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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6029_Библиотеки_им_академика_М_И_Перельмана.pdf
318
Index
C1-2 combination, 206
clinical symptoms, 198
incidence and classification
polytrauma patients, 197
sagittal, 197
skeletal traction, 198
radiology
anterior C2-3 dislocation, 198
oblique fracture, 199
plain radiographs, 198
sagittal MRI, 199
treatment
burst fractures, axis body, 203–205
conservative, 198
coronal axis body fractures, 199–201
non-hangman injuries, 205
sagittal axis body fractures, 201–202
superior facet area, 205–207
tear drop fractures, 205, 206
transverse axis body fractures, 202–203
transverse foramen, 206
Monosegmental fusion constructs
anterior, fixation methods
C1-2, 113–114
C2-1, 112–113
lateral
angled skin incision, 114–115
drawbacks, 115
odontoid fractures, 114
spinal canal penetration, 115
posterior, fixation methods
atlanto-occipital instabilities, 101
C0-1, 101
C1-2, 102–112
Multiple fractures, axis
combinations, 209
odontoid screw and C2-3 ACDF,
209, 211
“single” fractures, 209
teardrop and hangman’s combination,
209–210
Multisegmental constructs, CVJ and UCS
anterior, 117
decision process, 115
occipitocervical
anchoring elements, 116–117
biomechanical argument, 117
fibular strut graft, 115
modern modular systems, 117
plate and screw technique, 116
semi-rigid techniques, 116
subaxial lateral masses, 115
wire and frame application, 116
stabilization procedures, 115
suboccipital, 117
N
Neural anatomy
cervical spine nerves, 14
spinal cord
anterior entry zones, 13
ascending and descending fibers, 13
craniocervical junction, 13
Non specific inflammation
clinical symptoms, 228
differential diagnosis, 228, 231
external bracing, 231
incidence
orofacial infection, 227
pyogenic osteomyelitis, 227
posterior fixation, 232
pyogenic inflammation, 232
radiology
AA subluxation, 228
coronal plane reconstructions, 229
flexion and extension, 230
liquid abscess, 230
osseous destruction, 228
retropharyngeal pus spread, 229
spinal cord compression, 229, 230
treatment
delayed diagnosis, 231
long-term antibiotics, 231
tuberculosis, UCS, 232
UCS needle aspiration, 231
O
Occipital bone
anchoring structure
clivus, 71
condyles, 68–71
squama, 66–68
clivus, 5
condyles, 4–5
squama, 3–4
Occipital condyle fracture (OCF)
bilateral condyle fractures, 148–149
classification, 145
clinical symptoms, 146
coronal reconstruction, 147
diagnosis, UCS, 145
etiology and epidemiology, 145–146
occipital condyle, 148
radiology
broad condyle avulsion, 147–148
CT reconstruction, 146
diagnosis, 146
fracture morphology, 146–147
simple activity restriction, 147
treatment strategy, 147
types and subtypes, 145
Occipital condyles
anterior transarticular axial-atlantocondylar screw, 70–71
cranial image guidance, 68
multipoint construct, 67–68
posterior transarticular atlantocondylar screw, 68–69
posterior transcondylar screw, 69–70
Occipital squama
bicortical screw placement, 67
cervical polyaxial screws, 66
cranial anchor, 66
lateral placement, screws, 66
Index
319
midline thickness, 67–68
radiological evaluation, 67
surgical technique, 67
“Occipital vertebrae”, description, 285
OCF. See Occipital condyle fracture
Odontoid fracture (OF)
AA instability, 175
anterior compressive osteosynthesis,
172–173
C3 coronal split, 175
classification
Anderson D’Alonso, 166
direction based, 165
location based, 165
type IIT, 166
clinical symptoms, 167
disk prolapse, 170, 171
double-screw fixation, 172, 174
endosteal bone formation, 174–175
etiology and epidemiology, 166
fibrous union, 175
halo-ring traction, 173–174
halo-vest fixation, type II, 172
K-wires, 173, 174
MRI evaluation, 170
potential instability, 170, 171
radiology
algorithm, 167
lateral tear, 168
non dislocated, 167
posteriorly displaced, type II fracture, 167
type II fracture, 168
transverse ligament damage, 170, 172
treatment
anterior screw osteosynthesis, 170
Gallie technique, 169
halo-vest fixation, 169
horizontal fracture, 169
one/two screw construct, 170
posterior atlantoaxial fixation, 170
type I and III fracture, 168
Odontoid pseudarthrosis. See also Posttraumatic
deformity
spinal cord compression, 221
stable, 225
OF. See Odontoid fracture
Os odontoideum
anterior and posterior instability, 290–291
definition, 290
deterioration, 291
dystopic type, 290, 292
Magerl and Goel-Harms technique, 292
orthotopic type, 290, 291
surgery, 291
Ossiculum terminale, 289
Osteogenic sarcoma (OS), 268
P
Posterior C1-2 fixation methods
crosslaminar screw and rod fixation
advantages, 110
atlantoaxial fixation techniques, 110
disadvantages, 110
Wright’s technique, 110–111
Gallie method, 102
Goel-Harms technique, 108–109
halifax atlantoaxial interlaminar clamps
subaxial cervical spine trauma, 103–104
intralaminar screws
lateral mass fixation, 111
Magerl’s technique, 105, 107
Mixter and Osgood silk loop, 102
surgical immobilization, 103
wedge compression technique, 103
wiring techniques, 103
Posterior longitudinal ligament (PLL), 10
Posterior meningeal artery (PMA), 12
Posterior midline approach, 40–41
Posterior paramedian approach, 40
“Posterior rachischisis”, 289
Posterior spinal artery (PSA), 13
Posttraumatic deformity
anterior double-screw osteosynthesis, 225
clinical symptoms
injury type, 219
vascular compromise, 221
etiology
Goel-Harms fixation, 220
instability, 219
Marphan’s syndrome, 220
hard collar fixation, 223
irreducible odontoid malunion, 225
neurological deficit, 223
odontoid pseudarthrosis
fixed, stable and unstable types, 222
type II odontoid fracture, 222
radiology
AA instability, 221
odontoid process, imaging, 221
spinal cord compression, 221
surgery, 222–223
transarticular screw and graft fusion, 224–225
treatment, 221–222
“Pott’s disease”, 232
R
RA. See Rheumatoid arthritis
Radiographic data analysis
atlanto-axial parameters
instability, 29
posterior atlantodental interval (PADI), 29
atlanto-occipital joints, 24
basal/clival parameters
CT/MRI images, 24
plain lateral radiograph, 24–25
craniocervical parameters
basilar invagination, 26
BDI, 28
clivus and the odontoid process, 26
CMA, 27
CVJ and UCS alignment, 28–29
odontoid protrudes, 27
320
Index
platybasia/basilar impression, 26–27
vertical atlantoaxial index, 28
craniometric parameters, 25
CVJ and UCS, 24
“Real Time” Image Guided Surgery (rIGS)
direct spinal CT guidance, 130
3D isofluoroscopy, 130
intraoperative MRI (iMRI), 130
intraoperative scan, 129
vascular/neural structures, 129–130
Reconstruction techniques, basic principles
construct design
anterior column, 59–61
CVJ, plate and screw, 56–59
metallic implants, 56
surgical spinal stabilization, 56
defect/instability/decompression, 55
fracture healing/bone fusion
biological principles, 61
lag screw, 62
morphogenic enhancers, 61–62
posterior fusion techniques, 61
tissue differentiation, 61
Rheumatoid arthritis (RA)
cervical spine disease, 240
clinical symptoms
neural compression, 236–237
Ranawat classification, neurologic deficit, 236
definition, 235
etiology and UCS pathophysiology
cranial settling, 235
genetic susceptibility, 235
“stepladder deformity”, 235, 236
high-riding VA, 241
history and incidence
cervical spine, 235
mortality rate, 236
serum RF, 236
irreducible kyphotic deformity, 241, 242
odontoid migration/basilar invagination, 242
quadriparesis, 243
radiology
AA dislocation, 237, 238
dynamic MRI, 239
flexion/extension, 237
high riding VA, 238
MRI, 238–239
vertical subluxation, 237
reducible AA dislocations, 241
rheumatoid pannus, 242
traction-irreducible cranial settling, 243–244
treatment strategy
AADI and PADI length, 239
OC fusion, 240
plating systems, 240
reducible lesion, 240
surgical, 239
rIGS. See “Real Time” Image Guided Surgery
S
Sagittal axis body fractures
axial loading, 201
C1–C2 fusion, 202
unilateral/oblique, 201, 202
union, 202
Secondary bone tumors
classification, grading and scoring, 272
diagnosis
biopsy, 272
pain, 269
generalized melanoma, 273
gynecologic, 274
palliative occipitocervical fusion, 271
patient’s survival time, 273
radical resection, 273
renal carcinoma, 272
spine metastatic involvement, 269
therapeutics, 272
Solitary plasmocytoma
chemo and radiotherapy, combined, 268
high anterolateral approach and vertebral puncture, 269,
270
needle bone cement vertebroplasty, 269
Special radiology
CVJ, 24
data analysis, parameters
atlanto-axial, 29–30
basal/clival, 24–26
craniocervical, 26–29
dynamic imaging
AARF, 30
atlantoaxial pathologies, 30
CVJ and UCS abnormalities, 30
MRI, 31
upper cervical instabilities, 31
neoplastic conditions, 33–34
prevertebral soft tissue swelling, 23
tomography, defined, 23
traumatic cases, 33
vascular imaging
dynamic angiography, 32
invasive angiography, 31–32
posterior circulation strokes, 32
vertebrobasilar insufficiency, 32–33
“Stepladder deformity”, 235, 236
Surgical anatomy
bony structures
atlas, 5–7
axis, 7–9
occipital bone, 3–5
CVJ and UCS
internal carotid artery (ICA), 13
muscles, 10–11
vertebral artery (VA), 12–13
ligaments and joints
atlantoaxial lateral, 10
atlantodental, 10
atlanto-occipital, 10
odontoid apex, 10
UCS structures, 9
neural anatomy
cervical spine nerves, 14
spinal cord, 13
Surgical approaches
Index
321
C1–C2 transarticular fixation
antero-lateral aspect, 41
Barbour’s technique, 41
drilling, 41–42
retro-SCM approach, 41
high anterolateral
carotid artery, 42
digastric muscle, 42
drawbacks, 43
exposure and oblique approach, 43
subaxial cervical spine, 43
surgical technique, 42
posterior
midline, 39–40
paramedian, 40
posterolateral, 40–41
transoral
extended, 46–49
minimally invasive, 50–51
traspharyngeal, 43–46
Surgical failures
atlantoaxial fixation and fusion, 307
CVJ reconstructions, 311
direct decompression
anatomical variants, 308
tools, 308
hardware insertion
brittle and hard bone, 309
broken screws, 309, 310
erroneous trajectory, 311
odontoid screw fixation, 309, 310
improper positioning, 308
indirect decompression
dislocation, reduction and fixation, 309
realignment errors, 308
venous bleeding and air embolism, 307
T
Tear drop fractures, 205, 206
Total intravenous anesthesia (TIVA), 141
Transoral approach
extended, 46–50
minimally invasive, 50–51
traspharyngeal, 43–46
Transoral traspharyngeal approach
anesthetics and adrenalin, 45
atlantal ligament, 44
C1–2 dislocations and inflammatory process, 43
lateral fluoroscopy, 46
odontoid process, 45
posterior fixation techniques, 44
prophylactic antibiotics, 45
rheumatoid pannus, 44
Transverse axis body fractures, 202–203
Transverse ligament (TAL)
coincidental atlas fracture, 159–160
deficiency, 154–155
functional integrity, 152
MRI assessment, 153
traumatic intrasubstance disintegration, 156
Tumors
extradural UCS
primary bone, 250–269
radiological remarks, 247–248
secondary bone, 269–274
spine, 275
surgical oncologic terms, 248–250
therapeutics, 248
intradural
ependymoma and astrocytoma, 277–278
inoperable infiltrative cystic spinal cord, 279
intramedullary cavernous hemangioma, 279
meningiomas, 276
removal, 277
statodynamic system, 275–276
UCS region, 275
U
UCS and CVJ, reconstruction techniques
anchoring structure
atlas, 71–79
axis, 79–101
occipital bone, 66–71
monosegmental fusion constructs
anterior, 112–114
lateral, 114–115
posterior, 101–112
multisegmental constructs
anterior, 117
occipitocervical, 115–117
suboccipital, 117
Upper cervical spine (UCS)
AA subluxation, 240
abnormalities, 30
anterior decompressive procedures, 61
asymptomatic hyperextension, 47
atypical axial load distribution, 19
clinical and morphological instability, 19–20
combination injury, 212
computer guidance, 130
cranial settling, 240
delicate structures, 127
diagnosis, 145
extradural tumors (see Extradural UCS tumors)
failure, formation, 285
fracture combinations, 210
instrumentation, 134
laminae, 24
ligamentous connections, 9
mechanical instability, 55
minimally invasive approaches, 50–51
motion characteristics, 18
multidirectional instability, 44
muscles, 11–12
needle aspiration approaches, 231
OCFs, 147
posterior approach, 44
posttraumatic deformity (see Posttraumatic deformity)
pyogenic inflammation, 232
reconstructions, 307, 311
screw breakage, surgery, 309
“snaking”, 187
synovial joints, 10
transoral procedure, RA, 240
322
Index
tuberculosis, 232
vascular anatomy, 12–13
visualization, 24
V
Vertebral artery (VA)
ASA, 13
AV redundancy, 12
C1-2 screw, 309
high-riding, RA, 237, 238, 241
PMA, 12
PSA, 13
segments, 12
tapping, 311
Virtual image-guided surgery (vIGS)
atlantoaxial fixation, 134
C1-2
fixation, 132–133
posterior transarticular screw, 127
dorsal spine bony anatomic landmarks, 127
drill position, 128
fracture dislocations, 130–131
hangman’s fracture, 131
intact transverse ligament, 130–131
intraoperative imaging
CT scanner, 129
2D fluoroscopy, 129
3D fluoroscopy, 129
MRI, 129
lag screw compressing, 132
lateral fluoroscopy, 134
navigational plan, 133–134
preoperative imaging, 128–129
vertebra and instruments, 127