Video 6.1   Transoral approach: A 5-year-old with Down syndrome with a dystopic os odontoideum and dorsal displacement of the hypoplastic dens with instability between the craniocervical region and C2. At an outside institution, she underwent two previous posterior approaches including posterior decompression with instrumentation and fusion. However, proper reduction was not achieved. She was unable to stand and walk and use her arms after her second operative procedure due to severe cervicomedullary compression. Given her pathology and occipitocervical fusion, the reduction was unable to be performed. Therefore, a ventral transoral-transpalato-pharyngeal approach and decompression with removal of the anterior arch of C1, os odontoideum, and odontoid process was performed. The patient did well postoperatively and regained significant strength.

Video 8.1   Transoral closure: A proper closure after a transoral-transpalatopharyngeal approach is essential to minimizing complications. Proper closure reestablishes a barrier between the posterior pharyngeal space created by the approach and bony resection and the oropharyngeal space, eliminating dead space, therefore preventing abscess and hematoma formation. Proper closure also enables proper swallowing and prevention of velopharyngeal incompetence.

Video 11.1   High anterior cervical retropharyngeal surgical approach.

Video 28.1   Anterior cervical approach, diskectomy, and instrumented fusion: The video demonstrates the anterior approach to the cervical spine, with diskectomy, grafting, and instrumentation at the C6-C7 level. Video authorship: Anay R. Patel.

Video 30.1   Motion-preserving transcorporeal cervical forminotomy: The video demonstrates a short version of two surgical case examples: in the first case, a right-sided C6 transcorporeal foraminotomy, and in the second, a two-level left C5 and C6. Note that in both cases the disk is spared and a complete decompression is successfully achieved.

This technique is done through a regular anterior Smith-Robinson approach. One major difference between the surgical access for an anterior cervical diskectomy and fusion (ACDF) and the tunnel technique is that in the latter, exposure of only the target disk and proximal vertebral body is required, without the exposure of the inferior vertebral body. The level is confirmed at this stage, and an operating microscope is brought into the field. Before drilling is begun, indigo-carmine dye is injected in the affected disk to facilitate the orientation of disk space while drilling. The position of the drill hole is 4 to 6 mm above the lower border of the proximal vertebra, at the level of the medial border of the longus coli muscle. Drilling is done using a 4-mm diamond bur initially and a 3-mm bur later. At approximately one-third depth of the drilling, we can see the bluish discoloration of the stained disk and we can safely continue to drill further, keeping the blue-stained material in the center of the hole so as to maintain the direction of the trajectory.

After the desired depth is achieved, a blunt probe is used to palpate the base of the tunnel so that the thin ivory-white shell of the posterior vertebral wall can be carefully lifted with a fine bone punch or curette. The posterior longitudinal ligament still acts as a protective barrier between the instruments and the neural structures. Bone wax can be used to stop the bleeding from the spongy bone, and epidural bleeds can be managed with thrombin-soaked Gelfoam or FloSeal. The use of bipolar coagulation is strongly discouraged at this step.

The adequacy of the decompression can be confirmed by observing the bulging nerve root with cerebrospinal fluid (CSF) flow and palpating the superior and inferior pedicles along the course of the nerve root using a root probe.

Wound closure is the same as ACDF with a Hemovac drain for aspiration of postoperative hematoma.

Video 34.1   Tredway cervical microendoscopic foraminotomy.

Video 35.1   Cervical laminoplasty for cervical spondylotic my-elopathy (C3–C6: left open door; C7: partial laminectomy of the cranial third): A dorsal skin incision is made from the caudal C2 to C6 spinous process. An avascular plane between the right and left paraspinal muscles is divided at the midline. While preserving the muscles attaching to C2 and C7, the spinous processes from C3 to C6 and to the inner half of where the lateral mass is exposed. Then, the spinous processes of C3 through C6 are cut at the base with a Liston bone-cutting forceps, and the C6 spinous process is set aside for later use as a bone graft. A trough is made across each lamina using a high-speed drill with a 4-mm steel bur. Continuous irrigation is maintained to prevent thermal damage to the surrounding tissue and aid visualization of the bottom of the trough. The drilling continues until the epidural venous plexus at the cranial half of the lamina and yellow ligament at the caudal half of the lamina can be visualized through the thinned inner cortex. A 10-mm raspatory is inserted into the trough and twisted (the lamina makes a snapping sound and moves). The trough for the hinge side is subsequently made in the same manner. When drilling down to the surface of the inner cortex of the lamina at the hinge side, the springiness of the laminae should be checked frequently to prevent laminar fracture of the hinge side. The laminae are elevated starting from C6 (with the cranial third of C7) to C3. Hemostasis from the epidural venous plexus is achieved by bipolar cauterization. The autologous spinous processes from C6 is reshaped and implanted as a supporting strut with a nonabsorbable 2-0 suture. A hydroxyapatite spacer specially made for open-door laminoplasty is used at C4 with the same nonabsorbable 2-0 suture. After sufficient irrigation of the wound with saline, retractors are removed, hemostasis is achieved, and a drainage tube is placed at the hinge side. The fascia is closed with 2-0 Vicryl suture.

Video 55.1   Endoscopic lateral transthoracic approach: This approach is a powerful surgical tool that provides access to the anterior thoracic spine for treatment of a wide range of spinal pathologies. The video demonstrates the key steps involved in safely and effectively utilizing this approach. (Courtesy of Barrow Neurological Institute, Phoenix, Arizona.)

Video 56.1   Endoscopic technique for thoracic sympathectomy: This is an effective surgical strategy for treating hyperhidrosis syndromes. The video outlines the surgical steps involved in treating palmar and plantar hyperhidrosis syndromes via the endoscopic thoracic sympathectomy technique. (Courtesy of Barrow Neurological Institute, Phoenix, Arizona.)

Video 64.1   Minimally invasive retroperitoneal lateral lumbar interbody fusion: The video demonstrates the steps necessary to perform this fusion utilizing the “shallow docking” technique.

Video 72.1   Removal of an intradural schwannoma: This video illustrates the techniques of removal of an intradural schwannoma arising from the proximal caudal equina.

Video 78.1   Syrinx to subarachnoid space shunt placement.

Video 81.1   Open posterior pedicle screw construct correction of an idiopathic scoliosis deformity.

Video 95.1   Right L4-L5 microdiskectomy performed through a tubular retractor.

Video 107.1   Cortical bone screw fixation technique: The video demonstrates the use of this technique with a bilateral posterior lumbar interbody fusion (PLIF) in the treatment of degenerative spondylolisthesis at L3-L4. The video also demonstrates the hybrid mini-open techniques using the Minimal Access Spinal Technologies (MAST) retractor and illumination system (Medtronic, Memphis, TN).

Video 111.1   Lumboperitoneal shunt placement.

Video 112.1   Dorsal rhizotomies for cerebral palsy: This is an efficient and safe technique because of the accuracy of its radicular identification and root sectioning quantification. To optimize accuracy and selectivity while minimizing invasiveness, we developed a tailored interlaminar procedure targeting directly and individually the radicular levels involved in the harmful components of spasticity. In each patient, two to three interlaminar spaces, preselected based on preoperative planning, were enlarged in a “keyhole” fashion, respecting the spinous processes and interspinous ligaments.

The procedure is based on neurophysiological recordings. Ventral root stimulation identifies the radicular level (anatomic mapping). Dorsal root stimulation evaluates its implication in the hyperactive segmental circuits (physiological testing), helping quantify the percentage of rootlets to be cut.

Keyhole interlaminar dorsal rhizotomy (KIDr) offers direct intradural access to each of the ventral/dorsal roots, thus maximizing the reliability of anatomic mapping and enabling individual physiological testing of all targeted roots. The interlaminar (enlarged) approach minimizes invasiveness by respecting the posterior...