Patel / Burger / Brown Spine Trauma

Surgical Techniques
1. Auflage 2010
ISBN: 978-3-642-03694-1
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 413 Seiten

Spinal surgeons treat spinal trauma patients on a regular basis in their hospital emergency rooms. This well-illustrated, hands-on guide to the many surgical techniques required in these situations provides a solid basis for the management of spinal trauma.

Autoren/Hrsg.

Patel, Vikas V.

Burger, Evalina

Brown, Courtney W.

Inhaltsverzeichnis

1;Spine Trauma;1
1.1;Preface;5
1.2;Acknowledgment;6
1.3;Contents;7
1.4;Part 1: Cervical;10
1.4.1;1: Cervical Spinal Stability and Decision Making;11
1.4.1.1;1.1 Introduction;11
1.4.1.2;1.2 Cervical Stability;11
1.4.1.3;1.3 Classification Systems;12
1.4.1.3.1;1.3.1 Holdsworth;12
1.4.1.3.2;1.3.2 Mechanistic Systems;12
1.4.1.3.3;1.3.3 White and Panjabi;13
1.4.1.3.4;1.3.4 AO (Arbeitsgemeinschaft für Osteosynthesefragen) System;13
1.4.1.4;1.4 Advances in Cervical Trauma Classification;14
1.4.1.4.1;1.4.1 Cervical Spine Injury Severity Score;14
1.4.1.4.2;1.4.2 Subaxial Cervical Spine Injury Classification (SLIC);14
1.4.1.5;1.5 Summary: Critical Clinical Variables;17
1.4.1.6;1.6 Conclusions;17
1.4.1.7;References;17
1.4.2;2: Clearing the Cervical Spine;18
1.4.2.1;2.1 Introduction;18
1.4.2.2;2.2 Cervical Spine Clearance: Definition, Rationale, Objectives;19
1.4.2.3;2.3 Cervical Spine Clearance: Patient Groups;19
1.4.2.3.1;2.3.1 Group I (Asymptomatic);20
1.4.2.3.2;2.3.2 Group II (Symptomatic);20
1.4.2.3.3;2.3.3 Group III (Nonevaluable);21
1.4.2.4;2.4 Patient Management Before and During Cervical Spine Clearance;22
1.4.2.5;2.5 Clinical Clearance of the Cervical Spine;22
1.4.2.5.1;2.5.1 History;22
1.4.2.5.2;2.5.2 Physical Examination;23
1.4.2.6;2.6 Imaging Clearance of the Cervical Spine;24
1.4.2.6.1;2.6.1 Plain Radiography;24
1.4.2.6.2;2.6.2 Flexion–Extension Radiography;26
1.4.2.6.3;2.6.3 Dynamic Fluoroscopy;26
1.4.2.6.4;2.6.4 Computed Tomography;26
1.4.2.6.5;2.6.5 Magnetic Resonance Imaging;27
1.4.2.7;2.7 Current Cervical Spine Clearance Guidelines;27
1.4.2.7.1;2.7.1 ATLS Recommendations;27
1.4.2.7.2;2.7.2 EAST Guidelines;29
1.4.2.7.3;2.7.3 NEXUS Guidelines;30
1.4.2.7.4;2.7.4 Canadian C-Spine Rule;30
1.4.2.7.5;2.7.5 Obtunded Patient Clearance Protocols;31
1.4.2.7.6;2.7.6 Authors’ Cervical Spine Clearance Algorithm;32
1.4.2.8;2.8 Summary and Conclusions;34
1.4.2.9;References;36
1.4.3;3: Imaging of Spinal Trauma;39
1.4.3.1;3.1 Introduction;39
1.4.3.2;3.2 To Image or Not To Image the Cervical Spine?;39
1.4.3.2.1;3.2.1 Who Should Be Imaged?;40
1.4.3.2.2;How Should We Image the Cervical Spine?;42
1.4.3.2.3;3.2.3 Ligamentous/Soft Tissue Evaluation;46
1.4.3.3;3.3 Special Considerations;47
1.4.3.3.1;3.3.1 Pediatric Patients;47
1.4.3.3.2;3.3.2 Elderly Patients;49
1.4.3.3.3;3.3.3 The Ankylotic Spine;50
1.4.3.3.4;3.3.4 The Athlete;50
1.4.3.3.5;3.3.5 Neurovascular Injury;51
1.4.3.4;3.4 Cervical Spine Injury;53
1.4.3.4.1;3.4.1 Normal Cervical Spine Radiographs;53
1.4.3.4.2;3.4.2 Mechanisms of Injury;55
1.4.3.4.2.1;3.4.2.1 Axial Load: Occipital Condyle Fractures;56
1.4.3.4.2.2;3.4.2.2 Axial Load: Jefferson Burst Fracture;58
1.4.3.4.2.3;3.4.2.3 Axial Load: Cervical Burst Fracture;59
1.4.3.4.2.4;3.4.2.4 Hyperflexion: Hyperflexion Sprain;60
1.4.3.4.2.5;3.4.2.5 Hyperflexion: Bilateral Facet Dislocation;62
1.4.3.4.2.6;3.4.2.6 Hyperflexion: Hyperflexion Teardrop;64
1.4.3.4.2.7;3.4.2.7 Hyperflexion: Wedge Compression Fracture;64
1.4.3.4.2.8;3.4.2.8 Hyperflexion: Clay Shoveler’s Fracture;64
1.4.3.4.2.9;3.4.2.9 Hyperflexion with Rotation: Unilateral Facet Dislocation;64
1.4.3.4.2.10;3.4.2.10 Hyperextension: Dens Fractures;66
1.4.3.4.2.11;3.4.2.11 Hyperextension: Hangman’s Fracture;68
1.4.3.4.2.12;3.4.2.12 Hyperextension: Hyperextension Teardrop;69
1.4.3.4.2.13;3.4.2.13 Hyperextension: Hyperextension Avulsion of Anterior Arch of C1;70
1.4.3.4.2.14;3.4.2.14 Hyperextension: Hyperextension Sprain/Fracture Dislocation;70
1.4.3.5;3.5 Injury to the Thoracic and Lumbar Spine;71
1.4.3.5.1;3.5.1 Indications for Imaging;71
1.4.3.5.2;3.5.2 Concept of Thoracic and Lumbar Fracture Stability;71
1.4.3.5.3;3.5.3 Wedge Compression Fracture;72
1.4.3.5.4;3.5.4 Burst Fracture;72
1.4.3.5.5;3.5.5 Chance Fracture;73
1.4.3.6;3.6 Conclusion;74
1.4.3.7;References;75
1.4.4;4: Immunological Response to Spinal Cord Injury: Impact on the Timing of Spine Fixation;78
1.4.4.1;4.1 Pathophysiology of Spinal Cord Injury (SCI);78
1.4.4.1.1;4.1.1 Primary SCI;78
1.4.4.1.2;4.1.2 Secondary SCI;78
1.4.4.2;4.2 Posttraumatic Immunological Response;79
1.4.4.2.1;4.2.1 Disruption of the Blood-Spinal Cord Barrier;79
1.4.4.2.2;4.2.2 Cellular and Molecular Neuroinflammatory Reactions;79
1.4.4.2.3;4.2.3 “No-Go” – The Future Way to Go?;82
1.4.4.3;4.3 Impact on the Timing of Surgery;82
1.4.4.3.1;4.3.1 Timing of Surgery – Is It Important?;82
1.4.4.3.2;4.3.2 The Concept of “Spine Damage Control”;83
1.4.4.4;4.4 Conclusion;83
1.4.4.5;References;87
1.4.5;5: The Role of Orthosis in Spinal Injury;89
1.4.5.1;5.1 Introduction;89
1.4.5.2;5.2 Principles of Spinal Orthotic Immobilization;90
1.4.5.3;5.3 Motion Control;90
1.4.5.4;5.4 Orthoses as a Treatment for Spine Fracture;92
1.4.5.5;5.5 Postsurgical Orthoses;94
1.4.5.6;5.6 Summary;94
1.4.5.6.1;5.6.1 Cast Application for Burst Fracture;95
1.4.5.6.1.1;5.6.1.1 Equipment Needed;95
1.4.5.6.1.2;5.6.1.2 Technique;95
1.4.5.7;References;97
1.4.6;6: The Halovest;98
1.4.6.1;6.1 Description [1];98
1.4.6.2;6.2 Key Principles;98
1.4.6.3;6.3 Expectations;98
1.4.6.4;6.4 Indications [4];98
1.4.6.4.1;6.4.1 Trauma;98
1.4.6.4.2;6.4.2 Other;98
1.4.6.5;6.5 Contraindications;107
1.4.6.6;6.6 Special Considerations [3];107
1.4.6.7;6.7 Special Instructions, Positions and Anaesthesia [5, 6];107
1.4.6.8;6.8 Tips and Pearls;108
1.4.6.9;6.9 Pitfalls;108
1.4.6.10;6.10 Challenges;108
1.4.6.11;6.11 Complications [2];108
1.4.6.12;References;109
1.4.7;7: Direct Anterior Screw Fixation of Odontoid Fractures;110
1.4.7.1;7.1 Case Example;110
1.4.7.2;7.2 Background;110
1.4.7.3;7.3 Indications;111
1.4.7.4;7.4 Potential Contraindications;112
1.4.7.4.1;7.4.1 Age of the Fracture;112
1.4.7.4.2;7.4.2 Age of the Patient;112
1.4.7.5;7.5 Procedure;112
1.4.7.6;7.6 Technical Pearls and Pitfalls;116
1.4.7.6.1;7.6.1 Surgical Technique;116
1.4.7.6.2;7.6.2 One or Two Screws;117
1.4.7.7;7.7 Postoperative Considerations;118
1.4.7.7.1;7.7.1 Postoperative Bracing;118
1.4.7.7.2;7.7.2 Follow-up Monitoring;118
1.4.7.7.3;7.7.3 Potential Complications;118
1.4.7.8;7.8 Conclusions;119
1.4.7.9;References;119
1.4.8;8: Occiput–Cervical Fixation;121
1.4.8.1;8.1 Case Example;121
1.4.8.2;8.2 Background;121
1.4.8.3;8.3 Indications and Advantages for Procedure;122
1.4.8.4;8.4 Contraindications for Procedure;122
1.4.8.5;8.5 Procedure;122
1.4.8.5.1;8.5.1 Equipment;122
1.4.8.6;8.6 Anesthetic and Neuromonitoring Considerations;123
1.4.8.7;8.7 Patient Positioning and Room Setup;123
1.4.8.8;8.8 Surgical Approach;124
1.4.8.9;8.9 Technical Pearls and Pitfalls;126
1.4.8.9.1;8.9.1 Pearls;126
1.4.8.9.2;8.9.2 Pitfalls;127
1.4.8.10;8.10 Potential Intraoperative Complications;127
1.4.8.11;8.11 Bailout/Salvage for Procedure Failure;128
1.4.8.12;8.12 Postoperative Considerations;128
1.4.8.12.1;8.12.1 Bracing;128
1.4.8.12.2;8.12.2 Activity;128
1.4.8.12.3;8.12.3 Follow-up;128
1.4.8.12.4;8.12.4 Potential Complications;128
1.4.8.12.5;8.12.5 Treatments/Rescue for Complications;128
1.4.8.13;References;129
1.4.9;9: C1–2 Fixation: Transarticular Screws;130
1.4.9.1;9.1 Case Example;130
1.4.9.2;9.2 Background;130
1.4.9.3;9.3 Indications and Advantages for Procedure;132
1.4.9.3.1;9.3.1 Indications;132
1.4.9.3.2;9.3.2 Advantages;132
1.4.9.4;9.4 Contraindications and Disadvantages for Procedure;132
1.4.9.4.1;9.4.1 Contraindications;132
1.4.9.4.2;9.4.2 Disadvantages;132
1.4.9.5;9.5 Procedure;132
1.4.9.5.1;9.5.1 Equipments Needed;132
1.4.9.5.2;9.5.2 Anesthetic and Neuromonitoring Considerations;132
1.4.9.5.3;9.5.3 Patient Positioning and Room Setup;132
1.4.9.5.4;9.5.4 Surgical Approach;134
1.4.9.5.5;9.5.5 Reduction Technique;136
1.4.9.5.6;9.5.6 Fixation Technique;136
1.4.9.6;9.6 Technical Pearls and Pitfalls;141
1.4.9.6.1;9.6.1 Pearls;141
1.4.9.6.2;9.6.2 Potential Intraoperative Complications;142
1.4.9.6.3;9.6.3 Bailout/Salvage for Procedure Failure;142
1.4.9.7;9.7 Postonsiderations;142
1.4.9.7.1;9.7.1 Bracing;142
1.4.9.7.2;9.7.2 Activity;142
1.4.9.7.3;9.7.3 Follow-Up;142
1.4.9.7.4;9.7.4 Potential Complications;142
1.4.9.7.5;9.7.5 Treatments/Rescue for Complications;143
1.4.9.8;References;143
1.4.10;10: C1–2 Fixation: Lateral Mass/Pars Screw-Rod Fixation;145
1.4.10.1;10.1 Case Example;145
1.4.10.2;10.2 Background;145
1.4.10.3;10.3 Indications and Advantages for Procedure;146
1.4.10.4;10.4 Contraindications and Disadvantages for Procedure;148
1.4.10.5;10.5 Procedure;149
1.4.10.5.1;10.5.1 Anesthetic and Neuromonitoring Considerations;149
1.4.10.5.2;10.5.2 Patient Positioning and Room Setup;150
1.4.10.5.3;10.5.3 Surgical Approach;150
1.4.10.5.4;10.5.4 C1 Lateral Mass Screw Fixation;151
1.4.10.5.5;10.5.5 C2 Pedicle/Pars Screw Fixation;152
1.4.10.6;10.6 Technical Pearls and Pitfalls;154
1.4.10.7;10.7 Postoperative Considerations;154
1.4.10.8;References;155
1.4.11;11: Closed Reduction of Unilateral and Bilateral Facet Dislocations;156
1.4.11.1;11.1 Case Example;156
1.4.11.2;11.2 Introduction;156
1.4.11.3;11.3 Indications/Contraindications;156
1.4.11.4;11.4 Timing;157
1.4.11.5;11.5 Equipment Required;158
1.4.11.6;11.6 Reduction Technique;158
1.4.11.7;11.7 Conclusion;159
1.4.11.8;11.8 Pearls;159
1.4.11.9;11.9 Pitfalls;160
1.4.11.10;11.10 Complications;160
1.4.11.11;11.11 Bailouts/Salvage;160
1.4.11.12;11.12 Post Procedure;160
1.4.11.13;Further Reading;160
1.4.12;12: Cervical Open Posterior Reduction of Facet Dislocation;161
1.4.12.1;12.1 Case Example;161
1.4.12.2;12.2 Background;161
1.4.12.3;12.3 Indications and Advantages for Procedure;163
1.4.12.3.1;12.3.1 Contraindications and Disadvantages for Procedure;163
1.4.12.4;12.4 Procedure;163
1.4.12.4.1;12.4.1 Equipment Needed;163
1.4.12.4.2;12.4.2 Anesthetic and Neuromonitoring Considerations;163
1.4.12.4.3;12.4.3 Patient Positioning and Room Setup;163
1.4.12.4.4;12.4.4 Surgical Approach;164
1.4.12.4.5;12.4.5 Reduction Technique;164
1.4.12.4.6;12.4.6 Fixation Technique;164
1.4.12.4.7;12.4.7 Closure;164
1.4.12.5;12.5 Technical Pearls and Pitfalls;164
1.4.12.5.1;12.5.1 Pearls;164
1.4.12.5.2;12.5.2 Potential Intraoperative Complications;166
1.4.12.5.3;12.5.3 Bailout/Salvage for Procedure Failure;166
1.4.12.6;12.6 Postoperative Considerations;166
1.4.12.6.1;12.6.1 Bracing;166
1.4.12.6.2;12.6.2 Activity;166
1.4.12.6.3;12.6.3 Follow-Up;166
1.4.12.6.4;12.6.4 Potential Complications;167
1.4.12.6.5;12.6.5 Treatments/Rescue for Complications;167
1.4.12.7;References;167
1.4.13;13: Open Anterior Reduction of Cervical Facet Dislocation;168
1.4.13.1;13.1 Introduction;168
1.4.13.2;13.2 Mechanism of Injury;168
1.4.13.2.1;13.2.1 Unilateral Facet Dislocations;168
1.4.13.2.2;13.2.2 Bilateral Facet Dislocation;169
1.4.13.3;13.3 Surgical Technique;169
1.4.13.4;13.4 Unilateral Facet Dislocation;169
1.4.13.4.1;13.4.1 Bilateral Facet Dislocation;170
1.4.13.4.2;13.4.2 Irreducible Reduction;171
1.4.13.5;13.5 Postoperative Considerations;171
1.4.13.5.1;13.5.1 Pitfalls;172
1.4.13.5.2;13.5.2 Pearls;172
1.4.13.5.3;13.5.3 Complications;172
1.4.13.5.4;13.5.5 Occult body fracture;172
1.4.13.6;References;172
1.4.14;14: Anterior Cervical Discectomy and Fusion for Traumatic Disc Herniation;173
1.4.14.1;14.1 Case Example;173
1.4.14.2;14.2 Background;174
1.4.14.3;14.3 Indications and Advantages;175
1.4.14.4;14.4 Contraindications and Disadvantages;175
1.4.14.5;14.5 Procedure;175
1.4.14.5.1;14.5.1 Equipment Needed;175
1.4.14.5.2;14.5.2 Anesthetic and Neuromonitoring Considerations;176
1.4.14.5.3;14.5.3 Surgical Approach, Pearls, and Pitfalls;177
1.4.14.5.4;14.5.4 Reduction Technique;178
1.4.14.5.5;14.5.5 Fixation Technique;178
1.4.14.5.6;14.5.6 Potential Intraoperative Complications;179
1.4.14.6;14.6 Pearls;179
1.4.14.7;14.7 Postoperative Considerations;180
1.4.14.8;References;180
1.4.15;15: Posterior Cervical Fusion for Trauma;181
1.4.15.1;15.1 Case Example;181
1.4.15.2;15.2 Background;181
1.4.15.3;15.3 Indications and Advantages of Technique;181
1.4.15.4;15.4 Contraindications and Disadvantages;181
1.4.15.5;15.5 Procedure;181
1.4.15.5.1;15.5.1 Equipment needed;184
1.4.15.5.2;15.5.2 Anesthetic considerations;184
1.4.15.5.3;15.5.3 Patient positioning;184
1.4.15.5.4;15.5.4 Pearls;184
1.4.15.5.5;15.5.5 Pitfalls;185
1.4.15.5.6;15.5.6 Bailout;185
1.4.15.5.7;15.5.7 Bracing;185
1.4.15.5.8;15.5.8 Complications;185
1.4.15.6;References;185
1.4.16;16: Corpectomy for Burst Fracture;186
1.4.16.1;16.1 Case Example;186
1.4.16.2;16.2 Background;187
1.4.16.3;16.3 Indications and Advantages for Procedure;187
1.4.16.4;16.4 Contraindications and Disadvantages for Procedure;188
1.4.16.5;16.5 Procedure;188
1.4.16.5.1;16.5.1 Equipment Needed;188
1.4.16.5.2;16.5.2 Anesthetic and Neuromonitoring Considerations;188
1.4.16.5.3;16.5.3 Patient Positioning and Room Setup;188
1.4.16.5.4;16.5.4 Surgical Approach;189
1.4.16.5.5;16.5.5 Reconstruction and Fixation Technique;189
1.4.16.6;16.6 Technical Pearls and Pitfalls;190
1.4.16.6.1;16.6.1 Pearls;190
1.4.16.6.2;16.6.2 Potential Intraoperative Complications;191
1.4.16.6.3;16.6.3 Bailout/Salvage for Procedure Failure;191
1.4.16.7;16.7 Postoperative Considerations;192
1.4.16.7.1;16.7.1 Bracing;192
1.4.16.7.2;16.7.2 Activity;192
1.4.16.7.3;16.7.3 Follow-up;192
1.4.16.7.4;16.7.4 Potential Postoperative Complications;192
1.4.16.7.4.1;16.7.4.1 Soft Tissue Hematoma;192
1.4.16.7.4.2;16.7.4.2 Dysphagia;192
1.4.16.7.4.3;16.7.4.3 Recurrent Laryngeal Nerve (RLN) Injury;192
1.4.16.7.4.4;16.7.4.4 Other Nerve Injuries;192
1.4.16.7.4.5;16.7.4.5 Continuous CSF Leak;193
1.4.16.7.4.6;16.7.4.6 Hardware Failure and Nonunion;193
1.4.16.8;References;193
1.4.17;17: Posterior Pedicle Screw Fixation;194
1.4.17.1;17.1 Case Example;194
1.4.17.2;17.2 Background;194
1.4.17.3;17.3 Indications and Advantages for Procedure;194
1.4.17.4;17.4 Contraindications and Disadvantages for Procedure;198
1.4.17.5;17.5 Preoperative Imaging Study;198
1.4.17.6;17.6 Timing of Surgery;198
1.4.17.7;17.7 Procedure;198
1.4.17.7.1;17.7.1 Equipment Needed;198
1.4.17.7.2;17.7.2 Anesthetic and Neuromonitoring Considerations;198
1.4.17.7.3;17.7.3 Patient Positioning and Room Setup;199
1.4.17.7.4;17.7.4 Surgical Approach;199
1.4.17.7.5;17.7.5 Reduction Technique;200
1.4.17.7.6;17.7.6 Fixation Technique;200
1.4.17.8;17.8 Technical Pearls and Pitfalls;201
1.4.17.8.1;17.8.1 Pearls;201
1.4.17.8.2;17.8.2 Pitfalls;202
1.4.17.8.3;17.8.3 Potential Intraoperative Complications;203
1.4.17.8.4;17.8.4 Bailout/Salvage for Procedure Failure;203
1.4.17.9;17.9 Postoperative Considerations;203
1.4.17.9.1;17.9.1 Bracing;203
1.4.17.9.2;17.9.2 Activity;203
1.4.17.9.3;17.9.3 Follow-Up;204
1.4.17.9.4;17.9.4 Potential Complications;204
1.4.17.9.5;17.9.5 Treatments/Rescue for Complications;204
1.4.17.10;References;204
1.5;Part 2: Thoracic;206
1.5.1;18: Thoracic Spinal Stability: Decision Making;207
1.5.1.1;18.1 Introduction;207
1.5.1.2;18.2 Anatomic and Biomechanical Considerations;207
1.5.1.3;18.3 Evaluation and Imaging;208
1.5.1.4;18.4 Spinal Cord Injury;209
1.5.1.5;18.5 Classification of Thoracic Spine Injuries;209
1.5.1.6;18.6 Fracture Types;210
1.5.1.6.1;18.6.1 Compression Fractures;211
1.5.1.6.2;18.6.2 Burst Fractures;218
1.5.1.6.3;18.6.3 Fracture Dislocation;219
1.5.1.6.4;18.6.4 Flexion-Distraction Injuries;219
1.5.1.7;18.7 Summary;219
1.5.1.8;References;221
1.5.2;19: Anterior Corpectomy with Fixation, Thoracic;223
1.5.2.1;19.1 Case Example;223
1.5.2.2;19.2 Background;223
1.5.2.3;19.3 Indications and Advantages;225
1.5.2.4;19.4 Contraindications and Disadvantages;226
1.5.2.5;19.5 Procedure;226
1.5.2.5.1;19.5.1 Equipment Needed;226
1.5.2.5.2;19.5.2 Anesthetic and Neuromonitoring Considerations;226
1.5.2.5.3;19.5.3 Patient Positioning and Room Setup;227
1.5.2.5.4;19.5.4 Surgical Approach;227
1.5.2.5.5;19.5.5 Thoracic Corpectomy and Decompression of Neural Structures;228
1.5.2.5.6;19.5.6 Reduction Technique;230
1.5.2.5.7;19.5.7 Placement of Interbody Graft;230
1.5.2.5.8;19.5.8 Fixation Technique;231
1.5.2.5.9;19.5.9 Closure;232
1.5.2.6;19.6 Technical Pearls and Pitfalls;232
1.5.2.6.1;19.6.1 Pearls: Decompression;232
1.5.2.6.2;19.6.2 Pearls: Interbody Fusion;232
1.5.2.6.3;19.6.3 Pearls: Anterior Instrumentation;233
1.5.2.6.4;19.6.4 Potential Intraoperative Complications;233
1.5.2.6.5;19.6.5 Bailout/Salvage for Failed Procedures;234
1.5.2.7;19.7 Postoperative Considerations;234
1.5.2.7.1;19.7.1 Bracing;234
1.5.2.7.2;19.7.2 Activity;234
1.5.2.7.3;19.7.3 Follow-Up;234
1.5.2.7.4;19.7.4 Potential Postoperative Complications;234
1.5.2.7.5;19.7.5 Treatment of Postoperative Complications;234
1.5.2.8;References;235
1.5.3;20: Kyphoplasty, Osteoporotic and Traumatic;236
1.5.3.1;20.1 Case Example;236
1.5.3.2;20.2 Background;236
1.5.3.3;20.3 Indications and Advantages for Procedure;236
1.5.3.4;20.4 Contraindications and Disadvantages for Procedure;237
1.5.3.5;20.5 Procedure;238
1.5.3.5.1;20.5.1 Equipment Needed (Fig. 20.3);238
1.5.3.5.2;20.5.2 Anesthetic and Neuromonitoring Considerations;238
1.5.3.5.3;20.5.3 Patient Positioning and Room Setup;238
1.5.3.5.4;20.5.4 Surgical Approach;239
1.5.3.6;20.6 Technical Pearls and Pitfalls;243
1.5.3.6.1;20.6.1 Pearls;243
1.5.3.6.2;20.6.2 Intraoperative Complications and Bailout/Salvage Procedures;243
1.5.3.7;20.7 Postoperative Considerations;243
1.5.3.7.1;20.7.1 Bracing, Activity, Follow-Up, Complications;243
1.5.3.8;References;244
1.5.4;21: Costotransversectomy;245
1.5.4.1;21.1 Case Example;245
1.5.4.2;21.2 Background;245
1.5.4.3;21.3 Indications and Advantages of the Procedure;245
1.5.4.3.1;21.3.1 Indications;245
1.5.4.3.2;21.3.2 Advantages of the Procedure;246
1.5.4.4;21.4 Contraindications and Disadvantages of the Procedure;246
1.5.4.4.1;21.4.1 Contraindications;246
1.5.4.4.2;21.4.2 Disadvantages of the Procedure;247
1.5.4.5;21.5 Procedure;247
1.5.4.5.1;21.5.1 Equipment Needed;247
1.5.4.5.2;21.5.2 Anesthesia and Neuromonitoring;247
1.5.4.5.3;21.5.3 Surgical Procedure;247
1.5.4.6;21.6 Technical Pearls and Pitfalls;250
1.5.4.6.1;21.6.1 Pearls;250
1.5.4.6.2;21.6.2 Potential Intraoperative Complications;250
1.5.4.6.3;21.6.3 Salvage Procedure;250
1.5.4.7;21.7 Postoperative Considerations;250
1.5.4.7.1;21.7.1 Bracing;250
1.5.4.7.2;21.7.2 Activity;250
1.5.4.7.3;21.7.3 Follow-Up;251
1.5.4.7.4;21.7.4 Potential Postoperative Complications;251
1.5.4.8;Reference;251
1.6;Part 3: Thoracolumbar and Lumbar;252
1.6.1;22: Lumbar Spinal Stability: Decision Making;253
1.6.1.1;22.1 Introduction;253
1.6.1.2;22.2 Anatomic and Biomechanical Considerations;253
1.6.1.3;22.3 Evaluation and Initial Management of the Trauma Patient;254
1.6.1.4;22.4 Classification of Thoracolumbar and Lumbar Spine Injuries;255
1.6.1.5;22.5 Spinal Stability and General Principles of Management;257
1.6.1.6;22.6 Summary;259
1.6.1.7;References;260
1.6.2;23: Posterior Instrumentation for Thoracolumbar and Lumbar Fracture Dislocation;261
1.6.2.1;23.1 Case 1;261
1.6.2.2;23.2 Background;261
1.6.2.3;23.3 Classification and Indications;262
1.6.2.4;23.4 Contraindications;263
1.6.2.5;23.5 Advantages;263
1.6.2.5.1;23.5.1 Disadvantages;264
1.6.2.6;23.6 Surgical Technique;264
1.6.2.6.1;23.6.1 Positioning;264
1.6.2.7;23.7 Equipment;265
1.6.2.8;23.8 Neuromonitoring;265
1.6.2.9;23.9 Approach;266
1.6.2.9.1;23.9.1 Pedicle Screw Insertion;266
1.6.2.9.2;23.9.2 Fusion;269
1.6.2.10;23.10 Technical Pearls;269
1.6.2.10.1;23.10.1 Pitfalls;270
1.6.2.11;23.11 Intraoperative Complications;270
1.6.2.12;23.12 Bailout and Salvage Procedures;270
1.6.2.13;23.13 Postoperative Course;270
1.6.2.13.1;23.13.1 Bracing;270
1.6.2.13.2;23.13.2 Activity;271
1.6.2.13.3;23.13.3 Follow-Up;271
1.6.2.14;23.14 Complication Management;271
1.6.2.15;References;271
1.6.3;24: Posterior Decompression Technique for Thoracolumbar Burst Fracture;273
1.6.3.1;24.1 Background;273
1.6.3.2;24.2 Technique;273
1.6.3.3;24.3 Equipment Needed;275
1.6.3.4;24.4 Anesthesia/Neuromonitoring;276
1.6.3.5;24.5 Pearls;276
1.6.3.5.1;24.6 Pitfalls;276
1.6.3.6;24.7 Intraoperative Complications;278
1.6.3.7;24.8 Bailout;278
1.6.3.8;24.9 Bracing;278
1.6.3.9;24.10 Potential Complications;278
1.6.3.10;References;278
1.6.4;25: Anterior Treatment of Thoracolumbar Burst Fractures;280
1.6.4.1;25.1 Case Example;280
1.6.4.2;25.2 Background;280
1.6.4.3;25.3 Indications and Advantages for Procedure;281
1.6.4.4;25.4 Contraindications and Disadvantages for the Procedure;282
1.6.4.5;25.5 Procedure;282
1.6.4.5.1;25.5.1 Preoperative Planning;282
1.6.4.5.2;25.5.2 Patient Positioning;282
1.6.4.5.3;25.5.3 Surgical Approach;282
1.6.4.6;25.6 Technical Pearls and Pitfalls;286
1.6.4.7;25.7 Postoperative Considerations;287
1.6.4.8;Recommended Reading;287
1.6.5;26: Anterior and Posterior Surgery and Fixation for Burst Fractures;288
1.6.5.1;26.1 Case Example;288
1.6.5.2;26.2 Background;288
1.6.5.3;26.3 Indications and Advantages for Procedure;291
1.6.5.4;26.4 Contraindications and Disadvantages of the Procedure;292
1.6.5.4.1;26.4.1 Preoperative Imaging;292
1.6.5.4.2;26.4.2 Timing of Surgery;292
1.6.5.5;26.5 Procedure;292
1.6.5.5.1;26.5.1 Equipment Needed;292
1.6.5.5.2;26.5.2 Anesthetic and Neuromonitoring Considerations;292
1.6.5.5.3;26.5.3 Posterior Surgery;293
1.6.5.5.4;26.5.4 Anterior Surgery;294
1.6.5.6;26.6 Technical Pearls and Pitfalls;297
1.6.5.6.1;26.6.1 Pearls;297
1.6.5.6.1.1;26.6.2 Pitfalls;297
1.6.5.7;26.7 Potential Intraoperative Complications;297
1.6.5.8;26.8 Bailout/Salvage for Procedure Failure;297
1.6.5.9;26.9 Postoperative Considerations;297
1.6.5.9.1;26.9.1 Bracing;297
1.6.5.9.2;26.9.2 Activity;297
1.6.5.9.3;26.9.3 Follow-Up;298
1.6.5.9.4;26.9.4 Potential Complications;298
1.6.5.9.5;26.9.5 Treatments/Rescue for Complications;298
1.6.5.10;References;298
1.6.6;27: Percutaneous/Minimally Invasive Treatment for Thoracolumbar Fractures;299
1.6.6.1;27.1 Case Report;299
1.6.6.2;27.2 Background;299
1.6.6.3;27.3 Indications;300
1.6.6.4;27.4 Advantages;300
1.6.6.5;27.5 Equipment;301
1.6.6.5.1;27.5.1 Procedure;301
1.6.6.5.2;27.5.2 Technical Peals and Pitfalls;305
1.6.6.5.3;27.5.3 Postoperative Considerations;305
1.6.6.5.4;27.5.4 Conclusion;305
1.6.6.6;References;305
1.7;Part 4: Sacral;307
1.7.1;28: Surgical Stabilization Options forFractures and Fracture-Dislocationsat the Lumbosacral Junction and forPosterior Pelvic Ring Reconstruction;308
1.7.1.1;28.1 Indications;308
1.7.1.2;28.2 Contraindications;309
1.7.1.3;28.3 Techniques;309
1.7.1.4;28.4 Treatment Options and Decision-Making;309
1.7.1.4.1;28.4.1 External Fixation;310
1.7.1.4.2;28.4.2 Transiliac Sacral Bars;310
1.7.1.4.3;28.4.3 Transverse Transiliac Plating;310
1.7.1.5;28.5 Open Reduction and Internal Fixation with Small Fragment Plate and Screw Devices;311
1.7.1.5.1;28.5.1 Iliosacral Screws;311
1.7.1.5.2;28.5.2 Segmental Lumbopelvic Fixation;312
1.7.1.6;28.6 Results;313
1.7.1.6.1;28.6.1 Exposure;313
1.7.1.6.2;28.6.2 Neural Decompression, Fracture Reduction, Lumbopelvic Fixation;313
1.7.1.7;28.7 Postoperative Management;317
1.7.1.8;28.8 Avoiding Pitfalls and Complications;317
1.7.1.9;Further Reading;318
1.7.2;29: Sacral Screw Fixation;321
1.7.2.1;29.1 Introduction;321
1.7.2.2;29.2 Relevant Anatomy;321
1.7.2.3;29.3 Bone Mineral Density;322
1.7.2.4;29.4 Cortical Fixation;322
1.7.2.5;29.5 Screw Length;323
1.7.2.6;29.6 Biomechanical Comparisons;323
1.7.2.7;29.7 Technique of Screw Placement;323
1.7.2.7.1;29.7.1 Anteromedial (Pedicle) S1 Screw;323
1.7.2.7.2;29.7.2 Anterolateral (Alar) S1 Screw;324
1.7.2.7.3;29.7.3 S2 Screws;324
1.7.2.8;29.8 Choice of Technique;325
1.7.2.9;29.9 Conclusions;326
1.7.2.10;References;326
1.7.3;30: Percutaneous Placement of Iliosacral Screws;327
1.7.3.1;30.1 Case Example;327
1.7.3.2;30.2 Background;327
1.7.3.3;30.3 Indications and Advantages for Procedure Contraindications and Disadvantages for Procedure;328
1.7.3.4;30.4 Procedure;330
1.7.3.4.1;30.4.1 Equipment Needed;330
1.7.3.4.2;30.4.2 Anesthetic and Neuromonitoring Considerations;330
1.7.3.4.3;30.4.3 Patient Positioning and Room Setup;330
1.7.3.4.4;30.4.4 Surgical Approach, Reduction Technique, and Fixation Technique;330
1.7.3.5;30.5 Complications and Postoperative Considerations;333
1.7.4;31: Iliac Fixation in Trauma;336
1.7.4.1;31.1 Introduction;336
1.7.4.2;31.2 Technique;336
1.7.4.2.1;31.2.1 Exposure;336
1.7.4.2.2;31.2.2 Screw Placement;336
1.7.4.2.3;31.2.3 Connecting the Construct;337
1.7.4.2.4;31.2.4 Closure;340
1.7.4.3;31.3 Conclusion;340
1.7.4.4;References;340
1.8;Part 5: Special Circumstances;342
1.8.1;32: Minimally Invasive Treatment for Ankylosing Spondylitis and DISH Thoracolumbar Fractures;343
1.8.1.1;32.1 Case Example;343
1.8.1.2;32.2 Background;343
1.8.1.3;32.3 Advantages;343
1.8.1.4;32.4 Procedure;344
1.8.1.5;32.5 Technical Perils and Pitfalls;344
1.8.1.6;32.6 Postoperative Considerations;345
1.8.1.7;32.7 Results;345
1.8.1.8;32.8 Conclusions;346
1.8.1.9;References;347
1.8.2;33: Surgical Treatment of Thoracic orThoracolumbar Fractures of AnkylosingSpondylitis (AS) or Diffuse IdiopathicSkeletal Hyperostosis (DISH);348
1.8.2.1;33.1 Case Report;348
1.8.2.2;33.2 Introduction;348
1.8.2.3;33.3 Equipment;349
1.8.2.4;33.4 Patient Positioning;350
1.8.2.5;33.5 Procedure;350
1.8.2.6;33.6 Complications;350
1.8.2.7;References;350
1.8.3;34: Traumatic Dural Tears;351
1.8.3.1;34.1 Case Example;351
1.8.3.2;34.2 Background;352
1.8.3.3;34.3 Indications and Advantages for Procedure;352
1.8.3.4;34.4 Contraindications and Disadvantages for Procedure;352
1.8.3.5;34.5 Procedure;353
1.8.3.5.1;34.5.1 Suture Material;353
1.8.3.5.2;34.5.2 Dural Substitutes;353
1.8.3.5.3;34.5.3 Sealants;354
1.8.3.5.4;34.5.4 Surgical Technique;354
1.8.3.5.5;34.5.5 Surgical Adjuvants;355
1.8.3.6;34.6 Technical Pearls and Pitfalls;356
1.8.3.7;34.7 Postoperative Considerations;356
1.8.3.7.1;34.7.1 Activity;356
1.8.3.7.2;34.7.2 Treatment of CSF Hypotension Headache;357
1.8.3.7.3;34.7.3 Rescue Procedures;357
1.8.3.7.4;34.7.4 Disclosure;357
1.8.3.8;References;357
1.8.4;35: Civilian Gunshot Injury to the Spine;358
1.8.4.1;35.1 Introduction;358
1.8.4.2;35.2 Initial Assessment of Patients with Spinal Gunshot Injury;358
1.8.4.2.1;35.2.1 General Evaluation of Patients;358
1.8.4.2.2;35.2.2 Spine Injury Evaluation;361
1.8.4.2.3;35.2.3 Imaging;362
1.8.4.3;35.3 Initial Treatment;363
1.8.4.4;35.4 Pharmacologic Management;364
1.8.4.4.1;35.4.1 Antibiotics;364
1.8.4.4.2;35.4.2 Steroids;365
1.8.4.5;35.5 Surgical Management;366
1.8.4.5.1;35.5.1 Surgery for Neurologic Deficit;366
1.8.4.5.2;35.5.2 Surgery for Retained Missile Fragments;366
1.8.4.5.3;35.5.3 Surgery for Debridement;367
1.8.4.5.4;35.5.4 Bullet Metal Toxicity;367
1.8.4.5.5;35.5.5 Surgery for Spine Instability;368
1.8.4.6;35.6 Complications;368
1.8.4.7;35.7 Conclusions;369
1.8.4.8;APPENDIX;369
1.8.4.8.1;Epidemiology of Spinal Civilian Gunshot Injury;369
1.8.4.9;Ballistic Principles of a Gunshot Injury;369
1.8.4.10;Wounding Potential;370
1.8.4.10.1;Impact Energy;370
1.8.4.10.2;Distance to the Target;370
1.8.4.10.3;Missile Design;371
1.8.4.10.4;Target Tissue Characteristics;371
1.8.4.10.5;Missile Behavior Within the Target Tissue;371
1.8.4.11;Clinical Determinants of Gunshot Injury Severity;371
1.8.4.11.1;Injury Energy;371
1.8.4.11.2;Anatomic Structure Involvement;372
1.8.4.11.3;Types of Gunshot Wound;372
1.8.4.11.4;Gunshot Injuries to Bone;373
1.8.4.11.5;Infection Risk Secondary to Gunshot Injury;373
1.8.4.12;Gunshot Injury to the Spine Neural Elements;373
1.8.4.12.1;Injury Pathomechanism;373
1.8.4.12.2;Patterns of Neurologic Deficit;374
1.8.4.13;Spinal Stability Following Gunshot Injury;375
1.8.4.14;References;376
1.8.5;36: Complications in Spine Surgery;379
1.8.5.1;36.1 Introduction;379
1.8.5.2;36.2 Preoperative Planning;379
1.8.5.2.1;36.2.1 Imaging and Clinical Impressions;379
1.8.5.2.2;36.2.2 Equipment;379
1.8.5.2.3;36.2.3 Preoperative Evaluation of the Patient and Documentation is Extremely Important;380
1.8.5.3;36.3 Intraoperative Complications;380
1.8.5.3.1;36.3.1 Underestimation of Trauma;380
1.8.5.3.2;36.3.2 Bleeding;380
1.8.5.3.3;36.3.3 Soft Tissue Coverage;381
1.8.5.3.4;36.3.4 Fixation Failure;381
1.8.5.4;36.4 Postoperative Complications;381
1.8.5.4.1;36.4.1 Neurological Complications;381
1.8.5.4.2;36.4.2 Postoperative Infection;382
1.8.5.4.3;36.4.3 Misplaced Instrumentation;382
1.8.5.4.4;36.4.4 Pseudoarthrosis;382
1.8.5.5;36.5 Summary;382
1.8.5.6;36.6 Pearls;382
1.8.5.7;References;383
1.9;Index;384