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Michael Y. Wang Yi Lu D. Greg Anderson Praveen V. Mummaneni
Editors
Minimally Invasive Spinal Deformity Surgery
An Evolution of Modern Techniques
123
Minimally Invasive Spinal Deformity Surgery
Michael Y. Wang Y i L u D. Greg Anderson Praveen V. Mummaneni
Editors
Minimally Invasive Spinal Deformity Surgery
An Evolution of Modern Techniques
Editors
Michael Y. Wang, M.D., M.S. Department of Neurological Surgery University of Miami Miller School of Medicine Miami, FL USA
Yi Lu , M.D., Ph.D. Department of Neurosurgery Brigham and Women’s Hospital Harvard Medical School Boston, MA USA
D. Greg Anderson Department of Orthopaedics Thomas Jefferson University Philadelphia, PA USA
Praveen V. Mummaneni, MD Department of Neurological Surgery University of California San Francisco, CA USA
ISBN 978-3-7091-1406-3 ISBN 978-3-7091-1407-0 (eBook) DOI 10.1007/978-3-7091-1407-0 Springer Wien Heidelberg Dordrecht London New York
Library of Congress Control Number: 2013957182
© Springer-Verlag Wien 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms 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. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (
www.springer.com)

Foreword

Minimally Invasive Spinal Deformity Surgery: An Evolution of Modern Techniques is intended to provide an educational resource for surgeons in an
area where there has until now been a paucity of literature. Many advances in the area of minimally invasive spine surgery (MISS) are occurring through small series of patients operated on by innovative thought leaders. This book provides the opportunity to put this collection of surgical techniques and early outcomes into one place so that the student of this advancing fi eld may gain a broader exposure to the current knowledge base.
With the increasingly aging patient population, it is now common to see in one’s practice older patients with advanced degenerative spine disease and deformity. These issues can be incapacitating, causing pain and immobility, and reducing the patient’s quality of life. Multiple medical comorbidities often exist in these patients, along with osteoporosis, causing challenges and often complicating treatment. As a consequence, surgical treatment of adult spinal deformities is fraught with hazards and complications, which has led thought leaders to seek better solutions. Contemporary spine surgeons, both orthopedic surgeons and neurosurgeons, are recognizing that MISS is an increasingly desirable option for managing this diffi cult patient population. MISS techniques are reported to minimize blood loss and surgical site pain and to speed up recovery. Recent work by McGirt et al. [1] showed that the number of surgical site infections with two-level fusions performed via MISS was signifi cantly reduced as compared to that seen with open lumbar two­level fusions.
This book is divided into sections that will help provide good background information to readers wishing to become knowledgeable in all areas of MISS. The “Deformity Surgery Principles” section includes not only epide­miology and classifi cation but important issues for adult deformity surgery, such as sagittal balance and lumbopelvic parameters. The next section, “Percutaneous Segmental Fixation,” reviews techniques of screw insertion with a subsection on osteoporotic bone. The use of interbody fusion devices is separately discussed in the more popular “Posterior Approaches” and a section covering “Lateral Approaches.” The lateral approach section includes a chapter on the role of neuromonitoring, the use of which is vitally important in making this procedure safe. “Dealing with the Lumbo-Pelvic Junction” discusses the importance of good distal fi xation, not only to S1 but also to the ilium, and the minimally invasive techniques to accomplish this fi xation are also well discussed. “Achieving Intersegmental Arthrodesis” discusses the
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very important issue of bone grafting techniques. Much of what has been learned in adult deformity surgery is being incorporated into MISS approaches for posterior adolescent idiopathic scoliosis surgery and is covered in the “Future Directions” section.
I applaud the editors of this book for soliciting highly relevant informa­tion on this subject; they have done an outstanding job to make sure that signifi cant, new information is available to surgeons wishing to learn some of these techniques in order to take care of this increasing patient population.

Reference

1. McGirt MJ, Parker SL, Lerner J, Engelhart L, Knight T, Wang MY. Comparative
analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients. J Neurosurg Spine 2011;14(6):771–8.
Philadelphia, PA Randal R. Betz, M.D.
Foreword

Contents

Part I Deformity Surgery Principles
1 The Epidemiology of Adult Spinal Deformity
and the Aging Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Joseph S. Cheng, Jonathan Forbes, Cyrus Wong, and Edward Perry
2 Classifi cation Schema for Scoliosis. . . . . . . . . . . . . . . . . . . . . . . 11
Olaolu C. Akinbo, Tsung-Hsi Tu, John E. Ziewacz, and Praveen V. Mummaneni
3 Indications for Adult Spinal Deformity Surgery. . . . . . . . . . . . 21
Jeffrey H. Weinreb, Kristina L. Bianco, Virginie Lafage, and Frank Schwab
4 Sagittal Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Jeffrey B. Knox and Baron S. Lonner
5 Lumbopelvic Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Manish K. Kasliwal, Justin S. Smith, Manish Singh, and Christopher I. Shaffrey
6 The Importance of the Fractional Curve. . . . . . . . . . . . . . . . . . 47
Michael Y. Wang
7 Radiation Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
D. Greg Anderson
8 Costs of Minimally Invasive Spine Surgery. . . . . . . . . . . . . . . . 59
Kevin S. Cahill
9 The MiSLAT Algorithm: Minimally Invasive Evaluation
and Treatment for Adult Degenerative Deformity . . . . . . . . . . 67
Praveen V. Mummaneni, Michael Y. Wang, Fernando E. Silva, Lawrence G. Lenke, John E. Ziewacz, Beejal Y. Amin, and Tsung-Hsi Tu
vii
viii
Part II Percutaneous Segmental Fixation
10 Fluoroscopic Techniques in MIS Surgery . . . . . . . . . . . . . . . . . 77
D. Greg Anderson
11 Image Guidance for Minimally Invasive
Deformity Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Roger Härtl
12 Nuances of Percutaneous Thoracolumbar
Pedicle Screw Fixation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
D. Greg Anderson
13 Rod Contouring, Passage, and Connection . . . . . . . . . . . . . . . . 109
Bernhard Meyer, Michelle Falcone, Michael Y. Wang, Yi Lu, and Steven Wu
14 Percutaneous Sacropelvic Fixation. . . . . . . . . . . . . . . . . . . . . . . 113
Michael Y. Wang
15 Management of Osteoporotic Bone . . . . . . . . . . . . . . . . . . . . . . 123
John E. Ziewacz, Darryl Lau, Sigurd H. Berven, Armed J. Awad, and Praveen V. Mummaneni
16 Minimally Invasive Cement-Augmented
Pedicle Screw Fixation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Brian Hood and Steven Vanni
Contents
Part III Posterior Approaches
17 Interbody Cage Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Asdrubal Falavigna
18 Multilevel TLIF for Spinal Deformity . . . . . . . . . . . . . . . . . . . . 173
Yi Lu, Michelle M. Falcone, Michael Y. Wang, and Steven Wu
19 Expandable Cages for Thoracic Spinal Deformity . . . . . . . . . . 185
Paul E. Kaloostian and Daniel M. Sciubba
20 Expandable Cages for Lumbar Spinal Deformity . . . . . . . . . . 191
Michael Y. Wang
21 Lumbar Endoscopic Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Gun Choi, Guilherme Pereira Corrêa Meyer, and Daniel H. Kim
22 Minimally Invasive Osteotomy Techniques . . . . . . . . . . . . . . . . 215
Michael Y. Wang
Part IV Lateral Approaches
23 Thoracoscopic Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Jonathan D. Choi and Robert E. Isaacs
Contents
ix
24 Role of Neuromonitoring in Minimally Invasive
Latera Approaches to the Spine . . . . . . . . . . . . . . . . . . . . . . . . . 233
Khoi D. Than, Anthony C. Wang, Brian Bush, Paul Park, and Frank La Marca
25 Lateral Interbody Decompression and Fusion:
Which Side to Approach From? . . . . . . . . . . . . . . . . . . . . . . . . . 245
Andrew A. Sama
26 Stand-Alone Lateral Surgery for Spinal Deformity . . . . . . . . . 255
Amir Ahmadian and Juan S. Uribe
27 Complications of the Lateral Lumbar Transpsoas Approach . . . 263
Adam S. Kanter and Matthew B. Maserati
28 Minimally Invasive Anterior Column Reconstruction
for Sagittal Plane Deformities. . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Armen Deukmedjian and Juan S. Uribe
29 MIS Thoracic Interbody Surgery. . . . . . . . . . . . . . . . . . . . . . . . 287
Kai-Michael Scheufl er
Part V Dealing with the Lumbo-Pelvic Junction
30 Mini-Open ALIF for Fusing the Lumbosacral Junction . . . . . 303
Robert Watkins IV and Salvadore Brau
31 Presacral Approach for Discectomy and Interbody Fusion
in the Setting of Minimally Invasive Spine Surgery
Deformity Correction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Neel Anand and Eli M. Baron
32 Minimally Invasive Sacroiliac Joint Fusion. . . . . . . . . . . . . . . . 321
Yi Lu and Steven Wu
Part VI Achieving Intersegmental Arthodesis
33 Bone Graft Extenders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Sonia Teufack, James Harrop, and Srinivas Prasad
34 Minimally Invasive Wiltse Approaches for
Posterolateral Fusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Steve Ritland
35 Minimally Invasive Thoracolumbar Facet Joint Fusion . . . . . 363
Oliver Tannous, Kelley Banagan, and Steven C. Ludwig
Part VII Future Directions
36 Clinical Research in MIS Surgery: Current State
and Future Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Christina L. Goldstein and Y. Raja Rampersaud