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UweVieweg
FrankGrochulla
Editors
Manual ofSpine
Surgery
SecondEdition
123

Manual of Spine Surgery

Uwe Vieweg • Frank Grochulla
https://t.me/medicina_free
Editors
Manual of Spine Surgery
Second Edition

Editors
https://t.me/medicina_free
Uwe Vieweg
Surgical and Conservative Spine Therapy
Hospital Rummelsberg
Schwarzenbruck, Germany
Frank Grochulla
Metropol Medical Center
Center for Orthopaedics, Neurosurgery and
Traumatology, Nuremberg
Germany
ISBN 978-3-662-64060-9 ISBN 978-3-662-64062-3 (eBook)
https://doi.org/10.1007/978-3-662-64062-3
© Springer-Verlag GmbH Germany 2012, 2023
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer-Verlag GmbH, DE part of Springer Nature.
The registered company address is: Heidelberger Platz 3, 14197 Berlin, Germany

Preface
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The second edition of Manual of Spine Surgery has become necessary as a consequence of the
rapid expansion of spine surgery using different minimally invasive and non-fusion techniques.
To do justice to this development, the second edition of Manual of Spine Surgery aims to pres-
ent the different techniques to spinal surgeons in a clear and instructive way using detailed
illustrations. Its coverage of different principles and techniques of contemporary spine surgery,
including anatomy, pathology, procedures, and instrumentations, makes it highly useful as a
refresher before surgery, an easily digestible study guide. The success of any spinal operation
depends on good denition of the indications, consideration of the contraindications, technical
and organizational factors, correct preoperative preparation, and positioning of the patient and
good operating technique. The description of different open, less invasive or minimally invasive techniques with more than 700 illustrations will provide the spinal surgeon useful guidelines for their use. The Manual of Spine Surgery, Second Edition is authoritative, concise, and
portable, designed for use in a fast-paced clinical setting. The book is a daily companion for
spinal surgeons and spinal therapeutics caring for patients with spinal disorders.
UweVieweg
FrankGrochulla
v

Contents
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Part I General Aspects of Spinal Surgery
1 Definition and Trends of Modern Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Uwe Vieweg
2 Principles of Surgical Stabilisation of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Tobias Pitzen, Jörg Drumm, Gregor Ostrowski, and Michael Ruf
3 Implant Materials in Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Werner Schmoelz
4 Mechanical and Biomechanical Testing of Spinal Implants . . . . . . . . . . . . . . . . . . 23
Werner Schmoelz and Annette Kienle
5 Spinal Retractors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Luca Papavero
6 Fluoroscopy and Spinal Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Stefan Kroppenstedt
7 Surgical Microscopy in Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Frank Grochulla
8 Endoscopy in Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Uwe Vieweg
9 Equipment for Full Endoscopic Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Sebastian Ruetten
10 Electrosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Uwe Vieweg
11 Surgical Motor Systems in Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Frank Grochulla and Uwe Vieweg
12 Bone Grafts and Bone Graft Substitutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Robert Morrison
13 On- and Offline Documentation of Spine Procedures: Spine Tango . . . . . . . . . . . 83
Thomas Zweig, Marco Teli, Everard Munting, Samuel Morris,
and Markus Melloh
14 Spinal Orthoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Uwe Vieweg
15 Biological Repair Options in Degenerative Disk Diseases . . . . . . . . . . . . . . . . . . . . 99
Christian Hohaus and Hans Jörg Meisel
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16 Medical Strengthening Therapy for Treatment of Back Pain . . . . . . . . . . . . . . . . . 105
Christoph Spang, Bruno Domokos, and Florian Maria Alfen
17 Haemostasis in Spinal Surgery: An Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Fabio Dos Santos
18 Prophylaxis Against Thromboembolism in Spinal Surgery . . . . . . . . . . . . . . . . . . 127
Uwe Vieweg
19 Minimizing Human Error in Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Uwe Vieweg and Robert Morrison
20 Sagittal Balance Concept: Radiological Measurement Parameters . . . . . . . . . . . . 143
Theophilo Asfora Lins, Guilherme Augusto Foizer, and Wilson T. Asfora
21 Patient Positioning Techniques in Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Sven Y. Vetter and Uwe Vieweg
Part II Anterior Upper Cervical Spine
22 Overview of Surgical Techniques and Implants
for the Anterior Upper Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Meic H. Schmidt
23 Odontoid Screw Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Meic H. Schmidt
Contents
24 Anterior Transarticular Screw Fixation C1/C2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Uwe Vieweg and Meic H. Schmidt
25 Transoral Resection of the Odontoid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Meic H. Schmidt and Uwe Vieweg
26 Cervical Tong Extension and the Halo Fixator . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Uwe Vieweg, Pia Borgas, and Kiril Mladenov
Part III Anterior Cervical Spine
27 Overview of Surgical Techniques and Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Tobias Pitzen, Jörg Drumm, Gregor Ostrowski, and Michael Ruf
28 Anterior Cervical Discectomy and Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Frank Grochulla
29 Uncoforaminotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Kirsten Schmieder
30 Anterior Cervical Plating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Tobias Pitzen, Jörg Drumm, Gregor Ostrowski, and Michael Ruf
31 Cage Implantation in the Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Uwe Vieweg
32 Implantation of a Cervical Disc Prosthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Uwe Vieweg
33 Percutaneous Anterior Endoscopic Cervical Decompression . . . . . . . . . . . . . . . . . 235
Stefan Hellinger

Contents
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Part IV Posterior Cervical Spine
34 Overview of Surgical Techniques and Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Stefan Schären
35 Foraminotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Frank Grochulla
36 Laminoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Frank Grochulla
37 Occipital Cervical Stabilization with Rod-Screw Systems . . . . . . . . . . . . . . . . . . . 257
Grégoire P. Chatain, Meic H. Schmidt, and Michael A. Finn
38 Posterior Transarticular C1/C2 Screw Technique . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Michael Winking
39 C1–C2 (Harms) Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Christian Schultz
40 Rod-Screw Stabilization of the Posterior Cervical Spine . . . . . . . . . . . . . . . . . . . . 277
Uwe Vieweg
Part V Anterior Thoracic Spine
41 Overview of Surgical Techniques and Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Christian Schultz
42 Anterolateral Endoscopic Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Oliver Gonschorek
43 Vertebral Body Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Jürgen Nothwang
44 Anterior Correction of Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Cornelius Wimmer
45 Dynamic Scoliosis Correction: A Motion- Preserving Surgical
Technique for Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Per Trobisch
46 Vertical Expandable Prosthetic Titanium Rib (VEPTR) . . . . . . . . . . . . . . . . . . . . 321
Cornelius Wimmer and Uwe Vieweg
Part VI Posterior Thoracic Spine
47 Overview of Surgical Techniques and Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Paulo Tadeu Maia Cavali
48 Stabilization of the Thoracic Spine with Internal Fixator . . . . . . . . . . . . . . . . . . . 335
Robert Morrison and Uwe Vieweg
49 Transpedicular Stabilization with Freehand Technique
on the Thoracic Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Paulo Tadeu Maia Cavali
50 Posterior Correction of Adolescent Idiopathic Scoliosis (AIS) . . . . . . . . . . . . . . . . 349
Torsten Bräuer

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51 Thoracic Vertebrectomy and Spinal Reconstruction
Via Posterior or Combined Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
M. Ruf, J. Petrovics, G. Ostrowski, and T. Pitzen
52 Magnetically Controlled Growing Rod . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Jacques D. Müller-Broich
Part VII Anterior Lumbar Spine
53 Overview of Surgical Techniques and Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Karsten Wiechert
54 Anterior Lumbar Interbody Fusion (ALIF) Using Bone or Cage . . . . . . . . . . . . . 393
Karsten Wiechert and Uwe Vieweg
55 Total Lumbar Disk Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Christoph J. Siepe
56 Extreme Lateral Interbody Fusion (XLIF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Valentin Quack, Uwe Vieweg, and Philipp Kobbe
Part VIII Posterior Lumbar Spine
57 Overview of Surgical Techniques and Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Uwe Vieweg
Contents
58 Microsurgical Intra- and Extraspinal Discectomy . . . . . . . . . . . . . . . . . . . . . . . . . 433
Luca Papavero
59 Microsurgical Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Frank Grochulla
60 Endoscopic Lumbar Disk Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
Sebastian Ruetten
61 Translaminar Screw Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
Stefan Schären
62 Vertebroplasty and Kyphoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
Khalid Saeed, Edward Bayle, and Bronek Boszczyk
63 Transpedicular Stabilization with Internal Fixation
in the Thoracolumbar and Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Robert Morrison and Uwe Vieweg
64 Correction of Degenerative Scoliosis with Polyaxial Internal
Fixator and Intercorporeal Fusion with TLIF and PLIF Cages . . . . . . . . . . . . . . 475
Uwe Vieweg and Robert Morrison
65 Correction of Spondylolisthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Uwe Vieweg
66 Transforaminal Lumbar Interbody Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489
Stefan Kroppenstedt and Uwe Vieweg
67 Cement Augmentation of Pedicle Screw Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . 497
Jürgen Nothwang

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68 Less Invasive Pedicle Screw Instrumentation of Lumbar
Spine Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .507
Ulrich Hahn
69 Microsurgical Monosegmental Fusion with Internal Fixator
and Transforaminal Interbody Fusion (TLIF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Uwe Vieweg and Stefan Kroppenstedt
70 Posterior Lumbar Interbody Fusion with an Interbody
Fusion Spacer or Cage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Uwe Vieweg and Steffen Sola
71 Transsacral Screw Fixation for High- Grade L5/S1
Spondylolisthesis Including Spondyloptosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Palaniappan Lakshmanan and Sashin Ahuja
72 Percutaneous Pedicle Screw Instrumentation and Pedicle Screw
Augmentation with Vertebral Body Stenting (VBS) in Cases
with Unstable Osteoporotic Thoracolumbar Fractures . . . . . . . . . . . . . . . . . . . . . 543
Uwe Vieweg
73 Percutaneous Interspinal Process Implantation . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Uwe Vieweg
Part IX Sacrum and Ileosacral Joint
74 Overview of the Different Approaches and Different Techniques
of the Sacrum and the Sacroiliac Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565
Uwe Vieweg
75 Percutaneous Dorsolateral Fusion of the Sacroiliac Joint . . . . . . . . . . . . . . . . . . . . 569
Uwe Vieweg, Johannes Keck, and Hannes Moritz
76 Fusion Surgery of the Sacroiliac Joint (DIANA®/NADIA®) . . . . . . . . . . . . . . . . . . 577
Volker Fuchs
77 Percutaneous Iliosacral Screw (ISS) Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
Jörg Böhme, Uwe Vieweg, Johannes Keck, and Hannes Moritz
78 En Block Resection of the Sacrum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 593
Mehmet Zileli
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