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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6048_Библиотеки_им_академика_М_И_Перельмана.pdf
353
cervical disc arthroplasty, 291
clinical and laboratory testing, 289
complications, 293
degenerative spondylosis, 292
esophageal perforation, 290
exion–extension radiographs, 288
fusion mass, 291
infection, 287, 288
kyphotic deformity, 288, 292, 293
laminoforaminotomy, 291
motion-preserving techniques, 291, 292
MRI, 289
noncontrast computed tomography, 289
postsurgical cervical kyphosis with
sagittal/coronal imbalance, 292
pseudoarthrosis, 286, 291
recurrent laryngeal nerve injury, 290
recurrent symptoms/residual stenosis/poor
index indication, 287
standing scoliosis lms, 288
Cervical spine trauma
ankylosing spondylitis and other
ankylosing diseases, 313
cranio-cervical dislocations, 313
diagnostic tools
cervical tomography, 309
CT-angiography, 309
magnetic resonance imaging, 309
plain radiographs, 310
radionuclide scans/electrodiagnostics,
310
duration of surgery, 312
emergency retrieval and resuscitation,
308, 309
emergent interventions, 310
epidemiology, 308
fracture dislocations, 312
halo-vest management, 315
nonsurgical care, 314, 315
polytrauma/multiply injured patient, 313
rigid neck collars, 315
soft neck collars, 315
vertebral artery injuries, 312
Cervical spondylotic myelopathy (CSM), 9, 63
Cervical stenosis, 59
Chamberlain’s line, 40
Charité™ implant, 198
Chiari malformation, 38
Clivoaxial angle (CXA), 40
Complete unilateral facetectomy, 139, 140
Complex fracture-dislocations
classication, 334
diagnosis, 335
treatment, 335
Condyle-C1 interval (CCI), 40
Congenital scoliosis, 87
Construct failure, 80
Controlled “greenstick-type” fracture, 61
Conventional cervical laminectomies, 59
Coronal facet joint orientation, 104
Costotransversectomy approach, 106
C5 palsy, 55
Cranial angulation, 53
Cranio-cervical dislocations, 313
Cranio-cervical injuries
classication algorithm and
nomenclature, 317
diagnosis, 316–318
occipital-atlanto-axial unit, 318
nonoperative care, 318
surgical care, 318, 319
Craniocervical instability, 37
D
Denitive cervical decompression
surgery, 59
Degenerative disc disease (DDD), 129, 145
Degenerative spondylosis, 292
Demineralized bone matrix, 46
Direct lateral approach, 163
Direct vertebral rotation (DVR), 93
Disc decompression/excision without fusion
(DDE), 121
Disc space distraction, 138, 139
Discogenic back pain syndromes, 137
Double-door laminoplasty, see French-door
technique
Doyen elevator, 108
Dura-pleural stulas, 112
Dysphagia, 314
E
Endoscopic Kittner dissectors, 346
Ependymomas, 304
Epidural abscesses, 104
Erosive discitis, 104
Esophageal perforation, 290
Extreme lateral interbody fusion (XLIF)
advantages, 201, 202
case presentation, 207
indication, 202
limitations (see Lumbar lateral interbody
fusion)
outcomes, 206, 207
technique
approaches, 203
Index
354
Extreme lateral interbody fusion (XLIF)
(cont.)
bipolar electrocautery and blunt
dissection, 203
implant placement, 204
lateral plate, 205
monopolar electrocautery, 203
multiple initial incision locations, 203
percutaneous iliac/S2-Alar Iliac screw
xation, 205
postoperative care, 205, 206
preparation and positioning, 202–203
visual analogue scale pain scores, 202
F
Facet joint integrity, 61, 80
Far lateral disc herniations (FLDH)
conservative treatment, 130
minimally invasive far lateral discectomy
AP and lateral radiographs, 130
DRG, 131
herniated disc, 131, 132
intertransverse ligament, 131
patient positioning, 130
transverse process and facet
junction, 130
transverse process and lateral pars
border, 130
vs. open approach, 132
MRI, 130
postoperative care, 132, 133
prevalence, 129
Fibular strut grafts, 37
Flexion-compression mechanism, 326
Frankel scale scores, 149
French-door technique, 61, 62
G
Generous annulotomy, 156
Globus and SynFrame systems, 345
Grafting technique, 111, 112
Grisel’s syndrome, 37
H
Halo-vest management, 315
Hangman’s fractures, 324
Harrington rod system, 79
Hemangioblastomas, 303
Herniated thoracic discs, 116
Heterotopic ossication (HO), 25
Hirabayashi technique, see Open-door
technique
Homogeneous cylinder, 80
Hook or hybrid hook-screw constructs, 89
Horner’s syndrome, 100
Hybrid constructs, 90
I
Iliac cortical density (ICD), 249
Incidental durotomy, 127
Inferior articulating process (IAP), 90
In-out-in technique, 83
Inside-outside technique, 41
Intention to treat (ITT) analysis, 127
Interposition grafts, 62
Intervertebral disc herniation, 115, 119
Intervertebral kinematics, 18
Intervertebral lumbar disc, 123
Intractable radiculopathy, 20
Intractable symptomatic cervical disc
disease, 20
Intradural tumors resection
extramedullary lesions, 303
intramedullary tumors, 303
outcomes, 305
spinal cord tumors, 303, 304
surgical treatment, 304, 305
Intramedullary tumors, 303
Intrapleural approach, 108
Ipsilateral annulotomy, 165
J
Japanese Orthopaedic Association score, 101
K
Kambin’s triangle, 136, 139, 156
Kerrison rongeurs, 117, 120
Kyphotic deformity, 21, 104, 292, 293
L
Laminarthrectomy, 21
Laminectomy technique, 52–53
Laminoforaminotomy, 291
Laminotomy, 117, 119
Laparoscopic anterior lumbar approach, 163
Laparoscopic lumbar discectomy, 163
Lateral extracavitary approach, 106, 107
Lateral lumbar interbody fusion (LLIF),
157, 177
Index
355
ALIF, 177
anatomy, 179
L1–L2, L2–L3
anatomy, 171, 172
cage selection, 175
indications, 171
infradiaphragmatic retroperitoneal,
173, 174
intraoperative imaging, 173
neuromonitoring, 173
posterior xation, 175
postoperative care, 175, 176
retropleural/retroperitoneal, 174
L3–4, L4–5
advantages, 163
anatomy and anatomic
considerations, 164
anteriorly positioned psoas “mickey
mouse ears”, 167
complications, 169
contraindications, 168
cost analysis, 168
direct lateral approach, 163
fusion rates, 168
lumbar plexus, 164, 167, 168
operative room setup, 164
operative technique, 164, 165
outcomes, 163
Psoas morphology, 167
sagittal and coronal plane
deformities, 168
minimally invasive fashion, 177
OLIF, 177
advantage, 179
antepsoas approach, 177
follow-up, 178
preoperative planning, 179
surgical corridors, 179
surgical technique, 179–183
PLIF, 177
robotic surgery, 178
TLIF, 177
Left-sided anterolateral-retroperitoneal
approach, 147
Ligamentum avum, 99
Longitudinal narrow laminectomy, 61
Low back pain (LBP), 123
Lumbar corpectomy
contraindications, 146
extreme lateral approach, 149
indications, 145
miniopen lateral approach, 149
MIS approaches, 146
open anterior approaches, 146
outcomes, 148, 149
posterior approaches, 146
procedure
adjacent vertebral bodies, 148
after hemostasis, 148
contralateral and anterior cortices, 148
iliohypogastric, ilioinguinal and
subcostal nerves, 147
incision, 147
operative planning, 146–147
patient position, 147
retroperitoneum, 147
ureteral stents, 148
spinal fusion, 145, 146
Lumbar disc herniation
complications, 127
CT imaging, 124
MRI, 124
non-operative management, 124, 125
outcomes, 127
pain management, 126
pathophysiology, 123
patient positioning, 125
physical examination, 124
post-operative care, 126
surgical indications, 125
surgical technique (see Lumbar
microdiscectomy)
symptoms, 124
Lumbar microdiscectomy
central and posterolateral disc herniation,
125, 126
foraminal/extraforaminal disc
herniation, 126
Lumbar plexus, 164, 167, 168
Lumbar sagittal deformity, 145
Lumbar total disc replacement (TDR)
arthrodesis, 195
Charité™ implant, 198
complication rates, 198
contraindications, 196
disc degeneration, 195
discectomy/annulotomy, 197
indications, 196
motion segment mobility, 195
orthogonal uoroscopy, 197
Oswestry disability index, 199
patient positioning, 196
posterior longitudinal ligament, 197
postoperative care, 198
ProDisc™ implant, 198
surgical approach, 196, 197
Index
356
Lumbosacral spine
complications, 348
history, 341, 342
operative considerations
anterior rectus sheath, 346
discectomy and instrumentation, 347
endoscopic Kittner dissectors, 346, 347
L4-L5 disc/higher levels, 346, 347
patient position, 344
skin incision, 346
table mounted retractor system, 345
outcomes, 347
preoperative evaluation, 342, 343
preoperative imaging evaluation, 344, 345
M
Mageral technique, 218
McGregor’s line, 40
McRae’s line, 40
Meningiomas, 303
Metal-on-metal devices, 20
Metastatic spine tumors
impact of, 297
mortality rate, 297
outcome/prognosis, 299, 300
planning/timing, 298
preoperative embolization, 298
preparative chemotherapy, 298
radiation before surgery, 298
surgical considerations/operation
planning, 299
surgical treatment options, 298, 299
typical cancer patient, 297, 298
Midline opening, see French-door technique
Minimally invasive sacroiliac joint (SIJ) fusion
clinical examination, 249
history, 249
intraoperative complications, 250
preparation, 248
surgical technique and equipment,
249–250
Minimally invasive transforaminal lumbar
interbody fusion (MIS-TLIF)
advantages, 158
complications, 158, 159
history, 153
indications, 154
limitation, 158
repair techniques, 159
spinal deformity, 158
surgical management
cage placement, 156
decompression, 155, 156
grafting, 158
lordotic restoration, 157
multi-level MIS TLIF, 157
pedicle screw placement, 155
positioning, 154
radiation reduction, 154, 155
rod placement, 157
spondylolisthesis reduction, 157, 158
Minimally-invasive lateral retropleural
approach, 110, 111
Mini-open anterior lumbar interbody
fusion, 163
“Mini-open” transpedicular corpectomy, 110
MIS retractor systems, 155
Mobi-C, 25
Mobi-C cervical disc, 19, 21
Monopolar electrocautery, 203
Motion-preserving techniques, 291, 292
Motor evoked potentials (MEP), 42
Multilevel central canal decompression, 49
Multilevel cervical myelopathy, 64
Multilevel corpectomy, 12, 13
Multi-level discectomies, 10
Muscle atrophy, 314
Myelopathy, 20, 64
Myxopapillary ependymomas, 304
N
Naked facet sign, 331
Nerve sheath tumors, 303
Neurologic injury, 47
Neurological decit, 94
Neurological dysfunction, 17
Non pedicle screw constructs, 89, 90
O
Oblique lumbar interbody fusion (OLIF), 177
advantage, 179
antepsoas approach, 177
follow-up, 178
preoperative planning, 179
surgical corridors, 179
surgical technique, 179, 181–183
Occipitocervical fusion (OCF)
complication, 46, 47
contraindication, 38, 39
indications, 37
nonrheumatoid entities, 38
postoperative care, 46
radiographic assessment, 40
rheumatoid arthritis, 38
surgical anatomy, 39
surgical technique
C1 instrumentation, 43
Index
357
C2 instrumentation, 44
cranial xation, 44, 45
exposure, 42–43
fusion mass, 45, 46
inside-outside technique, 41
localization, 42
patient positioning, 42
preoperative considerations, 42
transarticular occiput to C1 screw, 45
Odontoid injuries, 322
diagnosis, 321, 322
nonoperative care, 322
surgical care, 322, 323
upper cervical spine, 322
Odontoid neck fractures
anatomy, 229
anterior screw xation
advantage, 231
blunt prevertebral dissection, 233
C2-C3 anterior discectomy, 233
computerized tomography, 233
contraindications, 231, 232
disadvantages, 235, 236
in elderly and osteoporotic deserve, 232
indication, 231
K-wire, 234
lateral and anteroposterior images, 233
nonunion rates, 230
patient positioning, 233
postoperative radiograph, 234
post-operative radiograph, 234
radiodense tool, 233
radiology, 232
treatment outcomes, 236
classication, 230
epidemiology, 230
Open reduction and internal xation
(ORIF), 324
Open transforaminal lumbar interbody fusion
anatomy, 136
clinical outcomes, 141
complete unilateral facetectomy, 139, 140
complications, 141
contraindications, 137
disc space, 136
disc space distraction, 138, 139
disc space preparation, 140
graft/cage placement, 140
indications, 137
intervertebral structural grafts, 136
neurologic injury and post-operative
dysesthetic pain, 140
non operative management, 137
pedicle screw insertion, 138
posterolateral grafting, 141
preoperative planning, 137, 138
surgical approach, 138
Open-door technique, 60–62
Open-hinged technique, see Open-door
technique
Orthotic, 314
Ossication of the posterior longitudinal
ligament (OPLL), 10, 12, 59
Osteomyelitis, 104, 112
Oswestry disability index (ODI),
149, 168, 199
Oswestry disability index scores, 141
Owl’s eye technique, 218
P
Paramesial basilar invagination condylar
hypoplasia, 38
Parietal pleura, 108–111
Pedicle screw constructs
biomechanics, 90
safety, 91
techniques, 91–93
Pedicle screw placement, 155
Pedicle screws insertion technique,
79, 137–138
Pedicle-based refractor systems, 155
Pedicle-based retractor systems, 155
Percutaneous iliac/S2-alar Iliac screw
xation, 205
Percutaneous lumbar screws
advantages, 211
complications, 219
disadvantages, 212
image-guided technology, 218, 219
imaging modalities, 213
intraoperative imaging, 213
ionization radiation, 213
minimally invasive procedures, 212, 220
multilevel screw placement, 212
navigation and robotics, 213
Owl’s eye technique, 218
patient positioning, 213
pedicle cannulation
Jamshidi needle, 214, 215
Kirchner wire placement, 214–216
nonpenetrating clamp, 215
patient positioning, 214, 215
pedicle screw instrumentation, 211
percutaneous xation, 212
postoperative care, 220
pulsed image acquisition, 213
rod passage techniques, 216, 217
rod placement strategies, 212
Index
358
Percutaneous thoracic pedicle screw xation
advantages, 85
disadvantages, 85
surgical technique, 85
Peripheral neuropathy, 289
Polymethylmethacrylate, 111
Ponticulus posticus, 39
Post discectomy chronic low back pain, 137
Posterior cervical foraminotomy (PCF), 49
contraindications, 74
history of procedure, 74
indications, 74
surgical technique, 74–76
Posterior cervical instrumentation, 49
Posterior cervical laminectomy and fusion
advantages, 49
C3-C6 instrumentation, 53–54
C7 instrumentation, 54
complications, 55, 56
cranial angulation, 53
exposure, 50–52
xed kyphotic deformity, 49
fusion/decortication technique, 54–55
hardware position and cervical
alignment, 55
laminectomy technique, 52–53
lateral angulation, 53
posterior cervical instrumentation, 49
post-laminectomy kyphosis, 49
preoperative MRI, 50
subaxial instrumentation, 49, 50
Posterior cervical positioning
indications, 31
Mayeld retractor, 33, 34
patient preparation, 33, 34
perioperative monitoring, 33
potential complication, 35
preoperative evaluation, 31
room setup and equipment, 32
roomsetup and equipment, 32
Posterior ligamentous complex (PLC), 325
Posterior ligamentous injury, 328–330
Posterior longitudinal ligament (PLL),
12, 119, 123
Posterior lumbar interbody fusion (PLIF),
135, 153, 177
Posterior spinal instrumented fusion
(PSIF), 330
Posterior/posterolateral decompression and
spinal fusion (PSF), 121
Posterolateral extracavitary technique, 99
Posterolateral herniation, 123
Post-laminectomy kyphosis, 49
Postoperative cerebral angiogram, 46
Pott’s disease, 341, 342
Powers Ratio, 40
Primary basilar invagination, 38
ProDisc-C, 19, 24
ProDisc-C total disc replacement device, 21
ProDisc™ implant, 198
Pseudoarthrosis, 18, 55, 159, 286, 291
Psoas morphology, 167
Psoas muscle, 109, 164
Pyogenic spinal infection, 253
R
Recurrent bony stenosis, 273–274
Recurrent disc rupture, 265
Recurrent laryngeal nerve injury, 290
Redo discectomy, 274–275
Redo laminotomy/laminectomy, 275–276
Repair techniques, 159
Retropleural approach, 108
Retrovertebral disease, 10
Reverse hamburger bun sign, 331
Revision lumber decompressions
AP and exion/ extension X-rays, 267
bony decompression, 270
CT scan, 265
denitive procedure, 261
diagnostic considerations, 267
disc herniation, 262
EMG/ NCV, 267
history/clinical evaluation, 261, 262
MRI, 264, 265
myelo/ CT, 265
nerve block, 267
neurological decits, 263
ongoing or recurrent radiculitis, 260
pain, 262
pre-op symptoms, 270, 271
recurrent bony stenosis, 273–274
recurrent/persistent radiculopathy,
261–264
redo discectomy, 274–275
redo laminotomy/laminectomy, 275–276
re-operation rate, 261
revision surgery, 272
complications, 276
outcomes, 277
risk factors, 263
short-term relief of pain, 270
soft disc rupture, 259, 273
spinal stenosis, 260
surgical intervention, 263
Index
359
Revision pedicle screw strategies
adjuncts to screw revisions, 282
advantages, 283
hardware, 282
misplaced screws, 283
preoperative imaging, 281
screw design, 283
S
S2-alar-iliac (S2AI) xation
cadaveric uoroscopic image, 224–226
CT-guided navigation, 224
distal xation points, 223
for comminuted sacral fractures, 223
for deformity or scoliosis, 223
for pelvic ring injuries, 223
post-operative radiograph, 226
pseudoarthrosis rate, 223
sacroiliac (SI) joint breaching, 223
Scar tissue, 265
Schwannomas, 304
Secure-C, 19, 26
Secure-C cervical articial disc, 21
Self-retaining retractors, 98
Short-TI inversion recovery (STIR)
sequence, 254
Single-door technique, see Open-door
technique
Soft disc rupture, 259
Somatosensory evoked potentials (SSEPs),
42, 74
Spinal cord tumors, 303, 304
Spinal deformity, 158
Spinal instability neoplasia score (SINS), 299
Spine Patient Outcomes Research Trial
(SPORT), 243
Spinous process-splitting, see French-door
technique
Spondylodiscitis
diagnosis, 254
epidemiology, 254
pathogenesis, 253
Red ags, 256
surgical site infection, 257
treatment, 255, 256
Spondylolisthesis reduction, 157, 158
SPORT trial, 127
Stand-alone cervical laminectomy, 49
Subaxial instrumentation, 49, 50
Superior articulating process (SAP), 90
Symptomatic cervical stenosis, 59
Symptomatic compressive cervical
spondylotic myelopathy, 66
Synovial cyst, 265
T
Table mounted retractor system, 345
Thompson Surgical lumbar spine
system, 345
Thoracic corpectomy
advantages and disadvantages, 103
anterior and anterolateral approach
Artery of Adamkiewicz, 107
intrapleural approach, 108
patient positioning, 108
retropleural approach, 108
thoracoabdominal approach, 109
transsternal or transmanubrial
approach, 108, 109
complications, 112
grafting technique, 111, 112
indications, 103, 104
minimally-invasive approach
lateral retropleural approach, 110, 111
“mini-open” transpedicular
corpectomy, 110
thoracoscopic corpectomy, 109, 110
posterior and posterolateral approach
costotransversectomy approach, 106
lateral extracavitary approach, 106, 107
transpedicular approach, 104–106
Thoracic disc herniation (TDH)
anterior approach
lateral retropleural approach, 119, 120
transthoracic approach, 120
complication
CSF leakage, 121
spinal cord injury, 121
surgical complication, 121
complications, 121
CT, 117
diagnosis, 116
incidence, 115
indication for surgery, 116
misidentication of surgical level, 121
MRI, 117
non-operative management, 116
posterior approach
costotransversectomy approach, 118
lateral extracavitary approach, 118, 119
transpedicular approach, 117, 118
symptoms, 116
Index
360
Thoracic posterior instrumentation
with scoliosis
adult scoliosis, 88
AIS, 87
assessment, 88
classication system, 88
complications, 94
congenital scoliosis, 87
imaging modality, 88
non pedicle screw constructs, 89, 90
nonoperative treatment, 89
pedicle screw constructs, 90–93
radiographic and clinical outcomes, 93
without scoliosis
anatomy, 80
complications, 84
contraindications, 81
indications, 80
in-out-in technique, 83
open procedure, 81–83
pedicle hook, 83
pedicle screw placement, 81
preoperative planning, 81
sublaminar hook, 83
supralaminar hooks, 84
transverse process hooks, 84
Thoracic vertebral body resection, 103
Thoracoabdominal approach, 109
Thoracolumbar vertebral body metastases, 149
Thoracoscopic corpectomy, 109, 110
Total cervical disc replacement devices, 21
Total disc arthroplasty (TDA), 23
Transarticular technique, 45
Transforaminal lumbar interbody fusion
(TLIF), 177
Transforaminal posterior approach
(TLIF), 135
Transpedicular approach, 104–106
Transpleural window, 99, 100
Transsternal/transmanubrial approach, 108
Transverse process (TP) hooks, 90
Trap-door rib head osteotomy, 110
T-Saw laminoplasty, see French-door
technique
Tubular retractor system, 130, 131, 155
U
Uncomplicated bony odontoid fractures
(C2 Type A), 321
Unilateral facet injury (with/without fracture)
diagnosis, 331
treatment, 332
Unilateral PLIF, 153
V
Ventral basilar invagination, 38
Vertebral artery (VA), 39
Vertebral artery injury (VAI), 6, 312, 332
Vertebral body fractures, 207
Video-assisted thoracoscopic surgery
(VATS), 109
Visual analogue scale (VAS) scores,
141, 149, 168, 202
W
Wilson frame, 125, 127
Z
Zygapophyseal articular facets, 21
Index