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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6013_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Contributors
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4: Reduction of Unilateral Facet Dislocation
- •Step 5: Reduction of Bilateral Facet Dislocation
- •Foreword to the First Edition
- •Preface
- •Video Contents
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Procedure: Halo Application
- •Step 1: Crown and Pin Placement
- •Step 2: Vest Application
- •Step 3: Construct Alignment
- •Step 4: Follow-up
- •Procedure: Halo Application in the Child or Infant
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Disk Excision
- •Step 2: Decompression
- •Step 3: Strut Graft Preparation and Placement
- •Step 4: Internal Fixation
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Preparation of Disk Spaces and/or Cervical Corpectomy
- •Step 2: Takedown of OPLL
- •Step 3: Graft Placement, Anterior Plating
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Evidence
- •9 Occipital-Cervical Fusion
- •Indications
- •Examination/Imaging
- •Procedure
- •Step 1
- •Step 2: Exposure of Inion to C5
- •Step 3: Instrumentation and Fusion
- •Step 4: Closure
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Making the Entry Hole for the First Translaminar Screw
- •Step 2: Drilling the Contralateral Lamina
- •Step 4: Placement of the First Screw
- •Step 5: Placement of the Second Screw
- •Step 6: Connection of the C2 Laminar Screws to C1 Lateral Mass Screws
- •Step 7: Arthrodesis
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Step 6
- •Step 7
- •Postoperative Care and Expected Outcomes
- •Technique B: C1-2 Transarticular Facet Screws (Magerl Technique)
- •Indications
- •Examination and Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Step 6
- •Step 7
- •Step 8
- •Step 9
- •Step 10
- •Step 11
- •Step 12
- •Step 13
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy (Figure 12-2)
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Determining the Entry Point
- •Step 2: Drilling the Screw Hole
- •Step 3: Tapping and Screw Insertion
- •Step 4: Rod Insertion
- •Step 5: Placement of Screw Caps
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Overview
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Manual Screw Placement
- •Computer-Assisted Screw Placement
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Summary
- •Evidence
- •Indications
- •Procedure Notes
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 2: Transthoracic Retropleural Deep Exposure
- •Step 3: Diskectomy
- •Step 4: Hemicorpectomy and Spinal Cord Decompression
- •Step 5: Arthrodesis, Cage Preparation, and Insertion
- •Step 6: Screw/Plate Instrumentation
- •Step 7: Closure
- •Postoperative Care
- •Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Positioning
- •Portals/Exposures
- •Thoracic
- •Thoracolumbar
- •Lumbar
- •Procedure: Thoracolumbar Spine Fusion via an Open Approach Using Single-Rod Instrumentation
- •Step 1: Anterior Release and Diskectomy
- •Step 2: Placement of the Anterior Vertebral Body Screws
- •Step 3: End-Plate Ablation
- •Step 4: Placement of Anterior Interbody Structural Supports
- •Step 5: Rod Placement
- •Step 6: Placement of Chest Tube and Wound Closure
- •Procedure: Thoracolumbar Spine Fusion via an Open Approach Using Dual-Rod Instrumentation
- •Step 1: Anterior Release and Diskectomy
- •Step 2: Placement of the Anterior Vertebral Body Screws
- •Step 3: End-Plate Ablation
- •Step 4: Placement of Anterior Interbody Supports
- •Step 5: Rod Placement
- •Step 6: Placement of Chest Tube and Wound Closure
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Procedure
- •Step 1: Anterior Release and Fusion
- •Postoperative Care and Expected Outcomes
- •Step 2
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Postoperative Care and Expected Outcomes
- •Surgical Outcomes
- •Complications and Avoidance
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Insertion of Superior Rib Cradle for the Hybrid VEPTR
- •Step 2: Opening Wedge Thoracostomy
- •Step 3: The Hybrid VEPTR
- •Step 4: Implantation of the Hybrid VEPTR
- •Step 5: Hybrid VEPTR Attachment to Pelvis by Dunn-McCarthy Hook over Iliac Crest
- •Step 6: Addition of Second Rib-to-Rib VEPTR
- •Step 7: Closure
- •Postoperative Care and Expected Outcomes
- •Expansion of the Devices
- •Replacement Procedure
- •Evidence
- •Indications
- •Surgical Anatomy: Choosing Levels for Fusion
- •Examination/Imaging
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Facetectomies
- •Step 2: Release of the Spine
- •Step 3: Pedicle Screw Placement
- •Step 4: Rod Placement and Correction of Deformity, Including Vertebral Derotation
- •Step 5: Closure
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: En Bloc Laminectomy
- •Step 2: En Bloc Corpectomy
- •Step 3: Anterior Reconstruction and Posterior Stabilization
- •Postoperative Care and Expected Outcomes
- •Evidence
- •25 Sacropelvic Fixation
- •Indications
- •Biochemical Considerations
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure A: S1 Pedicle Screws
- •Procedure B: Sacral Alar Screws
- •Procedure C: Iliosacral Screws
- •Procedure D: Galveston Rods
- •Procedure E: Iliac Screws (Iliac Bolts)
- •Procedure F: Transilial Bar
- •Procedure G: S2 Alar Iliac Screws (S2AI)
- •Postoperative Care and Expected Outcomes
- •Complications of Pelvic Fixation
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Procedure A: Smith-Petersen Osteotomy
- •Step 1
- •Step 2
- •Step 3
- •Procedure B: Pedicle Subtraction Osteotomy
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Postoperative Care and Expected Outcomes
- •Evidence
- •29 Spondylolysis Repair
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Positioning
- •Step 2: Incision
- •Step 3: Preparing Interspace
- •Step 4: Implantation
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1: Diskectomy
- •Step 2: Remobilization
- •Step 3: Trial Insertion
- •Step 4: Keel Preparation
- •Step 5: Device Insertion
- •Postoperative Care and Expected Outcomes
- •Evidence
- •36 Kyphoplasty
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •General Aspects to Posterior Tubular Retractor Surgery
- •Procedure
- •Step 1
- •Step 2
- •Step 3: Instrumentation
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure A: Lateral-Posterior Lumbar Hemivertebra Resection and Correction with Segmental Anterior Instrumentation
- •Step 1
- •Step 2
- •Procedure B: Hemivertebra Resection and Fusion: Anterior and Posterior Approach
- •Step 1
- •Step 2
- •Procedure C: Posterior Hemivertebra Resection and Correction
- •Step 1
- •Step 2
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Indications
- •Surgical Anatomy
- •Positioning
- •Portals/Exposures
- •Procedure
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Postoperative Care and Expected Outcomes
- •Evidence
- •Introduction
- •Indications
- •Contraindications
- •Examination/Imaging
- •Surgical Anatomy
- •Positioning
- •Procedure
- •Step 1
- •Step 3
- •Step 4
- •Step 5
- •Step 6
- •Step 7
- •Step 8
- •Step 9
- •Additional Steps
- •Postoperative Care and Expected Outcomes
- •Case Illustration
- •Evidence
Procedure 40 | Minimally Invasive Presacral Retroperitoneal Approach for Lumbosacral Axial Instrumentation 389
KWWSERRNVPHGLFRVRUJ
• The patient was taken for emergent decompression with initial minimally
invasive bilateral L5 laminectomies and partial transpedicular L5 corpectomy,
followed by pedicle screw fixation at L4 and S1 with minimally invasive screw
fixation.
n
In the same setting, in the prone position, an L4-S1 interbody fusion was done
with the AxiaLIF transsacral system.
n
Postoperative imaging demonstrated appropriate placement of the L4-S1
implant, removal of canal bone fragments, and placement of adjacent pedicle
screws. Figure 40-13, B and C show a midsagittal CT scan and lateral radiograph, respectively, demonstrating two-level AxiaLIF and pedicle screw placement at L4-S1, status post–partial transpedicular corpectomy at L5 for burst
fracture.
n
At 6-month follow-up, the patient had regained full strength and sensation.
n
The patient continued to do well at her 1-year follow-up.
Evidence
Cragg A, Carl A, Casteneda A, et al. New percutaneous access method for
minimally invasive anterior lumbosacral surgery. J Spinal Disord Tech
2004;17:21-8.
Ethier DB, Cain JE, Yaszemski MJ. The influence of anulotomy selection on disc
competence. A radiographic, biomechanical, and histologic analysis. Spine
1994;19:2071-6.
Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression
of lumbar spine. Spine 2002;27:432-8.
Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the
treatment of lumbar stenosis. Neurosurgery 2002;51(Suppl 2):144-51.
Khoo LT, Palmer S, Laich DT, et al. Minimally invasive percutaneous posterior
lumbar interbody fusion. Neurosurgery 2002;51(Suppl 2):166-81.
Ledet EH, Carl LA, Cragg A. Novel lumbosacral axial fixation techniques. Expert
Rev Med Devices 2006;3:327-34.
Marotta N, Cosar M, Pimenta L, Khoo LT. A New minimally invasive presacral
approach and instrumentation technique for anterior L5-S1 intervertebral
discectomy and fusion. Neurosurg Focus 2006;20:E9.
Perin NI. Complications of minimally invasive spinal surgery. Neurosurgery
2002;51(Suppl 6):26-36.
Slosar PJ, Reynolds JB, Koestler M. The axial cage. A pilot study for interbody
fusion in a higher-grade spondylolisthesis. Spine J 2001;1:115-20.
Trambert JJ. Percutaneous interventions in the presacral space: CT-guided
precoccygeal approach-early experience. Radiology 1999;213:901-4.
Yuan PS, Day TF, Albert TJ, et al. Anatomy of the percutaneous presacral space for
a novel fusion technique. J Spinal Disord Tech 2006;19:237-41.
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