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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6030_Библиотеки_им_академика_М_И_Перельмана.pdf
L3
Bilateral
pars
defect
A
L4
SI
L5
Reduction
screw
Spinal
nerve
root
L4
L5
SI
B
Figure 58–4
(A) Drawing illustrating pedicle screw placement in L4, L5, and S1 (L5 with specialized reduction screw). (B) Distraction is applied across L4-S1, providing a combined
cranial and dorsal movement of L5, contributing to the reduction effect. (C) Drawing illustrating reduction of slip with locking cap being tightened onto rod through reduction screw. After the fusion cage is placed, compression should be applied across the disc space.
■
270
SECTION III THE LUMBAR SPINE
Eurostile
C
(Cage)
structural
support
Bone graft
Figure 58–5
A fusion cage is inserted into the disc space and countersunk below the level of
the posterior vertebral body.
Figure 58–6
Drawing illustrating fusion cage in place with L5-S1 reduced, and barrel removed
from reduction screw.
Eurostile
58 REDUCTION OF SPONDYLOLISTHESIS
271
■
ing an adequate surface area for fusion as well as restoration of lordosis.
Pitfalls
1. L5 nerve root symptoms may occur postoperatively if an adequate
decompression is not performed prior to reduction. Bilateral
foraminotomies and maximal restoration of disc height help protect
the nerve roots from compression following reduction.
2. Postoperative sagittal decompensation may occur with unrecognized
adjacent segment instability and/or with overdistraction. Care must be
taken to identify all unstable segments and plan fusion levels accordingly.
3. Inability to achieve a reduction may result from inadequate exposure
or by attempting to use a posterior reduction-fixation system without a
concomitant lumbar interbody fusion.
4. Be certain to remove any loose fragments of bone in the canal. Check
anterior to the thecal sac and exiting nerve root.
Postoperative Care
1. The patient is kept NPO for 36 hours postoperative to allow for adequate return of bowel function.
2. A morphine patient-controlled anesthesia (PCA) pump is used for pain
control for the first 24 to 48 hours as indicated.
3. The patient may be out of bed on postoperative day 1. Ambulation is
allowed, as tolerated.
4. A lumbosacral orthosis (LSO) with leg extension is prescribed for 6
weeks postoperatively.
Suggested Readings
Bridwell KH, DeWald RL. The Textbook of Spinal Surgery. 2nd ed.
Philadelphia: Lippincott-Raven; 1997.
Harrington PR, Dickson JH. Spinal instrumentation in the treatment of
severe progressive spondylolisthesis. Clin Orthop 1976;117:157–163.
■
272
SECTION III THE LUMBAR SPINE
Eurostile
59
Coccygectomy
Franco P. Cerabona
Goal of Surgical Treatment
To alleviate pain from an unstable or deformed coccyx.
Diagnosis
1. Careful patient selection is mandatory.
2. History of significant trauma (fracture or dislocation), or severe congenital deformity is preferable.
3. Pain with sitting or while arising from a seated position (may be a
symptom of instability).
4. No other significant spinal problem.
5. No radiating pain.
6. Physical examination is helpful for evaluation of tenderness, motion,
deformity, or masses.
7. Look for pilonidal sinus or cyst.
8. Radiographs to evaluate anatomy.
9. Dynamic stress x-rays are valuable: Standing lateral of sacrum and coccyx (Fig. 59–1A); standing lateral after at least 10 minutes (Fig. 59–1B);
and sitting lateral with hips at 90 degrees. If this position does not reproduce symptoms, have the patient sit in a position that reproduces
usual pain. Two unstable patterns have been identified: posterior subluxation with sitting (Fig. 59–2A), and increase in flexion greater than
25 degrees when sitting (Fig. 59–2B).
10. Magnetic resonance imaging (MRI) or computed tomography (CT) are
rarely needed unless clinically indicated.
11. Lidocaine injection test can be helpful.
Indications for Surgery
1. Chronic pain not responsive to conservative measures
2. Malunion of fractures or dislocations
3. Coccygeal instability with positive dynamic stress x-rays and injection
test
4. Gross congenital deformities
Contraindications
1. Chronic pain disorders
2. Concomitant severe spinal disorders
3. Perirectal or pilonidal abscess
4. Secondary gain situations
Advantages
1. Relief of pain
2. Relatively low risk
Disadvantages
Failure to relieve pain.
Procedure
Technical goal: To remove the painful coccygeal segment.
Technique
1. Preoperative antibiotics.
2. Prone position with hips flexed (Wilson frame).
3. General or regional anesthesia.
4. Occlusive draping of rectal area.
5. Midline longitudinal incision exposing the dorsal part of the terminal
sacrum and extending to the painful coccygeal segment (Fig. 59–3).
6. Subperiosteal dissection is essential.
7. Electrocautery can be used on the dorsal surface but used with caution
while dissecting ventrally.
8. Excision begins at the disc space with sharp dissection, and then
proceeds with a Freer or small periosteal elevator. The proximal part of
the coccyx is held with a towel clamp or Kocher clamp (Fig. 59–4).
9. The dissection proceeds in a cranial to caudal direction.
10. The terminal segment need not be removed unless overly prominent.
11. Hemostatic agents can be used rather than cautery to guard against rectal injury.
12. Closure of the periosteum is done incorporating the terminal coccyx
with this layer. This helps eliminate dead space and applies tension on
the anococcygeal and sacrococcygeal ligaments (Fig. 59–5).
13. A drain is usually not needed.
14. Skin closure is done with subcuticular sutures and an occlusive dressing is applied.
Postoperative Care
1. Meticulous hygiene of the perineum
2. Use of gel or air donut when sitting
3. Use of stool softener to avoid increasing intraabdominal pressure
when straining during initial postoperative period
4. Usual resumption of full activities in about 4 weeks
Complications
Infection: Early infection can be treated with oral antibiotics, but if
drainage and fluctuance is present, operative drainage, debridement, and
intravenous antibiotics are needed.
Pitfalls
Operative
1. Incision need not be extended to the tip of the coccyx, because the coccyx angles anteriorly and can be reached through a smaller approach.
2. Keep subperiosteal especially on the anterior surface because bleeding
may occur and control can potentially endanger rectal tissues.
3. Some patients have a posteriorly angulated terminal sacrum, and trimming of the sacrum using a rongeur may be considered. Mobilization of
the gluteus maximus may also be needed for coverage.
Diagnostic
1. Failure to identify patients with secondary gain or chronic pain behavior
2. Failure to recognize perirectal or other spinal pathology
Suggested Readings
Bayne O, Bateman JE, Cameron HU. The influence of etiology on the re-
sults of coccygectomy. Clin Orthop 1984;190:266–272.
Maigne JY, Lagauhe D, Doursounian L. Instability of the coccyx in coccy-
godynia. J Bone Joint Surg Br 2000;82:1038–1041.
Maigne JY, Tamlet B. Standardized radiographic protocol for the study of
common coccygodynia and characteristics of lesions observed in the
sitting position: differentiating luxation, hypermobility and normal
mobility. Spine 1996;21:2588–2593.
Postacchini F, Massobrio M. Idiopathic coccygodynia. J Bone Joint Surg
Am 1983;65:1116–1124.
Eurostile
59 COCCYGECTOMY
273
■
Standing
Sitting Subluxation
A
Standing
Dynamic
x-ray
A
B
Figure 59–1
(A) Standing lateral x-ray of sacrum and coccyx. (B) Standing lateral x-ray after
10 minutes.
■
274
SECTION III THE LUMBAR SPINE
Eurostile
B
Figure 59–2
(A) Posterior subluxation with sitting. (B) Increase in flexion greater than 25
degrees when sitting.
Anococcygeal arteries
t
Joint
Osteotome in sacrococcygeal joint
and nerves, veins
Ligament and
periosteum
dissected
from bone
Figure 59–3
Midline longitudinal incision exposing the dorsal part of
the terminal sacrum and extending to the painful coccygeal segment.
Sacrococcygeal
joint line
Gluteus maximus
muscle
Levator ani muscles
Anococcygeal ligamen
A
Figure 59–5
Closure of the periosteum is done incorporating the terminal coccyx with this layer.
B
Figure 59–4
(A,B) Excision begins at the disc space with sharp dissection, and then
proceeds with a Freer or small periosteal elevator. The proximal part of the
coccyx is held with a towel clamp or Kocher clamp.
Closure of periosteum
and ligament
Eurostile
59 COCCYGECTOMY
275
■
■
276
SECTION III THE LUMBAR SPINE
Eurostile
Index
Page numbers in italics indicate that the entry on that page is in a figure.
A
Accordion procedure, rigid thoracic
scoliosis, 169, 170−172
Adolescent idiopathic scoliosis
classification system, 118, 118−120, 121
convex thoracoplasty, 131, 132−133, 134
King II curves, posterior correction, 145,
146−151
Alexander elevator, convex thoracoplasty,
131, 132−133, 134
Allograft selection and preparation
anterior lumbar interbody fusion, 237,
239, 240−241
lumbar corpectomy, 221
multiple-level cervical vertebrectomy
and stabilization, 36, 38
Anderson fracture, odontoid fixation, 16, 17
Andrews frame, revision disc surgery, 69−
71, 70
Anesthesia protocols
anterior odontoid resection, 10, 14
cranial cervical junction (CCJ) decom-
pression and fusion, 7
Ankylosing spondylitis, osteotomy guide-
lines, 227−232, 228−231
Annulus excision
anterior lumbar interbody fusion, 239,
240
total lumbar disc replacement, SB III
Charite prosthesis, 245, 246−248
Anterior bony decompression, anterior
odontoid resection, 10
Anterior cervical corpectomy and fusion
(ACCF), surgical techniques, 29−35, 30−
33
Anterior lumbar interbody fusion, guide-
lines, 237−241, 238−239
Anterior spinal fusion (ASF)
anterior lumbar interbody fusion, 237−
241, 238−239
Crankshaft phenomenon prevention and
treatment, 179, 180−181
Anterior surgical techniques
anterior threaded cage revision surgery,
263−267, 264−266
cervical disc, 66, 67, 68
cervical thoracic fixation, 72, 73−74, 76
cranial cervical junction (CCJ) decom-
pression and fusion, 3, 8
lumbar corpectomy, 218−221, 219−220
odontoid resection, 10−14, 11−13
Scheuermann’s kyphosis, release and fu-
sion techniques, 114−117, 115−116
thoracic scoliosis
anterior correction and instrumenta-
tion, 122, 123−127
anterior thoracoscopic release, 165,
166−167, 168
Kaneda anterior scoliosis system
(KASS), 140−144, 141−143
thoracoplasty, 135−139, 136−138
vertebral corpectomy, thoracic tumor or
infection, 97, 98−99, 100
Anterior threaded cage, revision surgery,
263−267, 264−266
Anterolateral approach
cervical thoracic fixation, 75, 76
lumbar corpectomy, 218−221, 219−220
Anteroposterior decompression and stabi-
lization, metastatic disease, transpedicular technique, 250−255, 251−254
Anteroposterior hemivertebrectomy, con-
genital spinal deformity, sublaminar
fixation with, 175−178, 176−177
Apical overcorrection, thoracolumbar id-
iopathic scoliosis, 198, 199
Arnold-Chiari malformation, occipital-cer-
vical spine wiring, Wertheim-Bohlman
technique, 52, 53
Atlantoaxial subluxation (AAS)
C1-C2 fusion, posterior screw fixation,
23−26, 24
cranial cervical junction (CCJ) decom-
pression and fusion, 3
Autograft devices
anterior lumbar interbody fusion, 237,
239, 240−241
posterior cervical laminectomy and fu-
sion, 46
Axial compression forces, posterior
column shortening, Scheuermann’s kyphosis, 111−112, 113
B
Bilateral hinge construction, spinal
process median splitting laminoplasty,
40, 42
Blood vessel management, anterior lumbar
interbody fusion, 237
Bohlman’s triple-wire technique, 55, 58−
59
Bone graft insertion
anterior cervical disc surgery, 68
anterior lumbar interbody fusion, 240
lumbar corpectomy, 221
lumbar fracture decompression, poste-
rior technique, 258, 261, 262
thoracic scoliosis, vertebral resection,
182, 184, 185
Bone removal, posterior surgical approach,
thoracic disc disease, 101−106, 102−105
Bookwalter retractor, lumbar corpectomy,
221
Brooks spinal wiring technique, 52, 54, 58
C
Cage misalignment, anterior threaded cage
revision surgery, 263−267, 264−266
Cavitron ultrasonic surgical aspirator
(CUSA), anterior odontoid resection, 14
C1-C2 instability
Brooks spinal wiring technique, 52, 54,
58
Gallie upper cervical spine wiring, 52,
53
posterior screw fixation, 23−26, 24−25
Central sacral vertical line (CSVL)
adolescent idiopathic scoliosis classifi-
cation, 118, 118−120, 121
King II curves, posterior correction, 145,
146−151
Cerebrospinal meningitis (CSM), anterior
cervical corpectomy and fusion (ACCF),
29, 30
Cervical corpectomy, anterior surgical
techniques, 29−35, 30−33
Cervical laminectomy and fusion, poste-
rior approach, 44−46, 45
Cervical laminoplasty, 40, 41−42, 43
Cervical myelopathy
anterior cervical disc surgery, 66, 67, 68
cervical laminoplasty, 40, 41−42, 43
posterior cervical plating technique, 62,
63−64, 65
spondylolytic myelopathy, open door
laminoplasty, 47, 48−50, 51
Cervical radiculopathy, anterior cervical
disc surgery, 66, 67, 68
Cervical spine surgery
far lateral approach, 27, 28
osteotomy guidelines, 228−231, 232
Rogers wiring technique, 54, 58
subaxial cervical sublaminar wiring, 55,
59
Cervical stenosis, cervical spondylolytic
myelopathy, open-door laminoplasty, 47,
49
Cervical thoracic fixation techniques, 72−
76, 73−75
anterior sternal splitting, 72, 73−74, 76
anterolateral approach, 75, 76
posterior approach, 72
“Chin on chest” flexion deformity,
osteotomy guidelines, ankylosing
spondylitis, 227, 231
Cobb elevator
anterior thoracoscopic release, 165, 167,
168
convex thoracoplasty, 131, 132−133, 134
sublaminar wire passage techniques,
186, 188−189
Eurostile
INDEX
277
■
Coccygectomy, guidelines for, 273, 274−275
Complications of surgery
anterior cervical corpectomy and fusion
(ACCF), 35
anterior cervical disc, 68
anterior cervical thoracic fixation, 76
anterior lumbar interbody fusion, 240−
241
anterior odontoid resection, 11, 14
anterior thoracoplasty, 139
anterior thoracoscopic release, 168
anterior threaded cage revision surgery,
267
anteroposterior hemivertebrectomy with
sublaminar fixation, 178
Bohlman’s triple-wire technique, 59
Brooks spinal wiring technique, 58
C1-C2 fusion, posterior screw fixation,
23
convex thoracoplasty, 134
cranial cervical junction (CCJ) decom-
pression and fusion, anterior and post-
erior techniques, 8
Crankshaft phenomenon prevention and
treatment, 179, 180−181
Dewar fusion procedure, 56, 59
domino technique, neuromuscular pel-
vic obliquity, 173, 174
double major curves, posterior scoliosis
correction, 153, 154, 155
en-bloc (“trap-door”) laminectomy, 208
Gallie upper cervical spine wiring, 52,
53
lumbar corpectomy, 221
lumbar fracture decompression, poste-
rior technique, 262
metastatic disease, anteroposterior
decompression and stabilization,
transpedicular approach, 255
microdiscectomy, 203−204
multiple-level cervical vertebrectomy
and stabilization, 36, 39
oblique facet procedure, 60
occipital-cervical spine wiring, Wer-
theim-Bohlman technique, 52, 53
odontoid fixation, 22
open-door laminoplasty, cervical
spondylolytic myelopathy, 51
osteoporotic vertebral fractures, verte-
broplasty, 79
osteotomy guidelines, ankylosing
spondylitis, 232
pedicle subtraction osteotomy, 236
posterior cervical laminectomy and
fusion, 46
posterior cervical plating, 62, 65
posterior cervical thoracic fixation, 72
posterior column shortening, Scheuer-
mann’s kyphosis, 113
posterior surgical approach, thoracic
disc disease, 106
revision disc surgery, 71
Rogers wiring technique, 54, 58
Scheuermann’s kyphosis, anterior re-
lease and posterior instrumentation,
117
Smith-Peterson osteotomy, 226
spinal process median splitting lamino-
plasty, 40, 42
spondylolisthesis reduction, pedicle
screw fixation and transforaminal
lumbar interbody fusion, 272
subaxial cervical sublamiinar wiring, 55,
59
sublaminar wire passage, 186, 190, 191
sublaminar wire passage, thoracolumbar
spine, 57, 60
thoracic disc disease, retropleural surgi-
cal technique, 94, 96
thoracic pedicle screw insertion, 86−90,
87−89
thoracic scoliosis, Kaneda anterior
scoliosis system (KASS), 144
transforaminal lumbar interbody fusion,
242
vertebral corpectomy, thoracic tumor or
infection, 100
Compression fractures, osteoporotic verte-
bral fractures, vertebroplasty and kyphoplasty, 79−84, 80−83
Computed tomography (CT)
anterior cervical disc surgery, 66, 67, 68
far lateral discectomy, 205, 206
posterior surgical approach, thoracic
disc disease, 101, 102
spinal process median splitting lamino-
plasty, 40, 41
Concave thoracoplasty, stiff thoracic
scoliosis, 128, 129−130
Congenital hemivertebra, vertebrectomy,
175−178, 176−177
Convex thoracoplasty, techniques and
complications, 131, 132−133, 134
Corpectomy
anterior cervical corpectomy and fusion
(ACCF), 29−35, 30−33
lumbar spine, 218−221, 219−220
multilevel corpectomy, cervical spondy-
lolytic myelopathy, 47
multiple-level cervical vertebrectomy
and stabilization, 36−39, 37−38
vertebral corpectomy, thoracic tumor or
infection, 97, 98−99, 100
Cortical bone, multiple-level cervical
vertebrectomy and stabilization using,
36−39, 37−38
anterior odontoid resection, 10−14, 11−13
decompression and fusion
case study, 5, 8−9
decompression and fusion, 3, 4
pathologic process involving, 3, 3
surgical techniques, 3−9, 4−6
Crankshaft phenomenon, prevention and
treatment, 179, 180−181
Curve classification system
adolescent idiopathic scoliosis, 118,
118−120, 121
double major curves, 153, 154, 155
King II curves, posterior correction, 145,
146−151
King V/double thoracic curves, posterior
correction, 156, 157−158
pedicle screws, posterior scoliosis cor-
rection, 159−164, 160−163
D
D’Alonzo type II fracture, odontoid fixa-
tion, 16, 17
Decompression
anterior cervical corpectomy and fusion
(ACCF) and extent of, 32, 34
cranial cervical junction, 3−9
lumbar corpectomy, 218−221, 219−220
lumbar fracture decompression, poste-
rior technique, 258−262, 259−261
metastatic disease, anteroposterior
decompression and stabilization,
transpedicular approach, 250−255,
251−254
multiple-level cervical vertebrectomy
and stabilization, 36
posterior cervical laminectomy and fu-
sion, 44, 45, 46
revision disc surgery, 71
spinal process median splitting lamino-
plasty, 40, 42
spondylolisthesis reduction, pedicle
screw fixation and transforaminal
lumbar interbody fusion, 268−272,
269−271
thoracic disc disease, retropleural ap-
proach, 94, 95−96
Dewar fusion procedure, 56, 59
Discectomy
anterior cervical disc surgery, 68
Crankshaft phenomenon prevention and
treatment, 179, 181
far lateral discectomy, 205, 206−207
microdiscectomy, 200, 201−202, 203−
204
posterior surgical approach, thoracic
disc disease, 101−106, 102−105
retropleural surgical technique, thoracic
disc disease, 94
revision disc surgery, 69−71, 70
thoracic scoliosis, anterior correction
and instrumentation, 122, 125−127
total lumbar disc replacement, SB III
Charite prosthesis, 245−249, 246−248
Disc excision, anterior lumbar interbody
fusion, 239, 240
Disc space preparation, spondylolisthesis
reduction, pedicle screw fixation and
transforaminal lumbar interbody fusion,
268−272, 269−271
Domino technique, neuromuscular pelvic
obliquity, 173, 174
Dorsal root ganglion, far lateral dis-
cectomy, 205, 206−207
Double major curve, posterior scoliosis
correction, 153, 154, 155
Double thoracic/King V curves
pedicle screws, posterior scoliosis cor-
rection, 159−164, 160−163
posterior scoliosis correction, 156, 157−
158
Doyen elevator, convex thoracoplasty, 131,
132−133, 134
■
278
INDEX
Eurostile
E
En-bloc (“trap-door”) laminectomy, lumbar
spine, 208−211, 209−210
External landmarks, anterior cervical
corpectomy and fusion (ACCF), 29, 29
Extraforaminal disc herniation, micro-
discectomy, 202, 204
Extrapedicular screw placement, thoracic
spine, 91, 92−93
Extruded disc, microdiscectomy, 202, 203−
204
F
Facetectomy, pedicle screws, posterior
scoliosis correction, 159−164, 160−163
Facet joints, en-bloc (“trap-door”) lumbar
spine laminectomy, 208, 209
Facet wiring
oblique facet procedure, 56, 59−60
posterior cervical laminectomy and
fusion, 46
Far lateral surgical approach
cervical spine surgery, 27, 28
discectomy, 205, 206−207
Forward bending test, stiff thoracic scolio-
sis, concave thoracoplasty, 128, 129
Fusion protocols
anterior cervical corpectomy and fusion
(ACCF), surgical techniques, 29−35,
30−33
anterior lumbar interbody fusion, 237−
241, 238−239
C1-C2 fusion, posterior screw fixation,
23−26, 24
concave thoracoplasty, 128, 129−130
craniocervical junction (CCJ), surgical
techniques, 3−9, 4−6
Crankshaft phenomenon prevention and
treatment, 179, 180−181
Dewar fusion, 56, 59
lumbar corpectomy, 221
lumbar lordosis, hook patterns, 195,
196−197
lumbar pedicle fixation, 216, 217
neuromuscular pelvic obliquity, domino
technique, 173, 174
posterior cervical laminectomy, 44, 45,
46
posterior spine wiring, 52−60, 53−57
retropleural surgical technique, thoracic
disc disease, 94, 96
Scheuermann’s kyphosis
anterior release and posterior instru-
mentation, 114−117, 115−116
posterior column shortening, 107−113,
108−112
scoliosis, posterior correction
double major curves, posterior correc-
tion, 153, 154, 155
King II curves, posterior correction,
145, 146−151
pedicle screw insertion, 159−164, 160−
163
Smith-Peterson osteotomy, 226
thoracic scoliosis, anterior correction
and instrumentation, 122, 123−127
transforaminal lumbar interbody fusion,
242, 243−244
G
Gallie-type fixation
C1-C2 fusion, posterior screw fixation,
23, 25
upper cervical spine wiring, 52, 53
H
Harms cage insertion, anterior threaded
cage revision surgery, 263−267, 266
Harrington instrumentation, lumbar lordo-
sis, 195
Harvesting techniques, anterior lumbar in-
terbody fusion, allografts and autografts,
240
Herniated discs
far lateral discectomy, 205, 206−207
microdiscectomy, 200, 201−202, 203−
204
posterior surgical approach, 101, 104
revision disc surgery, 71
Hook patterns, lumbar lordosis, 195, 196−
197
Hydroxyapatite spacer, spinal process me-
dian splitting laminoplasty, 40, 42
Hyperkyphosis, posterior column shorten-
ing, 110−111, 113
I
Incision techniques
anterior cervical corpectomy and fusion
(ACCF), 29, 31
anterior cervical thoracic fixation, 72,
73−74, 76
anterior lumbar interbody fusion, 237−
241, 238−239
anterior thoracoscopic release, 165, 166−
167, 168
anterior threaded cage revision surgery,
263−267, 264−266
anteroposterior hemivertebrectomy with
sublaminar fixation, 175−178, 176−
177
C1-C2 fusion, posterior screw fixation,
23, 24
coccygectomy, 273, 274−275
convex thoracoplasty, 131, 132−133, 134
cranial cervical junction (CCJ) decom-
pression and fusion, 6, 7
far lateral discectomy, 205, 206−207
far lateral surgical approach, cervical
spine surgery, 27, 28
lumbar corpectomy, 218−221, 219−220
lumbar fracture decompression, poste-
rior technique, 258−262, 259−261
metastatic disease, anteroposterior
decompression and stabilization,
transpedicular approach, 254, 255
multiple-level cervical vertebrectomy
and stabilization, 36−39, 37−38
neuromuscular pelvic obliquity, domino
technique, 173, 174
open-door laminoplasty, cervical
spondylolytic myelopathy, 47, 48
pedicle screws, posterior scoliosis cor-
rection, 159−164, 160−163
posterior cervical fixation
plating protocols, 62, 63
thoracic fixation, 72
posterior cervical laminectomy and fu-
sion, 44, 45
posterior scoliosis correction
double major curves, 153, 154, 155
King V/double thoracic curves, 156,
157−158
retropleural surgical technique, thoracic
disc disease, 94, 95
rigid thoracic scoliosis, accordion pro-
cedure, 169, 170−172
Smith-Peterson osteotomy, 226
spinal process median splitting lamino-
plasty, 40, 41−42
spondylolisthesis reduction, pedicle
screw fixation and transforaminal
lumbar interbody fusion, 268−272,
269−271
spondylolysis repair, 256, 257
thoracic pedicle screw insertion, 86−90,
87−89
thoracic scoliosis
anterior correction and instrumenta-
tion, 122, 123−127
Kaneda anterior scoliosis system
(KASS), 140−144, 141−143
total lumbar disc replacement, SB III
Charite prosthesis, 245−249, 246−248
transforaminal lumbar interbody fusion,
242, 243−244
Infectious disease, vertebral corpectomy,
thoracic tumor or infection, 97, 98−99,
100
Inflatable ballooon tamp, osteoporotic
vertebral fractures, kyphoplasty, 81−83,
84
Insertion techniques
anterior threaded cage revision surgery,
263−267, 265−266
extrapedicular screw placement, 91, 92−
93
lumbar pedicle fixation, 214−216, 217
metastatic disease, anteroposterior
decompression and stabilization,
transpedicular approach, 254, 255
posterior scoliosis correction
double major curves, 153, 154, 155
King V/double thoracic curves, 156,
157−158
pedicle screw insertion, 159−164, 160−
163
Smith-Peterson osteotomy, 226
thoracic pedical screws, 86−90, 87−89
thoracic scoliosis, anterior correction
and instrumentation, 122, 123−127
total lumbar disc replacement, SB III
Charite prosthesis, 245, 247−248, 249
Instrumentation complications
anterior threaded cage revision surgery,
265−266, 267
C1-C2 fusion, posterior screw fixation,
23
Eurostile
INDEX
279
■