAL CHOICE......Page 1356 CURRENT INDICATIONS AND CONTRAINDICATIONS......Page 1360 EXPANDED INDICATIONS AND FUTURE DIRECTIONS......Page 1362 SINGLE-LEVEL DISEASE......Page 1365 TWO-LEVEL DISEASE......Page 1369 META-ANALYSES OF OUTCOMES......Page 1370 PREVENTION OF ADJACENT SEGMENT DISEASE......Page 1372 COMPLICATIONS SPECIFIC TO CDA......Page 1374 AUTHOR’S PREFERRED SURGICAL TECHNIQUE......Page 1376 REFERENCES......Page 1378 40. Complications of Surgical Treatment of the Cervical Spine......Page 1384 BACKGROUND......Page 1385 DEFINING COMPLICATIONS IN CERVICAL SPINE SURGERY......Page 1387 RISK FACTORS FOR CERVICAL SPINE SURGERY COMPLICATIONS......Page 1388 COMPLICATION RATES IN CERVICAL SPINE SURGERY......Page 1390 IMPORTANT COMPLICATIONS ASSOCIATED WITH ANTERIOR CERVICAL SPINE SURGERY......Page 1391 IMPORTANT COMPLICATIONS ASSOCIATED WITH POSTERIOR CERVICAL SPINE SURGERY......Page 1393 IMPORTANT RADIOGRAPHIC COMPLICATIONS OF CERVICAL SPINE SURGERY......Page 1394 FUTURE DIRECTIONS......Page 1395 REFERENCES......Page 1396 41. Thoracic and Lumbar Degenerative Disorders: State of the Art......Page 1401 REFERENCES......Page 1408 42. Evaluation of Thoracic and Lumbar Axial Back Pain: Who Is a Surgical Candidate and Who Is Not?......Page 1412 INTRODUCTION......Page 1413 DEFINITION OF AXIAL BACK PAIN......Page 1414 ANATOMY, PATHOANATOMY, AND PATHOGENESIS OF AXIAL BACK PAIN......Page 1415 RISK FACTORS OF AXIAL BACK PAIN......Page 1417 CLASSIFICATION OF AXIAL BACK PAIN......Page 1418 NATURAL HISTORY OF AXIAL BACK PAIN......Page 1419 HISTORY AND PHYSICAL EVALUATION OF THE PATIENT WITH AXIAL BACK PAIN......Page 1420 MUSCLE STRAIN......Page 1423 SPONDYLOLYSIS AND SPONDYLOLISTHESIS......Page 1424 SPONDYLOARTHROPATHIES......Page 1425 BENIGN AND MALIGNANT TUMORS......Page 1426 INFECTIONS......Page 1427 METABOLIC BONE DISEASE......Page 1428 NONORGANIC BACK PAIN......Page 1429 PLAIN RADIOGRAPHS......Page 1430 MAGNETIC RESONANCE IMAGING......Page 1431 DISCOGRAPHY......Page 1432 DIAGNOSTIC INJECTIONS......Page 1433 NONOPERATIVE MANAGEMENT OF AXIAL BACK PAIN......Page 1434 OPERATIVE MANAGEMENT OF AXIAL BACK PAIN......Page 1436 CONCLUSION......Page 1441 REFERENCES......Page 1442 43. Surgical Treatment of Lumbar Disc Herniation......Page 1450 INTRODUCTION......Page 1451 SURGICAL TECHNIQUE......Page 1458 EXTRUDED DISC......Page 1467 FORAMINAL DISC HERNIATIONS......Page 1468 FAR-LATERAL EXTRAFORAMINAL HERNIATIONS......Page 1470 POSTOPERATIVE CARE......Page 1474 REFERENCES......Page 1475 44. Surgical Treatment of Lumbar Spinal Stenosis......Page 1477 INTRODUCTION......Page 1478 PATHOGENESIS AND PATHOANATOMY......Page 1481 MANIFESTATIONS OF LUMBAR SPINAL STENOSIS......Page 1483 NATURAL HISTORY OF LUMBAR SPINAL STENOSIS......Page 1484 HISTORY AND PHYSICAL EXAMINATION OF THE PATIENT WITH LUMBAR SPINAL STENOSIS......Page 1485 PLAIN RADIOGRAPHS......Page 1488 MAGNETIC RESONANCE IMAGING (MRI)......Page 1489 MYELOGRAPHY/COMPUTED TOMOGRAPHY MYELOGRAPHY......Page 1490 ELECTRODIAGNOSTIC STUDIES......Page 1491 DIFFERENTIAL DIAGNOSIS OF LUMBAR SPINAL STENOSIS......Page 1493 NONOPERATIVE MANAGEMENT OF LUMBAR SPINAL STENOSIS......Page 1494 SURGICAL MANAGEMENT OF LUMBAR SPINAL STENOSIS......Page 1496 INDICATIONS FOR SURGERY AND REVIEW OF SURGICAL TECHNIQUES......Page 1497 CENTRAL LAMINECTOMY......Page 1498 LAMINECTOMY WITH LATERAL RECESS DECOMPRESSION AND FORAMINOTOMY......Page 1499 LAMINOPLASTY......Page 1500 POSTERIOR SPINAL FUSION WITH AND WITHOUT INSTRUMENTATION......Page 1501 INTERBODY FUSION......Page 1502 INTERSPINOUS PROCESS DEVICE......Page 1504 MINIMALLY INVASIVE SURGICAL TECHNIQUES......Page 1505 LONG-TERM OUTCOMES......Page 1507 CONCLUSION......Page 1508 REFERENCES......Page 1509 45. Revision Laminectomy: Indications and Techniques......Page 1514 INTRODUCTION......Page 1515 EVALUATION AND INDICATIONS......Page 1516 TREATMENT......Page 1527 SURGICAL TECHNIQUES......Page 1528 COMPLICATIONS......Page 1532 CONCLUSION......Page 1534 REFERENCES......Page 1535 46. Minimally Invasive Posterior Surgery for the Lumbar Spine......Page 1537 INTRODUCTION......Page 1538 LIMITATIONS......Page 1540 EXPOSURE......Page 1541 LUMBAR DECOMPRESSION......Page 1542 RESULTS......Page 1543 OVERVIEW......Page 1545 PERCUTANEOUS SPINAL FIXATION......Page 1547 RESULTS......Page 1549 MINIMALLY INVASIVE POSTEROLATERAL FUSION......Page 1550 INTRODUCTION......Page 1551 TECHNIQUE (AUTHORS’ PREFERENCE)......Page 1553 RESULTS......Page 1557 FUTURE DIRECTION OF MINIMALLY INVASIVE SPINE SURGERY......Page 1558 MINIMALLY INVASIVE TWO-LEVEL TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 1559 REFERENCES......Page 1565 47. When to Consider ALIF, TLIF, and PLIF With PSF......Page 1569 INTRODUCTION/BACKGROUND......Page 1570 POSTERIOR LUMBAR INTERBODY FUSION......Page 1571 TRANSFORAMINAL LUMBAR INTERBODY FUSION......Page 1573 ANTERIOR LUMBAR INTERBODY FUSION......Page 1574 COMPARISON STUDY BETWEEN PLIF AND TLIF......Page 1577 COMPARISON STUDY BETWEEN TLIF AND ALIF......Page 1578 CONCLUSION......Page 1580 REFERENCES......Page 1581 48. Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion......Page 1584 INDICATIONS......Page 1585 PLIF SURGICAL PROTOCOL......Page 1586 TLIF SURGICAL PROTOCOL......Page 1587 THE IMPORTANCE OF LORDOSIS......Page 1588 OPERATING TABLE......Page 1589 MINIMALLY INVASIVE SURGERY......Page 1590 BILATERAL FACETECTOMIES......Page 1591 STEERABLE CAGES......Page 1595 EXPANDABLE CAGES......Page 1596 INTERPEDICULAR COMPRESSION......Page 1598 UNILATERAL VERSUS BILATERAL PEDICLE SCREWS......Page 1601 CONTRALATERAL RADICULOPATHY......Page 1602 CASE 2......Page 1603 CONCLUSION......Page 1604 REFERENCES......Page 1605 49. Revision Lumbar Spine Surgery......Page 1610 INTRODUCTION......Page 1611 CLINICAL EVALUATION......Page 1612 IMAGING EVALUATION......Page 1615 PATIENTS WITHOUT PRIOR INSTRUMENTATION......Page 1616 PATIENTS WITH PRIOR INSTRUMENTATION AND FUSION......Page 1617 ALIGNMENT EVALUATION......Page 1619 SURGICAL INDICATIONS AND PREOPERATIVE OPTIMIZATION......Page 1620 REVISION DECOMPRESSIONS......Page 1623 ADJACENT SEGMENT DISEASE......Page 1624 PSEUDARTHROSIS......Page 1628 MALALIGNMENT......Page 1630 CONCLUSIONS......Page 1633 REFERENCES......Page 1634 50. Thoracic Disc Herniation: Diagnosis and Management......Page 1647 INTRODUCTION......Page 1648 ANATOMICAL FINDINGS TO CONSIDER IN TDH......Page 1650 LOCATION OF THORACIC DISC HERNIATION......Page 1651 DIAGNOSIS......Page 1653 NONOPERATIVE MANAGEMENT......Page 1654 IDENTIFICATION OF THE CORRECT LEVEL AND PREVENTION OF WRONG-SITE SURGERY......Page 1655 INTRAOPERATIVE NEUROMONITORING......Page 1656 SURGICAL APPROACH—POSTERIOR......Page 1657 TRANSFACET PEDICLE–SPARING APPROACH......Page 1658 ANTEROLATERAL APPROACH TO THE THORACIC SPINE......Page 1659 Neurologic signs......Page 1661 THORACIC MICROSCOPIC DISCECTOMY......Page 1662 MINIMALLY INVASIVE LATERAL APPROACHES TO THORACIC SPINE......Page 1663 CONCLUSION......Page 1664 REFERENCES......Page 1665 51. Thoracic Stenosis......Page 1670 INTRODUCTION......Page 1671 ANATOMY......Page 1672 DIAGNOSIS......Page 1673 PATHOGENESIS......Page 1675 SURGICAL TREATMENT......Page 1676 COMPLICATIONS......Page 1681 POSTOPERATIVE CARE......Page 1684 REFERENCES......Page 1689 52. Treatment of Thoracic Myelopathy......Page 1692 INTRODUCTION......Page 1693 THORACIC DISC HERNIATIONS......Page 1695 THORACIC OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT......Page 1702 THORACIC OSSIFICATION OF YELLOW LIGAMENT......Page 1705 CONCLUSION......Page 1711 REFERENCES......Page 1712 53. Current State of Lumbar Total Disc Replacement: Concepts/Design Strategy/Indications/Contraindications/Complications......Page 1716 CONCEPTS......Page 1717 DESIGN STRATEGY......Page 1719 INDICATIONS......Page 1722 CONTRAINDICATIONS......Page 1723 PHYSICAL EXAMINATION......Page 1726 RADIOGRAPHIC ANALYSIS......Page 1727 PATIENT POSITIONING......Page 1728 COMPLICATIONS......Page 1732 IMPLANTS......Page 1737 EVIDENCE-BASED OUTCOMES......Page 1739 SUMMARY......Page 1741 REFERENCES......Page 1742 54. Sacroiliac Joint Dysfunction......Page 1746 INTRODUCTION......Page 1747 SI JOINT DYSFUNCTION AND LOW BACK PAIN......Page 1749 ANATOMY AND BIOMECHANICS......Page 1750 PATHOLOGY AND PATHOMECHANICS......Page 1756 CLINICAL HISTORY......Page 1759 PHYSICAL EXAMINATION......Page 1761 IMAGING EVALUATION......Page 1762 DIAGNOSTIC INJECTION......Page 1763 NONSURGICAL TREATMENT......Page 1766 TRADITIONAL OPEN SURGERY......Page 1768 MINIMALLY INVASIVE SURGERY......Page 1770 MINIMALLY INVASIVE SURGICAL TECHNIQUE......Page 1771 MIS SURGICAL OUTCOMES......Page 1775 COMPLICATIONS......Page 1783 CONCLUSION......Page 1785 REFERENCES......Page 1787 55. The Future: Disc Regeneration and Other Technologies......Page 1793 INTRODUCTION......Page 1794 GROWTH FACTORS......Page 1795 ANTI-INFLAMMATORY PROTEINS......Page 1796 CONCLUSION......Page 1798 SMALL MOLECULAR THERAPIES......Page 1799 CONCLUSION......Page 1800 DISC CELLS......Page 1802 STEM CELLS......Page 1803 DERMAL FIBROBLASTS......Page 1804 CONCLUSIONS......Page 1805 ANNULUS FIBROSUS TISSUE ENGINEERING......Page 1806 WHOLE INTERVERTEBRAL DISC ENGINEERING......Page 1807 CONCLUSIONS......Page 1808 CONCLUSIONS......Page 1809 REFERENCES......Page 1810 56. Complications of Lumbosacral Spine Surgery......Page 1821 INTRODUCTION......Page 1822 INSTRUMENTATION AND FUSION COMPLICATIONS......Page 1824 PSEUDARTHROSIS......Page 1830 VASCULAR AND BLEEDING–RELATED COMPLICATIONS......Page 1838 MUSCLE COMPLICATIONS......Page 1847 INFECTION......Page 1851 NEUROLOGIC COMPLICATIONS......Page 1857 SAGITTAL ALIGNMENT AND BALANCE COMPLICATIONS......Page 1862 COST EFFECTIVENESS OF LUMBAR SPINE SURGERY......Page 1864 CONCLUSION......Page 1867 REFERENCES......Page 1869 57. Wiltse and Marchetti–Bartolozzi Classifications of Spondylolisthesis: Guidelines for Treatment......Page 1878 TYPE 2 (ISTHMIC)......Page 1881 TYPE 5 (PATHOLOGIC)......Page 1882 MARCHETTI–BARTOLOZZI CLASSIFICATION......Page 1883 PROGRESSION OF DEFORMITY......Page 1887 ACQUIRED......Page 1890 MEYERDING GRADING SCALE......Page 1895 TREATMENT......Page 1897 REFERENCES......Page 1903 58. Sagittal Alignment and the Spinal Deformity Study Group Classification......Page 1905 INTRODUCTION......Page 1906 LOCAL ALIGNMENT: SLIP GRADE AND LUMBOSACRAL KYPHOSIS......Page 1908 REGIONAL ALIGNMENT: SACROPELVIC MORPHOLOGY, PELVIC BALANCE, AND PROXIMAL FEMORAL ANGLE......Page 1911 GLOBAL ALIGNMENT: SPINAL BALANCE......Page 1922 SPINAL DEFORMITY STUDY GROUP CLASSIFICATION......Page 1926 PROPOSED SURGICAL TREATMENT......Page 1930 REFERENCES......Page 1934 59. Natural History of Spondylolisthesis......Page 1937 INTRODUCTION......Page 1938 L5–SACRUM RELATIONSHIP......Page 1939 GLOBAL ANATOMICAL CLASSIFICATION......Page 1941 SPINAL DEFORMITY STUDY GROUP (SDSG AND MAC-THIONG) CLASSIFICATION......Page 1947 NATURAL HISTORY: PROPOSAL FOR A NEW CLASSIFICATION INTEGRATING THE TIME-SCALE DIMENSION......Page 1949 CONCLUSION......Page 1956 REFERENCES......Page 1957 60. Pars Interarticularis Repair......Page 1960 INTRODUCTION......Page 1961 REVIEW OF LITERATURE......Page 1962 INDICATIONS......Page 1963 PREOPERATIVE PLANNING......Page 1969 AUTHORS’ PREFERRED METHOD......Page 1970 POSTOPERATIVE CARE......Page 1972 AUTHORS’ SERIES......Page 1973 DISCUSSION AND CONCLUSION......Page 1978 REFERENCES......Page 1979 61. Low-Grade Spondylolisthesis in Children and Adolescents......Page 1981 INTRODUCTION......Page 1982 TREATMENT......Page 1986 COMPLICATIONS......Page 1991 SUMMARY......Page 1994 REFERENCES......Page 1995 62. Adult Degenerative Spondylolisthesis......Page 1998 ANATOMY AND BIOMECHANICS......Page 1999 NATURAL HISTORY AND EPIDEMIOLOGY......Page 2000 IMAGING STUDIES AND WORKUP......Page 2001 LEVEL-1 EVIDENCE FOR DECOMPRESSION ALONE VERSUS DECOMPRESSION WITH FUSION......Page 2006 POSTEROLATERAL FUSION......Page 2007 POSTEROLATERAL FUSION WITH PEDICLE SCREW INSTRUMENTATION......Page 2008 SURGICAL TECHNIQUES......Page 2015 REFERENCES......Page 2044 63. High-Grade Spondylolisthesis: Decision Making and Fusion Reduction......Page 2052 INTRODUCTION......Page 2053 ALIGNMENT......Page 2054 DECISION MAKING: TO REDUCE OR NOT TO REDUCE......Page 2056 IN SITU FUSION......Page 2057 REDUCTION......Page 2058 CASE ILLUSTRATIONS......Page 2063 CONCLUSION......Page 2072 REFERENCES......Page 2074 64. High-Grade Spondylolisthesis: Partial Reduction......Page 2077 DEFINITION......Page 2078 EFFECT OF THE POSITION OF L5 ON THE LUMBAR LORDOSIS......Page 2080 UNBALANCED HGS......Page 2081 L4–L5 COUPLING......Page 2084 FLAT VERSUS DOME-SHAPED SACRAL ENDPLATE......Page 2085 IS PARTIAL REDUCTION OF L5 A GOOD OPTION IN BALANCED HGS?......Page 2086 SURGICAL TECHNIQUE......Page 2088 SACRAL FIXATION......Page 2089 LUMBAR FIXATION......Page 2090 FUSION......Page 2091 ADJUSTING THE REDUCTION OF L5......Page 2092 NEUROLOGIC EXAMINATION......Page 2093 BRACING......Page 2094 EVALUATION OF THE WIDTH OF L5–S1 DISC SPACE......Page 2098 NO PAIN......Page 2100 LOSS OF REDUCTION......Page 2102 INSTRUMENTATION BULKINESS......Page 2104 CONCLUSION......Page 2106 REFERENCES......Page 2107 65. High-Grade Spondylolisthesis: Posterior Decompression and Spanning/Dowel Fibula......Page 2109 BACKGROUND......Page 2110 TREATMENT......Page 2112 PREOPERATIVE PLANNING......Page 2114 POSTERIOR APPROACH......Page 2120 ANTERIOR–POSTERIOR APPROACH......Page 2123 POSTOPERATIVE CARE......Page 2126 RESULTS......Page 2127 COMPLICATIONS......Page 2129 CASE 1......Page 2131 CASE 2......Page 2140 CONCLUSIONS......Page 2150 REFERENCES......Page 2151 66. High Dysplastic Spondylolisthesis: Anatomic Reduction Harms/Shufflebarger Technique......Page 2154 INTRODUCTION......Page 2155 PATHOMECHANICS OF SPONDYLOLISTHESIS......Page 2156 RATIONALE FOR REDUCTION OF SPONDYLOLISTHESIS......Page 2162 SURGICAL TECHNIQUE OF SPONDYLOLISTHESIS REDUCTION......Page 2163 COMPLICATIONS......Page 2172 RESULTS AND OUTCOMES......Page 2173 REFERENCES......Page 2174 67. Reduction of High-Grade Spondylolisthesis: The Edwards Technique......Page 2176 INTRODUCTION......Page 2177 PATHOMECHANICS OF SPONDYLOLISTHESIS......Page 2178 ADVANTAGES OF REDUCTION......Page 2182 IMPROVES FUSION RATE......Page 2184 STOPS SLIP PROGRESSION......Page 2185 RESTORES POSTURE AND MECHANICS......Page 2186 IMPROVES APPEARANCE AND SELF-IMAGE......Page 2187 TRACTION-CAST REDUCTION......Page 2188 POSTERIOR DISTRACTION INSTRUMENTATION......Page 2189 ANTEROPOSTERIOR RESECTION REDUCTIONS......Page 2190 VERTEBRECTOMY......Page 2191 PEDICLE SCREW LEVERED REDUCTION......Page 2192 SAGITTAL DECOMPENSATION......Page 2194 HIGH RISK OF SLIP PROGRESSION......Page 2195 EXCESS LUMBOSACRAL MOBILITY......Page 2196 TWO-POINT DISTAL FIXATION......Page 2198 ANATOMIC ALIGNMENT......Page 2199 EDWARDS GRADUAL REDUCTION TECHNIQUE......Page 2201 PREOPERATIVE PLANNING......Page 2202 ROOT LENGTHENING LIMIT......Page 2204 MONITORING NERVE FUNCTION......Page 2206 ALAR DISTRACTION RODS......Page 2207 L5 ROOT DECOMPRESSION......Page 2209 THE SPONDYLO CONSTRUCT: SCREW FIXATION......Page 2211 S1 SCREW OPTIONS......Page 2212 DISTAL SCREW OPTIONS......Page 2213 SPONDYLO CONSTRUCT: ASSEMBLY......Page 2215 GRADUAL INSTRUMENTED REDUCTION......Page 2216 GRAFTING......Page 2218 POSTOPERATIVE BRACING......Page 2219 SPECIAL SITUATIONS......Page 2220 CLINICAL RESULTS......Page 2223 REFERENCES......Page 2227 68. L5 Vertebrectomy for High-Grade Spondylolisthesis: Anterior–Posterior and Posterior-Only Approaches......Page 2230 INTRODUCTION......Page 2231 ETIOLOGY OF SPONDYLOPTOSIS......Page 2234 CLINICAL FEATURES......Page 2236 FIRST-STAGE PROCEDURE: ANTERIOR APPROACH (FIG. 68.3)......Page 2239 SECOND-STAGE PROCEDURE: POSTERIOR APPROACH (FIG. 68.6)......Page 2242 SURGICAL PROCEDURE: POSTERIOR-ONLY APPROACH (SENIOR AUTHOR’S TECHNIQUE)......Page 2245 STAGED ANTERIOR–POSTERIOR TECHNIQUE......Page 2255 POSTERIOR-ONLY TECHNIQUE......Page 2260 CONCLUSION......Page 2262 ACKNOWLEDGMENT......Page 2263 REFERENCES......Page 2264 69. Complications of Spondylolysis/Spondylolisthesis Surgery......Page 2268 INTRODUCTION......Page 2269 NEUROLOGIC COMPLICATIONS......Page 2270 PSEUDARTHROSIS......Page 2276 SLIP PROGRESSION......Page 2279 INSTRUMENTATION FAILURE......Page 2281 VASCULAR COMPLICATIONS......Page 2285 INFECTION......Page 2287 SUMMARY......Page 2289 REFERENCES......Page 2290 70. Natural History Including Measures of Maturity......Page 2293 INTRODUCTION......Page 2294 PREVALENCE AND INCIDENCE......Page 2295 TYPES OF IDIOPATHIC SCOLIOSIS......Page 2296 AGE OF ONSET......Page 2297 CURVE EVOLUTION—PROGRESSION DURING IMMATURITY......Page 2298 INFANTILE......Page 2300 JUVENILE......Page 2302 ADOLESCENT......Page 2303 PROGRESSION IN BRACED PATIENTS......Page 2304 ASSESSING PHYSICAL MATURITY......Page 2305 CURVE PROGRESSION AFTER MATURITY......Page 2311 WHY CURVES PROGRESS......Page 2313 INFLUENCE OF SPINAL DEFORMITY ON THE LUNGS......Page 2314 THORACIC INSUFFICIENCY SYNDROME......Page 2315 BACK PAIN......Page 2316 PREGNANCY......Page 2317 FUNCTION......Page 2318 EPILOGUE......Page 2320 REFERENCES......Page 2322 71. Clinical Assessment and Parent–Patient Expectations......Page 2329 PATIENT HISTORY......Page 2330 PHYSICAL EXAMINATION......Page 2333 PARENT AND PATIENT PERSPECTIVES......Page 2342 CONCLUSIONS......Page 2346 REFERENCES......Page 2347 72. Spinal Deformity Outcomes Measurement......Page 2350 INTRODUCTION......Page 2351 CHOOSING OUTCOME MEASURES......Page 2353 SRS INSTRUMENT......Page 2354 GENERIC AND SPINAL DISORDER–SPECIFIC OUTCOMES......Page 2356 STATISTICAL VALIDATION OF AN INSTRUMENT......Page 2357 CROSS-CULTURAL ADAPTATION......Page 2358 PATIENT-REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM......Page 2360 HEALTH ECONOMICS......Page 2361 FUTURE PERSPECTIVE......Page 2363 CONCLUSION......Page 2365 REFERENCES......Page 2366 73. Radiographic Classification Scheme: Lenke Classification......Page 2374 INTRODUCTION......Page 2375 RADIOGRAPHIC COMPONENTS OF THE CLASSIFICATION SYSTEM......Page 2376 CURVE TYPES......Page 2379 SUMMARY......Page 2394 CASE EXAMPLES......Page 2396 REFERENCES......Page 2416 74. Fusionless Surgery and Growing-Rod Techniques for Idiopathic Early-Onset Scoliosis......Page 2419 INTRODUCTION......Page 2420 PATIENT EVALUATION......Page 2421 IMAGING ASSESSMENT......Page 2423 MANAGEMENT THEMES......Page 2426 FUSIONLESS SURGERY OR GROWING-ROD EVOLUTION......Page 2428 TRADITIONAL DUAL GROWING RODS......Page 2431 LENGTHENING OF TRADITIONAL GROWING RODS......Page 2435 GRADUATION......Page 2438 MAGNETICALLY CONTROLLED GROWING RODS......Page 2439 SUMMARY......Page 2455 REFERENCES......Page 2456 75. Anterior and Posterior Scoliosis Correction Techniques Without Fusion......Page 2464 INTRODUCTION......Page 2465 VERTEBRAL BODY STAPLING......Page 2467 VBS INDICATIONS......Page 2469 VBS TECHNIQUE......Page 2470 VBS COMPLICATIONS......Page 2472 VERTEBRAL BODY TETHERING......Page 2474 VBT INDICATIONS......Page 2475 VBT TECHNIQUE......Page 2476 VBT COMPLICATIONS......Page 2483 POSTERIOR DYNAMIC CONCAVE DISTRACTION (ApiFix)......Page 2485 POSTERIOR DYNAMIC CONCAVE DISTRACTION TECHNIQUE......Page 2490 POSTERIOR DYNAMIC CONCAVE DISTRACTION COMPLICATIONS......Page 2492 SUMMARY......Page 2494 REFERENCES......Page 2495 76. Shilla Technique......Page 2500 INTRODUCTION......Page 2501 PATIENT SELECTION AND PREOPERATIVE PLANNING......Page 2503 OSTEOTOMIES AND INSTRUMENTATION......Page 2506 DEFORMITY CORRECTION......Page 2509 SURGICAL PEARLS......Page 2510 POSTOPERATIVE CARE......Page 2512 REVISION STRATEGIES......Page 2513 COMPLICATIONS......Page 2514 DEFINITIVE TREATMENT......Page 2516 COST EFFECTIVENESS......Page 2517 CASE STUDY......Page 2519 REFERENCES......Page 2523 77. Open and Thoracoscopic Anterior Thoracic Surgery......Page 2526 ANTERIOR THORACIC SURGERY......Page 2527 HISTORICAL PERSPECTIVE AND RECENT ADVANCEMENTS......Page 2528 GOALS OF ANTERIOR THORACIC SURGERY......Page 2530 INDICATIONS FOR ANTERIOR THORACIC SURGERY......Page 2532 CONTRAINDICATIONS FOR ANTERIOR THORACIC SURGERY......Page 2535 SURGICAL TECHNIQUE: OPEN ANTERIOR THORACOTOMY WITH DISC EXCISION AND INSTRUMENTATION......Page 2537 SURGICAL TECHNIQUE: THORACOSCOPIC ANTERIOR RELEASE AND INSTRUMENTATION......Page 2541 RADIOGRAPHIC AND CLINICAL OUTCOMES......Page 2551 CONCLUSIONS......Page 2554 REFERENCES......Page 2560 78. Thoracoplasty......Page 2564 BACKGROUND DATA......Page 2565 TECHNIQUE......Page 2570 POSTOPERATIVE MANAGEMENT......Page 2576 COMPLICATIONS......Page 2577 SUMMARY......Page 2584 REFERENCES......Page 2585 79. Evolution of Instrumentation for Adolescent Idiopathic Scoliosis......Page 2587 NATURAL HISTORY OF SCOLIOSIS......Page 2588 INITIAL TREATMENTS......Page 2589 POSTERIOR INSTRUMENTED FUSION......Page 2592 ANTERIOR INSTRUMENTATION......Page 2605 NONFUSION INSTRUMENTATION (GROWTH MODULATION TECHNIQUES)......Page 2611 REFERENCES......Page 2615 80. Posterior Spinal Deformity Correction Techniques......Page 2618 INTRODUCTION......Page 2619 CLINICAL ASSESSMENT......Page 2620 RADIOGRAPHIC EVALUATION......Page 2623 HALO-GRAVITY TRACTION......Page 2625 PHYSIOLOGIC ASSESSMENT......Page 2627 INTRAOPERATIVE POSITIONING......Page 2628 IMPLANT CONSIDERATIONS......Page 2629 SOFT TISSUE RELEASES AND OSTEOTOMIES......Page 2635 FACET-BASED OSTEOTOMIES......Page 2638 PEDICLE SUBTRACTION OSTEOTOMY......Page 2640 VERTEBRAL COLUMN RESECTION......Page 2644 CORRECTION TECHNIQUES......Page 2647 POSTEROLATERAL TRANSLATION......Page 2650 VERTEBRAL DEROTATION TECHNIQUES......Page 2651 KYPHOSIS CORRECTION......Page 2658 LORDOTIC CORRECTION......Page 2663 CONCLUSIONS......Page 2667 REFERENCES......Page 2668 81. Anterior Lumbar and Thoracolumbar Correction and Fusion for Adolescent Idiopathic Scoliosis......Page 2671 INTRODUCTION......Page 2672 EVOLUTION OF THE ANTERIOR APPROACH FOR THORACOLUMBAR/LUMBAR SCOLIOSIS......Page 2674 INDICATIONS......Page 2681 FUSION/INSTRUMENTATION LEVELS......Page 2684 SCREW PLACEMENT......Page 2686 DEFORMITY CORRECTION......Page 2690 FRONTAL PLANE CORRECTION......Page 2695 DEROTATION......Page 2696 COMPARISON WITH THE POSTERIOR APPROACH......Page 2700 PSEUDARTHROSIS......Page 2703 DECOMPENSATION......Page 2704 UNUSUAL COMPLICATIONS......Page 2705 CONCLUSION......Page 2706 REFERENCES......Page 2707 82. Strategies in the Management of Severe and Neglected Deformities......Page 2713 INTRODUCTION......Page 2714 PREVALENCE OF UNTREATED SPINE DEFORMITY......Page 2715 CLINICAL PRESENTATION......Page 2717 DIAGNOSTIC INVESTIGATIONS......Page 2723 NONSURGICAL TREATMENT......Page 2726 POSTERIOR APPROACHES......Page 2728 SURGICAL TECHNIQUE......Page 2733 POSTOPERATIVE MEDICAL MANAGEMENT......Page 2735 PAIN CONTROL......Page 2736 SUMMARY......Page 2737 REFERENCES......Page 2738 83. Complications Associated With Adolescent Idiopathic Scoliosis Surgery......Page 2740 INTRODUCTION......Page 2741 INFECTION......Page 2743 ACUTE DEEP WOUND INFECTIONS......Page 2744 DELAYED DEEP WOUND INFECTION......Page 2746 POSTOPERATIVE EPIDURAL ABSCESS......Page 2747 ANTIBIOTIC PROPHYLAXIS FOR SURGICAL PROCEDURES IN THE SETTING OF SPINAL IMPLANTS......Page 2748 SPINAL CORD INJURY......Page 2750 ROOT AND PLEXUS INJURIES......Page 2754 PSEUDARTHROSIS......Page 2756 SYMPTOMATIC IMPLANTS, BREAKAGE, AND DISLODGEMENT......Page 2759 COMPLICATIONS OF THORACIC VERTEBRAL BODY SCREWS......Page 2763 COMPLICATIONS OF PEDICLE SCREWS......Page 2764 THORACOSCOPIC APPROACH......Page 2767 SAGITTAL PLANE IMBALANCE (IATROGENIC FLATBACK)......Page 2769 CRANKSHAFT AND “ADDING ON”......Page 2770 SHOULDER ASYMMETRY......Page 2771 DEATH......Page 2772 VISUAL IMPAIRMENT OR LOSS......Page 2773 COMPRESSION INJURY OF NERVES......Page 2774 SUPERIOR MESENTERIC ARTERY SYNDROME......Page 2776 LONG-TERM OUTCOME OF THE INSTRUMENTED ADOLESCENT SPINE......Page 2777 CONCLUSION......Page 2778 REFERENCES......Page 2779 84. Adult Spinal Deformity: Introduction/State of the Art......Page 2788 85. Adult Spinal Deformity Classification......Page 2794 INTRODUCTION......Page 2795 CLASSIFICATION EFFORTS TO DATE......Page 2796 SRS SCHWAB ASD CLASSIFICATION......Page 2800 CLASSIFICATION......Page 2802 CLASSIFICATION AND TREATMENT......Page 2805 SURGICAL OUTCOME AND THE CLASSIFICATION......Page 2808 CONCLUSION......Page 2814 REFERENCES......Page 2817 86. De Novo Scoliosis......Page 2820 INTRODUCTION......Page 2821 DEFINITION OF BALANCE......Page 2823 THE AGING SPINE......Page 2825 CLINICAL EVALUATION......Page 2829 RADIOLOGIC EVALUATION......Page 2831 CORONAL EVALUATION......Page 2832 SAGITTAL EVALUATION......Page 2835 NONOPERATIVE TREATMENT......Page 2839 SURGICAL MANAGEMENT......Page 2841 THE ROLE OF MINIMALLY INVASIVE TECHNIQUES......Page 2850 OUTCOMES......Page 2852 CONCLUSION......Page 2854 REFERENCES......Page 2855 87. Sagittal Imbalance......Page 2860 BACKGROUND......Page 2861 C7 SAGITTAL VERTICAL ANGLE......Page 2863 T1 PELVIC ANGLE......Page 2865 SPINO-PELVIC ALIGNMENT......Page 2866 PELVIC INCIDENCE......Page 2868 PELVIC TILT AND SACRAL SLOPE......Page 2869 SPINAL COMPENSATION......Page 2870 LOWER EXTREMITY ALIGNMENT......Page 2872 REFERENCES......Page 2873 88. Fixed Coronal Malalignment of the Spine: Clinical Significance and Operative Management......Page 2877 SPINAL DEFORMITY AND HRQOL......Page 2878 THE PATHOGENESIS OF FIXED CORONAL PLANE DEFORMITY......Page 2879 CLINICAL EVALUATION OF CORONAL MALALIGNMENT......Page 2880 RADIOGRAPHIC EVALUATION OF CORONAL MALALIGNMENT......Page 2885 INDICATIONS FOR SURGICAL CARE......Page 2890 NONSURGICAL MANAGEMENT OF FIXED CORONAL MALALIGNMENT......Page 2894 SURGICAL MANAGEMENT OF FIXED CORONAL MALALIGNMENT......Page 2895 SPECIFIC CURVE TYPES......Page 2897 DECISION MAKING AND AN ALGORITHM FOR CARE......Page 2905 POSTOPERATIVE MANAGEMENT......Page 2910 REFERENCES......Page 2912 89. Spinal Deformity in the Older Patient With Kyphosis......Page 2915 PATHOGENESIS......Page 2917 ADVERSE HEALTH EFFECTS......Page 2919 VERTEBROPLASTY/KYPHOPLASTY......Page 2920 SURGERY......Page 2921 POSTERIOR COLUMN OSTEOTOMY TECHNIQUE......Page 2922 PEDICLE SUBTRACTION OSTEOTOMY......Page 2923 PSO TECHNIQUE......Page 2924 VERTEBRAL COLUMN RESECTION......Page 2927 VCR TECHNIQUE......Page 2928 SURGICAL OUTCOMES......Page 2930 CONCLUSIONS......Page 2935 REFERENCES......Page 2936 90. Decision Making in Treatment of Adult Spinal Deformity......Page 2940 INTRODUCTION......Page 2941 DECISION MAKING REGARDING TREATMENT FOR ADULT SCOLIOSIS......Page 2942 PRESENTATION OF ADULT SCOLIOSIS......Page 2946 SURGICAL TREATMENT OF ADULT SCOLIOSIS......Page 2949 SPECTRUM OF PRESENTATIONS OF ADULT SCOLIOSIS......Page 2953 RESULTS OF NIH STUDY ON QUALITY OF LIFE IN ADULT SCOLIOSIS......Page 2955 OPERATIVE FACTORS THAT MAY IMPACT OUTCOME IN ADULT SCOLIOSIS......Page 2962 TREATMENT OF FIXED SAGITTAL IMBALANCE/LUMBAR KYPHOSIS......Page 2963 SUMMARY/CONCLUSION......Page 2970 REFERENCES......Page 2975 91. Smith-Petersen Osteotomy of the Spine......Page 2977 INTRODUCTION......Page 2978 HISTORY......Page 2980 TECHNIQUE......Page 2981 RESULTS—ANKYLOSING SPONDYLITIS......Page 2984 RESULTS—ADULT SPINAL DEFORMITY......Page 2986 SUMMARY......Page 2988 REFERENCES......Page 2989 92. Pedicle Subtraction Procedures for Complex Spinal Deformity......Page 2993 INTRODUCTION......Page 2994 COMPLEX SPINAL DEFORMITY AND ASSOCIATED DISABILITY......Page 2995 SURGICAL TECHNIQUE......Page 2997 ADULT THORACOLUMBAR DEFORMITY......Page 2999 ADULT CERVICAL DEFORMITY......Page 3003 COMPLICATIONS......Page 3005 CONCLUSIONS......Page 3008 REFERENCES......Page 3009 93. Vertebral Column Resection for Complex Spinal Deformity: Posterior Approach......Page 3016 AUTHORS’ PREFERRED SURGICAL TECHNIQUE......Page 3020 CORRECTION OF SCOLIOSIS DEFORMITY......Page 3023 CORRECTION OF KYPHOSCOLIOSIS......Page 3026 CORRECTION OF KYPHOSIS......Page 3027 CORRECTION OF THORACIC LORDOSIS/LORDOSCOLIOSIS......Page 3028 CORRECTION OF SEVERE RIGID PELVIC OBLIQUITY IN NEGLECTED CONGENITAL SCOLIOSIS WITH INTRASPINAL ANOMALY AND PREVIOUS SURGERY WITH PVCR......Page 3034 AFTERCARE......Page 3035 INTRAOPERATIVE COMPLICATIONS......Page 3036 INTRAOPERATIVE BLOOD LOSS......Page 3041 NEUROLOGIC COMPLICATIONS......Page 3044 POSTOPERATIVE COMPLICATIONS......Page 3048 INFECTION......Page 3049 IMPLANT FAILURE AND PSEUDARTHROSIS......Page 3050 CONCLUSION......Page 3052 REFERENCES......Page 3053 94. Vertebral Column Resection for Complex Spinal Deformity: Combined Anterior and Posterior Approach......Page 3056 INTRODUCTION AND BACKGROUND......Page 3057 SPINAL SHORTENING PROCEDURES......Page 3059 INDICATIONS FOR VERTEBRAL COLUMN RESECTION......Page 3063 PREOPERATIVE CONSIDERATIONS......Page 3064 PREOPERATIVE EVALUATION......Page 3066 IMAGING......Page 3069 ANTERIOR STAGE......Page 3072 POSTERIOR STAGE......Page 3074 POSTOPERATIVE CARE......Page 3075 CONCLUSIONS......Page 3078 REFERENCES......Page 3079 95. Fusion to the Sacrum and Fixation Techniques of the Sacropelvic Junction......Page 3082 INTRODUCTION......Page 3083 HISTORICAL OVERVIEW......Page 3085 ANATOMIC AND BIOMECHANICAL CONSIDERATIONS......Page 3090 S1 SCREW PLACEMENT......Page 3101 ILIAC SCREWS WITH PSIS ENTRY......Page 3103 S2-ALAR-ILIAC APPROACH......Page 3113 TRADITIONAL GALVESTON TECHNIQUE......Page 3116 TRANSDISCAL SCREWS......Page 3120 OUTCOMES......Page 3122 SUMMARY......Page 3130 REFERENCES......Page 3132 96. Structural Grafting for Adult Spinal Deformity......Page 3140 INTRODUCTION......Page 3141 INDICATIONS FOR STRUCTURAL GRAFTING......Page 3143 ANTERIOR, LATERAL, AND POSTERIOR APPROACHES......Page 3146 ALLOGRAFT......Page 3149 TITANIUM......Page 3150 EXPANDABLE DEVICES......Page 3151 COMPLICATIONS......Page 3153 CONCLUSION......Page 3154 REFERENCES......Page 3160 97. Revision Surgeries for Adult Spinal Deformity......Page 3162 INTRODUCTION......Page 3163 COMORBIDITIES......Page 3165 PHYSICAL EXAMINATION......Page 3166 RADIOGRAPHIC EVALUATION......Page 3167 LIMITING BLOOD LOSS......Page 3169 INSTRUMENTATION......Page 3170 DEFORMITY CORRECTION......Page 3171 FUSION......Page 3172 OUTCOMES AND COMPLICATIONS......Page 3174 CONCLUSION......Page 3177 REFERENCES......Page 3178 98. Minimally Invasive Deformity Surgery: Future Directions......Page 3184 INTRODUCTION......Page 3185 PREOPERATIVE ASSESSMENT......Page 3187 STAGE 1: INTERBODY FUSION......Page 3188 STAGE 2: POSTERIOR INSTRUMENTATION AND FUSION......Page 3195 PITFALLS......Page 3198 CASE EXAMPLE......Page 3199 CONCLUSION......Page 3200 REFERENCES......Page 3202 99. ACR and Minimally Invasive Surgery for Sagittal Plane Deformities......Page 3203 INTRODUCTION......Page 3204 INDICATIONS/CONTRAINDICATIONS......Page 3205 ALIGNMENT......Page 3206 COMPUTED TOMOGRAPHY......Page 3209 MAGNETIC RESONANCE IMAGING......Page 3210 APPROACH SIDE......Page 3211 APPROACH......Page 3213 ACR ANATOMY......Page 3215 TECHNIQUE......Page 3216 POSTERIOR CONSTRUCT......Page 3217 MOTOR/NEUROLOGIC DEFICIT......Page 3220 SYMPATHETIC PLEXUS INJURY......Page 3221 PROXIMAL JUNCTIONAL KYPHOSIS......Page 3222 OUTCOMES......Page 3223 CONCLUSION......Page 3225 REFERENCES......Page 3226 100. Introduction/State of the Art in the Care of Dysplastic and Congenital Spine Deformities......Page 3231 INTRODUCTION......Page 3232 DIAGNOSIS......Page 3233 IMAGING......Page 3234 CLASSIFICATION......Page 3236 NONOPERATIVE TREATMENT......Page 3237 SURGICAL TREATMENT......Page 3238 CONCLUSION......Page 3241 REFERENCES......Page 3242 101. Dysplastic Scoliosis: Neurofibromatosis Spinal Pathology......Page 3246 INTRODUCTION......Page 3247 GENETICS......Page 3248 DIAGNOSIS......Page 3251 SPINAL DEFORMITIES, GENERAL......Page 3253 IMAGING......Page 3256 CERVICAL DEFORMITY MANAGEMENT......Page 3258 SCOLIOSIS......Page 3267 KYPHOSCOLIOSIS......Page 3277 LORDOSCOLIOSIS......Page 3286 SACRUM AND SPONDYLOLISTHESIS......Page 3287 DURAL ECTASIA......Page 3288 ENLARGED VASCULAR CHANNELS......Page 3290 SUMMARY REMARKS......Page 3292 REFERENCES......Page 3293 102. Spinal Deformity in Skeletal Dysplasia Conditions: Diagnosis and Presentation......Page 3301 SPONDYLOEPIPHYSEAL DYSPLASIA CONGENITA......Page 3304 KNIEST DYSPLASIA, SPONDYLOEPIPHYSEAL METAPHYSEAL DYSPLASIA (STRUDWICK), AND STICKLER SYNDROME......Page 3306 OSTEOGENESIS IMPERFECTA......Page 3308 ACHONDROPLASIA/HYPOCHONDROPLASIA......Page 3311 CONRADI–HUNERMANN SYNDROME (X-LINKED CHONDRODYSPLASIA PUNCTATA 2)......Page 3314 METATROPIC DYSPLASIA......Page 3316 LARSON SYNDROME/ATELOSTEOGENESIS TYPE III......Page 3317 DIASTROPHIC DYSPLASIA......Page 3319 MUCOPOLYSACCHARIDOSES......Page 3322 SUMMARY......Page 3326 REFERENCES......Page 3327 103. Surgical Management of Spinal Deformity in Skeletal Dysplasias......Page 3334 INTRODUCTION......Page 3335 PREOPERATIVE MANAGEMENT......Page 3336 SPINAL INSTRUMENTATION......Page 3337 POSTOPERATIVE MANAGEMENT AND COMPLICATIONS......Page 3338 FORAMEN MAGNUM STENOSIS......Page 3341 ODONTOID HYPOPLASIA AND ATLANTOAXIAL INSTABILITY......Page 3344 CERVICAL KYPHOSIS......Page 3346 THORACIC AND THORACOLUMBAR KYPHOSIS......Page 3349 SCOLIOSIS AND KYPHOSCOLIOSIS......Page 3352 SPINAL STENOSIS......Page 3354 CONCLUSIONS......Page 3360 REFERENCES......Page 3361 104. The Spine in Osteogenesis Imperfecta......Page 3366 INTRODUCTION......Page 3367 BASILAR INVAGINATION......Page 3368 BONE DENSITY IN OSTEOGENESIS IMPERFECTA......Page 3372 SPONDYLOLYSIS AND SPONDYLOLISTHESIS IN OSTEOGENESIS IMPERFECTA......Page 3374 PROGRESSION OF SCOLIOSIS IN OSTEOGENESIS IMPERFECTA......Page 3378 TREATMENT......Page 3380 UNANSWERED QUESTIONS REMAIN......Page 3384 REFERENCES......Page 3386 105. Spinal Deformity in Familial Dysautonomia......Page 3390 INTRODUCTION......Page 3391 ETIOLOGY AND GENETICS......Page 3392 DIAGNOSIS......Page 3393 MEDICAL MANIFESTATIONS......Page 3394 ONSET AND CURVE BEHAVIOR......Page 3396 NONOPERATIVE TREATMENT......Page 3397 SURGICAL TREATMENT......Page 3398 SURGICAL MANAGEMENT......Page 3399 NEUROGENIC MONITORING/INTRAOPERATIVE CONCERNS......Page 3401 POSTOPERATIVE PERIOD......Page 3402 OTHER TYPES OF HSAN......Page 3404 SUMMARY......Page 3405 REFERENCES......Page 3413 106. Congenital Intraspinal Anomalies: Spinal Dysraphism—Embryology, Pathology, and Treatment......Page 3415 SPINAL DYSRAPHISM—EMBRYOLOGY, PATHOLOGY, AND TREATMENT......Page 3416 FOLIC ACID SUPPLEMENTATION AND OPEN NEURAL TUBE DEFECTS......Page 3418 ROLE OF GENETICS IN OPEN NEURAL TUBE DEFECTS......Page 3421 EPIDEMIOLOGY OF SPINA BIFIDA OCCULTA......Page 3423 EMBRYOLOGY......Page 3424 EMBRYOLOGY......Page 3432 ANTENATAL EVALUATION AND TREATMENT—FETAL SURGERY FOR MYELOMENINGOCELE......Page 3433 POSTNATAL PRESENTATION AND EVALUATION......Page 3434 POSTNATAL REPAIR OF MYELOMENINGOCELE......Page 3436 MONITORING FOR HYDROCEPHALUS AFTER MYELOMENINGOCELE REPAIR......Page 3441 TETHERED CORD SYNDROME......Page 3443 LIPOMYELOMENINGOCELE......Page 3446 SPLIT CORD MALFORMATIONS......Page 3456 DIASTEMATOMYELIA......Page 3457 DERMAL SINUS TRACT......Page 3466 MENINGOCELES......Page 3468 ALTERED CAUDAL DEVELOPMENT......Page 3472 TIGHT FILUM TERMINALE SYNDROME......Page 3473 TERMINAL MYELOCYSTOCELE......Page 3475 DYSRAPHISM ASSOCIATED WITH ANORECTAL MALFORMATION......Page 3476 CHIARI MALFORMATIONS......Page 3478 SYRINGOMYELIA......Page 3485 ASSOCIATED CARE ISSUES IN SPINAL DYSRAPHISM......Page 3488 RETETHERING AND REOPERATION......Page 3489 LONG-TERM CARE......Page 3492 SUMMARY......Page 3495 REFERENCES......Page 3496 107. Congenital Scoliosis and Kyphosis......Page 3504 INTRODUCTION......Page 3505 CHEST......Page 3507 CLASSIFICATION AND NATURAL HISTORY......Page 3510 FULLY SEGMENTED HEMIVERTEBRA......Page 3512 INCARCERATED HEMIVERTEBRA......Page 3515 UNILATERAL UNSEGMENTED BAR......Page 3516 UNILATERAL UNSEGMENTED BAR WITH CONTRALATERAL HEMIVERTEBRAE......Page 3517 COMPLEX MIXED VERTEBRAL ANOMALIES......Page 3518 CONGENITAL RIB AND CHEST WALL ANOMALIES......Page 3519 SECONDARY DEFORMING FEATURES REQUIRING TREATMENT......Page 3520 PROGNOSIS......Page 3522 SPINE......Page 3524 INTRASPINAL ANOMALIES......Page 3525 OTHER ASSOCIATED CONGENITAL ANOMALIES......Page 3528 SURGICAL TREATMENT......Page 3531 CONVEX GROWTH ARREST (HEMIEPIPHYSIODESIS)......Page 3536 EXCISION OF A HEMIVERTEBRA......Page 3537 IN SITU FUSION......Page 3544 GROWTH ROD......Page 3547 RIB EXPANSION SURGERY......Page 3552 MAGNETICALLY CONTROLLED GROWING RODS......Page 3558 CORRECTION AND SPINAL FUSION WITH INSTRUMENTATION......Page 3559 VERTEBRAL COLUMN RESECTION, CORRECTION, AND ARTHRODESIS......Page 3562 CONGENITAL KYPHOSIS AND KYPHOSCOLIOSIS......Page 3567 CLASSIFICATION AND NATURAL HISTORY......Page 3569 TREATMENT OF CONGENITAL KYPHOSIS......Page 3572 REFERENCES......Page 3574 108. Hemivertebra Resection......Page 3579 INTRODUCTION......Page 3580 SURGICAL PROCEDURES......Page 3581 SURGICAL PROCEDURE......Page 3584 COMPLICATION MANAGEMENT......Page 3592 RESULTS......Page 3599 TEMPORARY INSTRUMENTATIONS......Page 3603 COMPLICATIONS AND ADDITIONAL OPERATIONS......Page 3604 TRANSPEDICULAR INSTRUMENTATION AND SPINAL GROWTH......Page 3605 CONCLUSIONS......Page 3606 FUTURE DEVELOPMENTS......Page 3609 HEMIVERTEBRA RESECTION IN THE CERVICAL SPINE......Page 3612 REFERENCES......Page 3613 109. Thoracic Insufficiency Syndrome......Page 3616 INTRODUCTION......Page 3617 PREOPERATIVE PLANNING......Page 3624 THE EXPOSURE......Page 3630 IMPLANTATION OF THE SUPERIOR RIB CRADLE......Page 3634 THE OPENING WEDGE THORACOSTOMY......Page 3635 IMPLANTATION OF A HYBRID VEPTR......Page 3637 IMPLANTATION OF THE SECOND VEPTR: RIB-TO-RIB CONSTRUCT......Page 3639 CLOSURE......Page 3641 VEPTR OUTPATIENT EXPANSION......Page 3644 VEPTR REPLACEMENT PROCEDURE......Page 3645 COMPLICATIONS......Page 3647 THE FUTURE TREATMENT OF TIS......Page 3649 ACKNOWLEDGMENT......Page 3652 REFERENCES......Page 3653 110. Congenital Anomalies of the Cervical Spine in Children: Management of Segmental Instability and Spinal Canal Encroachment......Page 3656 INTRODUCTION......Page 3657 EMBRYOLOGY OF THE PROXIMAL CERVICAL SPINE (OCCIPUT TO C2–C3 DISC SPACE)......Page 3658 EMBRYOLOGY OF THE DISTAL CERVICAL SPINE (C3–C7)......Page 3659 DEVELOPMENTAL ANATOMY OF THE IMMATURE CERVICAL SPINE......Page 3661 THE ATLAS......Page 3662 THE AXIS......Page 3663 THE SUBAXIAL SPINE......Page 3664 BIOMECHANICS......Page 3666 DIAGNOSING ENCROACHMENT......Page 3667 SPINAL INSTABILITY......Page 3668 DEFINITIONS AND MEASUREMENTS OF INSTABILITY......Page 3669 CONGENITAL CAUSES OF CERVICAL SPINAL INSTABILITY......Page 3672 UPPER CERVICAL SPINE: (OCCIPUT TO C2–C3 DISC SPACE)......Page 3673 KLIPPEL–FEIL SYNDROME......Page 3680 22q11.2 DELETION SYNDROME (DIGEORGE SYNDROME)......Page 3681 HALO VEST IMMOBILIZATION......Page 3682 ANTERIOR SURGICAL APPROACHES......Page 3684 POSTERIOR SURGICAL APPROACHES......Page 3685 CONCLUSION......Page 3699 REFERENCES......Page 3700 111. Complications of the Surgical Treatment of Congenital Spinal Deformities......Page 3703 RELATED ANOMALIES CONTRIBUTING TO COMPLICATIONS IN CONGENITAL SCOLIOSIS......Page 3704 PREOPERATIVE TRACTION COMPLICATIONS IN CONGENITAL SCOLIOSIS......Page 3709 COMPLICATIONS FROM THE SURGICAL TREATMENT OF CONGENITAL SCOLIOSIS......Page 3710 CONCLUSION......Page 3720 REFERENCES......Page 3721 112. Considerations in Neuromuscular Spine Deformity......Page 3727 OVERVIEW AND PREVALENCE......Page 3728 INDICATIONS......Page 3729 ETHICAL CONSIDERATIONS......Page 3730 PREOPERATIVE ASSESSMENT......Page 3732 INFECTION......Page 3734 NEED FOR PELVIC FIXATION......Page 3735 BLEEDING......Page 3736 OUTCOMES MEASURES FOR NMS PATIENTS......Page 3737 REFERENCES......Page 3739 113. Preoperative Preparation for Neuromuscular Spine Surgery......Page 3743 DECISION MAKING......Page 3744 MEDICAL PREPARATION......Page 3748 CONSULTATIONS......Page 3749 SURGICAL PREPARATION......Page 3758 CONCLUSION......Page 3763 REFERENCES......Page 3764 114. Surgical Techniques Unique to Neuromuscular Scoliosis......Page 3776 INTRODUCTION......Page 3777 RISK OF COMPLICATIONS......Page 3778 CONCURRENT HIP PATHOLOGY......Page 3779 PRE- AND PERIOPERATIVE TRACTION......Page 3781 PHONE A FRIEND? TWO ATTENDING SURGEONS FOR THE TREATMENT OF NMS......Page 3782 INTRAOPERATIVE NEURAL MONITORING......Page 3784 SPECIAL POSITIONING CONSIDERATIONS......Page 3785 INTRAOPERATIVE TRACTION......Page 3787 WORKING AROUND A BACLOFEN PUMP......Page 3789 DECREASING BLOOD LOSS DURING EXPOSURE......Page 3790 RODS, SCREWS, WIRES, AND BANDS......Page 3794 FUSION TO THE PELVIS......Page 3796 SACRAL–ALAR–ILIAC SCREW INSERTION TECHNIQUE......Page 3799 TECHNIQUES TO CORRECT PELVIC OBLIQUITY AND SPINE DEFORMITY......Page 3803 BARBED SUTURE......Page 3812 ROLE OF PLASTIC SURGEON IN WOUND CLOSURE......Page 3814 CONCLUSION......Page 3815 REFERENCES......Page 3816 115. Pelvic Fixation in Neuromuscular Scoliosis......Page 3823 INTRODUCTION......Page 3824 PELVIC OBLIQUITY......Page 3826 INDICATIONS FOR PELVIC FIXATION......Page 3827 GALVESTON TECHNIQUE WITH UNIT ROD......Page 3829 ILIAC SCREWS......Page 3832 SACRAL–ALAR–ILIAC SCREWS......Page 3834 SUMMARY......Page 3838 REFERENCES......Page 3839 116. Spinal Muscular Atrophy, Duchenne Muscular Dystrophy, and Other Neuromuscular Disorders......Page 3842 CLASSIC NATURAL HISTORY......Page 3845 RECENT MEDICAL ADVANCES......Page 3846 SPINAL DEFORMITY......Page 3847 OUTCOMES......Page 3860 NATURAL HISTORY......Page 3862 RECENT MEDICAL ADVANCES......Page 3863 SPINAL DEFORMITY......Page 3864 SURGICAL CARE......Page 3865 OUTCOMES......Page 3868 CONGENITAL MYOTONIC DYSTROPHY......Page 3869 FRIEDREICH ATAXIA......Page 3871 CHARCOT–MARIE–TOOTH......Page 3872 ACKNOWLEDGMENTS......Page 3874 REFERENCES......Page 3875 117. Spinal Deformity in Patients With Cerebral Palsy and Rett Syndrome......Page 3893 INTRODUCTION......Page 3894 ONSET AND NATURAL HISTORY......Page 3895 CHARACTERISTICS OF SPINAL DEFORMITY IN CEREBRAL PALSY......Page 3896 ONSET AND NATURAL HISTORY......Page 3898 CHARACTERISTICS OF SPINAL DEFORMITY IN RETT SYNDROME......Page 3899 FUNCTIONAL EFFECTS OF NEUROMUSCULAR SPINAL DEFORMITY......Page 3901 NONOPERATIVE MANAGEMENT STRATEGIES......Page 3902 OPERATIVE MANAGEMENT......Page 3903 COMPLICATIONS......Page 3909 OUTCOMES......Page 3910 REFERENCES......Page 3911 118. Surgical Treatment of Spinal Deformity in Myelomeningocele......Page 3918 INTRODUCTION......Page 3920 TREATMENT GUIDELINES......Page 3921 RADIOGRAPHIC IMAGING......Page 3923 PATIENT EVALUATION......Page 3924 SURGICAL PLANNING......Page 3928 SURGICAL TECHNIQUES......Page 3933 WOUND MANAGEMENT......Page 3945 POSTOPERATIVE CARE......Page 3946 REFERENCES......Page 3949 119. Introduction and Current State of the Art......Page 3952 120. Cervical Instability and Kyphosis (Rheumatoid, Dwarfism, Degenerative, Others)......Page 3956 INTRODUCTION......Page 3957 ANATOMY OF THE CERVICAL SPINE......Page 3958 CERVICAL SPINAL STABILITY......Page 3960 PATHOPHYSIOLOGY OF CERVICAL INSTABILITY......Page 3961 EVALUATION AND DIAGNOSIS OF CERVICAL INSTABILITY......Page 3962 RHEUMATOID ARTHRITIS......Page 3968 TREATMENT OF INSTABILITY IN RA......Page 3970 CASE EXAMPLE 120.1: RHEUMATOID PANNUS......Page 3971 CONGENITAL/GENETIC DISORDERS WITH CERVICAL INSTABILITY......Page 3972 CASE EXAMPLE 120.2: OS ODONTOIDEUM......Page 3973 CERVICAL SAGITTAL ALIGNMENT......Page 3976 ETIOLOGY AND EVALUATION OF CERVICAL KYPHOSIS......Page 3982 GENERAL PRINCIPLES IN MANAGING CERVICAL KYPHOSIS......Page 3983 CASE EXAMPLE 120.3: CERVICAL SPONDYLOTIC MYELOPATHY WITH KYPHOSIS......Page 3984 POSTLAMINECTOMY KYPHOSIS......Page 3986 CASE EXAMPLE 120.4: DROPPED HEAD SYNDROME......Page 3990 CONGENITAL AND MISCELLANEOUS CONDITIONS WITH CERVICAL KYPHOSIS......Page 3991 CASE EXAMPLE 120.5: RENAL OSTEODYSTROPHY......Page 3994 ANKYLOSING SPONDYLITIS AND FIXED KYPHOSIS......Page 3995 CASE EXAMPLE 120.6: CERVICAL OSTEOTOMY......Page 3998 CONCLUSION......Page 4002 REFERENCES......Page 4003 121. Surgical Treatment of Scheuermann Kyphosis......Page 4008 INTRODUCTION......Page 4009 CLINICAL EVALUATION......Page 4011 RADIOGRAPHIC EVALUATION......Page 4014 NONOPERATIVE TREATMENT......Page 4016 OPERATIVE TREATMENT......Page 4019 SURGICAL PROCEDURE (SEE TABLE 121.3)......Page 4023 CONCLUSION......Page 4035 CLINICAL CASES 121.1......Page 4037 REFERENCES......Page 4044 122. Delayed Posttraumatic Deformity: Presentation and Management......Page 4047 INTRODUCTION......Page 4048 EPIDEMIOLOGY......Page 4049 PATIENT PRESENTATION......Page 4050 POSTTRAUMATIC SPINAL DEFORMITY......Page 4051 PAIN......Page 4055 NEUROLOGIC DEFICIT......Page 4056 SURGICAL CONSIDERATIONS......Page 4058 OUTCOME......Page 4063 CONCLUSION......Page 4068 REFERENCES......Page 4069 123. Ankylosing Spondylitis/Thoracolumbar Deformities......Page 4072 INTRODUCTION......Page 4073 SPINAL FRACTURE......Page 4075 DISCITIS......Page 4077 PSEUDARTHROSIS......Page 4079 KYPHOSIS......Page 4080 RADIOGRAPHIC FEATURES......Page 4085 EVALUATIONS OF KYPHOSIS......Page 4088 NONSURGICAL TREATMENT......Page 4090 SURGICAL TREATMENT FOR THORACOLUMBAR DEFORMITIES......Page 4091 OPERATIVE TECHNIQUE......Page 4092 OPERATIVE TECHNIQUE......Page 4095 OPERATIVE TECHNIQUE......Page 4098 COMPUTER-BASED SIMULATION: SURGIMAP SOFTWARE......Page 4103 MATHEMATICAL FORMULAS......Page 4104 INTRAOPERATIVE SUBLUXATION OF THE OSTEOTOMIZED VERTEBRA......Page 4106 FRACTURE AND OPENING OF ANTERIOR CORTEX OF THE OSTEOTOMIZED VERTEBRA......Page 4109 PSEUDARTHROSIS ADJACENT TO THE OSTEOTOMY......Page 4110 FLEXIBILITY OF CERVICAL SPINE......Page 4113 SPINAL OSTEOTOMY AND TOTAL HIP REPLACEMENT: WHICH SHOULD BE PERFORMED FIRST?......Page 4114 NEUROLOGIC DAMAGE......Page 4121 SUPERIOR MESENTERIC ARTERY SYNDROME (SMAS)......Page 4122 INTRAOPERATIVE SUBLUXATION......Page 4123 POSTOPERATIVE CARE AND REHABILITATION......Page 4128 CONCLUSIONS......Page 4129 REFERENCES......Page 4130 124. Cervicothoracic Extension Osteotomy for Chin-on-Chest Deformity......Page 4136 ETIOLOGY......Page 4137 RADIOLOGIC PATTERNS OF CHIN-ON-CHEST DEFORMITY......Page 4140 PREOPERATIVE PLANNING......Page 4143 ANESTHESIA AND POSITIONING......Page 4147 SURGICAL TECHNIQUE......Page 4148 COMPLICATION......Page 4153 CONCLUSION......Page 4156 REFERENCES......Page 4159 125. The Role of Osteotomies in the Cervical Spine......Page 4161 INTRODUCTION......Page 4162 HISTORY......Page 4163 PRESENTATION AND INDICATIONS......Page 4167 PREOPERATIVE EVALUATION......Page 4168 ANESTHESIA AND PATIENT POSITIONING......Page 4171 EXPOSURE......Page 4175 HEMOSTASIS......Page 4176 PEDICLE SUBTRACTION OSTEOTOMY FOR ANKYLOSING SPONDYLITIS......Page 4177 IATROGENIC CERVICAL DEFORMITY CORRECTION......Page 4185 BONE GRAFTING......Page 4196 DRAIN AND CLOSURE......Page 4200 POSTOPERATIVE MANAGEMENT......Page 4201 CONCLUSION......Page 4205 REFERENCES......Page 4206 126. Complications of Surgical Treatment of Kyphotic Deformities......Page 4208 INTRODUCTION......Page 4209 ETIOLOGY......Page 4210 SCHEUERMANN KYPHOSIS......Page 4211 NONIDIOPATHIC......Page 4212 PROXIMAL JUNCTIONAL KYPHOSIS AND FAILURE......Page 4214 DISTAL JUNCTIONAL KYPHOSIS AND FAILURE......Page 4216 PREVENTION......Page 4217 TREATMENT OF JUNCTIONAL KYPHOSIS......Page 4219 NEUROLOGIC COMPLICATIONS......Page 4222 CAUSES......Page 4225 PREVENTION......Page 4226 TREATMENT......Page 4228 PSEUDARTHROSIS/IMPLANT FAILURE......Page 4229 VASCULAR/OTHER......Page 4230 THROMBOEMBOLIC DISEASE......Page 4231 REFERENCES......Page 4232 127. Classification of Cervical Spine Injury......Page 4239 INTRODUCTION......Page 4240 HISTORIC CLASSIFICATION SYSTEMS......Page 4242 CERVICAL SPINE INJURY SEVERITY SCORE......Page 4245 SUBAXIAL CERVICAL SPINE CLASSIFICATION......Page 4246 ABCD......Page 4249 AOSPINE......Page 4250 MORPHOLOGY......Page 4252 FACET INJURY......Page 4253 NEUROLOGY......Page 4254 CASE-SPECIFIC MODIFIERS......Page 4255 CONCLUSION......Page 4257 REFERENCES......Page 4261 128. Classification of Thoracic, Lumbar, and Sacral Fractures......Page 4263 INTRODUCTION......Page 4264 DEFINING INSTABILITY......Page 4265 VALIDITY AND RELIABILITY......Page 4266 HISTORICAL OVERVIEW OF THORACOLUMBAR CLASSIFICATION SYSTEMS......Page 4267 MORPHOLOGY: FRACTURE PATTERN......Page 4269 INTEGRITY OF THE POSTERIOR LIGAMENTOUS COMPLEX......Page 4272 NEUROLOGIC STATUS......Page 4273 QUALIFIERS......Page 4274 AOSpine THORACOLUMBAR CLASSIFICATION......Page 4275 AOSpine SACRAL CLASSIFICATION......Page 4278 CONCLUSION......Page 4280 BURST FRACTURE WITH AN INTACT PLC......Page 4281 BURST FRACTURE WITH DISRUPTED PLC......Page 4282 TRANSLATIONAL INJURY WITH PLC DISRUPTION AND CAUDA EQUINA SYNDROME......Page 4284 REFERENCES......Page 4286 129. Surgical Management of Cervical Spine Fractures......Page 4289 INTRODUCTION......Page 4290 CRANIOCERVICAL DISSOCIATION......Page 4291 ODONTOID FRACTURES......Page 4292 C2 TRAUMATIC SPONDYLOLISTHESIS......Page 4297 BURST AND FLEXION–COMPRESSION INJURIES......Page 4298 FLEXION–DISTRACTION/FACET DISLOCATIONS......Page 4299 FACET FRACTURES......Page 4305 LATERAL MASS FRACTURES......Page 4306 EXTENSION–DISTRACTION INJURIES......Page 4307 CONCLUSION......Page 4310 REFERENCES......Page 4311 130. Anterior Decompression and Instrumentation Techniques for Thoracolumbar Fractures......Page 4315 EPIDEMIOLOGY......Page 4316 CLINICAL AND RADIOGRAPHIC ASSESSMENT......Page 4317 THORACOLUMBAR SPINE FRACTURE CLASSIFICATION......Page 4318 INDICATIONS FOR ANTERIOR CORPECTOMY......Page 4324 HIGH THORACIC T1–T5......Page 4327 THORACOLUMBAR APPROACH (T10–L1)......Page 4329 RETROPERITONEAL APPROACH L2–L5......Page 4330 TRANSPERITONEAL APPROACH L3–S1......Page 4331 ADDITIONAL APPROACHES......Page 4333 CORPECTOMY TECHNIQUE......Page 4334 INSTRUMENTATION......Page 4337 COMPLICATION AVOIDANCE AND MANAGEMENT......Page 4340 REFERENCES......Page 4341 131. Surgical Treatment of Thoracolumbar Spine Fractures: Posterior Decompression and Instrumentation Techniques......Page 4343 INTRODUCTION......Page 4344 BACKGROUND......Page 4345 CLASSIFICATION SCHEMES FOR THORACOLUMBAR AND LUMBAR SPINE INJURIES......Page 4346 INDICATIONS FOR SURGICAL TREATMENT OF TL FRACTURES......Page 4353 DISADVANTAGES......Page 4356 POSTERIOR INSTRUMENTATION......Page 4358 THORACIC PEDICLE ANATOMY......Page 4359 BIOMECHANICAL PRINCIPLES......Page 4360 PEDICLE SCREW PLACEMENT......Page 4362 DIRECT DECOMPRESSION......Page 4368 INDIRECT DECOMPRESSION AND REALIGNMENT......Page 4370 ROD PLACEMENT TECHNIQUES......Page 4374 POSTOPERATIVE MANAGEMENT......Page 4375 COMPLICATIONS......Page 4376 OUTCOMES......Page 4377 FUTURE TRENDS......Page 4378 SUMMARY......Page 4379 REFERENCES......Page 4382 132. Minimal Access Techniques for Spine Trauma......Page 4387 INTRODUCTION......Page 4388 PERCUTANEOUS VERTEBRAL CEMENT AUGMENTATION......Page 4390 PERCUTANEOUS PEDICLE SCREW FIXATION......Page 4393 FUSION TECHNIQUES FOR MINIMALLY INVASIVE THORACOLUMBAR TRAUMA......Page 4399 LESS INVASIVE POSTERIOR DECOMPRESSION......Page 4401 MINI-OPEN LATERAL CORPECTOMY......Page 4403 MINIMALLY INVASIVE TREATMENT OF CERVICAL SPINE FRACTURES......Page 4405 SUMMARY......Page 4406 REFERENCES......Page 4408 133. Management of Central Cord Syndrome......Page 4413 BACKGROUND......Page 4414 MEDICAL MANAGEMENT......Page 4417 SURGICAL MANAGEMENT......Page 4421 INDICATIONS......Page 4423 TIMING......Page 4424 OUTCOMES......Page 4425 NONOPERATIVE MANAGEMENT......Page 4427 SUMMARY......Page 4429 REFERENCES......Page 4430 134. Surgical Treatment of Sacral-Pelvic Fractures......Page 4435 INTRODUCTION......Page 4436 SURGICAL ANATOMY......Page 4438 BIOMECHANICS......Page 4442 CLINICAL EXAMINATION......Page 4444 IMAGING TECHNIQUES......Page 4446 ELECTROPHYSIOLOGIC EXAMINATION......Page 4448 INSUFFICIENCY AND STRESS FRACTURES OF THE SACRUM......Page 4449 DENIS AND ISLER CLASSIFICATIONS......Page 4451 TRANSVERSE SACRAL FRACTURE CLASSIFICATIONS......Page 4452 LUMBOSACRAL INJURY CLASSIFICATION SYSTEM......Page 4457 AOSpine SACRAL FRACTURE CLASSIFICATION SYSTEM......Page 4458 GENERAL CONSIDERATIONS......Page 4461 NONOPERATIVE TREATMENT......Page 4462 SURGICAL TREATMENT......Page 4466 PEDIATRIC INJURIES......Page 4483 COMPLICATIONS AND OUTCOMES......Page 4484 SUMMARY......Page 4488 REFERENCES......Page 4489 135. Novel Approaches to Neural Repair and Regeneration After Spinal Cord Injury......Page 4496 INTRODUCTION......Page 4497 EXCITOTOXICITY AND IMPAIRMENT OF IONIC HOMEOSTASIS......Page 4499 INFLAMMATORY/IMMUNOLOGIC RESPONSE......Page 4500 OUTCOMES ASSESSMENT IN ANIMAL MODELS......Page 4502 BLUNT SPINAL CORD INJURY PARADIGMS......Page 4503 PHARMACOLOGIC INTERVENTIONS......Page 4505 BIOLOGIC THERAPIES DIRECTLY APPLIED TO THE SPINAL CORD......Page 4506 CELL-BASED THERAPIES......Page 4509 CONCLUSION—THE TRANSLATION FROM BENCH TO BEDSIDE......Page 4513 REFERENCES......Page 4516 136. Outcomes Measures in Spinal Trauma......Page 4523 INTRODUCTION......Page 4524 MEASUREMENT OF OUTCOMES......Page 4526 CHALLENGES......Page 4528 OUTCOME MEASURES IN SPINAL CORD INJURY......Page 4531 OUTCOME MEASURES IN SPINAL COLUMN INJURY......Page 4534 MOST RECENT DEVELOPMENTS......Page 4536 CONCLUSION......Page 4540 REFERENCES......Page 4541 137. Introduction and State-of-the-Art: Tumors and Osteomyelitis......Page 4546 138. Benign Tumors of the Spine......Page 4549 INTRODUCTION......Page 4550 DIAGNOSIS......Page 4551 STAGING......Page 4552 BIOPSY......Page 4553 SURGICAL TREATMENTS......Page 4554 CHONDROGENIC TUMORS......Page 4558 OSTEOGENIC TUMORS......Page 4561 OSTEOGENIC TUMORS......Page 4563 GIANT CELL–RICH TUMORS......Page 4565 NOTOCHORDAL TUMORS......Page 4569 VASCULAR TUMORS......Page 4572 UNDEFINED TUMORS......Page 4573 UNDEFINED TUMORS......Page 4576 CONCLUSION......Page 4579 ACKNOWLEDGMENT......Page 4580 REFERENCES......Page 4581 139. Primary Malignant Tumors of the Spine......Page 4588 DIAGNOSIS AND STAGING......Page 4589 IMAGING......Page 4590 BIOPSY......Page 4591 STAGING OF MALIGNANT TUMORS......Page 4594 METASTATIC TUMORS......Page 4597 MARGINS AND SURGICAL PLANNING......Page 4598 WBB STAGING SYSTEM......Page 4599 INTRALESIONAL EXCISION......Page 4600 EN BLOC RESECTION......Page 4601 PALLIATIVE PROCEDURE......Page 4602 PLANNING......Page 4604 PLANNING......Page 4609 PLANNING......Page 4613 SINGLE POSTERIOR APPROACH......Page 4614 COMBINATION OF ANTERIOR APPROACH FIRST AND POSTERIOR APPROACH SECOND......Page 4615 FIRST POSTERIOR APPROACH, SECOND CONTEMPORARY ANTERIOR AND POSTERIOR APPROACHES......Page 4617 PITFALLS AND COMPLICATIONS......Page 4619 PITFALLS TO AVOID......Page 4621 ADJUVANT THERAPY......Page 4622 SACRIFICING FUNCTIONAL STRUCTURES......Page 4623 OSTEOSARCOMA......Page 4624 EWING SARCOMA......Page 4626 CHORDOMA......Page 4627 CHONDROSARCOMA......Page 4628 AUTHORS’ PERSPECTIVE—SUMMARY......Page 4630 ACKNOWLEDGMENTS......Page 4632 REFERENCES......Page 4633 140. The Surgical Treatment of Metastatic Spine Disease......Page 4637 INTRODUCTION......Page 4638 DECISION MAKING......Page 4640 SURGICAL APPROACH......Page 4647 RECONSTRUCTION OF MECHANICAL STABILITY......Page 4650 VASCULAR STUDIES AND EMBOLIZATION......Page 4652 ATLANTOAXIAL REGION......Page 4654 SUBAXIAL CERVICAL SPINE......Page 4656 THORACIC AND LUMBAR APPROACHES......Page 4659 CONCLUSION......Page 4662 REFERENCES......Page 4664 141. Intramedullary Spinal Cord Tumors......Page 4668 INTRODUCTION......Page 4669 EPIDEMIOLOGY......Page 4671 CLINICAL PRESENTATION......Page 4672 PHYSICAL EXAMINATION......Page 4673 ANATOMIC CONSIDERATIONS......Page 4674 EPENDYMOMAS......Page 4676 MYXOPAPILLARY EPENDYMOMA......Page 4678 ASTROCYTOMA......Page 4679 HEMANGIOBLASTOMA......Page 4680 CAVERNOUS ANGIOMA......Page 4683 SCHWANNOMA......Page 4685 METASTATIC DISEASE......Page 4687 GERMINOMA......Page 4689 DIAGNOSTIC IMAGING STUDIES......Page 4691 INFECTION......Page 4693 MULTIPLE SCLEROSIS AND TRANSVERSE MYELITIS......Page 4694 SARCOIDOSIS......Page 4696 SPINAL ARTERIOVENOUS FISTULAE......Page 4697 NONSURGICAL MANAGEMENT......Page 4699 SURGICAL TREATMENT......Page 4701 SURGICAL APPROACHES......Page 4703 TUMOR RESECTION......Page 4706 POSTSURGICAL CARE......Page 4710 NEUROLOGIC DEFICITS......Page 4711 POSTOPERATIVE INSTABILITY/DEFORMITY......Page 4712 FOLLOW-UP CARE......Page 4713 CHEMOTHERAPY......Page 4714 CONCLUSION......Page 4716 REFERENCES......Page 4717 142. Intradural Extramedullary Spinal Tumors......Page 4723 OVERVIEW......Page 4724 PRESENTATION......Page 4725 PREOPERATIVE EVALUATION AND IMAGING......Page 4726 NERVE SHEATH TUMORS......Page 4728 MENINGIOMAS......Page 4731 EPENDYMOMAS......Page 4732 PARAGANGLIOMAS......Page 4733 LEPTOMENINGEAL METASTASES......Page 4734 OTHERS......Page 4735 PRINCIPLES OF TREATMENT......Page 4736 APPROACHES......Page 4737 INTRADURAL COMPONENT......Page 4739 CLOSURE AND RECONSTRUCTION......Page 4744 POSTOPERATIVE MANAGEMENT......Page 4750 COMPLICATIONS......Page 4751 OUTCOMES AND FOLLOW-UP......Page 4752 ADJUVANT THERAPY......Page 4754 CONCLUSION......Page 4755 REFERENCES......Page 4756 143. Spinal Vascular Malformations......Page 4759 INTRODUCTION......Page 4760 CAVERNOUS MALFORMATIONS......Page 4762 ARTERIOVENOUS FISTULAS......Page 4763 ARTERIOVENOUS MALFORMATIONS......Page 4767 ARTERIOVENOUS FISTULAS......Page 4770 ARTERIOVENOUS MALFORMATIONS......Page 4773 IMAGING......Page 4774 ARTERIOVENOUS FISTULAS......Page 4775 ARTERIOVENOUS MALFORMATIONS......Page 4777 CAVERNOUS MALFORMATIONS......Page 4779 ARTERIOVENOUS FISTULAS......Page 4780 ARTERIOVENOUS MALFORMATIONS......Page 4784 CONCLUSION......Page 4787 REFERENCES......Page 4788 144. Spinal Infection/Osteomyelitis......Page 4791 BACKGROUND......Page 4792 PATHOPHYSIOLOGY......Page 4793 CLINICAL PRESENTATION......Page 4794 DIAGNOSTIC WORKUP......Page 4797 SURGICAL INDICATIONS......Page 4801 INFECTION PROPHYLAXIS......Page 4807 SURGICAL TREATMENT......Page 4808 CONCLUSION......Page 4814 REFERENCES......Page 4815 145. Sacral Tumors......Page 4822 GENERAL CONSIDERATIONS IN THE EVALUATION OF SACRAL TUMORS......Page 4823 PRIMARY TUMORS WITH A PREDILECTION FOR SACRAL INVOLVEMENT......Page 4827 PRIMARY BONE TUMORS ARISING IN THE SACRUM......Page 4833 METASTATIC/HEMATOPOIETIC SACRAL TUMORS......Page 4837 BENIGN BONE TUMORS......Page 4838 NEUROGENIC TUMORS......Page 4840 SACRAL INVASION FROM VISCERAL MALIGNANCIES......Page 4842 PRINCIPLES OF SACRAL TUMOR RESECTION......Page 4843 ONCOLOGIC OUTCOMES......Page 4852 CONCLUSIONS......Page 4854 REFERENCES......Page 4855 146. Adjuvant Therapy of Spinal Tumors......Page 4860 INTRODUCTION......Page 4861 BIOLOGIC BASIS OF TUMOR RADIATION RESPONSE......Page 4862 RADIATION DELIVERY TECHNOLOGY......Page 4864 TREATMENT PLANNING......Page 4865 TREATMENT DELIVERY......Page 4870 ALTERNATIVE METHODS OF RADIATION DELIVERY......Page 4872 TREATMENT PARADIGMS......Page 4875 OUTCOMES......Page 4876 TOXICITY/TOLERANCE......Page 4879 CONCLUSIONS......Page 4880 REFERENCES......Page 4881 147. Complications of Surgical Treatment of Tumor and Infection......Page 4885 INTRODUCTION......Page 4887 DURAL TEARS......Page 4888 BLOOD LOSS......Page 4889 CAPSULAR VIOLATIONS AND PLANNED SACRIFICE DURING EN-BLOC RESECTIONS......Page 4890 ACUTE/SUBACUTE......Page 4892 DELAYED......Page 4895 CONCLUSIONS......Page 4907 REFERENCES......Page 4908 148. Neurologic Complications in Spine Surgery......Page 4918 INTRODUCTION......Page 4919 PREVALENCE......Page 4920 MECHANISMS OF NEUROLOGIC COMPLICATIONS......Page 4922 PATIENT EVALUATION AND PREOPERATIVE PLANNING......Page 4923 INTRAOPERATIVE PREPARATION......Page 4925 MOTOR EVOKED POTENTIALS......Page 4926 ELECTROMYOGRAPHY......Page 4927 STAGNARA WAKE-UP TEST......Page 4928 MULTIMODALITY INTRAOPERATIVE MONITORING......Page 4930 INTRAOPERATIVE NEUROLOGIC COMPLICATIONS......Page 4931 STAGNARA WAKE-UP TEST......Page 4932 RELEASE OF CORRECTION......Page 4933 STEROID PROTOCOL......Page 4935 POSTOPERATIVE MANAGEMENT......Page 4936 DELAYED POSTOPERATIVE NEUROLOGIC COMPLICATIONS......Page 4937 CHAPTER SUMMARY......Page 4938 REFERENCES......Page 4939 149. Perioperative Spinal Cord Deficits and Myelopathy......Page 4942 INTRODUCTION......Page 4943 PATHOPHYSIOLOGY OF INJURY......Page 4944 PRESURGICAL AND POSTSURGICAL......Page 4945 CERVICAL SPINE......Page 4946 THORACIC AND LUMBAR SPINE......Page 4948 GENERAL MEASURES......Page 4950 NEURONAVIGATION......Page 4951 NEUROMONITORING......Page 4953 INITIAL MANAGEMENT......Page 4955 LATE MANAGEMENT......Page 4956 REFERENCES......Page 4958 150. Reconstruction of Complex Spinal Wounds......Page 4964 SPINAL WOUNDS: INCIDENCE AND ETIOLOGY......Page 4965 RECONSTRUCTIVE LADDER......Page 4967 ANATOMY OF THE PARASPINAL AND ASSOCIATED MUSCULATURE......Page 4970 CERVICAL AND UPPER THORACIC SPINE......Page 4971 TECHNIQUE—TRAPEZIUS MUSCULOCUTANEOUS FLAP......Page 4972 MIDDLE TO LOWER THORACIC SPINE......Page 4974 TECHNIQUE—LATISSIMUS DORSI FLAP......Page 4975 TECHNIQUE—ERECTOR SPINAE FLAP......Page 4977 LUMBAR SPINE......Page 4982 TECHNIQUE—VERTICAL RECTUS ABDOMINIS MUSCLE FLAP......Page 4984 FREE FLAPS......Page 4986 POSTOPERATIVE CARE......Page 4990 SUMMARY......Page 4994 REFERENCES......Page 4995 151. Vascular Complications......Page 4999 INTRODUCTION......Page 5000 ANATOMY......Page 5001 ANTERIOR PROCEDURES......Page 5002 POSTERIOR PROCEDURES......Page 5009 ANTERIOR PROCEDURES......Page 5011 POSTERIOR PROCEDURES......Page 5014 ANATOMY......Page 5017 ANTERIOR PROCEDURES......Page 5018 LATERAL PROCEDURES......Page 5020 POSTERIOR PROCEDURES......Page 5022 VERTEBROPLASTY/KYPHOPLASTY......Page 5025 CONCLUSION......Page 5026 REFERENCES......Page 5027 152. Postoperative Early and Late Wound/Implant Infections......Page 5034 INTRODUCTION......Page 5035 BACKGROUND......Page 5037 DIAGNOSIS......Page 5043 LABORATORY STUDIES......Page 5044 RADIOGRAPHIC STUDIES......Page 5047 TREATMENT AND OUTCOMES......Page 5051 PREVENTION......Page 5057 CONCLUSION......Page 5061 REFERENCES......Page 5062 153. Dural Lacerations, CSF Fistula, Pseudomeningoceles, and Strategies for Repair......Page 5068 INTRODUCTION......Page 5069 IATROGENIC......Page 5071 TRAUMATIC......Page 5072 CONGENITAL......Page 5073 COMPLICATIONS OF CSF LEAKAGE......Page 5074 TREATMENT—DURAL LACERATIONS......Page 5076 SUTURE TYPE AND TECHNIQUE......Page 5077 DURAL SEALANTS......Page 5078 DRAINS......Page 5079 REFRACTORY CSF FISTULA......Page 5080 ANTERIOR CERVICAL......Page 5081 MINIMALLY INVASIVE APPROACHES......Page 5082 TREATMENT—PSEUDOMENINGOCELE......Page 5084 REFERENCES......Page 5086 154. Pseudarthrosis in Spinal Deformity Surgery......Page 5095 INTRODUCTION......Page 5096 DEFINITION......Page 5097 CHARACTERISTICS OF ADULT PSEUDARTHROSIS IN ASD......Page 5099 RADIOGRAPHS......Page 5101 COMPUTED TOMOGRAPHY......Page 5105 BONE SCAN......Page 5106 RISK FACTORS......Page 5108 BIOLOGIC RISK FACTORS......Page 5109 BIOMECHANICAL RISK FACTORS......Page 5111 TREATMENT......Page 5113 APPROACH......Page 5115 INSTRUMENTATION......Page 5116 BONE GRAFT SUBSTITUTE AND OSTEOBIOLOGICS......Page 5122 CONCLUSION......Page 5124 REFERENCES......Page 5125 155. Legal Implications and Strategies......Page 5129 INTRODUCTION......Page 5131 COURT STRUCTURE......Page 5132 STEPS OF A LAWSUIT......Page 5134 NEGLIGENCE......Page 5137 TYPES OF DAMAGES......Page 5140 PLAINTIFF ATTORNEY PERSPECTIVE......Page 5141 THE NATURE AND EXTENT OF THE PATIENT’S INJURIES......Page 5142 SPECIAL ISSUES FOR AN ELDER OR DEPENDENT ADULT......Page 5143 A STRONG CASE......Page 5145 INFORMED CONSENT......Page 5146 PATIENT EDUCATION TOOLS AS ADJUNCTIONS......Page 5149 BATTERY......Page 5150 FRAUD......Page 5151 PROOF THAT MEDICAL RECORDS HAVE BEEN ALTERED......Page 5152 FAILURE TO RECOMMEND AND DOCUMENT SECOND OPINIONS......Page 5153 SOURCES OF SURGEON LIABILITY......Page 5154 PRACTICING WITH INCOMPETENT OR CARELESS PARTNERS IN YOUR MEDICAL GROUP......Page 5155 SURGEON LIABILITY AND ANESTHESIA PROVIDERS......Page 5156 SURGEON LIABILITY, PODS, AND CORPORATE RELATIONSHIPS......Page 5158 OFF-LABEL USE......Page 5160 SPINE MEDICOLEGAL LANDSCAPE......Page 5162 PHYSICIAN’S APOLOGIES......Page 5165 DOCUMENTATION......Page 5167 LEVEL OF SURGERY AND CHANGE OF SURGERY......Page 5168 SURGEON SUBSTITUTION......Page 5170 ALWAYS HAVE ADEQUATE MALPRACTICE INSURANCE......Page 5171 REPORT ALL CLAIMS PROMPTLY......Page 5172 HAVE A GOOD ATTORNEY......Page 5173 GIVE CONSENT TO SETTLE IF A DEMAND IS MADE WITHIN POLICY LIMITS ON A CASE WHERE YOU WERE WRONG......Page 5174 REGULATORY REPORTING......Page 5175 PRE-EVENT RISK REDUCTION STRATEGIES......Page 5177 MEDICAL ERRORS AND DISCLOSURE REQUIREMENTS......Page 5179 TELEMEDICINE......Page 5181 LACK OF LICENSURE JEOPARDIZES PROTECTION......Page 5182 CYBERMEDICINE......Page 5183 ACKNOWLEDGEMENT......Page 5185 BIBLIOGRAPHY......Page 5186 156. Unresolved Postoperative Spine Pain......Page 5194 INTRODUCTION......Page 5195 DIFFERENTIAL DIAGNOSIS/ETIOLOGY......Page 5197 HISTORY......Page 5201 IMAGING STUDIES......Page 5203 DIAGNOSTIC PROCEDURES......Page 5205 PHYSIOTHERAPY......Page 5209 MEDICATIONS......Page 5210 PSYCHOLOGICAL THERAPY......Page 5213 INTERVENTIONAL PROCEDURES......Page 5214 NEUROMODULATION......Page 5216 SURGICAL INDICATIONS......Page 5217 CONCLUSION......Page 5220 REFERENCES......Page 5221 157. Medical Complications Associated With Spinal Surgery......Page 5223 INTRODUCTION......Page 5224 PULMONARY COMPLICATIONS......Page 5226 PNEUMONIA......Page 5227 PNEUMOTHORAX AND HEMOTHORAX......Page 5228 PULMONARY EMBOLISM......Page 5229 CARDIAC COMPLICATIONS......Page 5231 RENAL FAILURE......Page 5232 GASTROINTESTINAL BLEED......Page 5234 PANCREATITIS......Page 5235 SUPERIOR MESENTERIC ARTERY SYNDROME......Page 5236 COLITIS......Page 5237 ALCOHOL WITHDRAWAL SYNDROME......Page 5238 CEREBRAL ISCHEMIA......Page 5239 COAGULOPATHIES......Page 5240 HYPONATREMIA......Page 5242 DECUBITUS ULCERS......Page 5243 CONCLUSIONS......Page 5245 REFERENCES......Page 5246 Index......Page 5250