Benzel's Spine Surgery, 2-Volume Set: Techniques, Complication Avoidance and Management

Description

Written and edited by world-renowned experts in the field, Benzel’s Spine Surgery: Techniques, Complication Avoidance and Management, 5th Edition, provides expert, step-by-step guidance on the evaluation and management of disorders of the spine. This definitive, two-volume work explores the full spectrum of techniques used in spine surgery, giving you the tools you need to hone your skills and increase your knowledge in this challenging area. Clearly organized and extensively revised throughout, it features contributions from both neurosurgeons and orthopaedic surgeons to present a truly comprehensive approach to spine disease. Offers a thorough overview of the effective management of patients with spinal disorders, including fundamental principles, biomechanics, applied anatomy, instrumentation, pathophysiology of spinal disorders, surgical techniques, motion preservation strategies, non-surgical management, and complication avoidance and management, as well as controversies.    Focuses on both pathophysiology and surgical treatment of spine disease, with an increased emphasis on minimally invasive surgery.  Contains new features such as key points boxes at the beginning of chapters and algorithms to help streamline the decision making process.  Covers today’s hot topics in spine surgery, such as health economics, artificial intelligence, predictive analytics, new less invasive techniques including endoscopic spine surgery, and the future of spine surgery.  Provides expert coverage of key topics including biomechanics of motion preservation techniques, spinal injuries in sports, biologics in spine fusion surgery, anterior sub-axial cervical fixation and fusion techniques, complex lumbosacropelvic fixation techniques, and many more.  Features more than 1,500 high-quality illustrations, as well as new procedural videos on en bloc spondylectomy, minimally invasive endoscopic posterior cervical foraminotomy, cervical total disc replacement, minimally invasive lumbar decompression of stenosis, and more.  Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.  0 001 - Front Matter Benzel’s Spine SurgeryTechniques, Complication Avoidance,and Management 002 - Copyright Copyright 003 - Dedication Dedication 004 - List of Contributors List of Contributors 005 - Preface Preface 005 -Contents - id=utEvEAAAQBAJ&pg=PR23&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U1gCJ id=utEvEAAAQBAJ&pg=PR24&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U3toB id=utEvEAAAQBAJ&pg=PR25&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U1bT2 id=utEvEAAAQBAJ&pg=PR26&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U3D4N id=utEvEAAAQBAJ&pg=PR27&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U3BJA id=utEvEAAAQBAJ&pg=PR28&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U2_ND id=utEvEAAAQBAJ&pg=PR29&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U0z44 id=utEvEAAAQBAJ&pg=PR30&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U2ieX 006 - Chapter 1 - History of Spine Surgery 1 - History of Spine Surgery Antique Period and Spine Surgery Medieval Period and Spine Surgery Renaissance and Spine Surgery Early Modern Period and Spine Surgery Spinal Decompression and the Early Modern Period Birth and Development of the Laminectomy HJ Cline, Jr. and the Argument Against Spine Surgery AG Smith and the First Successful Laminectomy Laminectomy for Extramedullary Spinal Tumors Laminectomy for Intramedullary Spinal Tumor Variations in Laminectomy Technique Charles A Elsberg: The Laminectomy in Stride Laminectomy for Intervertebral Disc Herniation. Intervertebral disc pathology was first described by Rudolph Virchow54 in 1857 (... Laminectomy for Cervical Disc Herniation. In 1905 Watson and Paul66 performed a negative exploration for cervical spinal cord tu... Laminectomy for Spinal Stenosis. Unlike the herniated intervertebral disc, the stenotic spinal canal was described comparatively... Approaches to the Spine Dorsolateral Approaches to the Spine Ménard’s Costotransversectomy Capener’s Lateral Rhachotomy Larson’s Lateral Extracavitary Approach Spinal Stabilization and Deformity Correction Birth and Development of Spinal Fusion and Spinal Instrumentation Spinal Fusion Interbody Cages Spinal Instrumentation and Clinical Biomechanics FW Holdsworth Paul Harrington and the Birth of Modern Surgical Stabilization Ventral Approaches to the Spine Ventral Decompression and Stabilization W Müller BH Burns Ito and Others Hodgson and Stock Ventral Deformity Reduction and the Development of Ventral Instrumentation AF Dwyer Laminoplasty Minimally Invasive Spine Surgery, Robotics, and Navigation Spine Imaging Summary 007 - Chapter 2 - History of Spine Biomechanics 2 - History of Spine Biomechanics Classical Antiquity Mythological Period Scientific Period History of Spine Biomechanics Pythagoras (580–500 bce) Hippocrates (460–377 bce) Plato (427–347 bce) Aristotle (384–322 bce) Herophilus of Chalcedon (335–280 bce) Archimedes (287–212 bce) Galen of Pergamon (130–200 ce) Middle Ages (330–1453 ce) Paulus of Aegina (625–690 ce) Haly Abbas (930–994 ce) Avicenna (981–1037 ce) Albucasis (936–1013 ce) The Renaissance and the Premodern Era Leonardo da Vinci (1452–1519) Andreas Vesalius (1514–1564) Galileo Galilei (1564–1642) René Descartes (1596–1650) Giovanni Alfonso Borelli (1608–1679) Robert Hooke (1635–1703) Isaac Newton (1642–1727) Leonard Euler (1707–1783) Thomas Young (1773–1829) Weber Brothers (1795–1891) Etienne Jules Marey (1838–1904) Christian Wilhelm Braune (1831–1892) and Otto Fischer (1861–1917) Karl Culmann and Herman von Meyer Julius Wolff (1836–1902) Emergence of Modern Biomechanics in the 20th Century In vivo Human Biomechanical Studies Finite Element Analysis Clinical Studies Organizations and Publications 008 - Chapter 3 - History of Spinal Instrumentation_ The Modern Era 3 - History of Spinal Instrumentation: The Modern Era The Harrington Rod Area The Birth of Segmental Spinal Fixation The Comeback of Hook-Rod Systems and the Rod Rotation Revolution Pedicle Screws Development of Dynamic Stabilization Systems Interspinous Devices Ventral Thoracolumbar Instrumentation Dorsal Cervical Instrumentation Ventral Cervical Instrumentation Development of Dynamic Systems for Anterior Cervical Instrumentation Total Disc Arthroplasty: Cervical and Lumbar Cage Technology: Horizontal and Vertical Minimally Invasive Approaches Using Instrumentation Image Guidance and Robotics Summary 009 - Chapter 4 - Functional Anatomy of the Spine 4 - Functional Anatomy of the Spine Spinal Curvature Vertebra Atlas (C1) and Axis (C2) Subaxial Cervical Vertebrae (C3‒C7) Thoracic Vertebrae Lumbar Vertebrae Sacrum and Coccyx Intervertebral Discs Spinal Ligaments Spinal Musculature Spinal Cord 010 - Chapter 5 - Biomechanical Modeling of the Spine 5 - Biomechanical Modeling of the Spine Biomechanics of Deformity Correction Biomechanical Modeling of the Spine Computational Biomechanical Modeling of the Spine Applications of Biomechanical Models of the Spine Biomechanical Modeling and Analysis of Pedicle Screw Patterns in Adolescent Idiopathic Scoliosis Instrumentation Biomechanical Analysis of Adolescent Idiopathic Scoliosis Instrumentation Using Concave Rod Translation First Versus Convex Rod ... Biomechanical Analysis of Adolescent Idiopathic Scoliosis Instrumentation Using Superelastic Nickel–Titanium Shape-Memory Alloy ... Biomechanical Analysis of Multirod Constructs in Adult Spinal Instrumentation Biomechanical Analysis of Transforaminal Lumbar Interbody Fusion Verification, Validation, and Uncertainty Quantification Conclusion 011 - Chapter 6 - The Intervertebral Disc_ Anatomy, Pathophysiology, and Aging 6 - The Intervertebral Disc: Anatomy, Pathophysiology, and Aging Intervertebral Disc Nucleus Pulposus Annulus Fibrosus The Intervertebral Disc: Anatomy, Pathophysiology, and Aging Vascular Supply Innervation Physiology Extracellular Matrix Metabolic Balance Disc Nutrition Biomechanics Aging Extracellular Matrix Changes Structural and Functional Changes Summary 012 - 7 – Muscles and the Spine_ Dynamic Stabilization 7 - Muscles and the Spine: Dynamic Stabilization Anatomic Considerations Microanatomy Structure Classification of Muscle Type Quantitative Studies of Muscle Architecture Gross Anatomy Erector Spinae (Divided by Motion Segment Control Arm) Long Polysegmental Muscles Shorter, Robust Polysegmental Short (Deep) Intersegmental Muscles Regional Special Muscles (Multiple Use or Axial and Limb) Lumbopelvic Cervicohumural Functional-Postural Considerations Conclusion 013 - Chapter 8 - Bone Physiology and Osteoporosis 8 - Bone Physiology and Osteoporosis Function Structure Physiology Bone Physiology and Osteoporosis Bone Density, Quality, and Strength Pathological Conditions Osteoporosis Osteomalacia Osteopetrosis Paget disease Epidemiology of Osteoporosis Prevalence Incidence of Fragility Fractures Future Risk Factors Morbidity Mortality Assessment of Bone Status Bone Mineral Density Fracture Risk Assessment Tool and Fracture Risk Prediction Adjuncts to Dual Energy X-Ray Absorptiometry Opportunistic Computed Tomography Bone Health in Spine Patients Vitamin D Deficiency Osteoporosis in Spine Surgery Patients Consequences of Osteoporosis in Spine Patients Bone-Related Complications Adjacent Segment Disease Proximal Junctional Failure Pseudoarthrosis Iatrogenic Spondylolisthesis Revision Surgery Association With Poor Outcomes Options Available for Salvage Bone Health Optimization Secondary Fracture Prevention Conclusion 014 - Chapter 9 - Applied Anatomy of the Thoracolumbar Spine 9 - Applied Anatomy of the Thoracolumbar Spine Vertebrae and Ligaments Vertebral Body Intervertebral Disc and Vertebral End Plate Anterior Longitudinal Ligament Posterior Longitudinal Ligament Pedicle Facet and Pars Interarticularis Transverse Process Rib Articulations of the Thoracic Spine Lamina and Spinous Process Ligamentum Flavum Interspinous and Supraspinous Ligaments Spinal Canal Paraspinal Musculature Neural Anatomy Spinal Segmentation Spinal Cord Intradural Roots and the Cauda Equina Lateral Recess, the Neural Foramen, and the Intraforaminal Root Extraforaminal Spinal Nerve Innervation of the Spine Anomalous Root Anatomy Vascular Anatomy Upper Thoracic Spine Arterial Supply Middle Thoracic, Lower Thoracic, and Lumbar Arterial Supply: The Segmental System Spinal Cord Arterial Supply Artery of Adamkiewicz Nerve Root and Cauda Equina Arterial Supply Venous Drainage of the Spinal Cord and Cauda Equina Anatomic Variation and Surgical Localization 015 - Chapter 10 - Fundamentals of Spinal Alignment and Balance 10 - Fundamentals of Spinal Alignment and Balance The Concept of the Spinal Organ and the Chain of Balance Fundamentals of Spinal Alignment and Balance The Importance of Pelvic Anatomy and its Parameters Upon Spine Alignment Consequences Practical Applications for Spinal Evaluation and Surgery 016 - Chapter 11 - Applied Anatomy of the Spinal Cord 11 - Applied Anatomy of the Spinal Cord Functional Spinal Segment Functional Anatomy of the Gray Matter Functional Anatomy of the White Matter Descending Tracts Pyramidal Tracts Extrapyramidal Tracts Ascending Tracts Dorsal Column–Medial Lemniscus Pathway Anterolateral System (Spinothalamic Tracts) Spinocerebellar Tracts Clinical Correlations Central Cord Syndrome Spinal Cord Control of Visceral Organs Autonomic Nervous System Cardiovascular Function The Spinal Cord and Respiratory Function Spinal Cord and Bladder Control Conclusion 017 - Chapter 12 - Molecular and Anatomic Mechanisms of Nerve Root, Spinal Nerve, and Peripheral Nerve Injury 12 - Molecular and Anatomic Mechanisms of Nerve Root, Spinal Nerve, and Peripheral Nerve Injury Oligodendrocytes Schwann Cells Obersteiner–Redlich Zone Motor Exit Point Glia Transition From Dura to Perineurium Apoptosis Molecular and Anatomic Mechanisms of Nerve Root, Spinal Nerve, and Peripheral Nerve Injury Necrosis Anatomic Considerations and Mechanisms of Injury Spinal Anatomy: Brief Review Central Canal Lateral Recess Pedicles Neural Foramen Neural Structures Dorsal Root Ganglion: Marking the Transition Nerve Compression Nerve Injury and Operative Implications Degenerative Disease, Instability, and Spinal Misalignment Iatrogenic Injury Stretch Injuries Double Crush Phenomenon Familial Propensity to Compressive Neuropathy Molecular Response to Injury and Putative Theraputic Options Neuropathic Pain Considerations Conclusion 018 - Chapter 13 - Spine Fusion_ Biology and Biomechanics 13 - Spine Fusion: Biology and Biomechanics Histological Components Spine Fusion: Biology and Biomechanics Biology of Bone Graft Incorporation Osteoinduction, Osteoconduction, and Osteogenicity Graft Material Autograft Demineralized Bone Matrix Allograft Xenograft Ceramics Growth Factors and Cytokines Host Immune Response and Incorporation of Autograft and Allograft in Spine Fusion Cancellous and Cortical Bone Graft Incorporation Temporal Profile of Graft Incorporation Systemic Factors Nicotine Drugs Osteoporosis Hormones Biomechanics of Fusion Biomechanics of Graft Incorporation Axis of Rotation and Spine Fusion Modeling and Remodeling Associated With Spine Fusion Load Sharing Stress Shielding Conclusion 019 - Chapter 14 - Implant Attributes_ Cantilever Beam Fixation 14 - Implant Attributes: Cantilever Beam Fixation Cantilevers in Spinal Instrumentation Bone–Screw Cantilever Resistance to Shear Stress Implant Attributes: Cantilever Beam Fixation Resistance to Bending Moment Other Forces and Moments at the Bone–Screw Interface Screw–Rod Interface Clinical Modes of Failure and Strategies to Reduce Their Incidence Bone–Screw Interface Failure Strategies to Increase the Resistive Moment Strategies to Decrease the Applied Moment Screw–Rod Interface Failure Strategies to Reduce the Incidence of Implant Failure at the Screw–Rod Interface Conclusion 020 - Chapter 15 - Biomechanics and Implant Materials_ The Anterior Column 15 - Biomechanics and Implant Materials: The Anterior Column Interbody Fusion Biomechanics and Implant Materials: The Anterior Column Biomechanics Cage Material and Design Subsidence Factors Affecting Construct Rigidity Summary 021 - Chapter 16 - Biomechanics of Motion Preservation Techniques 16 - Biomechanics of Motion Preservation Techniques Physical Principles Biomechanics of Motion Preservation Techniques Intervertebral Disc Biomechanics of Intervertebral Disc Degeneration Adjacent-Segment Degeneration Biomechanics of Motion-Sparing Implants Total Disc Arthroplasty Clinical Performance Ideal Total Disc Arthroplasty Other Motion-Sparing Devices Conclusion Disclaimer 022 - Chapter 17 - Complications in Spine Surgery_ Expected Rates and Classification 17 - Complications in Spine Surgery: Expected Rates and Classification Complications in Spine Surgery: Expected Rates and Classification Complication Risk Factors Operative Complications Postoperative Complications Complication Classification Conclusion 023 - Chapter 18 - Spinal Cord Dysraphism and Myelodysplasia 18 - Spinal Cord Dysraphism and Myelodysplasia Embryology Spina Bifida Aperta––Open Neural Tube Defects Myeloschisis Myelomeningocele and Meningocele Surgical Treatment Fetal Myelomeningocele Repair Outcomes Spina Bifida Occulta––Closed Neural Tube Defects Dermal Sinus Tract Fatty Filum Lipoma and Lipomyelomeningocele Split Cord Malformation Neurenteric Fistula or Cysts Anterior Sacral Meningocele Conclusion 024 - Chapter 19 - Congenital Spinal Deformity 19 - Congenital Spinal Deformity Congenital Spinal Deformity Associated Anomalies, Evaluation, Imaging Classification Natural History and Observation Surgical Indications, Imaging, Intraspinal Anomalies Surgical Options, Timing of Intervention, Global Versus Local Treatment Common Contemporary Surgical Options Conclusion 025 - Chapter 20 - Early-Onset Scoliosis 20 - Early-Onset Scoliosis Classification Initial Evaluation of the Child With Early-Onset Scoliosis Consequences of Curve Progression: Pulmonary Development, Spinal Growth, and Thoracic Insufficiency Syndrome Nonoperative Treatment of Early-Onset Scoliosis Brace Treatment of Early-Onset Scoliosis Cast Treatment of Early-Onset Scoliosis Role of Halo-Gravity Traction in the Management of Early-Onset Scoliosis Operative Treatment Surgical Treatment of Isolated Hemivertebrae Distraction-Based Treatment Traditional Growing Rods and Rib-Based Distraction Magnetically Controlled Growing Rods Shilla Complications Conclusion 026 - Chapter 21 - Late-Onset Idiopathic Scoliosis 21 - Late-Onset Idiopathic Scoliosis Curve Patterns/Progression Late-Onset Idiopathic Scoliosis Thoracic Curves Lumbar Curves Thoracolumbar Curves Double-Major Curves Skeletal Maturity/Progression Summary Cardiopulmonary Concerns Restrictive/Obstructive Lung Disease Mortality/Summary Back Pain/Disability Psychosocial Concerns Pregnancy/Marriage Body Image/Body Satisfaction/Cosmesis Mental Health Summary 027 - Chapter 22 - Scheuermann Disease 22 - Scheuermann Disease History Nomenclature Clinically Relevant Embryology of the Vertebral Column Postnatal Development of the Vertebral Column Sagittal Spinal Alignment and Deformity Epidemiology Prevalence Incidence Gender Ratio Associated Conditions Age Location Classification Genetics Etiopathogenesis Genetic Background Disorganized Endochondral Ossification Mechanical Factors Repetitive Strain Stature of the Sternum Osteoporosis Height and Body Mass Index Pathophysiology Vertebral Body Wedging Thickening of the Anterior Longitudinal Ligament Irregular Vertebral End Plate and Schmorl’s Nodes Impaired Ring Apophysis Disc Impairment Pathology/Histopathology Clinical Features History Onset Progressive Deformity Pain Neurological Compromise Cardiopulmonary Complaints Cosmetic Issues Physical Examination Radiographic Features Magnetic Resonance Imaging Features Natural History Presentation Deformity Progression and Pain Mechanics of Pulmonary Function Cardiac Function Thoracolumbar Disc Herniation Neurological Sequelae Diagnosis The Berlin Criteria Differential Diagnosis Treatment Approach Considerations Nonoperative Treatment Advice and Observation Antiinflammatory Medications Rehabilitation Exercises, Bracing, and Casting Surgical Treatment Surgical Indications Goals of Surgical Correction Preoperative Workup Biomechanical Principles of Kyphosis Correction Surgical Techniques Literature Review/Current Controversies What Techniques of Posterior Correction Should be Used Postoperative Care Patient-Reported Surgical Outcomes Prognosis Complications Surgical Complications Junctional Kyphosis Conclusion 028 - Chapter 23 - Developmental Spondylolisthesis 23 - Developmental Spondylolisthesis Developmental Spondylolisthesis Pathophysiology Hip–Spinopelvic Balance and Morphology Postural Compensation Mechanisms in Developmental Spondylolisthesis Spondylolisthesis Classification Method for Classifying a Patient Using the Spinal Deformity Study Group Classification System Slip Severity Sacropelvic Balance Spinopelvic Balance (If High-Grade With Unbalanced Sacropelvis) Implications for Surgical Treatment Treatment Algorithm Using the Spinal Deformity Study Group Classification System 029 - Chapter 24 - Craniovertebral Junction Deformities 24 - Craniovertebral Junction Deformities Rotatory Atlantoaxial Dislocation Vertical Atlantoaxial Dislocation Lateral Atlantoaxial Dislocation Goel Classification of Atlantoaxial Dislocation Craniovertebral Junction Deformities Surgery for Atlantoaxial Dislocation Biomechanical Issues Regarding Stabilization Atlantoaxial Fixation Techniques Goel and Laheri Technique of Lateral Mass Plate and Screw Fixation. (see Figs. 24.1 to 24.4) Alternative Sites of C2 Screw Insertion Complications Surgical Issues With Bleeding in the Region Other Techniques of Atlantoaxial Fixation C1–C2 Wiring Techniques Occipitocervical Fixation Irreducible or Fixed Atlantoaxial Dislocation Basilar Invagination Evolution of Personal Understanding Reversibility of Musculoskeletal and Neural Alterations Goel’s Clinical Grading System Surgical Management Atlantoaxial Fixation for Group A and B Basilar Invagination (Figs. 24.6 and 24.7) Chiari Formation and Syringomyelia (Fig. 24.8) Idiopathic Syringomyelia Central Atlantoaxial Dislocation in Association With Cervical Myelopathy Related to Multisegmental Cervical Spondylosis, Ossific... 030 - Chapter 25 - Developmental Deformity in the Cervical Spine 25 - Developmental Deformity in the Cervical Spine Developmental Deformity in the Cervical Spine Occipitocervical Synostosis Congenital Atlas Anomalies Odontoid Anomalies Posterior Arch Defects Congenital Muscular Torticollis Klippel–Feil Syndrome Laxity of the Transverse Atlantal Ligament Other Disorders With Common Cervical Spine Involvement 031 - Chapter 26 - Tarlov Cysts 26 - Tarlov Cysts Histopathology Clinical Findings Tarlov Cysts Radiological Features Pathogenesis Differential Diagnosis Surgical Treatment Patient Selection Diagnostic Cyst Aspiration Needle Aspiration and Fibrin Glue Injection Surgical Extirpation of the Tarlov Cyst Summary 032 - Chapter 27 - Dural and Meningeal Pathologies 27 - Dural and Meningeal Pathologies Epidemiology Pathophysiology Dural and Meningeal Pathologies Presentation Imaging Treatment and Outcome Spinal Cord Herniation Epidemiology Pathophysiology Presentation Imaging Treatment and Outcome Cerebrospinal Fluid Leaks and Spontaneous Intracranial Hypotension Epidemiology Pathophysiology Presentation Imaging Treatment and Outcomes Segmental Amyotrophy Secondary to Dural Defect–Related Extraarachnoid Fluid Collections Epidemiology Pathophysiology Presentation Imaging Treatment and Outcomes 033 - Chapter 28 - Chiari Malformations and Syringomyelia 28 - Chiari Malformations and Syringomyelia Signs, Symptoms, and Imaging: Pathological Features Chiari I Chiari Malformations and Syringomyelia Chiari II Chiari III Chiari IV Chiari 1.5 Chiari 0 Pathophysiology Patient Selection and Surgical Management Diagnostic Imaging Surgical Indications Chiari I Chiari II Surgical Technique (Video 28.1) Anesthetic and Positioning Considerations Exposure Dural and Arachnoid Opening Graft Selection and Dural Closure Postoperative Care and Complications Prognosis Chiari I Chiari II Summary 034 - Chapter 29 - Pathophysiology of Cervical Spondylosis, Radiculopathy, and Myelopathy 29 - Pathophysiology of Cervical Spondylosis, Radiculopathy, and Myelopathy Cervical Spondylosis Pathology Cervical Spondylosis and Axial Neck Pain Cervical Radiculopathy Anatomy Presentation Etiology Cervical Myelopathy Pathophysiology Biomechanics Histopathology Spinal Cord Ischemia and Cervical Spondylotic Myelopathy Summary 035 - Chapter 30 - Pathophysiology of Thoracic Spondylosis, Radiculopathy, and Myelopathy 30 - Pathophysiology of Thoracic Spondylosis, Radiculopathy, and Myelopathy Anatomic Consideration of the Thoracic Spine Specific Pathologies Ossification of the Ligamentum Flavum Ossification of the Posterior Longitudinal Ligament Ankylosing Spondylitis Diffuse Idiopathic Skeletal Hyperostosis Thoracic Myelopathy Thoracic Disc Herniations Disc Degeneration Fractures Management of Thoracic Spine Pathologies 036 - Chapter 31 - Pathophysiology of Intervertebral Disc Degeneration and Pain 31 - Pathophysiology of Intervertebral Disc Degeneration and Pain Anatomy Extracellular Matrix Cells Nutrition Innervation Function The Degenerative Cascade Physiological Degeneration Pathological Degeneration Degeneration Risk Factors Age Sex Physical Loading Smoking Overweight or Obesity Diabetes Genetics Diagnostics Current and Future Diagnostic Methods With Magnetic Resonance Imaging Summary and Obstacles to Improved Understanding and Clinical Translation 037 - Chapter 32 - Deformity in the Cervical Spine 32 - Deformity in the Cervical Spine Background Pathophysiology Congenital Cervical Scoliosis Idiopathic Scoliosis Traumatic/Iatrogenic Scoliosis Preoperative Evaluation Clinical Evaluation Radiographic Evaluation Surgical Management Anterior Subaxial Correction Posterior Subaxial Correction Combined Correction Techniques Surgical Outcomes Conclusion 038 - Chapter 33 - Adult Degenerative Scoliosis 33 - Adult Degenerative Scoliosis Clinical Evaluation of the Adult Patient with Spinal Deformity Diagnostic Imaging Conventional Radiography Advanced Imaging Classification Current Classification of Adult Spinal Deformity Future Directions Management of Adult Degenerative Scoliosis Nonoperative Treatment Versus Surgical Approach Optimizing the Patient Before Surgery Conclusion 039 - Chapter 34 - Lumbar Spondylolisthesis 34 - Lumbar Spondylolisthesis Isthmic Spondylolisthesis Degenerative Lumbar Spondylolisthesis Natural History Management Lumbar Spondylolisthesis Transforaminal Lumbar Interbody Fusion Anterior Lumbar Interbody Fusion Lateral Lumbar Interbody Fusion Oblique Lumbar Interbody Fusion Surgery for Spondylolisthesis in the Elderly Management of Osteoporosis Surgical Considerations for Patients With Osteoporosis Cost Effectiveness Guidelines Surgical Treatment Conclusion 040 - Chapter 35 - Occipitocervical Injuries 35 - Occipitocervical Injuries General Principles Diagnosis and Management C0––Occipital Condyle Fractures C0–C1––Atlantooccipital Dislocations C1 Fracture Transverse Ligament Injuries Rotatory C1–C2 Subluxations C2 Fractures Odontoid Fractures C2 Body Fractures C2 Pars/Pedicle Fractures (Hangman Fractures) Combination Occipitocervical Junction Injuries Surgical Procedures General Principles Preoperative Care Intraoperative Care Postoperative Care Occipitocervical Junction Fusions Dorsal C1–C2 and C1–C3 Fixation Odontoid Screw Fixation Ventral C1–C2 Fixation Ventral C2–C3 Fixation Dorsal Occipital Cervical Fusion Summary 041 - Chapter 36 - Subaxial Cervical Spine Injuries 36 - Subaxial Cervical Spine Injuries Anatomy Clinical Assessment Radiographic Assessment Injury Classification Subaxial Injury and Classification AOSpine Classification System Management Prehospital Immobilization and Transportation Initial Reduction Acute Cardiopulmonary Management Intensive Care Unit Status Pulmonary Care Cardiovascular Factors Pharmacological Therapy Acute Central Cord Syndrome Spinal Cord Injury Without Radiological Abnormality Treatment by Fracture Type Simple Compression Fractures Burst Compression Fractures Teardrop Fractures Simple Posterior Element Fractures Facet Fractures Facet Dislocations/Severe Flexion Distraction Injuries Severe Hyperextension Injuries Fracture Dislocations Associated Vertebral Artery Injury Prognosis Conclusion 042 - Chapter 37 - Thoracic and Lumbar Spine Injuries 37 - Thoracic and Lumbar Spine Injuries Evaluation and Diagnosis Assessment in the Emergency Department Imaging Classification of Thoracolumbar Fractures Denis Three-Column Classification System Magerl AO Classification System Thoracolumbar Injury Classification and Severity Score AOSpine Thoracolumbar Injury Classification System Management of Thoracolumbar Fractures Nonoperative Management Operative Management Timing of Surgery Postoperative Management Management of Specific Thoracolumbar Injuries Compression Fractures Burst Fractures Flexion-Distraction Injuries Fracture-Dislocations Conclusion 043 - Chapter 38 - Peripheral Nerve Injury 38 - Peripheral Nerve Injury Anatomy and Physiology of the Peripheral Nervous System Biology of Nerve Injury and Repair The Nerve Cell Body and Proinflammatory Response in the Nerve Injury Zone The Proximal Stump The Interstump Gap The Distal Stump The Role of Neurotrophic Factors in Regeneration Schwann Cells and Injury Outcomes Central Nervous System Versus Peripheral Nervous System Regeneration Nerve Injury Grading and Prognosis Nerve Injury Mechanisms Direct Nerve Injury (Trauma) Medium- to High-Energy Low-Energy Indirect Nerve Injury (Complex Nerve Injuries) Electrical Thermal Irradiation Current and Future Surgical Nerve Repair Concepts Innovative Current and Future Directions Cauda Equina Syndrome Definition and Significance Pathophysiology Neurogenic Bladder Cauda Equina Syndrome Secondary to Disc Herniation Clinical Syndrome Clinical Course Diagnostic Imaging Timing of Surgical Intervention 044 - Chapter 39 - Spinal Cord Injury 39 - Spinal Cord Injury Mechanisms of Spinal Cord Injury Pathophysiology Primary Injury Secondary Cascade Spinal Cord Injury Clinical Manifestations of Spinal Cord Injury American Spinal Injury Association Classification Patterns of Incomplete Spinal Cord Injury Central Cord Syndrome Anterior Cord Syndrome Posterior Cord Syndrome Brown–Séquard Syndrome Conus Medullaris Injury Cauda Equina Syndrome Special Considerations Cervicomedullary Injury Penetrating Cord Injuries Conclusion 045 - Chapter 40 - Spinal Injuries in Sports 40 - Spinal Injuries in Sports Sport-Specific Spinal Injuries American Football Baseball and Softball Spinal Injuries in Sports Basketball Cycling Equestrian Sports Gymnastics Ice Hockey Mixed Martial Arts Rugby Water Sports Wrestling Cervical Spine and Brachial Plexus Cervical Sprains, Strains, and Contusions Brachial Plexus Neurapraxia Central Cord Syndrome Cervical Cord Neurapraxia and Transient Quadriplegia Traumatic Intervertebral Disc Herniation Minor Cervical Fractures Compression Fractures Spinous Process Fractures Isolated Laminar Fractures/Facet Fractures Catastrophic Cervical Spine Injury Upper Cervical Spine Injury Lower Cervical Spine Injury On-Site Evaluation and Management of Spinal Cord Injury Primum non Nocere On-Site Management Off-the-Field Management Thoracic Spine Lumbosacral Spine Disc Herniation Facet Syndrome Pars Interarticularis Injury Impending Spondylolysis or Impending Pars Defect Spondylolysis and Spondylolisthesis Summary 046 - Chapter 41 - Rheumatoid Arthritis 41 - Rheumatoid Arthritis Pathophysiology Clinical Manifestations Radiological Evaluation Operative Indications Specific Regions of the Spine Cervical Spine Upper Cervical Spine Lower Cervical Spine Thoracic and Lumbar Spine Surgical Management of the Rheumatoid Spine Surgical Techniques C1–C2 Stabilization Dorsal Techniques Screw Fixation Occipitocervical Fusion Transoral Surgery Subaxial Cervical, Thoracic, and Lumbar Surgery Postoperative External Orthoses Postoperative Results Neurological Outcome Fusion Outcome Mortality Medical Adjuncts Summary 047 - Chapter 42 - Ankylosing Spondylitis and Related Disorders 42 - Ankylosing Spondylitis and Related Disorders Introduction and Epidemiology Pathophysiology Clinical Manifestations and Diagnosis Laboratory Findings Radiographic Findings Nonoperative Treatment Modalities Operative Interventions: Fractures Deformity Preoperative Planning Osteotomy: Cervical Osteotomy: Thoracolumbar Cervical Pedicle Subtraction Osteotomy: C7 Osteotomy Technique Complications Conclusion 048 - Chapter 43 - Ossification of the Posterior Longitudinal Ligament 43 - Ossification of the Posterior Longitudinal Ligament Natural History Progression of Ossification Progression of Myelopathy Ossification of the Posterior Longitudinal Ligament Genetic Expression and Biomarkers Symptoms and Diagnosis Imaging Evaluation and Classification Diagnosis of Ossification of the Posterior Longitudinal Ligament Dural Ossification Intramedullary Signal Change on Magnetic Resonance Imaging Systematic Ossification in Patients With Ossification of the Posterior Longitudinal Ligament Nonoperative Treatment for Ossification of the Posterior Longitudinal Ligament Surgical Treatment for Cervical Ossification of the Posterior Longitudinal Ligament Surgical Selection for Cervical Ossification of the Posterior Longitudinal Ligament Anterior Decompression and Fusion Laminoplasty Posterior Decompression With Fusion Anterior Versus Posterior Surgery Posterior Laminectomy With Fusion Versus Laminoplasty Summary of Surgical Procedures for Cervical Ossification of the Posterior Longitudinal Ligament Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament Surgical Complications of Thoracic Ossification of the Posterior Longitudinal Ligament Conclusion 049 - Chapter 44 - Primary Infections of the Spine 44 - Primary Infections of the Spine Definition and Clinical Significance Primary Infections of the Spine Epidemiology Etiology Pathophysiology Clinical Presentation and Course Clinical Symptoms Clinical Signs Differential Diagnosis Diagnostic Modalities and Imaging Blood Investigations Radiological Imaging Nuclear Scans Culture/Sensitivity and Molecular Diagnostics Classification System Treatment Nonoperative Treatment Surgical Therapy Spinal Epidural Abscess Modic Changes and Subclinical Infections Clinical Outcome, Treatment Failure, and Relapse Tubercular Spondylodiscitis History and Background Epidemiology Etiopathogenesis Histopathology of Tubercular Lesions Pathogenesis of Vertebral Destruction and Deformity Pathogenesis of Deformity Progression in Adults Versus Children Clinical Presentation Pain Cold Abscesses Spinal Deformity Neurological Deficit Atypical Presentations141 Diagnostic Investigations Laboratory Investigations Immunological Tests Imaging Nuclear Scans Tissue Sampling Treatment Nonoperative Treatment Surgical Treatment General Principles of Surgical Management in Healed Tuberculosis Other Granulomatous Spinal Lesions Brucellosis Fungal Infections Conclusion 050 - Chapter 45 - Secondary Infections of the Spine 45 - Secondary Infections of the Spine Secondary Infections of the Spine Prevention Clinical Presentation Diagnostic Workup Management Conclusion 051 - Chapter 46 - Primary Tumors of the Spine 46 - Primary Tumors of the Spine Symptoms Radiological Evaluation Management Biopsy Medical Staging Surgical Staging and Classification Treatment Medical Therapy Surgery Complications Radiotherapy Primary Lesions Benign Primary Tumors Osteochondroma Hemangioma Eosinophilic Granuloma Aneurysmal Bone Cyst Osteoid Osteoma Osteoblastoma Chondroma and Enchondroma Locally Aggressive (Benign) Tumors Giant Cell Tumor Chordoma Malignant Primary Tumors Multiple Myeloma and Plasmacytoma Ewing Sarcoma Osteosarcoma Chondrosarcoma Future Directions Conclusion 052 - Chapter 47 - Metastatic Tumors of the Spine 47 - Metastatic Tumors of the Spine Imaging Findings Metastatic Tumors of the Spine Evaluation Neurological Function Oncological Status Mechanical Instability Systemic Considerations Management Surgical Approaches Cervical Spine Thoracic Spine Lumbar Sacrum Minimally Invasive Surgery Vertebroplasty and Kyphoplasty Conclusion 053 - Chapter 48 - Intradural Extramedullary Spine Tumors 48 - Intradural Extramedullary Spine Tumors Patient Presentation Intradural Extramedullary Spine Tumors Nerve Sheath Tumors Neurofibroma Background Schwannoma Background Treatment Outcomes Meningioma Treatment Outcomes Myxopapillary Ependymoma Imaging Outcome Other Histological Subtypes Surgical Considerations Radiation Therapy and Stereotactic Radiosurgery Conclusion 054 - Chapter 49 - Intramedullary Spinal Cord Lesions 49 - Intramedullary Spinal Cord Lesions Patient Selection Intramedullary Spinal Cord Lesions Surgical Objectives Surgical Technique Advances in Surgical Approaches Postoperative Management A Note on Differential Diagnosis Summary 055 - Chapter 50 - Brachial Plexus Tumors Extending Into the Cervicothoracic Spine 50 - Brachial Plexus Tumors Extending Into the Cervicothoracic Spine Brachial Plexus Tumors Extending Into the Cervicothoracic Spine Surgical Approaches Surgical Considerations for Brachial Plexus Tumors Extending Into the Cervical and Upper Thoracic Spine Dorsal Approach Ventral Supraclavicular Approach Dorsal Subscapular Approach Conclusion 056 - Chapter 51 - Spinal Disorders Associated With Connective Tissue Disorders 51 - Spinal Disorders Associated With Connective Tissue Disorders General Considerations Atlantoaxial Instability Basilar Invagination Cervical Failure of Segmentation Congenital Scoliosis Dystrophic Scoliosis Kyphosis Dural Ectasia Thoracic Dystrophy Spinal Deformity From Soft Tissue Contractures Spinal Stenosis Spondylolisthesis Spinal Angiomas Summary 057 - Chapter 52 - Osteoporosis, Osteomalacia, and Metabolic Bone Disease 52 - Osteoporosis, Osteomalacia, and Metabolic Bone Disease Osteoporosis Definition Diagnosis of Osteoporosis Prevalence and Costs Pathophysiology Risk Assessment Morbidity and Mortality Prevention of Osteoporosis Hormone Replacement Therapy Nutrition Exercise Who Should be Treated Pharmacological Therapy Osteomalacia Clinical Features/Diagnosis Treatment Paget Disease of the Bone Definition, Epidemiology, and Pathophysiology History and Clinical Presentation Diagnosis Radiographic Findings Laboratory Manifestations Treatment Surgical Considerations in Metabolic Bone Disease Management of Fractures of the Spine Attributed to Osteoporosis Fixation Strategies in Osteoporotic Bone Spinal Mobilization with Osteotomies: Limitations of Minimally Invasive Surgery Surgical Considerations in Paget Disease of the Spine Surgical Considerations in Osteomalacia of the Spine Preoperative Evaluation and Management of Osteoporosis in Spinal Fusion Surgery Screening 058 - Chapter 53 - Vascular Malformations of the Spine 53 - Vascular Malformations of the Spine History and Nomenclature Embryology and Vascular Anatomy Imaging Techniques Extradural Arteriovenous Fistulas Demographics Pathogenesis Management Outcomes Type 1 Dural Arteriovenous Fistulas Demographics Pathophysiology Management Outcomes Type II Glomus Arteriovenous Malformations Pathophysiology Demographics Management Type III Juvenile Extradural-Intradural Arteriovenous Malformations Pathophysiology Demographics Management Outcome Type IV Intradural Perimedullary Arteriovenous Fistula Pathophysiology Demographics Management Outcomes Conus Arteriovenous Malformations Spinal Aneurysms Demographics and Pathophysiology Management Outcomes Cavernous Angiomas Demographics Management 059 - Chapter 54 - Neuromuscular Disorders in the Pediatric Spine 54 - Neuromuscular Disorders in the Pediatric Spine Classification of Neuromuscular Scoliosis General Considerations for Patients With Neuromuscular Scoliosis Natural History of Neuromuscular Scoliosis General Goals of Treatment in the Neuromuscular Population General Preoperative Considerations General Goals of Surgery in the Neuromuscular Population General Intraoperative Considerations General Postoperative Considerations in Patients With Neuromuscular Scoliosis Neuromuscular Scoliosis Secondary to Cerebral Palsy Nonoperative Management Specific Preoperative Considerations for Patients With Cerebral Palsy Outcomes of Corrective Scoliosis Surgery in Patients With Cerebral Palsy Neuromuscular Scoliosis Secondary to Myelodysplasia Specific Preoperative Considerations in Patients With Scoliosis Because of Myelomeningocele Intraoperative Considerations for Patients With Myelomeningocele Outcomes in Patients With Scoliosis Secondary to Myelomeningocele Neuromuscular Deformity in the Adult Management of Neuromuscular Deformity in the Adult Summary 060 - Chapter 55 - Neuromuscular Disorders in the Adult Spine 55 - Neuromuscular Disorders in the Adult Spine Pathophysiology Classification and Evaluation Parkinson Disease Management Nonoperative Interventions Surgical Intervention Primary Myopathies Management Immunomodulatory Disorders (Multiple Sclerosis) Management Conclusion 061 - Chapter 56 - Postoperative Spinal Disorders—Cervical 56 - Postoperative Spinal Disorders—Cervical Background Anterior Cervical Spine Surgery Anterior Surgery Biomechanics Short-Term Complications Pseudoarthrosis After Anterior Cervical Spine Surgery Adjacent Segment Disease After Anterior Cervical Spine Surgery Posterior Cervical Spine Surgery Posterior Surgery Biomechanics Early Postoperative Complications in Posterior Cervical Spine Surgery Postlaminectomy Kyphosis in Posterior Cervical Spine Surgery Pseudoarthrosis in Posterior Cervical Spine Surgery Fusion Choices in Posterior Cervical Spine Surgery Avoiding Iatrogenic Destabilization Conclusion 062 - Chapter 57 - Postoperative Spinal Deformity 57 - Postoperative Spinal Deformity Pathophysiology: Prevalence and Impact Cervical Spine Alignment Lumbar Degenerative Alignment Thoracolumbar Deformity Alignment Avoiding Fusion of the Spine in Malalignment Treatment of Postoperative Malalignment of the Spine Conclusion 063 - Chapter 58 - Adjacent Segment Degeneration and Disease of the Cervical Spine 58 - Adjacent Segment Degeneration and Disease of the Cervical Spine Biomechanics of Adjacent Segment Pathology Adjacent Segment Degeneration and Disease of the Cervical Spine Adjacent Segment Degeneration (Radiographic Adjacent Segment Pathology) Adjacent Segment Disease (Clinical Adjacent Segment Pathology) Prevention of Adjacent Segment Pathology Minimize Disruption of Surrounding Soft Tissue Patient/Level Selection Sagittal Alignment Authors’ Perspective 064 - Chapter 59 - Adjacent Segment Degeneration and Disease of the Lumbar Spine 59 - Adjacent Segment Degeneration and Disease of the Lumbar Spine Epidemiology Risk Factors Adjacent Segment Degeneration and Disease of the Lumbar Spine Surgical Strategies to Avoid Adjacent Segment Disease Surgical Strategies to Manage Adjacent Segment Disease Outcomes and Complications Conclusion 065 - Chapter 60 - Proximal and Distal Junctional Kyphosis and Failure 60 - Proximal and Distal Junctional Kyphosis and Failure Adolescent Idiopathic Scoliosis Proximal and Distal Junctional Kyphosis and Failure Adult Spinal Deformity Scheuermann Kyphosis Impact of Proximal Junctional Kyphosis and Distal Junctional Kyphosis Strategies for Prevention Conclusion 066 - Chapter 61 - Physical and Neurological Examination 61 - Physical and Neurological Examination Taking a Medical History General Physical Examination Spine Examination Posture Palpation and Range of Motion Testing of the Spine Cervical Spine Thoracic Spine Lumbar Spine Neurological Examination Motor Examination Cervical Spine Lumbar Spine Gait and Coordination Testing Deep Tendon and Superficial Reflexes Other Pathological Reflexes Sensory Examination Provocative Nerve Root or Nerve Testing Cervical Spine and Arm Provocative Examination Maneuvers Lumbar Spine and Leg Provocative Examination Maneuvers Differentiating Spinal Cord and Peripheral Nerve Pathology From Bony or Soft Tissue Pathology Cervical Radiculopathy Versus Upper Extremity Pathology Shoulder Elbow Sacroiliac Joint Hip Joint Video-Telemedicine Spine Evaluation During the COVID-19 Pandemic 067 - Chapter 62 - Sagittal Spinal Alignment_ An Evolutionary Perspective 62 - Sagittal Spinal Alignment: An Evolutionary Perspective Sagittal Spinal Alignment: An Evolutionary Perspective The Anatomical Transition From Quadrupeds to Bipeds The Establishment of Spinal Parameters Radiographic Measurement of Global Spinal Alignment Clinical Relevance of the Spinopelvic Relationship The Contribution of Pelvic Anatomy to Global Alignment The Relevance of Sagittal Balance to Spinal Surgery Planning Conclusion 068 - 63 – Spinal Alignment_ Significance and Preoperative Planning 63 - Spinal Alignment: Significance and Preoperative Planning Clinical and Radiographic Evaluation Etiology of Sagittal Malalignment Exhaustion of Nonsurgical Management Surgical Management Conclusion 069 - Chapter 64 - Overview of Imaging Procedures Available for Spinal Diagnosis 64 - Overview of Imaging Procedures Available for Spinal Diagnosis Plain Radiography Myelography Fluoroscopy Nuclear Scans Computed Tomography Ultrasonography Discography Magnetic Resonance Imaging Diffusion Tensor Imaging Conclusion 070 - Chapter 65 - Electrodiagnostic Studies 65 - Electrodiagnostic Studies Key Anatomy for Electrodiagnosis Nerve Fiber Injury Types and Relevance Components of the Electrodiagnostic Examination Nerve Conduction Studies Motor Conduction Studies Sensory Conduction Studies Needle Electrode Examination Late Responses Electrodiagnostic Localization of Spinal Disorders Radiculopathy Case Studies Polyradiculopathy Cervical Root Avulsion Lumbar Canal Stenosis Postoperative Electrodiagnostic Examination Recommendations for the Referring Physician 071 - Chapter 66 - Differential Diagnosis of Surgical Disorders of the Spine 66 - Differential Diagnosis of Surgical Disorders of the Spine Degenerative Disease of the Cervical Spine Degenerative Disease of the Lumbar Spine Trauma Posttraumatic Syringomyelia Charcot Spine Spinal Infection Spondylodiscitis Spinal Epidural Abscess Neoplastic Disease Inflammatory Disease of the Spine Rheumatoid Arthritis Ankylosing Spondylitis Vascular Lesions Affecting the Spinal Cord Spinal Cord Infarct Vascular Malformations Neurological Conditions of the Spinal Cord and Spinal Nerves Multiple Sclerosis Amyotrophic Lateral Sclerosis Guillain–Barré Syndrome Masqueraders of Spinal Pathology Musculoskeletal System Shoulder Hip Nervous System Compression Neuropathy Upper Extremity Compression Neuropathies Lower Extremity Compression Neuropathies Metabolic Neuropathy: Diabetic Neuropathy Visceral Organs and Related Systems Cardiovascular System Pulmonary System: Pancoast Tumor Gastrointestinal System Genitourinary System Gynecological System Summary 072 - Chapter 67 - Patient Selection for Spine Surgery_ Preoperative Optimization 67 - Patient Selection for Spine Surgery: Preoperative Optimization Diabetes Mellitus Patient Selection for Spine Surgery: Preoperative Optimization Tobacco Abuse Obesity Anemia Osteoporosis Psychosocial Factors Conclusion 073 - Chapter 68 - Evaluation of the Aging Patient 68 - Evaluation of the Aging Patient Evaluation of the Aging Patient Osteoporosis Functional Assessment Age-Related Risk Factors Summary 074 - 69 - Preoperative Evaluation of Psychosocial Aspects and Work-Related Issues 69 - Preoperative Evaluation of Psychosocial Aspects and Work-Related Issues Preoperative Evaluation of Psychosocial Aspects and Work-Related Issues Work-Related Issues Conclusion 075 - Chapter 70 - Preoperative Evaluation of Patients With Tumors Affecting the Spine 70 - Preoperative Evaluation of Patients With Tumors Affecting the Spine Diagnostic Imaging Plain Radiographs Preoperative Evaluation of Patients With Tumors Affecting the Spine Bone Scan Computed Tomography Magnetic Resonance Imaging Angiography Laboratory Tests and Inflammatory Markers Consideration of Spine Surgery in Metastatic Cancer The NOMS Criteria Neurological Oncological Mechanical Instability Systemic Prognostic Scoring Systems Conclusion 076 - Chapter 71 - Measuring Preoperative Health-Related Quality of Life_ What Metrics Matter 71 - Measuring Preoperative Health-Related Quality of Life: What Metrics Matter Key Characteristics of Health-Related Quality of Life Tools Measuring Preoperative Health-Related Quality of Life: What Metrics Matter Reliability, Validity, and Responsiveness Reliability Validity Floor and Ceiling Effects Responsiveness Clinically Important Differences Some Commonly Used Health-Related Quality of Life Tools in Spine Care (Table 71.1) Static Dynamic Choice of Health-Related Quality of Life Tools: Potential Considerations Conclusion 077 - Chapter 72 - Rehabilitation and Interventions in Management of Spinal Disorders 72 - Rehabilitation and Interventions in Management of Spinal Disorders Etiology of Back and Neck Pain Medical Treatment Options Prevention Initial Management Exercise and Physical Therapy Nonpharmacological Treatments Manipulation Massage Traction Superficial Heat or Cold Low-Level Laser Therapy Transcutaneous Electrical Nerve Stimulation, Ultrasound, Taping Summary: An Evidence-Informed Approach to Nonsurgical Management of Back and Neck Pain Acute Pain (12 Weeks) 078 - Chapter 73 - Spine Injections 73 - Spine Injections Epidural Injection Anatomy Spine Injections Cervical Epidural Steroid Injections Thoracic Epidural Steroid Injections Lumbar Epidural Steroid Injections Caudal Epidural Steroid Injection Medications Complications Contraindications Interlaminar Versus Transforaminal Approach Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks Indications Anatomy Technique Cervical Technique Lumbar Technique Sacral Technique Thoracic Technique Complications Facet Joint Injections, Medial Branch Nerve Blocks, and Radiofrequency Denervation Introduction Anatomy Facet Injections Atlantoaxial (C1‒C2) Facet Injection Cervical Intraarticular Facet Injection Cervical Medial Branch Block and Radiofrequency Treatment Thoracic Intraarticular Facet Injection Thoracic Medial Branch Block and Radiofrequency Treatment Lumbar Intraarticular Facet Injection Lumbar Medial Branch Block and Radiofrequency Treatment Complications Sympathetic Blocks Indications for Stellate Ganglion Blocks Anatomy of the Stellate Ganglion Technique of the Stellate Ganglion Block Fluoroscopic Technique Ultrasound Technique Complications of Stellate Ganglion Block Indications for Lumbar Sympathetic Block Anatomy of the Lumbar Sympathetic Chain Technique of the Lumbar Sympathetic Block Complications of the Lumbar Sympathetic Block Diagnostic Block Considerations Conclusion 079 - Chapter 74 - Cognitive Behavioral Therapy and Back Pain 74 - Cognitive Behavioral Therapy and Back Pain Key Components and Goals of Treatment for Chronic Pain and Chronic Low Back Pain Cognitive Behavioral Therapy and Back Pain Theoretical Foundation for Cognitive Behavioral Therapy for Pain Cognitive Behavioral Therapy: In-Depth Application to Chronic Pain Key Components of Clinical Intervention Pain Science Education Psychophysiological Relaxation Cognitive Restructuring Activity Pacing Case Example of the Cognitive Behavioral Therapy Model Cognitive Behavioral Therapy Adaptations: New Directions for Cognitive Behavioral Therapy and Pain Acceptance and Commitment Therapy Mindfulness-Based Stress Reduction Emotional Awareness and Expression Therapy Empirical Support for Cognitive Behavioral Therapy for Chronic Low Back Pain Cognitive Behavioral Therapy is Effective for Patients with Chronic Pain Cognitive Behavioral Therapy is Effective for Patients with Chronic Low Back Pain Treatment Format, Duration, and Intensity Brief Cognitive Behavioral Therapy for Pain. In recent years there have been efforts to develop and evaluate brief interventions... Digital Cognitive Behavioral Therapy for Pain. Darnall and colleagues adapted the abovementioned single-session pain psychology ... Special Subgroups: Efficacy of Cognitive Behavioral Therapy for Pain in Spine Surgery Special Subgroups: Efficacy of Cognitive Behavioral Therapy for Pain for Subacute Low Back Pain Treatment Moderators: Who Benefits Most From Cognitive Behavioral Therapy for Pain Conclusion 080 - Chapter 75 - Regenerative Strategies and Intervertebral Disc Degeneration 75 - Regenerative Strategies and Intervertebral Disc Degeneration Background Anatomy and Pathophysiology of the Intervertebral Disc Biological Therapy Cell-Based Therapy Indications for Disc Degeneration and Discogenic Pain Conclusion 081 - Chapter 76 - Neuromodulation and Rehabilitative Interventions for the Spine 76 - Neuromodulation and Rehabilitative Interventions for the Spine Past: Spinal Stimulation for Pain Control Present: Advances in Neuromodulation New Targets for Neuromodulation: Multifidus Stimulation Spinal Epidural Stimulation for Chronic Paralysis Future: The Spine as a Platform for Clinical Neuromodulation Treatment of Spasticity Related to Cerebral Palsy Advanced Spinal Imaging Spine Machine Interfaces Conclusion 082 - Chapter 77 - Pain Management_ Opioids and Alternatives 77 - Pain Management: Opioids and Alternatives Acetaminophen Nonsteroidal Antiinflammatory Drugs Oral Steroids Antidepressants Opioids Muscle Relaxants Anticonvulsants Topicals Cannabinoids Conclusion 083 - Chapter 78 - Fundamentals of Spine Surgery 78 - Fundamentals of Spine Surgery The Decision-Making Process Patient Selection Consent for Surgery Informed Consent Beyond Informed Consent Surgical Considerations Spinal Anatomy and Biomechanics Technology and the Spine Economics Conclusion 084 - Chapter 79 - Perioperative Management Protocols_ Enhanced Recovery After Surgery 79 - Perioperative Management Protocols: Enhanced Recovery After Surgery Brief History of Enhanced Recovery After Surgery in Other Surgical Specialties Perioperative Management Protocols: Enhanced Recovery After Surgery Physiological Foundation for Enhanced Recovery After Surgery Need for Enhanced Recovery After Surgery Programs in Spinal Surgery Phases of Enhanced Recovery After Surgery in Spinal Surgery Preoperative Phase Intraoperative Phase Postoperative Phase University of Miami Spinal Enhanced Recovery After Surgery Experience Awake Endoscopic Transforaminal Lumbar Interbody Fusion Enhanced Recovery After Surgery Following Traditional Lumbar Fusion Literature Review of Established Spinal Enhanced Recovery After Surgery Programs Enhanced Recovery After Surgery and Degenerative Lumbar Surgery Enhanced Recovery After Surgery Lumbar Laminectomy and Discectomy Enhanced Recovery After Surgery Lumbar Fusion Enhance Recovery After Surgery in Degenerative Cervical Surgery Enhanced Recovery After Surgery and Combined Spinal Pathologies Enhanced Recovery After Surgery and Spinal Deformity Surgery Enhanced Recovery After Surgery in Spinal Oncology Conclusion and Future Direction 085 - Chapter 80 - Surgical Incisions, Positioning, and Retraction 80 - Surgical Incisions, Positioning, and Retraction Sitting Position Ventral Cervical Operations Lateral Approaches Retractors Transoral Retractors Ventral Cervical Retractors Surgical Incisions, Positioning, and Retraction Ventral Thoracic and Lumbar Retractors Dorsolateral Thoracic and Lumbar Retractors Tube Retractors Approaches Dorsal Approaches to the Upper Cervical Spine Midline Dorsal Approach Lateral Transcondylar Approach Ventral Approaches to the Upper Cervical Spine Transoral Approach Endoscopic Approach Median Labiomandibular Glossotomy Bilateral Sagittal Split Mandibular Osteotomies Transthyroid Approach Ventrolateral Retropharyngeal Approach Lateral Cervical Approach Dorsal Approaches to the Subaxial Cervical Spine Laminectomy and Laminoplasty Laminoforaminotomy for Cervical Disc Disease Ventral Approaches to the Subaxial Cervical Spine Ventromedial Approach Ventrolateral Approach Ventral Approaches to the Cervicothoracic Junction Lower Ventromedial Cervical Approach Transsternal Approach Transmanubrial Approach Transverse Supraclavicular Approach Transclavicular Approach Transaxillary Extrapleural Approach Lateral Parascapular Extrapleural Approach Transpleural Transthoracic Approach Trapdoor Approach Combined Anterior-Posterior Approach in the Sitting Position Dorsal Approaches to the Thoracic and Thoracolumbar Spine Junction Thoracic Laminectomy Transpedicular Approach Costotransversectomy Lateral Extracavitary Approach Dorsal En Bloc Total Spondylectomy Ventral Approaches to the Thoracic and Thoracolumbar Spine Junction Transpleural Thoracotomy Extrapleural Thoracotomy Transdiaphragmatic Approach Ventrolateral Retroperitoneal Approach Simultaneous Ventral-Dorsal Approach Dorsal Approaches to the Lumbar and Lumbosacral Spine Lumbar Laminectomy and Laminotomy Paraspinal Approach Mini-Open Pedicle Subtraction Osteotomy Lateral Extracavitary Approach Ventral Approaches to the Lumbar and Lumbosacral Spine Lateral Transpsoas Approach Pelvic Brim Extraperitoneal Approach Transperitoneal Approach Dorsal Approaches to the Sacrum Ventral Approaches to the Sacrum Retroperitoneal Approach Transperitoneal Approach Combined Abdominosacral Approach 086 - Chapter 81 - Intraoperative Imaging Protocols 81 - Intraoperative Imaging Protocols Intraoperative Imaging Protocols Plain Film Radiography Fluoroscopy Image-Guided Navigation Components of Image-Guided Navigation Systems Navigation Techniques Clinical Applications Robot-Assisted Spinal Instrumentation Case Illustration Conclusion 087 - Chapter 82 - Anesthesia for Spine Surgery and the Prevention of Complications 82 - Anesthesia for Spine Surgery and the Prevention of Complications National Surgical Quality Improvement Program Database Risk Model Revised Cardiac Risk Index Anesthesia for Spine Surgery and the Prevention of Complications Biomarkers Ankle Brachial Index Movement of the Cervical Spine With Intubation Manual In-Line Stabilization and Cricoid Pressure Central Cord Syndrome and Direct Laryngoscopy Pathophysiological Changes With Prone Position Cardiovascular Changes Hemodynamic and Fluid Management during Spine Surgery in the Prone Position Important Functions of the Glycocalyx Perioperative Fluid Management and Glycocalyx Suitable and Practical Techniques for Goal-Directed Fluid Therapy and Perfusion Pressure During Spine Surgery Commonly Used Colloids During Spine Surgeries Albumin Hydroxyethyl Starch In Conclusion Changes in Respiratory Physiology Poisson Effect and Prone Position Intraoperative Neurophysiological Monitoring Mechanisms and Pathophysiology of Spinal Monitoring Changes Somatosensory-Evoked Potentials Limitations of Somatosensory-Evoked Potentials Motor-Evoked Potentials Spinal Versus Myogenic Motor-Evoked Potentials Myogenic Motor-Evoked Potentials After Multiple Stimulation Effects of Neuromuscular Blockade on Myogenic Motor-Evoked Potentials Effect of Temperature on Evoked Potentials Electromyography Effects of Anesthetics on Evoked Potentials Intravenous Anesthetics Treatment of Surgical Pain After Spine Surgeries Chronic Postsurgical Pain Postoperative Visual Loss After Spine Surgery Retinal Perfusion Pressure Arterial Blood Pressure Intraocular Pressure Types of Visual Loss and Impairment Associated With Spine Surgery Ischemic Optic Neuropathy Cortical Blindness Central Retinal Artery Occlusion Central Retinal Vein Occlusion Factors Contributing to Vision Loss and Impairment After Spine Surgery Head Position and Compartment Syndrome Effect of α2-Adrenergic Agonists on the Eye During Spine Surgery Other Complications Excessive Blood Loss and Inadequate Fluid Resuscitation Brachial Plexus Injuries Rhabdomyolysis Postoperative Neurocognitive Dysfunction After Spine Surgery Medicolegal Concerns 088 - Chapter 83 - Intraoperative Monitoring in Routine and Complex Surgery 83 - Intraoperative Monitoring in Routine and Complex Surgery Somatosensory-Evoked Potentials Electrode Placement System Settings Intraoperative Somatosensory-Evoked Potential Monitoring Assessment Motor-Evoked Potentials Electrode Placement Intraoperative Motor-Evoked Potential Monitoring Assessment Electromyography Free-Running Electromyography Triggered Electromyography Anesthesia Significant Changes in Neuromonitoring Conclusion 089 - Chapter 84 - Blood Management and Complex Spine Surgery 84 - Blood Management and Complex Spine Surgery Preoperative Evaluation Blood Management and Complex Spine Surgery Medication History Preoperative Estimation of Blood Loss Autologous Blood Use Allogenic Blood Product Use Transfusion Risks and Counseling Anesthetic Techniques for Lessening Intraoperative Blood Loss Operative Team Management Surgical Techniques for Reducing Blood Loss Local Agents for the Reduction of Blood Loss Fibrin Glue Positioning Intraoperative Blood Transfusion Intraoperative and Postoperative Blood Salvage Postoperative Drugs and Blood Loss Treatment and Diagnosis of Diffuse Intraoperative and Postoperative Bleeding Summary 090 - Chapter 85 - Intraoperative Crisis Management in Spine Surgery_ What to Do When Things Go Bad 85 - Intraoperative Crisis Management in Spine Surgery: What to Do When Things Go Bad Cardiac Arrest Vascular Injuries Anterior Cervical Approach Intraoperative Crisis Management in Spine Surgery: What to Do When Things Go Bad Posterior Cervical Approach Posterior Lumbar Approaches Anterior Lumbar Approaches Pedicle Screw Placement (Thoracic/Lumbar Spine) Iliac Crest Bone Graft Harvest Visceral Injuries Facet Reduction Electrophysiological Spinal Cord Monitoring Neurological Injuries Perioperative Emergent Complications Site-Specific Neurological Emergencies Spinal Cord Injury Conclusion 091 - Chapter 86 - Biologics in Spine Fusion Surgery 86 - Biologics in Spine Fusion Surgery Autograft Iliac Crest Bone Graft Local Bone Graft Bone Marrow Concentrates Allograft Demineralized Bone Matrix Cellular-Based Allograft Synthetic (Ceramic-Based) Bone Substitutes Recombinant Human Bone Morphogenetic Protein–2 Conclusion 092 - Chapter 87 - Osteointegration_ The Bone and Implant Interface 87 - Osteointegration: The Bone and Implant Interface Materials Osteointegration: The Bone and Implant Interface Surface Topography Surface Chemistry Hydroxyapatite Coating Porosity Conclusion 093 - Chapter 88 - Common Complications in Spine Surgery_ Pseudoarthrosis 88 - Common Complications in Spine Surgery: Pseudoarthrosis Biology of Bone Healing Diagnosis of Pseudoarthrosis Standard Radiography Dynamic Radiography Computed Tomography Magnetic Resonance Imaging Bone Scan Radiological Assessment of Bone Substitutes Risk Factors for Pseudoarthrosis Smoking Age and Race Osteoporosis and Nutrition Use of Nonsteroidal Antiinflammatories Radiation Therapy Alignment Incidence and Treatment Cervical Spine Thoracic and Lumbar Spine Thoracolumbar Pseudoarthrosis Lumbosacral Pseudoarthrosis Three-Column Osteotomy Interbody Fusion Augmentation of Fusion With Graft, Biologics, and Other Factors Autograft Osteoinductive Agents Osteoconductive Agents Summary 094 - Chapter 89 - Postoperative Medical Complications 89 - Postoperative Medical Complications Postoperative Medical Complications Pulmonary and Thromboembolic Complications Deep Venous Thrombosis Pulmonary Embolism Other Pulmonary Complications Cardiac Complications Renal Complications Gastrointestinal Complications Miscellaneous Complications Delirium Vision Loss Decubitus Ulceration Impact on Length of Stay Conclusion 095 - Chapter 90 - Preventing Postoperative Infections_ An Evidence-Based Approach 90 - Preventing Postoperative Infections: An Evidence-Based Approach Nutrition Antiseptic Shower Preventing Postoperative Infections: An Evidence-Based Approach Mupirocin Nasal Ointment Hair Removal Skin Preparation Handwashing Intraoperative Factors Surgical Gowns Double Gloving Antimicrobial Adhesive Drapes Antibiotic Prophylaxis Core Body Temperature Intraoperative Hyperoxygenation Surgical Drains Vancomycin Powder in the Surgical Bed Operating Room Hygiene Postoperative Factors Glucose Control Summary of the 2017 Centers for Disease Control Guidelines Summary 096 - Chapter 91 - Neurological Complications of Common Spine Operations 91 - Neurological Complications of Common Spine Operations Anterior Cervical Neurological Complications of Common Spine Operations Posterior Cervical Thoracic Spine Lumbar Spine Posterior Lumbar Anterior and Lateral Lumbar Conclusion 097 - Chapter 92 - Cerebrospinal Fluid Leak_ Repair and Outcomes 92 - Cerebrospinal Fluid Leak: Repair and Outcomes Cerebrospinal Fluid Leak: Repair and Outcomes Pathophysiology Clinical Features Diagnostic Studies Conservative Management Surgical Management Conclusion 098 - Chapter 93 - Arachnoiditis 93 - Arachnoiditis Pathogenesis Etiology Arachnoiditis Clinical Features Radiographic Features Spinal Epidural Fibrosis Treatment Summary 099 - Chapter 94 - Arachnoiditis and Syringomyelia 94 - Arachnoiditis and Syringomyelia Arachnoiditis and Syringomyelia Pathophysiology of Arachnoiditis-Associated Syringomyelia Arachnoiditis Syringomyelia Formation Radiographic Findings of Arachnoiditis Clinical Presentation and Clinical Course Treatment and Outcomes Nonsurgical Treatment Surgical Techniques to Minimize Development of Arachnoiditis Surgical Management of Lumbar Arachnoiditis Surgical Management of Syringomyelia Arachnoiditis Ossificans Summary 100 - Chapter 95 - Posttraumatic and Idiopathic Syringomyelia 95 - Posttraumatic and Idiopathic Syringomyelia Classification Posttraumatic and Idiopathic Syringomyelia Etiology Clinical Presentation Diagnosis Management Conclusions 101 - Chapter 96 - Vascular and Soft Tissue Complications 96 - Vascular and Soft Tissue Complications Complications in the Subaxial Spine Vascular and Soft Tissue Complications Recurrent Laryngeal Nerve Injury Esophageal Injury Esophageal Repair Laryngotracheal Injuries Carotid and Vertebral Artery Injury Complications at the Cervicothoracic Junction and in the Thoracic Spine Thoracic Duct Injuries Vascular Injuries Pulmonary Complications Thoracolumbar Junction and Lumbar Spine Splenic and Vascular Injury Ureteral Injury Bowel Injury Transabdominal Approaches to the Lumbosacral Spine Vascular Injury Lymphocele After the Anterior Approach to the Spine Complications of Posterior Lumbar Discectomy Complications of Minimally Invasive Thoracolumbar Discectomy and Fusion Complications Related to Thoracoscopy and Transthoracic Discectomy Vascular Injury Other Visceral Injury Instrumentation Complications Complications of Vertebral Cement Augmentation Summary 102 - Chapter 97 - Postoperative Spinal Deformities 97 - Postoperative Spinal Deformities Postoperative Spinal Deformities Decompression-Related Postoperative Spinal Deformities Posterior Decompression Clinical Presentation Instrumentation-Related Postoperative Deformities Adjacent Segment Disease Proximal Junctional Failures Surgical Correction of Postsurgical Deformity Conclusion 103 - Chapter 98 - Implant Wear, Degradation, and Breakage 98 - Implant Wear, Degradation, and Breakage Implant Wear, Degradation, and Breakage Wear Debris Particulate Characterization Quantifying and Characterizing Wear Debris Gravimetric Mass Morphological Characterization of Particulate Penetration Rate Ionic Concentrations Corrosion General Corrosion Fretting Corrosion Pitting Corrosion Crevice Corrosion Galvanic Corrosion Conclusion 104 - Chapter 99 - Spine Readmissions and Reoperations 99 - Spine Readmissions and Reoperations Definition and Prevalence Rates in Spine Surgery Risk Factors Spine Readmissions and Reoperations Cervical Spine Persistent Radiculopathy or Myelopathy Postoperative Cervical Instability Thoracolumbar Spine Persistent or Recurrent Neural Compression Postoperative Thoracolumbar Instability Postoperative Cauda Equina Syndrome Cerebrospinal Fluid Leakage Postoperative Infection Postoperative Hematoma Conclusion 105 - Chapter 100 - Cervical Spine Construct Design 100 - Cervical Spine Construct Design Fundamental Concepts Indications for Cervical Construct Application Clinical Instability Maintenance of Alignment Pain Management Construct Selection General Considerations Modes of Application Simple Distraction Tension-Band Fixation Three-Point Bending Cantilever Beam Fixation Construct Materials Bone Grafts Implants Construct Application Ventral Constructs Interbody Strut Graft Ventral Cervical Plate and Screw Constructs Hybrid Fusion Constructs Dorsal Constructs Wire Constructs Interlaminar Clamps Lateral Mass Rod Fixation Anterior-Posterior Constructs Economic Considerations Supplementary External Immobilization 106 - Chapter 101 - Occipitocervical Spine Approaches for Decompression 101 - Occipitocervical Spine Approaches for Decompression Pathology Surgical Anatomy Dorsal Surgical Anatomy of the Occipitocervical Region Occipitocervical Spine Approaches for Decompression Vertebral Artery Atlantooccipital Joint Approaches to the Occipitocervical Region Dorsal Approach to the Occipitocervical Region Ventral Approaches Ventral Retropharyngeal Approach Open Transoral Approach Endoscopic Approaches Endoscopic Transoral (Endooral) Approach Endoscopic Transnasal Approach Transcervical Approach Extended Approaches to the Craniocervical Junction Extended Maxillotomy Bilateral Sagittal Split Mandibular Osteotomy Transcondylar Approach to Craniovertebral Junction (Extreme Radial Craniocervical Approach) Avoidance of Complications Summary Acknowledgment 107 - Chapter 102 - Occipitocervical Spine Posterior Approaches for Fusion 102 - Occipitocervical Spine Posterior Approaches for Fusion Anesthetic Considerations Occipitocervical Spine Posterior Approaches for Fusion Ventral Approaches Indications Direct Odontoid Screw Fixation Contraindications Patient Positioning Operative Technique Controversies One-Screw Versus Two-Screw Constructs. Theoretically, with one screw the odontoid process could rotate on C2, although the inter... Screw Size and Type. Biomechanical data suggest that cannulated screws are only about 5% to 10% weaker than solid screws.33 Scre... Results Ventral C1‒C2 Transarticular Screw Fixation Other Ventral Techniques Dorsal Approaches Transarticular Screw Fixation Indications Contraindications Patient Positioning Operative Technique C1‒C2 Screw/Rod Constructs Bone Grafting Lasso Technique Screws Postoperative Care Results and Complications Occipitocervical Fusion Patient-Reported Outcomes Summary 108 - Chapter 103 - Endoscopic and Transnasal Approaches to the Craniocervical Junction 103 - Endoscopic and Transnasal Approaches to the Craniocervical Junction Endoscopic Transnasal Surgical Technique Operating Room Setup, Patient Positioning, and Equipment Endoscopic and Transnasal Approaches to the Craniocervical Junction Anesthetic Considerations Nasal Approach Endoscopic Transnasal Transclival Approach Endoscopic Transnasal Odontoidectomy Approach Reconstruction Postoperative Care Discussion Clinical Outcomes: Advantages and Limitations Conclusion 109 - Chapter 104 - Cervical Spine and Cervicothoracic Junction—Posterior 104 - Cervical Spine and Cervicothoracic Junction—Posterior Surface Anatomy Posterior Triangle of the Neck Spinal Anatomy Cervical Spine and Cervicothoracic Junction—Posterior Discs Ligaments Ligamentum Nuchea Intravertebral Foramen Blood Supply Posterior Subaxial Cervical Spine and Cervicothoracic Junction Pathology Degenerative Cervical Myelopathy Subaxial Cervical Spine and Cervicothoracic Junction Trauma Other Pathologies of the Subaxial Cervical Spine and the Cervicothoracic Junction Posterior Surgical Approaches Laminectomy and Fusion Laminoplasty Posterior Keyhole Laminotomy/Foraminotomy Transpedicular Costotransversectomy and the Lateral Extracavitary Approach Minimally Invasive Posterior Approach Acknowledgment 110 - Chapter 105 - Posterior Cervical Decompressions_ Cervical Laminectomy and Laminoforaminotomy 105 - Posterior Cervical Decompressions: Cervical Laminectomy and Laminoforaminotomy Technique Positioning Anesthetic Concerns Incision and Dissection Laminectomy Foraminotomy Summary 111 - Chapter 106 - Cervical Laminoplasty 106 - Cervical Laminoplasty Background of the Development of Laminoplasty Surgical Indication Surgical Technique used for Laminoplasty Surgical Results Complications Closure of Expanded Lamina Segmental Motor Paralysis (C5 Palsy) Axial Pain Conclusions 112 - Chapter 107 - Dorsal Subaxial Cervical Instrumentation Techniques 107 - Dorsal Subaxial Cervical Instrumentation Techniques Etiologies Indications for Surgery Trauma Tumor Degenerative Disorders Surgical Exposure Bony Fusion Techniques Lateral Mass Screw Fixation Cervical Pedicle Screw Fixation Minimally Invasive Intrafacet Fusion Decision to Cross the C7–T1 junction Postoperative Care Complication Management Neurological and Vascular Complications Spinal Complications Wound Complications Summary 113 - Chapter 108 - Posterior Percutaneous and Minimally Invasive Approaches to Decompression and Arthrodesis of the Cervical Spine 108 - Posterior Percutaneous and Minimally Invasive Approaches to Decompression and Arthrodesis of the Cervical Spine Posterior Percutaneous and Minimally Invasive Approaches to Decompression and Arthrodesis of the Cervical Spine Indications Preoperative Evaluation Operative Setup Positioning Surgical Approach Laminotomy/Foraminotomy/Discectomy Decompression for Stenosis Posterior Cervical Transfacet Fusion Cages Lateral Mass Fixation Closure and Postoperative Care Outcomes and Results Complications Summary 114 - Chapter 109 - Cervical Spine and Cervicothoracic Junction—Anterior Approach 109 - Cervical Spine and Cervicothoracic Junction—Anterior Approach Cervical Spine Pathology and Indications for Surgery Degenerative Disease Goals of Surgery Surgical Consideration Neoplasm Surgical Considerations Infection Goals of Surgery Surgical Considerations Trauma Surgical Considerations Surgical Approaches Subaxial Cervical Spine Patient Positioning Surgical Exposure: Anterior Surgical Exposure: Anterolateral Cervicothoracic Junction Positioning Surgical Exposure: Supracalvicular Surgical Exposure: Transmanubrial-Transclavicular Surgical Exposure: Transsternal Discectomy Corpectomy Fusion and Instrumentation Bone Graft Titanium Graft Polyetheretherketone Graft Cervical Disc Arthroplasty Cervicothoracic Junction Complications Esophageal Injury Recurrent Laryngeal Nerve Injury Vertebral Artery Injury Cerebrospinal Fluid Leak 115 - Chapter 110 - Anterior Cervical Discectomy and Corpectomy 110 - Anterior Cervical Discectomy and Corpectomy Anterior Cervical Pathologies Approach and Limitations Preoperative Planning Positioning Complication Avoidance Exposure Complication Avoidance High Dissections (C4 and Above) Complication Avoidance Low Dissections (C7 and Below) Complication Avoidance Retractor and Distracting Pin Placement Discectomy Complication Avoidance Corpectomy Complication Avoidance Spinal Reconstruction Complication Avoidance Discectomy Versus Corpectomy Conclusion 116 - Chapter 111 - Management of Soft Cervical Disc Herniation_ Controversies and Complication Avoidance 111 - Management of Soft Cervical Disc Herniation: Controversies and Complication Avoidance Approach to Surgical Decision Making Surgical Options for Soft Disc Herniation Anterior Approaches Anterior cervical discectomy and fusion Cervical total disc replacement Cervical corpectomy Posterior Approaches Posterior cervical laminoforaminotomy Approach Decision Common Complications and Avoidance Vascular Injury Esophageal and Tracheal Injury Dural Tear and Cerebrospinal Fluid Leak Neurological Injury Airway Compromise Complications and Complication Avoidance Unique to Cervical Total Disc Replacement Complications and Complication Avoidance Unique to Posterior Cervical Laminoforaminotomy Conclusion 117 - Chapter 112 - Anterior Subaxial Cervical Fixation and Fusion Techniques 112 - Anterior Subaxial Cervical Fixation and Fusion Techniques Background Anterior Instrumentation Rigid and Dynamic Anterior Plating Systems Interbody Options for Anterior Subaxial Fixation Anterior Interbody Pseudarthrosis and Subsidence Additional Techniques for Anterior Subaxial Fixation and Fusion Skip Corpectomy Floating Corpectomy Anterior Controllable Antedisplacement Fusion Conclusion 118 - Chapter 113 - Cervical Total Disc Arthroplasty 113 - Cervical Total Disc Arthroplasty Rationale for Cervical Arthroplasty Nomenclature, Biomaterials, and Biomechanics Indications and Contraindications Cervical Arthroplasty: The Clinical Evidence Effect of Cervical Disc Replacement on Adjacent Segment Disease Potential Complications and Complication Avoidance Conclusion 119 - Chapter 114 - Combined Ventral-Dorsal Surgery 114 - Combined Ventral-Dorsal Surgery ACUTE CERVICAL SPINE INJURY Kyphotic Deformity Neoplasms Ankylosing Spondylitis Cervical Spondylotic Myelopathy Complications and Avoidance Summary 120 - 115 - Thoracic and Lumbar Spine Construct Design 115 - Thoracic and Lumbar Spine Construct Design Nomenclature Indications for Spinal Instrumentation Construct Types (Modes of Force Application) Development of a Construct Blueprint Line Drawing of Proposed Construct Level of Lesion and Level of Fusion Depiction of Implant Components Mechanical Attributes of Spinal Implants: Construct Type Construct Design Strategies Bony Integrity Location of the Unstable Spinal Segment Implant Length Instrumentation Fusion Mismatch (“Rod Long, Fuse Short”) Short-Segment Fixation Cross Fixation Axial Loadbearing Capacity of the Instrumented Spine Finite Element Spinal Surgical Simulator Nature of Instability Kyphotic Deformity Translational Deformity Axial Loading Deformity (Burst Fracture) Flexion-Distraction (Seat Belt) Deformity Scoliotic Deformity Need for Decompression Armamentarium of the Surgeon 121 - Chapter 116 - Posterior Approaches to the Thoracic Spine 116 - Posterior Approaches to the Thoracic Spine ANATOMY Thoracic Spine Approaches Selecting an Approach Midline Approach Indications and Contraindications Advantages and Disadvantages Technique Transpedicular Approach Indications and Contraindications Advantages and Disadvantages Technique Costotransversectomy Indications and Contraindications Advantages and Disadvantages Technique Lateral Extracavitary Approach Indications and Contraindications Advantages and Disadvantages Technique Summary 122 - 117Chapter - Anterior and Lateral Approaches to the Thoracic Spine 117 - Anterior and Lateral Approaches to the Thoracic Spine Transpedicular Approach Overview Operative Planning Surgical Technique Postoperative Care and Follow-Up Costotransversectomy and Lateral Extracavitary Mini-Open Extracavitary Transpedicular Corpectomy Overview Operative Planning Surgical Technique Postoperative Care and Follow-Up Retropleural Thoracotomy Overview Surgical Technique Postoperative Care and Follow-Up Minimally Invasive Retropleural Approach Transpleural Thoracotomy Endoscopic Transpleural Thoracotomy Direct Anterior Thoracic Approaches Summary 123 - Chapter 118 - Minimally Invasive Lateral Thoracic Decompression 118 - Minimally Invasive Lateral Thoracic Decompression Indications for Operative Intervention Neoplasm Trauma Infection Deformity and Degenerative Conditions Minimally Invasive Surgical Approaches for Thoracic Decompression Minimally Invasive Transthoracic Approach Thoracoscopic-Assisted Minimally Invasive Approach Minimally Invasive Extracavitary Approach Minimally Invasive Retropleural Approach Minimally Invasive Retropleural Approach to the Thoracolumbar Spine Conclusion 124 - Chapter 119 - Thoracoscopic Corpectomy and Reconstruction 119 - Thoracoscopic Corpectomy and Reconstruction Advantages and Disadvantages Indications and Contraindications Preoperative Assessment and Planning Radiographic and Diagnostic Evaluation Planning of Approach Planning of Resection and Reconstruction Operative Technique Thoracoscopic Instruments and Instrumentation Systems Anesthesia Patient Positioning Localization Access Dissection and Exposure Vertebral Body Screw Instrumentation Vertebral Body Resection and Spinal Canal Decompression Vertebral Body Reconstruction and Completion of Instrumentation Chest Tube Placement and Wound Closure Technical Tips Outcomes Conclusion 125 - 120 - Posterolateral Thoracolumbar Fusion 120 - Posterolateral Thoracolumbar Fusion Surgical Technique Graft Materials Bone Morphogenetic Proteins Postoperative Bracing Other Nonunion Risks Instrumentation Spondylolisthesis as an Indication for Posterolateral Fusion Cost Effectiveness Summary 126 - 121 – Posterior Thoracic and Lumbar Universal Spine Instrumentation 121 - Posterior Thoracic and Lumbar Universal Spine Instrumentation HISTORY Surgical Indications Distraction Tension Band Fixation Three-Point Bending Cantilever Beam Constructs Biomechanical Properties Of Universal Spine Instrumentation Systems Metallurgy Polyetheretherketone Hook Design Pedicle Screws Longitudinal Members Component–Component Junctions Polyaxial Pedicle Screws Technical Aspects of Implant Application Pedicle Screw Insertion Laminar Hook Insertion Pedicle Hooks Transverse Process Hook Insertion Cross-Fixation Complication Avoidance and Management Complications of Hook Fixation Complications of Transpedicular Fixation Summary 127 - Chapter 122 - Midline Lumbar Interbody Fusion With Cortical Bone Trajectory Pedicle Screw Placement 122 - Midline Lumbar Interbody Fusion With Cortical Bone Trajectory Pedicle Screw Placement Surgical Indications and Contraindications Surgical Technique Positioning Fluoroscopy Exposure Laminectomy and Facetectomy Disc Preparation and Interbody Placement Cortical Bone Screw Placement Closure Postoperative Care Complications 128 - Chapter 123 - Transforaminal Lumbar Interbody Fusion 123 - Transforaminal Lumbar Interbody Fusion Indications Preoperative Radiographic Studies Overview of the Procedure Surgical Technique Patient Positioning Planning the Incision Phase I: Access Port Docking, Exposure, and Pedicle Screw Placement Phase II: Osteotomies and Decompression of the Segment Phase III: End Plate Preparation, Trial, and Interbody Placement Complication Avoidance Surgical Early Postoperative Phase Late Postoperative Phase Conclusion 129 - Chapter 124 - Dorsal Semirigid Stabilization 124 - Dorsal Semirigid Stabilization Adjacent Segment Pathology Semirigid System Rationale Neutral Semirigid Systems Dynamic Screw Systems Semirigid Rod Systems Compressive Semirigid Systems Artificial Ligament Systems Distractive Semirigid Systems, Interspinous Process Spacers Wallis X-Stop Device for Intervertebral Assisted Motion Coflex System Superion Total Facet Replacement Systems Total Facet Arthroplasty System ACADIA TOPSTM Posterior Arthroplasty System Facet Joint Resurfacing Disadvantages and Complications Conclusion 130 - 125 – Lumbar Total Disc Arthroplasty 125 - Lumbar Total Disc Arthroplasty BACKGROUND INDICATIONS CURRENT DESIGNS LUMBAR TDR DEVICES AVAILABLE IN THE UNITED STATES LUMBAR TDR DEVICES AVAILABLE OUTSIDE THE UNITED STATES TWO-LEVEL LUMBAR TDR MID- AND LONG-TERM OUTCOMES HYBRID RECONSTRUCTION ADJACENT SEGMENT DEGENERATION COMPLICATIONS COST AND INSURANCE COVERAGE FUTURE DIRECTIONS AND CONCLUSIONS 131 - Chapter 126 - Minimally Invasive Spinal Decompression and Stabilization Techniques I_ Philosophy and Rationale 126 - Minimally Invasive Spinal Decompression and Stabilization Techniques I: Philosophy and Rationale EVOLUTION OF MINIMALLY INVASIVE SPINE SURGERY Lumbar Spine Minimally Invasive Lumbar Discectomy Percutaneous Endoscopic Lumbar Laminectomy Endoscopic Lumbar Foraminotomy Percutaneous Translaminar Facet Screw Fixation Transforaminal Lumbar Interbody Fusion Mini-Open Retroperitoneal Interbody Fusion Minimally Invasive Lateral Approach for Lumbar Interbody Fusion Minimally Invasive Oblique Approach for Lumbar Interbody Fusion Midline Lumbar Fusion With Cortical Bone Trajectory Screws Thoracic Spine Cervical Spine Anterior Cervical Spine Decompression Posterior Cervical Decompression Conclusion 132 - Chapter 127 - Posterior Approaches to the Lumbar Spine_ Minimally Invasive Decompression 127 - Posterior Approaches to the Lumbar Spine: Minimally Invasive Decompression POSTERIOR MINIMALLY INVASIVE APPROACHES TO THE LUMBAR SPINE Indications Preoperative Evaluation Operative Setup Positioning Surgical Technique Minimally Invasive Lumbar Foraminotomy Minimally Invasive Lumbar Discectomy Minimally Invasive Posterior Lumbar Decompression Closure and Postoperative Care Outcomes and Results Complications Summary 133 - Chapter 128 - Endoscopic Approaches to the Cervical Spine 128 - Endoscopic Approaches to the Cervical Spine POSTERIOR CERVICAL UNILATERAL LAMINECTOMY FOR BILATERAL DECOMPRESSION Indications Surgical Technique Posterior Cervical Foraminotomy Indications Surgical Technique Anterior Endoscopic Cervical Discectomy Indications Surgical Technique Anterior Cervical Transcorporal Discectomy Indications Surgical Technique Discussion 134 - Chapter 129 - Endoscopic Surgical Approaches to the Lumbar Spine 129 - Endoscopic Surgical Approaches to the Lumbar Spine ENDOSCOPIC LUMBAR DISCECTOMY Transforaminal Discectomy11 Interlaminar Discectomy14 Patient Selection Technical Considerations Outcome Endoscopic Lumbar Fusion Patient Selection for Endoscopic Lumbar Fusion Technique Technical Considerations Outcome Conclusion Endoscopic Revision of Lumbar Spinal Fusions Complications Associated With Endoscopic Spine Surgery Neural Injury and Dural Tears Injury to Vascular Structures and Postoperative Hematoma Injury to Abdominal Contents Incomplete Decompression and Recurrence of the Disc Herniation Future Trends 135 - Chapter 130 - Posterior Approaches to the Lumbar Spine_ Minimally Invasive Fusion 130 - Posterior Approaches to the Lumbar Spine: Minimally Invasive Fusion Midline Lumbar Interbody Fusion Minimally Invasive Posterior Lumbar Interbody Fusion Minimally Invasive Transforaminal Lumbar Interbody Fusion Endoscopic Transforaminal Lumbar Interbody Fusion Comparison With Open Techniques Biomechanics Complications and Clinical Results Infection Cost Benefit Conclusion 136 - Chapter 131 - Anterior Lumbar Interbody Fusion 131 - Anterior Lumbar Interbody Fusion HISTORY Preoperative Considerations Patient Selection Medical Considerations Imaging Intraoperative Considerations Positioning Incision Exposure Retraction Discectomy Distraction Bone Graft Harvest Bone Morphogenetic Protein Fusion Plating Dorsal Supplementation Postoperative Complications Specific Issues Related to the Lower Lumbar Anterior Lumbar Interbody Fusion and the Relationship to Sagittal Balance Multilevel Anterior Lumbar Interbody Fusion Summary 137 - Chapter 132 - Anterior and Anterolateral Lumbar Spine Decompression and Fusion_ Minimally Invasive Surgery Approaches 132 - Anterior and Anterolateral Lumbar Spine Decompression and Fusion: Minimally Invasive Surgery Approaches REGIONAL ANATOMY Lumbar Plexus Safety Zones Vascular Anatomy Applications of Anterolateral Approaches Surgical Technique Preoperative Planning Lateral Positioning Operative Procedure Lateral Plate Complications Numbness, Paresthesia, and Weakness Abdominal Wall Paresis Subsidence Prespoas Versus Transpsoas Approaches Anterior Approach Conclusion and Key Points 138 - Chapter 133 - Complex Lumbosacropelvic Fixation Techniques 133 - Complex Lumbosacropelvic Fixation Techniques Anatomic and Biomechanical Considerations Sacrum Structures Adjacent to the Sacrum Sacroiliac Joint Muscular Interactions Indications for Lumbosacropelvic Fixation Lumbosacral Pivot Point Complex Techniques of Sacral Fixation Fixation with Sublaminar Devices Fixation With Screws Devices for Sacral Fixation With Multiple Screws Fixation Across the Sacroiliac Joint Complications of Complex Lumbopelvic Fixation Revision Surgery Summary 139 - Spinal Augmentation for Vertebral Compression Fractures 134 - Spinal Augmentation for Vertebral Compression Fractures Workup for Vertebral Compression Fractures Vertebroplasty Surgical Technique Case Example Lumbar Spine Compression Fracture Outcomes Kyphoplasty Surgical Technique Outcomes Vertebral Augmentation with Expandable Metal Implants Complications of Vertebroplasty and Kyphoplasty Conclusion 140 - Chapter 135 - Indications for Spine Fusion for Axial Pain 135 - Indications for Spine Fusion for Axial Pain Pathophysiology Diagnosis Plain Radiographs Discography Magnetic Resonance Imaging Nonsurgical Treatment Surgical Treatment Lumbar Fusion Outcomes of Lumbar Fusion Patient Predictors of Treatment Outcome Conclusion 141 - Chapter 136 - Cervical Disc Herniation 136 - Cervical Disc Herniation Background Pathophysiology and Diagnosis Case Example Management Surgical Approach Posterior Cervical Foraminotomy Anterior Cervical Discectomy and Fusion Cervical Disc Arthroplasty Complications Preoperative Considerations Dysphagia Recurrent Laryngeal Nerve Injury Durotomy Surgical Site Infection Esophageal Perforation Airway Compromise Vertebral Artery Injury Case Examples Case 1 Case 2 142 - Chapter 137 - Lumbar Intervertebral Disc Herniation 137 - Lumbar Intervertebral Disc Herniation RISK FACTORS FOR RECURRENT DISC HERNIATIONS Evaluation of Recurrent Disc Herniation Management of Recurrent Disc Herniation Conclusion 143 - Chapter 138 - Thoracic Discectomy 138 - Thoracic Discectomy CLINICAL PRESENTATIONS Indications for Surgery Preoperative Planning and Imaging Surgical Strategies Posterior Approach Laminectomy Posterolateral Approaches Transpedicular Approach Transfacet Pedicle-Sparing Approach Oblique Paraspinal Approach with a Tubular Retractor Lateral Approaches Lateral Extracavitary Approach Lateral Parascapular Extrapleural Approach Costotransversectomy Ventrolateral Approaches Transthoracic thoracotomy Mini-Open Thoracotomy Approach Transthoracic Thoracoscopy Transsternal Approach Transforaminal Endoscopic Approach Special Considerations Postoperative Management Complications Case Examples 144 - Chapter 139 - Degenerative Spondylolisthesis 139 - Degenerative Spondylolisthesis Classification Clinical Presentation Imaging Nonsurgical Treatment Surgical Treatment Decompression Alone Versus Decompression and Fusion Use of Interbody Fusion Sagittal Alignment Complications Conclusion 145 - Chapter 140 - Sacroiliac Joint Pain 140 - Sacroiliac Joint Pain ANATOMY AND PATHOPHYSIOLOGY OF THE SACROILIAC JOINT Diagnosis of Sacroiliac Joint Pain Physical Examination of the Sacroiliac Joint Diagnostic Injection of the Sacroiliac Joint Nonoperative Treatment of Sacroiliac Joint Pain Surgical Treatment of Sacroiliac Joint Pain Surgical Approaches for Sacroiliac Joint Fusion Minimally Invasive Sacroiliac Joint Fusion Minimally Invasive Transiliac Approach Open Sacroiliac Joint Fusion Conclusion 146 - Chapter 141 - Surgical Principles for Spinal Deformity 141 - Surgical Principles for Spinal Deformity Indications for Surgery Patient Selection Mitigating Surgical Risk General Terms Preoperative Planning and Radiographic Analysis Measurements in the Coronal Plane Measurements in the Sagittal Plane Causes of Spinal Deformity Congenital Deformities Neuromuscular Scoliosis Adolescent Idiopathic Scoliosis Scheuermann Kyphosis Degenerative Deformities Iatrogenic Deformities Principles of Deformity Surgery Obtaining Flexibility Ventral Releases Posterior Osteotomies Obtaining Correction Cantilever Forces In Situ Rod Contouring Compression and Distraction Derotation Obtaining Fixation Pedicle Screw Placement Sacroiliac Fixation Summary 147 - Chapter 142 - An Approach for Treatment of Complex Adult Spinal Deformity 142 - An Approach for Treatment of Complex Adult Spinal Deformity Define the Problem Goals Osteoporosis Options Decompression Alone Fusion Without Instrumentation Limited Fusion Instrumented Correction and Fusion Instrumentation in Osteoporosis Interspinous Spacers Anterior Column Reconstruction Osteotomies Vertebral Column Resection Plans Outcomes of Complex Surgery for Adult Deformity Conclusion 148 - Chapter 143 - An Approach for Treatment of Complex Pediatric Spinal Deformity 143 - An Approach for Treatment of Complex Pediatric Spinal Deformity GROWTH OF THE SPINE Evaluation Clinical Evaluation Imaging Evaluation Idiopathic Scoliosis: Early Onset and Adolescent Onset Adolescent Idiopathic Scoliosis Clinical Features Classification Treatment Early-Onset Scoliosis Clinical Features Treatment Congenital Disorders Congenital Scoliosis Dysplastic Spondylolisthesis Congenital Lordosis Congenital Kyphosis Neuromuscular Disorders Cerebral Palsy Neuromuscular Dystrophies and Myopathies Conclusion 149 - Chapter 144 - Cervicothoracic Deformity_ The Role of Anterior Surgery 144 - Cervicothoracic Deformity: The Role of Anterior Surgery Clinical Evaluation of Cervicothoracic Junction Deformity Patients Anatomical Considerations Anatomy of Anterior Access Etiologies of Deformity Surgical Management of Cervicothoracic Junction Deformity Surgical Access Approaches Smith–Robinson Sternal Splitting Manubriotomy T Incision Interaortocaval Subinnominate Window Approach Algorithm Complications Case Presentations Case 1 Case 2 Conclusion 150 - Chapter 145 - Cervical and Cervicothoracic Deformity Correction_ Posterior-Based Osteotomies 145 - Cervical and Cervicothoracic Deformity Correction: Posterior-Based Osteotomies Preoperative Evaluation Cervical Alignment Parameters and Quality of Life Outcomes Surgical Strategies for the Correction of Cervical and Cervicothoracic Deformities Posterior-Based Osteotomies Grade 1 Osteotomy Grade 2 Osteotomy Smith-Petersen Osteotomy Grade 5 Osteotomy Grade 6 Osteotomy Grade 7 Osteotomy Perioperative and Mechanical Complications Case Presentations Smith-Petersen Osteotomy Pedicle Subtraction Osteotomy Conclusion 151 - Chapter 146 - The Role of Anterior Surgery for Thoracolumbar Deformity 146 - The Role of Anterior Surgery for Thoracolumbar Deformity ANTERIOR VERSUS POSTERIOR APPROACHES TO SPINAL DEFORMITY Advantages of the Anterior Approach to the Spine Surgical Approaches to the Anterior Thoracolumbar Spine Paramedian approach to L3‒S1 Anterior Approaches to the Lumbar Spine in the Lateral Position Complications and Complication Avoidance in Anterior Spine Surgery Anterior Surgery Lateral Approaches to the Lumbar Interbody Space Anterior Approaches for Spinal Deformity: Case Examples Postlaminectomy Deformity Anterior Spinal Fusion for the Lenke 5C Deformity in Children and Adults Fractional Deformity Correction Conclusion 152 - Chapter 147 - Anterior Column Release in Deformity 147 - Anterior Column Release in Deformity Preoperative Evaluation Lordosis Procedural Contraindications Surgical Considerations Side of Approach Approach Anterior Column Release Anatomy Surgical Technique Posterior Fixation Complications Vascular Injuries Neurological Injury Proximal Junctional Kyphosis Conclusion 153 - Chapter 148 - Posterior-Based Management of Spinal Deformity 148 - Posterior-Based Management of Spinal Deformity POSTERIOR OSTEOTOMIES FOR SPINAL MOBILIZATION Partial Facet Joint Resection Complete Facet Joint Resection Pedicle Subtraction Osteotomy Conclusion 154 - Chapter 149 - Minimally Invasive Approaches to Spinal Deformity 149 - Minimally Invasive Approaches to Spinal Deformity GOALS OF MINIMALLY INVASIVE TECHNIQUES FOR SPINAL DEFORMITY Correct Sagittal Imbalance (Sagittal Vertical Axis >5 cm) Correct Coronal Curvature Restore Pelvic Incidence and Lumbar Lordosis Harmony Minimally Invasive Surgery Deformity Algorithm Minimally Invasive Surgical Approaches Anterior Lumbar Interbody Fusion Lateral Lumbar Interbody Fusion Transpsoas Approach Prepsoas/Antepsoas Approach Anterior Column Release Posterior Approaches for Stabilization and Fusion Expandable Transforaminal Lumbar Interbody Fusion With Facetectomies Percutaneous Thoracolumbar Pedicle Screw Fixation Percutaneous Sacropelvic Fixation Rod Contouring, Passage, and Connection Navigation and Robotics in Minimally Invasive Surgery Complications and Complication Avoidance Conclusion 155 - Chapter 150 - Surgical Management of High-Grade Dysplastic Spondylolisthesis 150 - Surgical Management of High-Grade Dysplastic Spondylolisthesis Clinical Presentation of High-Grade Dysplastic Spondylolisthesis Management of High-Grade Dysplastic Spondylolisthesis Operative Versus Nonoperative Management of High-Grade Dysplastic Olisthesis Specific Surgical Approaches for the Management of High-Grade Dysplastic Olisthesis In Situ Fixation and Partial Reduction and In Situ Fixation for Spondylolisthesis Posterior-Based Reduction of High-Grade Dysplastic Spondylolisthesis Anterior and Posterior Approach to High-Grade Dysplastic Spondylolisthesis Conclusion 156 - Chapter 151 - Deformity Surgery for Ankylosing Spondylitis 151 - Deformity Surgery for Ankylosing Spondylitis CLINICAL PRESENTATION Clinical Management Principles of Medication Management for Ankylosing Spondylitis Patients Complications of Ankylosing Spondylitis Surgical Management General Principles Surgical Correction Smith-Petersen Osteotomy Polysegmental Wedge Osteotomy Pedicle Subtraction Osteotomy Anesthesia, Neuromonitoring, and Intraoperative Care Internal Fixation Complications Navigation Summary 157 - Chapter 152 - Failed Back Surgery Syndrome 152 - Failed Back Surgery Syndrome Risk Factors for Failed Back Surgical Syndrome Preoperative Factors Operative and Perioperative Risk Factors Pathophysiology of Failed Back Surgical Syndrome Diagnosis History and Physical Imaging Medical Treatment Pharmacological Therapies Other Conservative Treatments Invasive Procedures and Surgical Treatment Injections Adhesiolysis Rhizotomy Spinal Cord Stimulation Revision Surgery Intrathecal Pump Case Presentations Case 1 Case 2 Conclusion 158 - Chapter 153 - Oncological Approaches, and Outcomes for Primary Spine Tumors 153 - Oncological Approaches, and Outcomes for Primary Spine Tumors Preoperative Planning Clinical Features and Evaluation Biopsy for Histopathological Diagnosis Oncological Staging Surgical Staging Oncological Surgical Approaches General Concepts Level-Specific Challenges Craniocervical Junction, Subaxial Cervical Spine, and Cervicothoracic Junction Thoracic Spine Lumbar Spine Sacrum Complications Outcomes of Primary Spine Tumors Benign Tumors Malignant Tumors Summary 159 - Chapter 154 - Staging, Classification, and Oncological Approaches for Metastatic Tumors Involving the Spine 154 - Staging, Classification, and Oncological Approaches for Metastatic Tumors Involving the Spine DECISION FRAMEWORKS Presentation Staging and Classification Imaging Metabolic and Physiological Issues Estimating Tumor Burden in Other Regions Pain Control Treatment Antitumor Systemic Therapy Steroids Bisphosphonates and Denosumab Treatment Decisions Radiosensitive Tumors Radioresistant Tumors Surgery Systemic Disease Assessment Treatment Decision Making Case Presentations Case 1: Mechanical Back Pain Requiring Posterolateral Decompression Case 2: Biological Pain Treated With Image-Guided Intensity-Modulated Radiation Therapy Case 3: Mechanical Instability Conclusion 160 - Chapter 155 - Tumors at the Foramen Magnum and Craniocervical Junction 155 - Tumors at the Foramen Magnum and Craniocervical Junction Pathology and Epidemiology Intradural Intramedullary Tumors Intradural Extramedullary Tumors Extradural Tumors Differential Considerations Clinical Presentation Surgical Anatomy Osseous Structures Muscles Neural Structures Vascular Structures Imaging of Tumors Alteration of Anatomy by the Tumor Surgical Approach Selection and Considerations Dorsal Approach Far Lateral Approach Transoral Approach Endoscopic Approaches Complications Neurological Complications Vascular Injury Infections Cerebrospinal Fluid Leak Systemic Complications Summary 161 - Chapter 156 - Cervicothoracic Junction Tumors 156 - Cervicothoracic Junction Tumors PRESENTATION AND TREATMENT Radiation and Stereotactic Radiosurgery Surgical Treatment Surgical Indications Preoperative Evaluation Ventral Approach Operative Technique Advantages and Risks Lateral Parascapular Extrapleural Approach Operative Technique Advantages and Risks Dorsal Approach Operative Technique Cervicothoracic Junction Challenges: Biomechanical Considerations Cervicothoracic Junction Tumors: Instrumentation Outcomes and Complications Following Surgical Treatment Summary 162 - Chapter 157 - Thoracic and Thoracolumbar Spinal Tumors_ Regional Challenges 157 - Thoracic and Thoracolumbar Spinal Tumors: Regional Challenges Primary Spinal Tumors Metastatic Spinal Tumors Surgical Margins Spine Stability Neurological Stability Surgical Considerations for Patients Undergoing Radiation Therapy Technical Aspects of the Surgical Approach Preoperative Embolization in Surgical Treatment Dorsal Approach Ventral Approach Dorsolateral Approach Separation Surgery Minimally Invasive Approach New Horizons in the Treatment of Thoracic and Thoracolumbar Spinal Tumors Complications Summary 163 - Chapter 158 - Sacral Tumors_ Regional Challenges 158 - Sacral Tumors: Regional Challenges TUMOR CLASSIFICATION Metastatic Tumors Congenital Lesions Primary Osseous Tumors Primary Neurogenic Tumors Diagnosis Clinical Presentation Diagnostic Imaging Diagnostic Biopsy Surgical Approaches Preoperative Planning Sacral Laminectomy Dorsal Approach for Sacrectomy Combined Ventral and Dorsal Sacral Resection Reconstruction After Sacrectomy Postoperative Management and Complications Summary 164 - Chapter 159 - Radiosurgery for Spinal Tumors 159 - Radiosurgery for Spinal Tumors Benefits of Spine Radiosurgery Spine Radiosurgery as Primary and Definitive Therapy Radiosurgery as a Postsurgical Adjuvant Treatment Radiosurgery in the Setting of Reirradiation Radiosurgery Combined with Minimally Invasive Techniques and High-Grade Compression Oligometastatic Disease Complications of Spine Radiosurgery Benign Tumors and Future Applications Summary 165 - Chapter 160 - The Acute Management of Traumatic Spinal Cord Injury and Polytrauma 160 - The Acute Management of Traumatic Spinal Cord Injury and Polytrauma Overview of Acute Management of Spinal Cord Injury Prehospital Care Clinical Assessment Initial Resuscitation and Blood Pressure Management Radiographic Assessment Injury Classification and Surgical Decision Making Timing of Surgery Considerations for Polytrauma Conclusion 166 - Chapter 161 - Timing of Surgery Following Traumatic Spinal Cord Injury 161 - Timing of Surgery Following Traumatic Spinal Cord Injury Classifying Spinal Cord Injury Cervical Traumatic Spinal Cord Injury Central Cord Syndrome Thoracic and Thoracolumbar Traumatic Spinal Cord Injury Ultra-Early Surgery in Traumatic Spinal Cord Injury Limitations and Future Directions Case Illustration Conclusion 167 - Chapter 162 - Medical Management of Adult and Pediatric Spinal Cord Injury 162 - Medical Management of Adult and Pediatric Spinal Cord Injury Pathophysiology Primary Injury Secondary Injury Systemic Consequences of Spinal Cord Injury Acute Medical Management Airway Protection and Ventilation Intubation Circulatory Support Bradycardia and Other Arrhythmias Transfer Administration of Neuroprotective and Neuroregenerative Agents Neuroprotection Corticosteroid Administration Minocycline Granulocyte Colony-Stimulating Factor Riluzole BA-210 Magnesium Monosialotetrahexosylganglioside Therapeutic Hypothermia Neuroregeneration Anti-Nogo Antibody Neural Stem/Precursor Cells Mesenchymal Stem Cells Polymer Scaffolds and Hydrogels Medical Management of Subacute and Chronic Complications Venous Thromboembolic Prophylaxis Gastrointestinal Complications and Nutrition Respiratory Complications Orthostatic Hypotension Autonomic Dysreflexia Conclusion 168 - Chapter 163 - Spinal Traction 163 - Spinal Traction Indications for Use Head Halter Traction Gardner–Wells Tongs Cranial Halo Cervical Spine Lumbar Spine Pediatric Considerations Case Report 169 - Chapter 164 - Medical Management of Fractures Without Spinal Cord Injury 164 - Medical Management of Fractures Without Spinal Cord Injury AT THE SCENE At the Hospital Imaging Studies Closed Reduction of the Cervical Spine Reduction Techniques Definitive Treatment Timing of Surgical Intervention Upper Cervical Injuries Subaxial Injuries Thoracic and Thoracolumbar Fractures Burst Fractures Multilevel and Noncontiguous Injuries Kinetic Therapy Neurological Complete Cord Injuries Penetrating Injuries and Gunshot Wounds Osteoporosis Fractures Orthoses Cervical Orthoses and Occipital-Mandibular-Cervical Orthoses Occipital-Mandibular High-Thoracic Orthoses Occipital-Mandibular Low-Thoracic Orthoses Thoracolumbosacral Orthoses Lumbosacral Orthoses Sacroiliac Orthoses Halo Skeletal Fixation Complications of Spinal Bracing Keys to Nonoperative Care 170 - Chapter 165 - Anterior Surgery for Cervical Trauma 165 - Anterior Surgery for Cervical Trauma INITIAL EVALUATION Advantages of Surgical Management and the Anterior Approach Overview of Common Anterior Approaches and Complication Avoidance Lateral Retropharyngeal (Whitesides) Approach to the Upper Cervical Spine Smith–Robinson Approach: C2‒T1 Accessing the Cervicothoracic Junction Upper Cervical Spine Traumatic Injuries with Anterior Management Approaches Relevant Anatomy C1 (Atlas) Fractures Odontoid Fractures Subaxial Cervical Spine Traumatic Injuries with Anterior Management Approaches Classification and Management of Subaxial Cervical Spine Injuries Type A: Compression Injuries Type B: Tension Band Injuries Type C: Translation Injuries Type F: Facet Joint Injuries Conclusion 171 - Chapter 166 - Posterior Surgery for Cervical Trauma 166 - Posterior Surgery for Cervical Trauma UPPER CERVICAL SPINE INJURIES Occipitocervical Injury Occipitocervical Fusion Preparation/Positioning Occipital Instrumentation Cervical Spine Instrumentation Atlas/C1 Injury Atlas Fracture Traumatic Transverse Atlantal Ligament Avulsion C1‒C2 Fusion C1 Instrumentation C2 Instrumentation C1‒C2 Wiring Transarticular Fixation Axis/C2 Injury Odontoid Fracture Traumatic Spondylolisthesis of the Axis (Hangman Fracture) Subaxial Cervical Spine Injuries Classification of Subaxial Cervical Spine Injuries Nonoperative Techniques for Distracted Facet Injuries Operative Techniques for Posterior Reduction and Fixation Cervical Spondyloptosis Case Examples Case Presentation 1 Case Presentation 2 Case Presentation 3 172 - Chapter 167 - Surgical Approaches to Thoracolumbar Trauma 167 - Surgical Approaches to Thoracolumbar Trauma Anatomy Thoracic Spine Thoracolumbar Junction Imaging Computed Tomography Magnetic Resonance Imaging Biomechanics Concurrent Injuries Thoracic Spine Fractures Thoracolumbar Junction Fractures Classification Treatment Options and Strategies Nonoperative Strategies Operative Strategies Ventral Versus Dorsal Approaches Surgical Stabilization Methods Neurological Decompression for Incomplete Injuries Additional Operative Considerations Summary 173 - Chapter 168 - Surgical Approaches for Sacral Fractures and Sacropelvic Injuries 168 - Surgical Approaches for Sacral Fractures and Sacropelvic Injuries Anatomy Epidemiology Clinical Presentation and Diagnosis Classification Schemes (Table 168.1) Management and Outcomes Surgical Techniques Illustrative Case Conclusion 174 - Chapter 169 - Rehabilitation and Recovery After Spinal Cord Injury 169 - Rehabilitation and Recovery After Spinal Cord Injury Rehabilitation and the Role of the Spinal Cord Injury Specialty and Therapist Consult in Setting the Stage for Rehabilitation Rehabilitation Process Classification of Spinal Cord Injury: International Standards for Neurological Classification of Spinal Cord Injury and Internat... The International Standards for Neurological Classification of Spinal Cord Injury Motor Examination Sensory Examination Scoring International Standards to Document Remaining Autonomic Function After Spinal Cord Injury Prognosis and Outcome Measures Outcome Measures Prevention of Complications Pressure Injuries Neurogenic Bowel Bowel Management Program Oral Medication Management Advanced Management Acute Abdomen Neurogenic Bladder Management in the Acute Phase Postacute Management Muscle Spasticity Measuring Spasticity Conservative Management of Spasticity Chemodenervation and Neurolysis Surgical Management and Intrathecal Baclofen Nutrition Calcium Metabolism Thyroid Function Adrenal Function Sodium Metabolism Bracing and Prosthetics Electrical Neuromodulation in Rehabilitation Peripheral Nerve Neuromodulation Functional Electrical Stimulation Devices for Upper Extremity Function Functional Electrical Stimulation Devices for Lower Extremity Function Spinal Cord Neuromodulation Future of Neuromodulation Conclusion 175 - Chapter 170 - Harvest of Autograft for Spinal Fusion 170 - Harvest of Autograft for Spinal Fusion Overview: Historical and Current AUTOGENOUS Bone Graft Harvest Iliac Crest Bone Graft: Harvest Techniques Complications of Iliac Crest Harvesting Comparing AUTOGENOUS Grafts: Local Bone Versus Iliac Crest Bone Graft Conclusion 176 - Chapter 171 - Vascularized Bone Grafts in Spine Surgery 171 - Vascularized Bone Grafts in Spine Surgery Bone Grafts in Spine Surgery Vascularized Bone Grafts Indications and Principles Surgical Technique Preoperative Planning Fibula Iliac Crest Rib Results Complications Case Example Summary 177 - Chapter 172 - Spinal Wound Closure 172 - Spinal Wound Closure SOFT TISSUE ANATOMY OF THE BACK Primary Closure Nonhealing Spinal Wounds Debridement Vacuum-Assisted Closure Hyperbaric Oxygen Therapy Skin Grafts Flaps Paraspinous Muscle Flaps Trapezius Flaps Latissimus Flaps Gluteus Maximus Flaps Perforator Flaps Free Flaps and Other Wound Closure Techniques Summary 178 - Chapter 173 - Big Data in Healthcare 173 - Big Data in Healthcare Introduction to Big Data in Medicine The Law of Large Numbers The Centrality of Predictions in Medicine Why Big Data Now Applications Decision Support Systems Patient Care Monitoring and Coordination Image Processing Electronic Health Record Management Reimbursement and Claims Management Drug and Bio Discovery Omics Device Design and Manufacturing Enabling Tools Data-Gathering Tools Preprocessing and Cleaning Tools Big Data Analysis Tools Data Visualization Tools Asking Why Data Privacy and Overreliance on Correlative Data Putting Big Data In Medicine In Context The Chudnovsky Brothers Pi Biological Data is Transcendental Patient Age and Geographic Location of Treatment Impact Satisfaction With Outpatient Orthopedic Procedures Seeking Patterns and Predictability Squaring the Biological Circle Age and Location Determine Treatment Outcomes 179 - 174 - Spine Registries 174 - Spine Registries CLINICAL DATA SYSTEMS IN THE CONTEXT OF VALUE-BASED CARE Clinical Registries Registry Design Current Status: Defining High-Quality Registries Highlights of Notable Registries Evaluating Cost Effectiveness Using Registry Data Subspecialty Registries Future Trends/Areas for Improvement Conclusion 180 - Chapter 175 - Conflicts of Interest in Spine Surgery 175 - Conflicts of Interest in Spine Surgery Surgeon–Industry Collaboration Importance of Disclosure Publication Bias Case Study: Bone Morphogenetic Protein–2 Case Study: Lumbar Artificial Disc Replacement Scott’s Parabola Consequences Conclusion 181 - Chapter 176 - Art of the Clinical Trial 176 - Art of the Clinical Trial COMPARATIVE EFFECTIVENESS Prospective Studies Randomized Controlled Trials Informational Bias Research Question Patient Population Influence Feasibility Pilot Studies Cost Summary 182 - Chapter 177 - Meaningful Retrospective Analysis 177 - Meaningful Retrospective Analysis Retrospective Clinical Studies Limitations of Randomized Clinical Trial Methodologies Advantages of Retrospective Methodology Limitations of Retrospective Methodology Administrative Databases Complication and Cost Outcomes Using Administrative Databases Clinical Registries Summary 183 - Chapter 178 - Art and Science of Guideline Formation 178 - Art and Science of Guideline Formation Author Group Question Formation Literature Search Evidence Grading Creation of Recommendations Final Caveats Beyond Recommendations: Implementation and Review Summary 184 - Chapter 179 - Appropriate Use Criteria in Spine Surgery 179 - Appropriate Use Criteria in Spine Surgery RAND Corporation/University of California Los Angeles Appropriateness Method Existing Appropriate Use Criteria In Spine Surgery Cervical Fusion Lumbar Laminectomy Degenerative Lumbar Scoliosis Degenerative Lumbar Spondylolisthesis Vertebral Fragility Fractures Persistent Pain After Spine Surgery Imaging Appropriate Use Criteria Program Criticism of the Appropriateness Method 185 - Chapter 180 - Precision Medicine_ Artificial Intelligence Applied to Evaluation and Management of Spinal Disorders 180 - Precision Medicine: Artificial Intelligence Applied to Evaluation and Management of Spinal Disorders ARTIFICIAL INTELLIGENCE, MACHINE LEARNING, AND DEEP LEARNING Application of Artificial Intelligence to the Evaluation of Spinal Disorders Automated Segmentation and Measurement of Spinal Images Diagnosing Conditions Using Automated Methods Automated Fracture Identification and Grading Application of Artificial Intelligence to the Management of Spinal Disorders Prediction of Surgical Outcomes and Complications Predicting Trajectory of Disorder Pitfalls and Limitations of Artificial Intelligence Models Conclusions and Future Applications of Artificial Intelligence for Spinal Disorders 186 - Chapter 181 - Healthcare Reform and Spine Surgery 181 - Healthcare Reform and Spine Surgery Expenditures and Spinal Disorders Payment Models in Spine Surgery Managed Care and Managed Competition The Patient Protection and Affordable Care Act Value-Based Care Models and Spine Surgery Accountable Care Organizations Episode-Based Care With Bundled Payments Integrated Practice Units With Centers of Excellence Shared Savings Approaches: Merit-Based Incentive Payment System and Medicare Access and CHIP Reauthorization Act Summary and Conclusions 187 - Chapter 182 - Development of New Technologies in Spine Surgery 182 - Development of New Technologies in Spine Surgery HISTORY OF INNOVATION IN SPINAL SURGERY Development of Surgical Techniques Development of Surgical Technologies Development of Pedicle Fixation Acceleration of Spinal Technology Development Classification of Surgical Innovations and Technology Development Fundamentals of Surgical Innovation and Development Intellectual Property Protection Idea Development and Refinement Pathways to Commercialization of New Technology Ethical and Regulatory Considerations Industry’s Role in Advancing Innovation U.S. Food and Drug Administration Clearance Adoption of Surgical Technology Conclusion Index - 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