Minimally Invasive Spine Surgery (eBook)

Foreword 6
Foreword 7
Preface 8
Contents 9
Contributors 11
General Introduction and Principles of Minimally Invasive Spine Surgery 14
Image-Guided Spinal Navigation: Principles and Clinical Applications 19
Introduction 19
Principles of Image-Guided Spinal Navigation 20
Clinical Applications 23
Pedicle Fixation 23
Minimally Invasive Spinal Surgery 25
C1-2 Transarticular Screw Fixation 26
Segmental C1-2 Screw Fixation 28
Transoral Surgery 29
Anterior Thoracolumbar Surgery 30
Other Spinal Applications 31
Pitfalls of Image-Guided Spinal Navigation 31
Fluoroscopic Navigation 31
Conclusion 34
References 34
Anterior Cervical Foraminotomy 35
Introduction 35
Surgical Indications and Preparation 36
Surgical Technique 36
Positioning 36
Original Description of Anterior Cervical Foraminotomy 36
Surgiologic Evolution of Anterior Cervical Foraminotomy 37
Lower-Vertebral Transcorporeal Approach 37
Transuncal Approach 39
Upper-Vertebral Transcorporeal Approach 39
Anterior Cervical Foraminoplasty 39
Postoperative Management 41
Results 42
Discussion 42
References 44
Posterior Cervical Foraminotomy and Laminectomy 45
Introduction 45
Indications 46
Preoperative Evaluation 46
Equipment 46
Setup 47
Technique Description 48
CMEF/D Technique 48
CMEDS Technique 51
Closure and Postoperative Care 51
Complications 52
Pearls and Pitfalls 53
Conclusion 53
References 53
Posterior Cervical Instrumentation and Fusion 55
Introduction 55
Rationale and Indications for a Minimally Invasive Approach 57
Positioning and Setup 59
Tubular Dilation and Exposure 59
Instrumentation 62
Transfacet Screws 65
Closure 68
Pearls and Pitfalls 68
Clinical Experience 68
References 69
Thoracoscopic Discectomy 71
Introduction 71
Technique 71
Case 1 75
Case 2 78
References 78
Thoracic and Lumbar Kyphoplasty 79
Introduction 79
Indications 79
Treatment of Osteoporotic Fractures 79
Treatment of Lytic Neoplastic Lesions 80
Equipment 81
Setup 81
Anesthesia 81
Positioning 81
Technique Description 82
Vertebral Body Cannulation: Placement of the Jamshidi Needle 82
Transpedicular Approach 82
Lateral Extrapedicular Approach 83
Posterolateral Approach 83
Creating a Bone Void: Biopsy, Drilling, and Balloon Inflation 84
Stabilizing the Void: Cement Delivery 85
Postoperative Care 85
Complications 85
Pearls and Pitfalls 86
Difficult Reductions: Using the Bone Curette 86
Directing Reduction: Use of Directional Balloon Tamps 86
Vertebral Body Breakthrough: Eggshell Technique of Containing Bone Cement 86
References 86
Thoracoscopic Deformity Correction 88
Introduction 88
Indications 88
Scoliosis 88
Crankshaft Deformity Prevention 89
Thoracic Hyperkyphosis Deformities 89
Congenital Deformity 89
Contraindications 89
Thoracoscopic Technique 90
Preoperative Planning 90
Surgical Equipment 90
Positioning of the Patient 90
Port Location 90
Spine Exposure 90
Anterior Release 91
Anterior Instrumentation 92
Pleural Closure 93
Postoperative Management 94
Complications 94
Illustrative Case 94
Summary 95
References 96
Paracoccygeal Transsacral Access to the Lumbosacral Junction for Interbody Fusion and Stabilization 98
Introduction 98
Presacral Anatomy 98
Evolution of Technique 99
Surgical Technique 99
Preoperative Planning 99
Patient Preparation 99
Operating Room Setup 99
Access and Trajectory Planning 100
Centerline Trajectory 100
Working Cannula and Disc Space Preparation 101
Bone Graft Application 101
Preparing to Implant the Axial Rod 101
Axial Rod Implantation 102
Potential Complications 102
Conclusion 102
References 103
Facet Joint Anatomy and Approach for Denervation 104
Introduction 104
Indications 104
Anatomy 105
Biomechanics 105
Innervation 105
Denervation Technique 105
Complications 107
Discussion 107
References 108
Facet Joint and Epidural Injections 110
Facet Joint Injections 110
Anatomical Considerations 110
Indications 110
Technique 110
Intraarticular Facet Injections 111
Cervical 111
Thoracic 112
Lumbar 112
Medial Branch Blocks 112
Cervical 112
Thoracic 112
Lumbar 113
Complications 113
Epidural Steroid Injections 113
Anatomical Considerations 113
Indications 113
Technique 114
Cervical 114
Interlaminar Approach 114
Transforaminal Approach 114
Lumbar 114
Interlaminar Approach 114
Transforaminal Approach 114
Caudal 115
Complications 115
Chap11Bib1 115
Suggested Reading 110
Discography and Endoscopic Lumbar Discectomy 116
Introduction 116
Endoscopic Discectomy Technique 116
Indications/Contraindications 116
Anesthetic Technique 117
Determining Surgical Landmarks 117
Needle Insertion 119
Cannula Insertion 119
Discectomy 119
Discectomy After Previous Surgery 121
Endoscopic Decompression 121
Pearls and Pitfalls 121
Clinical Outcomes 123
Discussion 124
References 124
Discectomy and Laminectomy 125
Introduction 125
Indications 125
Description of System Components 125
Operative Technique 125
Preparation and Positioning 125
Surgical Procedure 126
Complications 129
Discussion 130
References 130
Combining Minimally Invasive Techniques for Treating Multilevel Disease as Well as Adult Degenerative Scoliosis 131
Introduction 131
Clinical Presentation 131
Diagnostic Evaluation 131
Plain Radiography 131
MRI and CT Myelography 132
Discograms and Facet Blocks 132
Therapeutic Intervention 132
Nonoperative Management 132
Operative Management 132
The Lateral Transpsoas Approach 132
The Paracoccygeal Transsacral Access to the Lumbosacral Junction for Interbody Fusion and Stabilization 133
Percutaneous Pedicle Screw Placement for Spinal Instrumentation 133
Case Examples 133
Case 1 133
Case 2 134
Discussion 135
Conclusion 136
References 137
Transforaminal Lumbar Interbody Fusion (TLIF) 138
Introduction 138
Indications 138
Description of System Components 138
Operative Technique 139
Preparation and Positioning 139
Surgical Procedure 139
Complications 141
Discussion 141
References 141
Lateral Approach for Anterior Lumbar Interbody Fusion (XLIF and DLIF) 143
Introduction 143
Materials and Methods 143
Patient Selection and Surgical Indications 143
Surgical Technique 143
Patient Preparation 143
Retroperitoneal Access 144
Transpsoas Access 145
Disc Exposure 146
Discectomy and Interbody Implant Placement 147
Closure 147
Results 148
Discussion 148
Conclusion 149
References 150
Anterior Lumbar Interbody Fusion (ALIF) 151
Introduction 151
Technique 152
Preoperative Planning 152
Patient Positioning 152
Surgical Approach 153
Approach of L5-S1 153
Complete Discectomy 155
Discectomy Technique 155
Endplate Preparation 155
Fluoroscopy 156
References 156
Percutaneous Pedicle Screw Placement for Spinal Instrumentation 157
Introduction 157
Pedicle Access Using a Lateral-to-Medial Trajectory 158
Bull’s-Eye Targeting of the Pedicle Screws 161
Minimally Invasive Instrumentation 161
Electrophysiological Monitoring 164
Radiographic Confirmation of Pedicle Screw Placement 164
Conclusion 165
References 165
Iliac Crest Bone Graft Harvest and Fusion Techniques 167
Introduction 167
Anterior Iliac Crest Harvest 167
Technique 168
Posterior Iliac Crest Bone Grafting 170
Technique 170
Discussion 172
References 172
Technologies for Use in Indirect Distraction Procedures 174
Introduction 174
Polymethylmethacrylate Cement 174
Handling and Setting Characteristics 175
Mechanical and Biomechanical Performance 176
In vivo Behavior 176
Calcium Phosphate Cements 177
Calcium Phosphate Cement Chemistry 177
Handling and Setting 178
Strength and Biomechanical Properties 179
Calcium Phosphate Cement Resorption and Remodeling 180
Clinical Findings 180
Future Technologies for Use in Indirect Distraction 181
Conclusion 182
References 182
Index 185