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- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •Potential Complications
- •Preoperative Planning
- •Neuromonitoring
- •Positioning
- •Approach
- •Postoperative Course
- •References
- •Introduction
- •Surgical Approach
- •References
- •Introduction
- •History
- •Surgical Management
- •Technique
- •Postoperative Care
- •Prestige
- •PCM Disc Prosthesis
- •ProDisc-C
- •Mobi-C
- •Bryan Cervical Disc
- •Secure-C
- •Summary
- •References
- •Introduction
- •Initial Evaluation
- •Positioning
- •References
- •Overview
- •Indications
- •Contraindications
- •Relevant Surgical Anatomy
- •Radiographic Assessment
- •Technique
- •Preoperative Considerations
- •Positioning
- •Localization
- •Exposure
- •C1 Instrumentation
- •C2 Instrumentation
- •Cranial Instrumentation
- •Transarticular O-C1 Instrumentation
- •Fusion Mass
- •Postoperative Care
- •Complication Management
- •References
- •Introduction
- •Exposure
- •Laminectomy Technique
- •C3–C6 Instrumentation
- •C7 Instrumentation
- •Fusion/Decortication Technique
- •Final Steps
- •Complications
- •Summary
- •References
- •Introduction
- •Surgical Technique (Open Door Versus French Door)
- •Graft Materials
- •Complications
- •Outcomes
- •Conclusions
- •References
- •Introduction
- •Indications
- •Surgical Technique
- •Literature Review
- •References
- •Introduction
- •Anatomy
- •Indications
- •Surgical Management
- •Pedicle Screw Instrumentation
- •Preoperative Planning
- •Open Procedure
- •Bailout Options
- •Complications
- •Thoracic Spine Percutaneous Pedicle Screw Fixation
- •Introduction
- •Surgical Technique
- •Conclusion
- •References
- •Introduction
- •Assessment
- •Treatment
- •Nonoperative Treatments
- •Operative Treatments
- •Non-pedicle Screw Constructs
- •Pedicle Screw Constructs
- •Pedicle Screw Technique
- •Outcomes
- •References
- •Conclusion
- •References
- •Background
- •Indications
- •Approaches/Techniques
- •Postoperative Care
- •Introduction
- •Indications
- •Open Approaches
- •Transpedicular Approach
- •Costotransversectomy
- •Lateral Extracavitary
- •Transsternal/Transmanubrial
- •Thoracoabdominal
- •Minimally Invasive Approaches
- •Thoracoscopic Corpectomy
- •“Mini-Open” Transpedicular Corpectomy
- •Minimally Invasive Lateral Retropleural Corpectomy
- •Grafting Technique
- •Complications
- •References
- •Introduction
- •Presentation
- •Non-operative Management
- •Evaluation
- •Surgical Considerations
- •Posterior Approaches
- •Transpedicular Approach
- •Costotransversectomy Approach
- •Lateral Extracavitary Approach
- •Anterior Approaches
- •Lateral Retropleural Approach
- •Surgical Technique
- •Transthoracic Approach
- •Surgical Technique
- •Complications
- •References
- •Introduction
- •Pathophysiology
- •Clinical Presentation
- •Symptoms
- •Physical Examination
- •Imaging
- •Treatment
- •Non-operative Management
- •Surgical Indications
- •Surgical Techniques
- •Positioning
- •Foraminal/Extraforaminal Disc Herniations
- •Complications
- •Outcomes
- •Conclusions
- •References
- •Introduction
- •Presentation/Work-Up
- •Treatment
- •MIS Versus Open
- •Postoperative Care
- •Conclusions
- •References
- •Introduction
- •Anatomy
- •Indications
- •Contraindications
- •Non-operative Management
- •Surgical Procedure
- •Surgical Approach
- •Pedicle Screw Insertion
- •Disc Space Distraction
- •Complete Unilateral Facetectomy
- •Disc Space Preparation
- •Graft/Cage Placement
- •Posterolateral Grafting
- •Outcomes
- •Complications
- •Summary
- •References
- •Introduction
- •Procedure
- •Operative Planning
- •Positioning
- •Outcomes
- •Conclusions
- •References
- •Introduction
- •Indications
- •Surgical Management
- •Positioning
- •Radiation Reduction
- •Pedicle Screw Placement
- •Decompression
- •Cage Placement
- •Rod Placement
- •Lordotic Restoration
- •Multilevel Cases
- •Spondylolisthesis Reduction
- •Grafting
- •Summary
- •References
- •References
- •Anatomy
- •Intraoperative Imaging
- •Neuromonitoring
- •Surgical Techniques
- •Infradiaphragmatic Retroperitoneal
- •Retropleural/Retroperitoneal
- •Cage Selection
- •Final Images
- •Postoperative Care
- •References
- •Background
- •Anatomy
- •Surgical Technique
- •Summary
- •References
- •History
- •Anatomy
- •Musculature
- •Genitourinary
- •Vasculature
- •Lymphatics
- •Sympathetics
- •Patient Selection
- •Surgical Approach
- •Positioning
- •Surgical Approach to Retroperitoneum
- •Complications
- •Conclusion
- •References
- •Introduction
- •Technique
- •Approach
- •Implant Placement
- •Postoperative Care
- •Outcomes
- •Conclusion
- •References
- •Introduction
- •Technique
- •Approach
- •Implant Placement
- •Lateral Plating
- •Posterior Percutaneous Screw Fixation
- •Postoperative Care
- •Outcomes
- •Case Study
- •Conclusion
- •References
- •Introduction
- •Indication
- •Proper Imaging Technique
- •Patient Positioning
- •Surgical Technique
- •Percutaneous Pedicle Screw Fixation Using Image Guidance
- •Complications
- •Postoperative Care
- •Limitations
- •References
- •Technical Notes
- •Conclusion
- •References
- •Background
- •Odontoid Anatomy
- •Epidemiology
- •Anterior Screw Fixation Versus Other Management
- •Indications
- •Contraindications
- •Radiology
- •Procedure
- •One Screw or Two?
- •Common Pitfalls
- •Outcomes
- •Conclusion
- •References
- •Introduction
- •Incidence
- •Clinical Manifestation
- •Imaging Studies
- •Treatment
- •Conclusion
- •References
- •Introduction
- •Diagnosis
- •References
- •Diagnosis
- •Treatment
- •Special Treatment Considerations
- •Surgical Site Infection
- •References
- •Overview
- •Soft Disc Ruptures
- •Lumbar Stenosis
- •History/Clinical Evaluation
- •Myelo/CT
- •CT Scan
- •EMG/ NCV
- •Blocks
- •Miscellaneous Diagnostic Considerations
- •Clinical Scenarios
- •Never Adequate Pain Relief
- •Possible Overall Pathologies
- •Technical Considerations
- •Redo Discectomy
- •Redo Laminotomy/Laminectomy
- •Outcomes
- •References
- •Preoperative Imaging
- •Screw Design
- •Misplaced Screws
- •Summary
- •References
- •Introduction
- •Adjacent Segment Disease
- •Pseudoarthrosis
- •Recurrent Symptoms/Residual Stenosis/Poor Index Indication
- •Infection
- •Kyphosis/Deformity
- •Imaging
- •Further Testing
- •Revision Strategies
- •Complications
- •References
- •Introduction
- •Metastatic Spine Tumors
- •The Cancer Patient
- •Treatment Considerations
- •Surgical Considerations/Operation Planning
- •Outcome/Prognosis
- •References
- •Surgical Treatment
- •Outcome
- •Bibliography
- •Basic Principles
- •Introduction
- •Epidemiology
- •Diagnostic Tools
- •Emergent Interventions
- •Nonsurgical Care
- •Summary
- •Cranio-cervical Injuries
- •Key Concept
- •Surgical Care
- •Atlas Injuries
- •Key Concept
- •Surgical Care
- •Odontoid Injuries
- •Key Concept
- •Surgical Care
- •Hangman’s Fractures
- •Key Concept
- •Treatment
- •Introduction
- •Burst Fractures
- •General Features
- •Diagnosis
- •Treatment
- •Key Concepts
- •Posterior Ligamentous Injury
- •General Description
- •Diagnosis
- •Treatment
- •Key Concepts
- •Facet Injury (Unilateral or Bilateral) With/Without Fracture
- •General Description
- •Diagnosis: Unilateral Facet Injury (With/Without Fracture)
- •Diagnosis: Bilateral Facet Injury (With/Without Fracture)
- •Treatment: Unilateral Facet Injury (With/Without Fracture)
- •Treatment: Bilateral Facet Injury (With/Without Fracture)
- •Key Concepts
- •Complex Fracture-Dislocation
- •General Description
- •Diagnosis
- •Treatment
- •Key Concepts
- •References
- •Introduction
- •Historical Perspective
- •Preoperative Evaluation
- •Preoperative Imaging Evaluation
- •Operative Considerations
- •References
- •Index

123
Joseph R. O’Brien
S. Bobby Kalantar
Doniel Drazin
Faheem A. Sandhu
Editors
The Resident’s Guide
to Spine Surgery

The Resident’s Guide to Spine Surgery

Joseph R. O’Brien • S. Bobby Kalantar
Doniel Drazin • Faheem A. Sandhu
Editors
The Resident’s Guide
to Spine Surgery

ISBN 978-3-030-20846-2 ISBN 978-3-030-20847-9 (eBook)
https://doi.org/10.1007/978-3-030-20847-9
© Springer Nature Switzerland AG 2020
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 Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Editors
Joseph R. O’Brien, MD, MPH
Washington Spine & Scoliosis
Institute at OrthoBethesda
Bethesda, MD
USA
Doniel Drazin, MD
Pacic Northwest University
of Health Sciences
Yakima, WA
USA
S. Bobby Kalantar, MD
Department of Orthopaedic Surgery
MedStar Georgetown University Hospital
Washington, DC
USA
Faheem A. Sandhu, MD, PhD
Department of Neurosurgery
MedStar Georgetown University Hospital
Washington, DC
USA

v
Preface
Spine surgery in 2019 is more advanced than ever. As a multidisciplinary eld, it
draws from the expertise of orthopaedic surgeons and neurosurgeons. Additionally,
the advances in minimally invasive techniques have added a layer of complexity.
For residents in either specialty, it can be a daunting task to learn all of the pro-
cedures in a short period of time. This book has been assembled by a group of
experts with a long tradition of educating residents. The overarching goal has been
to create a concise guide to each procedure and make it “learnable”. For both ortho-
paedic and neurological resident surgeons, this book will be a guide to acquire the
requisite skills in spine surgery.
Bethesda, MD, USA JosephR.O’Brien, MD, MPH

vii
I would like to acknowledge my co-editors and Claire van Ekdom for their work
over the last 2 years in preparing this text book. In particular, Claire has been
instrumental in organizing the entire textbook. Without their collective effort, this
book would not have been possible. I would also like to thank my family (Janet,
Brad and Alex) for their love and support while I focused on thisproject.
Acknowledgments

ix
1 Anterior Cervical Discectomy and Fusion . . . . . . . . . . . . . . . . . . . . . . 1
Crystal Adams, Fadi Sweiss, Michelle Feinberg,
and Jonathan H. Sherman
2 Cervical Corpectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Gregory Callanan, Ra’ Kerry Rahman, and Kris Radcliff
3 Cervical Disc Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Blake M. Bodendorfer, Ashley E. MacConnell,
and S. Babak Kalantar
4 Posterior Cervical Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Joseph Rabe
5 Posterior Cervical Fusion Surgery: Occiput to C2 . . . . . . . . . . . . . . . 37
R. Tushar Jha and Faheem A. Sandhu
6 Posterior Cervical Laminectomy and Fusion Surgery C3-C7 . . . . . . 49
S. Tim Yoon and Chase Bennett
7 Cervical Laminoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Ronen Blecher, Emre Yilmaz, and Jens R. Chapman
8 Minimally Invasive Posterior Cervical Foraminotomy
and Discectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Joel Z. Passer, Shahin Manoochehri, and Bong-Soo Kim
9 Thoracic Posterior Instrumentation Without Scoliosis . . . . . . . . . . . . 79
Dany Aouad and Oliver Tannous
10 Posterior Thoracic Instrumentation for Scoliosis . . . . . . . . . . . . . . . . 87
Fred F. Mo, William D. Zelenty, and Daniel M. Dean
11 Anterior Thoracic Decompression and Fusion:
Open and Minimally Invasive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Jason Kappa, Jeffrey H. Weinreb, Warren Yu, and Joseph R. O’Brien
Contents

x
12 Thoracic Corpectomy: Indications and Techniques . . . . . . . . . . . . . . 103
Steven Spitz and Anthony Conte
13 Thoracic Discectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Jason E. McGowan, Islam Fayed, Marcelle Altschuler,
and Faheem A. Sandhu
14 Lumbar Microdiscectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Ravi S. Nunna, Joshua T. Wewel, and John E. O’Toole
15 Approaching Far Lateral Disc Herniations:
The MIS Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Kyle Mueller and Amjad Anaizi
16 Open Transforaminal Lumbar Interbody Fusion
with Posterior Spinal Instrumentation and Fusion . . . . . . . . . . . . . . . 135
Sean K. Jandhyala and Saad B. Chaudhary
17 Lumbar Corpectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Danny Lee, Ryan Lee, Jeffrey H. Weinreb, Uchechi Iweala,
and Joseph R. O’Brien
18 Minimally Invasive Transforaminal Lumbar Interbody Fusion . . . . 153
David Vincent and J. Alex Thomas
19 Lateral Lumbar Interbody Fusion L3–L4, L4–L5 . . . . . . . . . . . . . . . 163
Kurt E. Stoll, Daniel A. Marchwiany, Daniel L. Cavanaugh,
and Gurvinder S. Deol
20 Lateral Lumbar Interbody Fusion L1–2, L2–3 . . . . . . . . . . . . . . . . . . 171
Ryan DenHaese, Clint Hill, and Jeffrey H. Weinreb
21 The Ante-Psoas Approach for Lumbar Interbody Fusion . . . . . . . . . 177
Melvin C. Makhni, James D. Lin, and Ronald A. Lehman Jr.
22 Anterior Lumbar Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Tiffany Grace Perry
23 Lumbar Total Disc Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Jeffrey H. Weinreb
24 Lateral Lumbar Interbody Fusion for Lumbar Scoliosis . . . . . . . . . . 201
Jeffrey H. Weinreb, Uchechi Iweala, Danny Lee, Warren Yu,
and Joseph R. O’Brien
25 Percutaneous Lumbar Screws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Brianna Lindsey Cohen, Karthik Madhavan,
and Michael Y. Wang
26 Percutaneous Iliac and S2AI Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Lauren Matteini
Contents

xi
27 Anterior Odontoid Screws: Tips and Tricks . . . . . . . . . . . . . . . . . . . . . 229
Daniel Kerekes, A. Karim Ahmed, Camilo Molina,
C. Rory Goodwin, and Daniel M. Sciubba
28 Cerebrospinal Fluid Leak After Spine Surgery . . . . . . . . . . . . . . . . . . 241
Michelle Feinberg, Kathleen Knudson, Jezer Martinez,
Crystal Adams, Fadi Sweiss, and Jonathan H. Sherman
29 Minimally Invasive Sacroiliac Joint Fusion . . . . . . . . . . . . . . . . . . . . . 247
Cristian Gragnaniello, Fadi Sweiss, Crystal Adams,
and Jonathan H. Sherman
30 Treatment Considerations for Pyogenic Spinal Infection . . . . . . . . . . 253
Ehab Shiban and Bernhard Meyer
31 Revision Lumber Decompressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
David Hanscom and Peter Grunert
32 Revision Pedicle Screw Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Tiffany Grace Perry
33 Revision Strategies for Cervical Spine Surgery . . . . . . . . . . . . . . . . . . 285
Anthony Conte and Faheem A. Sandhu
34 Metastatic Tumor Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Rod J. Oskouian Jr., Emre Yilmaz, and Tamir A. Tawk
35 Intradural Tumor Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Rod J. Oskouian Jr., Emre Yilmaz, Thomas O’Lynnger, and David
W. Newell
36 Cervical Spine Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Jens R. Chapman, Andrew S. Jack, and Wyatt L. Ramey
37 Anterior Approach to the Lumbosacral Spine . . . . . . . . . . . . . . . . . . . 341
Joseph C. Babrowicz Jr.
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Contents

xiii
Contributors
CrystalAdams, MD Department of Neurological Surgery, The George Washington
University School of Medicine and Health Sciences, Washington, DC, USA
A. Karim Ahmed, BS Department of Neurosurgery, Johns Hopkins University
School of Medicine, Baltimore, MD, USA
MarcelleAltschuler, BS Georgetown University School of Medicine, Washington,
DC, USA
AmjadAnaizi, MD Department of Neurosurgery, MedStar Georgetown University
Hospital, Washington, DC, USA
DanyAouad, MD Saint Georges University Medical Center, Beirut, Lebanon
Joseph C. Babrowicz Jr., MD Department of Surgery, Inova Fairfax Medical
Campus, Inova Vascular Surgery, Falls Church, VA, USA
ChaseBennett, MD Orthopaedic Spine Surgeon, Novant Brain and Spine Surgery,
Winston-Salem, NC, USA
Ronen Blecher, MD, PhD
Swedish Neuroscience Institute, Swedish Medical
Center, Seattle, WA, USA
Blake M. Bodendorfer, MD Department of Orthopaedic Surgery, MedStar
Georgetown University Hospital, Washington, DC, USA
GregoryCallanan, DO Orthopedic Surgery, Inspira Health Network, Vineland,
NJ, USA
Daniel L. Cavanaugh, MD Department of Orthopaedics, University of North
Carolina, Chapel Hill, NC, USA
JensR.Chapman, MD Swedish Neuroscience Institute, Swedish Medical Center,
Seattle, WA, USA
SaadB.Chaudhary, MD Mount Sinai Hospital, New York, NY, USA
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