137
NerveGraftHarvestingand Repair
991
--
Figure
137-1
(A)
A simple
external
epineural
repair is appropriate
for approximating
smaller
to medium-sized
nerves where there is no ten-
sion on the repair. A reasonable effort should be
made
to
realign
the larger fasicles and avoid
trauma
to the nerve tissue. Commonly,
two or
three sutures are sufficient.
The sutures may be
reinforced
with
fibrin
glue or tissue adhesive if
necessary
to
keep
the
nerve
ends in close
approximation.
(B) Excellent coaptation
of the
nerve ends should
be the goal of repair tech-
niques. Fasicles of the proximal stump should be
well aligned with the distal end to permit axonal
regrowth
across the site.
A
B
A
Figure 137-2
(A) When suturing larger periph-
eral nerves a fasicular repair can be usedto best
align the nerve bundles. Suture material andma-
nipulation of tissue,which can engender scarring,
should be kept to a minimum.
The external
epineurium is gently peeled to allow separation
and identification of fasicles. (B) Using fasicular
anatomy and surface topography,
matching
fasicles are individually
sutured
with
10-0
monofilament.
B
992
Peripheral Nerve: Other Nerves
A
B
Figure 137-3
(A) When a nerve gap exists,
graft material is used to bridge the deficit.
Fasicular anatomy
should be matched as closely aspossi-
ble on the proximal
and distal ends. When measuring
the anticipated
length of an interposition
graft it is paramount
to avoid any tension across
both the proximal
and distal repair sites. The graft should be long enough to completely
bridge the gap and allow a modest
redundant amount
for some nerve retraction
and limb motion
and still avoid tension. A sufficient
number of grafts should be used to roughly approximate the cross-
sectional diameter
of the parent nerve. (8) The grafts must be of sufficient
length to eliminate
any tension across the repair. To reduce scarringat
the nerve anastomosis site, 9-0 or 10-0 monofilament
suture material is used.
.
Harvesting Nerve Grafts
Donorsites for nerve grafts are often dependent on the clini-
calsituation and needs of the patient. The most common site
for harvesting of nerve grafts is the medial and lateral sural
nerves (Fig.137-4A,B).3They are readily obtained with little
or no impairment to the patient, the major disadvantage be-
ing the length of the incision needed to harvest sufficient
nerve to allow creation of multiple cable grafts. The other
advantage,isthe low frequencyofpainful neuroma formation
in this nerve. Other possible nerve donors are the superficial
sensory radial nerve, and the lateral or medial antebrachial
cutaneous. The disadvantage to these, is the frequent
occurrence of painful neuromas
at the proximal stump. How-
ever, strong consideration should be given to these donor
sites in patients who have proximal nerve injuries where the
occurrence of neuroma formation is not an issue.
When harvesting
nerve graft, attention
should be paidto
treatment
of the proximal
donor
stump.
The nerve end
should be suture ligated and patulous
fascicles sealed with
the bipolar unit to prevent
development
of a neuroma. The
stump should be protected
from pressure or irritative forces
and well padded
in soft tissue. In nerves that are prone to
neuroma
formation,
placing
the end of the nerve into a
pocket of normal muscle tissue my help prevent a painful
neuroma.
r
137
NerveGraft Harvestingand Repair
993
I
,
I
/
I
,
I
I
\
)(
r
A
References
1.
Kline DG.Hudson AR Ulnar nerve surgical anatomy. In: Kline DG.Hud-
son AR.eds. Nerve Injuries: Operative Results for Major Nerve Injuries.
Entrapments and Tumors. Philadelphia: WBSaunders; 1995:127- 130
2.
Harris ME. Tindall
SE. Techniques of peripheral
nerve repair. In:
Burchiel
KJ. ed. Neurosurgical
Clinics of North America:
Surgical
Figure
137-4
(A) The incision for a sural nerve graft. This is the
most common donor nerve site. The incision begins approxi-
mately halfway between the lateral malleolus and the calcaneal
tendon. The incision is started near the top of the malleolus to
prevent a painful scar when a shoe is worn postoperatively.
(B)Themedial and lateral sural nervescan both be harvestedfor
graft purposeswith little long-term sensorydeficit.
Management of Peripheral
Nerve
Injuries
and Entrapment.
Vol 2. no.
t. Philadelphia: WB Saunders;
1991 :93- 103
3.
Clemente
C. Anatomy:
A Regional
Atlas of the
Human
Body.
Balti-
more. MD: Urban
and Schwarzenberg;
1993:460-463
Index
Pagesfollowed
by an "f' or "t" indicate that the entry is in a figure or a table,
respectively
A
Accident-related injury, lumbar/lumbosacral
disk surgery, 557
Airway control, occipitocervical junction, retropharyngeal ap-
proach, 106
Allograft techniques
anterior decompression surgery, reconstruction following, 331,
332
lumbar/lumbosacral spine
interbody fusion and transpedicular screw fixation, 683
transverse process fusion, 678
thoracoscopic anterior internal stabilization, 806, 806-807
Amine precursor uptake and decarboxylation (APUD)system,
glomus jugulare tumor, occipitocervical junction, 29-30
Anesthesia
anterior approach, cervical spine surgery, 195, 196
arteriovenous malformations, 480
axillary nerve surgery, 925
Brooks fusion technique, (1-(2
junction, 140
cervical foraminotomy, 247-248
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 145
far-lateral microdiskectomy, 639
foraminal epidural endoscopic diskectomy, 828
genitofemoral neuralgia surgery, 984
infraclavicular surgical technique, brachial plexus, 916
intermedulIary
spinal cord tumor surgery, 171
lateral transthoracic surgical approach,
thoracic/thoracolumbar
spine, 404
lower thoracic sympathectomy/splanchinectomy,
423
lumbar/lumbosacral spine surgery
anterolateral retroperitoneal
approach, 606
cerebrospinal fluid leak repair, 644
chemonucleolysis, 812-813
disk surgery, 558
dorsal rhizotomy, 771
lumboperitoneal
shunt, 649
posterior approach, 613
interbody fusion and transpedicular
screw fixation, 684
rhizotomy, 652-654
sacrococcygeal teratoma resectioning, 723-724
lumbar/lumbosacral
surgery, diastematomyelia
repair, 760
lumbosacral plexus surgery, 946
tumor removal, 950-952, 951-952
micro endoscopic diskectomy, 847
microendoscopic foraminotomy, 786-787, 787
odontoid screw placement, 219
percutaneous spinal cord stimulator implantation,
832
posterior surgical techniques
atlantoaxial approach, 133
Bohlman triple-wire
technique, 255
cervical diskectomy, 250
cervical spine, 228
iliac crest bone graft, 777
intradural extramedulIary tumor resectioning, 289-290
locked/perched facet exposure and release, 265
myelomeningocele repair, 713
sacral agenesis, 765, 766
in situ fusion, thoracic spine, 538-539
subaxial cervical spine stabilization sublaminar cable
placement, 267-268
thoracic spine, pedicle screw procedures, 543
spinal accessory nerve surgery, 921
supraclavicular surgery
brachial plexus, 909
cervicothoracic junction, 308
syringoperitoneal shunting, 535
syringopleural shunting, 522, 522
syringosubarachnoid shunting, 531
thoracic extension osteotomy, 464, 464
transmanubrial
transclavicular surgery, cervicothoracic
junction, 319-320
transoral techniques
craniocervical junction, 56-57
midline tumor resectioning,
65
transsternal surgery, cervicothoracic junction, 314
transthoracic surgical approach
995
-.-"
996
Index
Anesthesia (Continued)
diskectomy, 427
lateral parascapular extrapleural exposure, upper thoracic
spine, 344
thoracic/thoracolumbar spine, 338-339
upper thoracic ganglionectomy, 422
vertebrectomy, 432
Aneurysmal bone cyst
cervicothoracic junction, 303
thoracic/thoracolumbar spine, 390
Ankylosingspondylitis
craniocrevical junction, 53
occipitocervical junction inflammation, 21
Anterior atlantoaxial subluxation (AAS),pathogenesis, 17-19
Anterior instrumentation, lumbar/lumbosacral spine,
retroperitioneal approach, 841,841-842
Anterior interosseus nerve syndrome (AINS),897-898
Anterior longitudinal ligament (ALL),thoracic/thoracolumbar
spine trauma, 397
Anterior surgical approach
axillary nerve surgery, 923-927, 925
cervical spine, 193-203
advantages/disadvantages, 195
anesthesia and positioning, 195, 196
Cloward technique, 201,201
complications and avoidance, 204-205
corpectomy, 193, 196,198,199
diskectomy, 193, 194,196-197, 197
dissection, 195-196,197-198,198
exposure risks, 204-205
grafting, 199,200
complications, 205
illumination and magnification equipment, 195
indications, 195
internal fixation complications, 205
neurological complications, 205
plating techniques, 201-203,202--204
right- vS.left-sided approach, 195, 195-196
trauma
combined posterior-anterior stabilization, 190
decompression and arthrodesis, 178-179, 178-181
posterior technique VS.,177
stabilization techniques, 178-181
vascular injury, 205
visceral injury, 205
decompression, reconstruction following, 330-334, 331t, 332,
334
femoral nerve, 955, 956
iliaccrest bone graft, 779-780
lateral femoral cutaneous nerve, 953, 954, 955
lumbar/lumbosacral spine
computer-assisted fusion, 590-595
decompressive techniques, 599-600, 599-601
transperitoneal approach, 596-602, 597-599
tumor dissection, 571t, 573
microendoscopic foraminotomy, cervical spine, osteophyte
decompression, 788, 790-791, 791
microforaminotomy (transuncal), cervical spine, 207-216,
209-210
cord decompression, spondylotic myelopathy/OPLL,
211-213,212-213
radiculopathy, 208-211,209-211
spinal cord tumors, 213-217,214-215
thoracoscopic anterior internal stabilization, 806-807,
808-809
ulnar nerve incision and dissection, 941-942, 941-942
vertebrectomy following, 326-329, 327-329
Anterolateral graft and plate reconstruction, thoracic/
thoracolumbar spine, 436-440, 437-440
Anterolateral surgical approach, lumbar/lumbosacral spine
retroperitoneal approach combined with, 604-611,605-609
tumor surgery, 571t, 573
Anteroposterior (AP)imaging, thoracic disk herniation,
transpedicular approach, 473,472-474
Antimicrobial therapy, epidural abscess, 459
Apert's syndrome, facial-ocular deformities and hearingdeficits,
157
Arachnoid cysts, thoracic/thoracolumbar congenital
abnormalities, 370-371, 371
extradural cysts, 372
Arcade of Fohse, radial nerve entrapment, 898, 900
Arteriovenous fistula (AVF)
classification, 479t
dural AVFs,480, 480-481
thoracic/thoracolumbar spine, 475
Arteriovenous malformations (AVMs),thoracic/thoracolumbar
spine, 478-488
cavernous angiomas, 485-488, 486-487
classification, 479t
dural AVMs,480, 480-481
intradural AVMs,481
normal vascular anatomy, 479, 479-480
perimedullary intradural AVMs,484, 485
spinal cord AVMs,481-484, 482-483
surgical technique, 480
Arthrodesis techniques
atlantoaxial subluxation, 18-19
cervical spine, trauma stabilization, 178-179, 178-181
craniovertebral stabilization, C1arch to C3strut arthrodesis,
105,105-106
Arthroscopic microdiskectomy, posterolateral surgicalapproach,
816-824
ASIAclassification system, lumbar/lumbosacral spine trauma,
585, 585t
Atlantoaxial instability
craniocerMidvical junction, 53
posterior fusion techniques, 128-138
anatomy, 128-129, 129
anesthesia, 133
cable fixation, bony wedge compression, 135-136, 135-136
exposure and nuchal musculatures, 133, 134,135
Halifaxclamp fixation, 136, 137
patient positioning, 133
regional biomechanics, 130
screw fixation, 136-138, 137-138
surgical anatomy, 129, 131-132
Atlantoaxial rotatory fixation (AARF),occipitocervicaljunction,
20, 20-21
Atlantoaxial rotatory subluxation, pathogenesis, 19
Atlantoaxial subluxation (AAS),rheumatoid arthritis
epidemiology, 13
natural history, 13-14
pathogenesis, 16-19, 18-19
Atlantodental interval (ADI)
atlantoaxial subluxation, 17-19
posterior atlantoaxial surgical anatomy and techniques, 128
transverse ligament injuries, 34-35, 35-38
Atlas-axis fractures, occipitocervical junction, 32t, 39t, 44-45,
45-46
Atlas fractures, occipitocervical junction, 35-38, 39,40-42
nonsurgical treatment, 46
Autogenous bone grafting, rheumatoid arthritis, basilar
invagination, 16
Autograft techniques
Index
997
anterior decompression surgery, reconstruction following, 331,
332
lumbar/lumbosacral spine
posterior lumbar interbody fusion, 683
transverse process fusion, 678
Axialpain, cervical spondylosis, 166
Axillaryhyperhidrosis, endoscopic sympathectomy, 794
Axillarynerve
anatomy, 924, 924-925
surgical approach to, 923-927
Axisfractures, occipitocervicaljunction, 39, 39t, 42
Axonotmesis,characteristics of, 891
B
Baclofenpumps, lumbar placement, 704-711
Basilarinvagination (BI)
craniocervical junction, transoral approaches, 53, 54
odontoid resection and, 62
rheumatoid arthritis
epidemiology, 13
pathogenesis, 14-16, 15
Basilarmigraine, craniocervical junction abnormalities, 6, 7
Benigntumors
occipitocervical junction, 28
thoracic/thoracolumbar spine, 389-391, 391t
Benttitanium rods and cables, posterior occipitocervical fusion
and stabilization, 118-121, 119-120
Biomechanics
cervical spine, 165
posterior atlantoaxial surgical anatomy and techniques, 130
thoracic/thoracolumbar spine trauma, 397,397-398
Biomolecular structure, cervical spine, 165
Biopsyprocedures
occipitocervical junction tumors, 26
sural nerve, 967-968,968
thoracic/thoracolumbar spine tumors, 385
Bladdercontrol
lumbar/lumbosacral spine lipomas, 667-668
spinal cord lipoma surgery, 750
Bloodsupply, sacrococcygeal teratoma resectioning, 726, 726
Bohlman triple-wire technique, posterior stabilization, 254-256,
255-257
Boijsenmeasurements, cervical stenosis, 168
Boneexposure, thoracic extension osteotomy, 464, 465
Bonegraft harvesting
Brooks fusion technique, C1-C2junction, 141-142, 142
interfacet wire stabilization, cervical spine, 272,273
lumbar/lumbosacral spine
computer-assisted fusion, 593, 594
hook-rod fusion instrumentation, 695
iliac crest bone graft, 776-781,777-781
posterolateral grafting, 594-595, 595
subaxial cervical spine stabilization sublaminar cable
placement, 269-270
Boneresection, retropharyngeal surgical approach, 98, 98-99
Bonescans
cervicothoracic junction tumors, 298
thoracic/thoracolumbar spine, tumor imaging, 385
Bonesoftening disease, craniocervical junction, transoral
approaches, 53-54
Bonetumors, cervicothoracic junction, 301-302
"Bonewindows" technique, extreme lateral transcondylar
transtubercular approach, anterior craniocervical
junction, 145
Bonywedge compression, posterior atlantoaxial surgical
techniques,135-136,135-136
Bowelinjury, lumbar/lumbosacral disk surgery, 562
Brachalgiaand cord syndrome, 166
Brachialplexus
anatomy, 907-908, 908, 915, 915
avulsion, dorsal root entry zone surgery, 503-505, 504-505
axillary nerve surgery, 923-927
infraclavicular surgical approach, 914-918
median nerve, 932-936
musculocutaneous nerve, surgical techniques, 928-931,
929-930, 929t
pathology, vertebroplasty /kyphoplasty, 866-874
peripheral nerve compressive lesions, 895-906
peripheral nerve tumors, 879-886
radial and ulnar nerves, 937-942
spinal accessory nerve surgery, 919-922
supraclavicular surgical approach, 907-913
anesthesia and positioning, 909, 909
dissection, 909-910, 910
donor nerve graft harvesting, 910
incision, 909
laceration repair, 911
penetrating injury repair, 911
stretchinjuries,911-912,911-912
Brantigancages,posteriorlumbarinterbodycages,686,686-687
Breast cancer, cervicothoracic junction tumors, 299, 299t
Brooks fusion technique
atlantoaxialstabilization,135-136,136
C1-C2junction, 139-143
advantages/disadvantages, 139-140
anesthesia, 140
bone graft harvest, 141-142, 142
closure, 143
complications, 143
graft placement, 142-143, 142-143
incisions, 141,141
indications, 139
patient positioning, 140, 140
postoperative care, 143
preoperative planning, 140
radiological evaluation, 140
sublaminar wire placement, 141,142
Brown-Sequardsyndrome,cervicalspinesymptoms,166
"Buckling-type alignment," cervicallaminoplasty and risk of,
244-245
Bulbar function, transoral closure procedures, postoperative
assessment, 77, 77
Burst fractures
lumbar/lumbosacralspinetrauma,581-582,582-583,583t
thoracic/thoracolumbar spine trauma
classification, 398t
features of,397,399-400, 400
neurological injury, 400-401
Butterflyvertebra,congenitalkyphosis,367
C
Cable fixation
lumbar/lumbosacral
spine surgery, Luque instrumentation,
698
posterior atlantoaxial surgical techniques, 135-136, 135-136
subaxial
cervical spine stabilization
sublaminar
cable
placement, 269
Cancer pain, endoscopic
sympathectomy,
794
Cannula placement,
arthroscopic
and endoscopic
microdiskectomy,
posterolateral
surgical approach, 819-821, 819-822
Capitis muscles, retropharyngeal surgical approach, 96, 97
Carbon fiber rectangular
cage posterior
lumbar
interbody
fusion,
lumbar/lumbosacral spine, 684
Cardiac arrhythmias,
endoscopic
sympathectomy,
794
998
Index
Cardiopulmonary defects, Klippel-Feilsyndrome, 159-160
C-arm image intensifier, lumbar chemonucleolysis, 812, 812
Carotidartery location
anterior cervical spine dissection, 198
supraclavicular surgery, 308-310, 310-311
Carpal tunnel syndrome
etiology,898, 898, 899t
risk factors, 898, 899t
Cartilagetumors, cervicothoracic junction lesions, 300-301
Caspar plating system, anterior cervical spine plating, 201-203,
202-204
Catheter preparation
lumbar pump placement, 705-710,706-710
lumboperitoneal shunt, 649, 649-650
microendoscopic foraminotomy, cervical spine, 786-787
syringoperitoneal shunting, 535
syringopleural shunting, 524-526
syringosubarachnoid shunting, 531-532
Cauda equina
ependymoma resection, lumbar/lumbosacral spine, 657-659
intradural/extramedullary
tumors, 567, 568t
intramedullary spinal cord tumor surgery, 284-285
Caudal extension, midline tumor resectioning, transoral ap-
proach, 68-69, 69
Caudalis dorsal root entry zone (DREZ),514-516, 514-517
Cavernous angiomas
pathophysiology/objectives, 483, 484
surgical indications, 483-484
Cavitron ultrasonic aspirator (CUSA),intermedullary spinal cord
tumor surgery, 173, 174
Cl-C2 junction
anterior atlantoaxial subluxation, 17-19
atlantoaxial rotatory subluxation, 19
atlantoaxial stabilization, posterior techniques, 135-138,
135-138
Brooks fusion technique, 139-143
advantages/disadvantages, 139-140
anesthesia, 140
bone graft harvest, 141-142, 142
closure, 143
complications, 143
graft placement, 142-143, 142-143
incisions, 141,141
indications, 139
patient positioning, 140, 140
postoperative care, 143
preoperative planning, 140
radiological evaluation, 140
sublaminar wire placement, 141,142
caudalis dorsal root entry zone, 516,515-520
cervical spine structure and, 164-165
craniovertebral stabilization
Cl arch to C3strut arthrodesis, 105, 105-106
retropharyngeal approach, 105, 105
occipitocervicaljunction trauma assessment, 33-34
atlas fractures, 35-38,39,40-42
combined atlas-axis fractures, 32t, 39t, 44-45, 45-46
isolated fractures, 38-39, 39t
miscellaneous fractures, 39t, 43-4
nonsurgical treatment, 46
rotatory Cl-C2 dislocation, 34, 35,38
transverse ligament injuries, 34-35, 35-38
odontoid fractures, screw placement, 218-223
posterior atlantoaxial surgical anatomy and techniques,
128-129,131-132
retropharyngeal surgical approach
anterior arch preservation, 99
median tubercle Cl anterior arch, 98, 98
suboccipital craniectomy, 116,116-117
transoral odontoidectomy, 61,61-62
tumor anatomy and biomechanics, 23
C2-C3junction, transoral odontoidectomy. 62
Central canal enlargement, cervicallaminoplasty, 241-243,
242-244
Central cord syndrome, cervical spine symptoms, 166
Cerebral palsy, spasticity, dorsal rhizotomy, 771-775, 772-775
Cerebrospinal fluid leakage
craniocervical junction, transoral complications, 58
encephaloceles, occipitocervical junction, 123, 123-126
epidural abscess, 458, 458-459
intradural extramedullary tumor resectioning, 491
limited dorsal myeloschisis, 751,752-754,753
lumbar/lumbosacral spine
disk surgery, 562
repair techniques. 644-646
occipitocervical junction. retropharyngeal closure, 103-104
diversion procedures, 105
open spinal dysraphism surgery, myelomeningocele, 738-739
posterior surgery, cervical spine, 231
sacrococcygeal teratoma mobilization, lumbar/lumbosacral
spine, 725, 725-726
syringoperitoneal shunting, 534-536
transoral closure procedures, postoperative management,
76-77
Cervical diskectomy, 250-253,251-252
Cervical fascia, retropharyngeal surgical approach and, 91-92
Cervical foraminotomy, posterior approach. 247-249,248-249
Cervical fractures, orthoses, 39. 39t
Cervical laminectomy
advantages/disadvantages, 233
Chiari malformation, 115-117,116-117
closure, 236
complications, 237-238
drilling technique, 234.235-237. 236
indications/contraindications, 233
lateral dissection, 233-234,234-236
Cervicallaminoplasty
advantages/disadvantages, 241
complications, 245
indications, 240-241
midline enlargement technique, 243.244
outcomes. 244-245
overview of techniques, 239. 240t
surgical techniques, 241-244
unilateral enlargement (open-door) technique, 241-243,
242-244
Cervical myelopathy, rheumatoid arthritis, natural history,13-14
Cervical schwannomas, intradural extramedullary tumor
resectioning, 290-293,292-293
Cervical spine
anatomical structure, 164-165
anterior surgical approach, 193-203
advantages/disadvantages, 195
anesthesia and positioning, 195, 196
Cloward technique, 201.201
complications and avoidance, 204-205
corpectomy. 193, 194, 198,200, 201
diskectomy, 193, 194,198-199, 199
dissection, 195-196,197-198,198
exposure risks, 204-205
grafting, 199.200
complications, 205
illumination and magnification equipment, 195
indications, 195
Index
999
internal fixation complications, 205
microforaminotomy (transuncal), 207-216
cord decompression, spondylotic myelopathy/OPLL,
211-213,212-213
radiculopathy, 208-211,209-211
spinal cord tumors, 213-216,214
neurological complications, 205
plating techniques, 201-203,202-204
right- vS.left-sided approach, 195, 195-196
vascular injury, 205
visceral injury, 205
biomolecular structure, 165
congenital mid- to lower osseous anomalies
cardiopulmonary defects, 159-160
cineradiography, 160
classification, 155-156
facial and ocular deformities and hearing deficits, 157
genitourinary defects, 160, 160
Klippel-Feilsyndrome anomalies, 159, 159t
magnetic resonance imaging, 160-161, 161
neurological problems, 162
phenotypic features, 156, 156
plane radiography, 160
pterygium colli, 157,157
sagittal plane deformities, 158-159
scoliosis, kyphosis, and lordosis, thoracolumbar spine, 158
spinal stenosis and instability, 162
Sprengel's deformity, 157-158, 158
stenosis and instability evaluation, 161-162
tomograms and computed tomography, 160
torticollis, 157,157
treatment, 162
degenerative disease and stenosis, 164-168
clinical symptom complexes, 166-167
pathophysiology, 165-166
endoscopic foraminotomy, 785-789, 787-791
anesthesia and patient positioning, 786-787, 787
closure techniques, 791
diskectomy and anterior osteophyte decompression, 788,
790-791, 791
incision and approach, 787-788, 788-789
laminotomy and, 788, 789-790
posterior surgical approach, 225-231
advantages/disadvantages, 225
anatomy, 225-226,227-228
anesthesia, 228
closure and postoperative management, 230-231
complications, 231
indications, 225, 226t
interfacet wire stabilization, 271-273
lateral mass plates, stabilization, 274-278
patient positioning, 228-229,229
principle techniques, 229-230,229-231
subaxial stabilization, sublaminar cables, 267-270
rheumatoid arthritis
natural history, 13
pathogenesis, 14
trauma
anterior plating, 180-181, 181
anterior stabilization, 178-181
decompression and arthrodesis, 178-179,178-181
anterior vs. posterior surgical technique, 177
combined posterior-anterior stabilization, 190
initial assessment and stabilization, 176
patient positioning and anesthesia, 177-178
posterior stabilization, 181-190
clamp and hook systems, 188
facet wiring, 188
Hartshill rectangle, 190
interspinous wiring, 188, 189,190
lateral mass plates and screws, 181-188, 182-187
sublaminar wiring, 190
radiological evaluation, 176-177
Cervicocranial anatomy, posterior atlantoaxial surgical anatomy
and techniques, 128-129, 129-130
Cervicothoracicjunction
anterior surgical approach
decompression, reconstruction following, 330-334, 331t,
332,334
vertebrectomy following,326-329, 327-329
supraclavicular surgical approach, 306-310, 307-311
trans manubrial transclavicular surgical approach, 318-325,
320-324
transsternal surgical approach, 312-317,313-317
transthoracic surgical approach
lateral parascapular extrapleural exposure, upper spine,
343-348,344-349
closure techniques, 348
diskectomy, 347
musculocutaneous flap, 344-345, 344-346
vertebral reconstruction, 348, 348
thoracic spine, 335-342, 336t
chest wall anatomy, 336
complications, 342
decompressive techniques, 340-342, 341
ribs/spinal column, 337-338, 337-339
surgical technique, 338-340, 339-340
tumors, management of,297-304
anatomy, 297-298
chondroscarcoma, 301
chordoma, 303
extraspinal anatomy, 298
laboratory analysis, 299
metastatic lesions, 299-300, 299t
nonneoplastic mass lesions, 303-304
nonspinal metstatic lesions, 300
osteoblastoma, 301
osteochondroma, 300-301
osteoid osteoma, 301
osteosarcoma, 302
plasma cell dyscrasias, 302-303
radiological evaluation, 298, 298t
spinal anatomy, 297-298
Chance fractures, thoracic/thoracolumbar
spine trauma,
classification, 396t, 397,397
Chest wall anatomy, transthoracic surgical approach,
thoracic/thoracolumbar spine, 336
Chiari malformation
hydrosyringomyelia, 373-374
spina bifida aperta, 356-357, 356
suboccipital craniectomy and cervical laminectomy, 115-117,
116-117
syringopleural shunting, 521,522
Children
arteriovenous malformations in,482, 483-484
lumbar/lumbosacral spine lipomas in, 666-674, 667-673
spondylolisthesis in, 549-553
Chondrification, thoracic/thoracolumbar spine congenital
abnormalities, 355
Chondroid chordomas, occipitocervical junction, 28
Chondrosarcoma
cervicothoracic junction tumors, 301
occipitocervical junction, 28
thoracic/thoracolumbar spine, 391
1000
Index
Chordoma
cervicothoracic junction tumors, 303
occipitocervical junction, 27-28, 27t, 28
malignant tumors, 28
thoracic/thoracolumbar spine, 390-391
Chylothorax,anterior cervical spine surgery, 195
Cineradiography, Klippel-Feilsyndrome anomalies, 160
Clamp and hook system, cervical spine trauma, 188
CIival/pharyngeal tubercle, retropharyngeal surgical approach, 98
Clivus
craniocervical junction anatomy, 51,52
lesions, 55
midline tumor resectioning, transoral approach, 67-68
transoral closure, 73-74, 74
Closure
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 147,151
lumbar/lumbosacral disk surgery, 562
open spinal dysraphism surgery, myelomeningocele, 737-738
Closure techniques. See also Dural closure
anterolateral graft and plate reconstruction, 439
axillary nerve repair, 927
Brooks fusion procedure, 143
caudalis dorsal root entry zone, 517
cervical foraminotomy, 249
cervical laminectomy, 236
dural closure
intermedullary spinal cord tumor surgery, 174
occipitocervical junction, retropharyngeal approach,
104- 105
suboccipital craniectomy, 117,117
endoscopic sympathectomy, 797, 797
epidural endoscopic diskectomy, 829
extreme lateral transcondylar transtubercular approach, 147,
151
genitofemoral neuralgia surgery, 985
intradural extramedullary tumor resectioning, 493, 493
intramedullary spinal cord tumor surgery, 285,286
lateral transthoracic surgical approach,
thoracic/thoracolumbar spine, 410-411
lower thoracic sympathectomy/splanchinectomy, 425
microendoscopic procedures
assisted transforaminallumbar
interbody fusion, 865, 865
decompression, lumbar stenosis, 857
diskectomy, 849
foraminotomy, cervical spine, 791
musculocutaneous nerve surgery, 930, 931
myelomeningocele, 357
occipitocervical junction, retropharyngeal closure, 103-104
open spinal dysraphism, myelomeningocele
dural closure, 735-736, 737
skin/myofascial closure, 736, 736-737
posterior surgical approach
Bohlman triple-wire technique, 256
cervical spine, 230-231
diskectomy, 253
interfacet wire stabilization, 273
lateral mass plate, stabilization, 277
subaxial stabilization sublaminar cable placement, 270
diastematomyelia repair, 763-764
iliac crest bone graft, 781, 781
intradural extramedullary tumor resectioning, 291,294
locked/perched facet exposure and release, 266
lumbar/lumbosacral spine
decompression techniques, 599, 601
disk surgery, 561-562
hemilaminectomy, 629
hook-rod fusion instrumentation, 695
laminectomy, 621-623
plate stabiliztion, 610
posterior fusion, Luque instrumentation, 703
posterior lumbar interbody fusion/screw fixation,688
sacrococcygeal teratoma resectioning, 727,727
transverse process fusion, 678
myelomeningocele repair, 713-714, 713-714
in situ fusion, thoracic spine, 540, 541
thoracic spine, pedicle screw instrumentation, 544
retroperitoneal approach and closure
lumbar spine, 841
thoracic/thoracolumbar spine, 418,419-420
spinal accessory nerve surgery, 922, 922
sural nerve surgery, 968-969
sympathectomy via costotransversectomy, 447
syringopleural shunting, 526
syringosubarachnoid shunting, 531
thoracic extension osteotomy, 466-467
thoracic laminectomy, 450
thoracic laminoplasty, 455, 455
thoracic vertebrectomy, 435
thoracoabdominal approach and closure,
thoracic/thoracolumbar spine, 412
thoracoscopic anterior internal stabilization, 809-810
transmanubrial transclavicular surgery, cervicothoracic
junction, 325
transoral approaches, 73-78
advantages/disadvantages, 73
objectives, 73
postoperative bulbar function and oral cavitydysfunction,
77-78
postoperative management, 76-77
surgical techniques, 73-76
transsternal surgery, cervicothoracic junction, 316
transthoracic diskectomy, 430
transthoracic surgical approach
lateral parascapular extrapleural exposure, upper thoracic
spine, 348
thoracic/thoracolumbar spine, 342
upper thoracic ganglionectomy, 423
Cloward/Un technique, posterior lumbar interbody fusionand
transpedicular screw fixation, 684-685
Cloward technique, anterior cervical spine surgery,201,201
Coccyx,excision, sacrococcygeal teratoma resectioning,726,726
"Cock-robin" deformity
atlantoaxial rotatory fixation, 20, 20-21
occipitocervical junction trauma, rotatory Cl-(2 dislocation,
34, 35,38
Commissural myelotomy, thoracic/thoracolumbar spine.
498-499,499-500
Compensatory hyperhidrosis syndrome, sympathectomy
complications, 798, 798t
Complications
anterior cervical spine surgery, 204-205
Brooks fusion technique, Cl-(2 junction, 143
cervical spine
laminectomy, 237-238
laminoplasty, 243
posterior surgical technique, 231
craniocervical junction, transoral surgery, 58
endoscopic sympathectomy, 798, 798t
foraminal epidural endoscopic diskectomy, 830
intermedullary spinal cord tumor surgery, 175
intramedullary spinal cord tumor surgery, 287
lateral transthoracic surgical approach.
thoracic/thoracolumbar spine, 411-412
Index
1001
lumbar/lumbosacral spine surgery
anterior transperitoneal approach, 601-602
disk surgery, 562
dorsal rhizotomy, 775, 775
hook-rod fusion instrumentation, 696
laminectomy, 623-624
lipoma resectioning, 674
lumboperitoneal shunt, 650
posterior fusion, Luqueinstrumentation, 703
posterior lumbar interbody fusion/screw fixation, 688
retroperitoneal approach, 845
sacrococcygeal teratoma resectioning, 727
tethered spinal cord release, 663
transverse process rusion, 679-680
tumor surgery, 577-578
microforaminotomy, anterior approach, spinal cord tumors,
214-216
midline tumor resectioning, transoral approach, 71
odontoid screw fixation, 223-224
open spinal dysraphism surgery, myelomeningocele, 737-739
percutaneous spinal cord stimulator implantation, 836
retroperitoneal approach and closure, thoracic/thoracolumbar
spine, 420
retropharyngeal approach, occipitocervical junction,
106t-l08t,
108
thoracoabdominal approach and closure,
thoracic/thoracolumbar spine, 416
thoracoscopic sympathectomy, 798, 798t
transoral odontoidectomy, 62
transthoracic surgical approach, thoracic/thoracolumbar spine,
342
vertebroplasty/kyphoplasty, 873
Compression fractures, lumbar/lumbosacral spine trauma, 581,
582-583
Computed tomography (Cf)
Brooks fusion technique, Cl-C2junction, 140
cervical stenosis evaluation, 168
cervicothoracic junction tumors, 298
craniocervical junction abnormalities, 6, 9
transoral approaches, 55
intermedullary spinal cord tumors, 170, 170
Klippel-Feilsyndrome anomalies, 160
lumbar/lumbosacral disk surgery, 557
lumbar/lumbosacral tumors, 568
occipitocervical junction trauma, rotatory Cl-C2 dislocation,
34,35,38
occipitocervical junction tumors, 26, 29,29
spondylolisthesis, in children, 550-551, 551
thoracic disk herniation, 468
thoracic/thoracolumbar spine
metastatic tumors, 391
pedicle screw procedures, 543
tumor imaging, 383
thoracic/thoracolumbar spine congenital abnormalities, 354
thoracic/thoracolumbar spine trauma, 400, 403
transoral odontoidectomy, 60-61
transverse ligament injuries, 35, 36-38
Congenital abnormalities
craniocrevical junction, transoral techniques, 53
dermal sinus, excision, 715-722
mid- to lower-cervical spine, osseous anomalies
cardiopulmonary defects, 159-160
cineradiography, 160
classification, 155-156
facial and ocular deformities and hearing deficits, 157
genitourinary defects, 160, 160
Klippel-Feilsyndrome anomalies, 159, 159t
magnetic resonance imaging, 160-161, 161
neurological problems, 162
phenotypic features, 156, 156
plane radiography, 160
pterygium colli, 157,157
sagittal plane deformities, 158-159
scoliosis, kyphosis, and lordosis, thoracolumbar spine, 158
spinal stenosis and instability, 162
Sprengel's deformity, 157-158, 158
stenosis and instability evaluation, 161-162
tomograms and computed tomography, 160
torticollis, 157,157
treatment, 162
thoracic/thoracolumbar spine
dermoids, epidermoids, and dermal sinus tracts, 361-362,
361-362
diastematomyelia (split cord malformations), 360-361, 361
dysplastic (congenital) spondylolisthesis, 369-370, 369-370
embryology, 354-355
epidemiology, 353-354
extradural arachnoid cysts, 372
extradural meningeal cysts, 372
extradural spinal cysts, 372
formation errors, 364,365-366
hydrosyringomyelia, 373,373-374
intradural spinal cysts, 370-372, 371
intraspinal cysts, 370
Klippel-Feilsyndrome, 370
kyphosis, 366-367, 366-367
lipomas, 359-360, 360
lipomyelomeningocele, 359, 359
lordosis, 367-368
meningoceles, 357
lateral/anterior, 372
neuroenteric cysts, 358
radiological evaluation, 354
scoliosis, kyphosis, and lordosis, 158
segmental spinal dysgenesis, 368, 368
segmentation defects, 364-365, 364-365
spina bifida aperta (myelomeningocele), 356,356-357
spinal dysraphism, 355, 355t
occult, 357,357t
Tarlov's perineural cysts, 372
terminal syringohydromyelia, 374
tethered cord syndrome (tight filume terminale), 362,
362-363
vertebral bodies, 363, 363t-364t
Contained disk herniation, arthroscopic and endoscopic
microdiskectomy, posterolateral approach, 819,822
Contralateral decompression, microendoscopic decompression,
lumbar stenosis, 856-857, 857-858
Conus medullaris
avulsion, dorsal root entry zone surgery, 507-509, 508-509
congenital dermal sinus excision, 716, 719
intramedullary tumors
classification, 567, 568t
surgery, 284-285
Coracoid process, musculocutaneous nerve surgery, 930
Cordotomy, thoracic/thoracolumbar spine, open anterolateral
cordotomy, 495-497, 496
Corpectomy
anterior approach, 193, 194, 197-198.200,201
decompression surgery, reconstruction following,331,332,
333
vertebrectomy following, 328-329, 328-329
thoracic vertebrectomy, 434, 434-435
thoracoscopically-asssisted spinal surgery, 805-806, 807
1002
Index
Corticosteroids,rheumatoid arthritis, natural history, 14
Costotransversectomy
epidural abscess, 460, 461
thoracic/thoracolumbar spine, 441-447
diskectomy via, 441-442
surgical technique, 442-446, 442-446
sympathectomy via, 446-447
Coupling devices, lumbar/lumbosacral spine, hook-rod fusion
instrumentation, 605
Cranial nerve morbidity, transoral closure procedures,
postoperative assessment, 77, 77
Cranial nerve palsies, craniocervical junction, transoral
complications, 58
Cranialsettling, rheumatoid arthritis, basilar invagination, 14-16,
15
Craniectomy, suboccipital
Chiari malformation, 115-117, 116-117
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 147,148-149
Craniocervicaljunction(CCJ)
abnormalities
research background, 3
transoral approaches, 53
anterior region, extreme lateral transcondylar transtubercular
approach,144-152
advantages/disadvantages, 145
anesthesia, 145
incision and dissection, 145-146, 146-149
indications/contraindications,
144
intradural exposure, 147,151
lateral suboccipital craniectomy and hemilaminectomy, 147,
148-149
occipital condyle and jugular tubercle reduction, 147,150
patient positioning, 145, 145
postoperative care, 152
radiological evaluation, 145
vertebral artery exposure, 146-147, 148-149
wound closure, 147,151
classification, 3, 4t
diagnosis, 3. 5
lesions, transcervical resection, 106, 106t-108t
midline tumor resectioning, transoral approach, 67-68
occipitocervical junction pathology, 3, 4t
radiological evaluation,S, 6, 7-9
transoral approaches
advantages, 52
anatomy, 51,52
anesthesia protocols, 56-57
bone softening diseases and metabolic disorders, 53-54
classic approach, 48-49, 49
clinical presentation, 54-55
complications, 58
congenital malformations, 53, 54
contraindications, 52
disadvantages, 52
extended approach, 49, 50
indications, 52
infections, 54
nonrheumatoid cranial settling and atlantoaxial instability,
53
objectives, 52-53
odontoidectomy procedures, 60
odontoid fractures and os odontoideum, 53
outcomes, 58
preoperative evaluation, 56-57, 57
radiological evaluation, 54, 55,56
rheumatoid arthritis, 53
surgical techniques, 57.57-58
tumors, 54, 54
treatment, 11,l1t
Craniovertebral junction (CV)
instability, craniocervical junction, postoperative
complications, 58
rheumatoid arthritis
basilar invagination, 16
epidemiology, 13
pathogenesis, 14
stabilization, retropharyngeal approach, 105, 105
trauma, spinal cord injury and mortality rates, 32t
Crockard transoral instruments
craniocervical junction, transoral surgery, 57-58
odontoidectomy, insertion procedures, 61
Crouzon's disease, facial-ocular deformities and hearing deficits,
157
"Cruciate paralysis," craniocrevical junction, 55
Cubital tunnel syndrome (CuTS),900-901, 901
ulnar nerve incision and dissection, 940-942, 940-942
Cystolipomyelomeningocele, lumbar/lumbosacral lipoma
resectioning, 672, 673
D
Dead space, transoral closure and avoidance of,74-75
Decompression techniques
anterior approach
microforaminotomy, spinal cord decompression,
spondylotic myelopathy/OPLL.211-213,212-213
reconstruction following, 330-334, 331t, 332,334
vertebrectomy, 326
axillary nerve repair, 927
cervical spine, trauma stabilization, 178-179,178-181
far-lateral microdiskectomy, 638-643
lumbar/lumbosacral spine
anterior trans peritoneal approach, 599-600, 599-601
microendoscopic decompression, stenosis, 852-858
retroperitioneal approach, 841,841-842, 842, 844
lumbosacral plexus surgery, 948
microendoscopic foraminotomy, cervical spine, osteophyte
decompression, 788, 789-791, 791
occipitocervical junction, retropharyngeal closure, 104,104
posterior laminectomy surgery, titanium rectangle technique,
260-261
rheumatoid arthritis, basilar invagination, 16, 17
thoracic disk herniation, trans pedicular approach, 472-476,
473-475
thoracic/thoracolumbar spine
disk disease, 378
in situ fusion, 539-540, 540
transthoracic surgical approach, thoracic diskectomy,340-341,
341
Decortication, in situ fusion, thoracic spine, 540, 541
Denis classification system, thoracic/thoracolumbar spine
trauma, 396, 398, 398t
Denis three-column spinal theory, lumbar/lumbosacral spine,
posterior fusion with hook-rod instrumentation, 690,691
Dermal fat grafts, transoral closures, 74,75
Dermal sinus tracts, thoracic/thoracolumbar congenital
abnormalities, 361-362,361-362
Dermoids
lumbar/lumbosacral spine. posterior excision, 715-722
thoracic/thoracolumbar congenital abnormalities, 361,
361-362
Diagnostic algorithm, thoracic disk herniation, 468, 469-470
Diastematomyelia (split cord malformations)
posterior surgical repair, 759-764,760-764
Index
1003
thoracic/thoracolumbar congenital abnormalities, 360-361,
361
Dickman-Sonntag posterior fusion, atlantoaxial stabilization, 136,
136
Differential diagnoses
far-lateral microdiskectomy, 638, 638t
lumbar/lumbosacral tumors, 569
occipitocervical junction tumors, 26-27
Digastric muscle and tendon, retropharyngeal approach,
occipitocervical junction, 94-95
Digital subtractive angiography, craniocervical junction
abnormalities, 55
Diplomyelia,surgical repair, 762-763,762-764
Diskectomy.See also Microdiskectomy
anterior approach, 193, 194,198-199, 198-199
vertebrectomy following, 327,327-328
foraminal epidural endoscopic techniques, 826-830
lumbar/lumbosacral spine
anterolateral retroperitoneal approach, 609, 609-610
computer-assisted fusion, 593, 593
decompressive techniques, 599, 599-600
degenerative disk disease, 556
disk herniation, 559-560
retroperitioneal approach, 841.841
microendoscopically assisted transforaminallumbar
interbody
fusion, 862-863, 863
microendoscopic decompression, lumbar stenosis, 856, 856
microendoscopic foraminotomy, cervical spine, 788, 789-791.
791
microendoscopic technique, 846-850, 851
posterior approach, cervical diskectomy, 250-253
thoracic spine, 340-341. 341
costotransversectomy, 441-442
vertebrectomy, 434, 434-435
thoracoscopically-asssisted spinal surgery, 801-805, 803-804
transthoracic surgical approach
lateral parascapular extrapleural exposure, upper thoracic
spine, 347
thoracic/thoracolumbar spine, 335, 336t, 426-430, 428-429
Disk herniation
arthroscopic and endoscopic microdiskectomy
biportal access, intervertebral disk, 823, 823-824
contained or nonmigrated sequestered disk retrieval, 819,
822
foraminal/extraforaminal retrieval, 822-823
posterolateral surgical approach, 816-824
anatomy, 817-818, 818
outcomes, 824
transforaminal access, sequestered disk fragments, 821,822,
823
cervicothoracic junction tumors, 304
costotransversectomy, 443, 443-444
epidemiology, 378
far-lateral microdiskectomy, 638-643, 638t
lumbar degenerative disk disease, 555-563
recurrence risk, 562
pathophysiology, 378
thoracic/thoracolumbar spine, 379-381, 467-474
diagnostic algorithm, 470, 471-472
radiological evaluation, 470
transpedicular decompression, 472-474, 473-475
Diskitis, lumbar/lumbosacral disk surgery, 562
Dissection techniques
anterior cervical spine surgery, 195-196, 197-199, 198
arteriovenous malformations, 482-483, 484
axillary nerve surgery, 926, 926
cervical laminectomy, lateral dissection, 233-234,235-236
extreme lateral transcondylar transtubercular approach,
anterior craniocervicaljunction, 145-146, 146-149
genitofemoral neuralgia surgery, 984-985
infraclavicular surgical technique, brachial plexus, 916-917,
916-918
intercostal nerve surgery, 976-977, 976-977
intradural extramedullary tumor resectioning, 491-493,
492-493
lateral transthoracic surgical approach,
thoracic/thoracolumbar spine,404-409, 406-408
lower thoracic sympathectomy/splanchinectomy, 423, 424
lumbar/lumbosacral spine
disk surgery, 558-559, 558-561, 561t
lipoma resectioning, 669-670, 669-673, 674
microdiskectomy, 634
posterior approach, 614-616, 614-616
hook-rod fusion instrumentation, 692-693, 693
interbody fusion and transpedicular screw fixation,
684-687
Luque instrumentation, 698, 699
transverse process fusion, 676-678, 676-678
tumor surgery, 571-572, 572
lumbosacral plexus surgery, tumor removal, 951,951-952
median nerve survery, 933, 935, 935
meralgia parasthetica management, lateral femoralcutaneous
nerve,987-988,988
musculocutaneous nerve surgery, 929-930, 930
posterior surgery
Bohlman triple-wire technique, 255
iliac crest bone graft, 778-779, 778-779
locked/perched facet exposure and release, 265
subaxial cervical spine stabilization sublaminar cable
placement, 268
radial/ulnar nerve surgery, 937,938-942, 940-942
retroperitoneal approach and closure, thoracic/thoracolumbar
spine,417-419,418-419
spinal accessory nerve surgery, 921,921
supraclavicular surgery, 308-310, 310-311
brachial plexus, 909-910, 910
thoracic vertebrectomy, 433
transmanubrial transclavicular surgery, cervicothoracic
junction, 320-324,320-325
transsternal surgery, cervicothoracic junction, 314,314-315
transthoracic diskectomy, 427-428
transthoracic surgical approach
lateral parascapular extrapleural exposure, upper thoracic
spine, 347,348-349, 348
thoracic/thoracolumbar spine, 339-340
Dorsal occipitocervical fusion, craniocervical junction
abnormalities, 6, 9
Dorsal root entry zone (DREZ)operation
caudalis DREZ,515-520
dorsal spinal cord lipoma, 745, 746
thoracic/thoracolumbar spine, 503-514,504
brachial plexus avulsion, 505-507, 506-507
conus medullaris avulsion, 507-508, 507-508
paraplegia with cyst, 511-513, 512-513
postherpetic pain, 513-514
spinal cord injury, 509-511, 510-511
surgical technique, 504-505, 505
transitional spinal cord lipoma, 746-747, 747-748
Dorsal spinal cord lipoma
classification, 741
embryogenesis, 742,742-743
surgical management, 744-745,745-746
Down syndrome, craniocervical junction abnormalities, imaging
studies,S, 10
1004
Index
Drillingtechnique, cervical laminectomy, 234,235-237. 236
Dublin's method, occipitocervical junction trauma assessment,
33-34
Dumbbell neurofibromas
intradural extramedullary tumor resectioning, 293, 293-294
surgical removal, 883-886. 885
Duralarteriovenous fistula, 480. 480-481
Duralclosure.SeealsoClosuretechniques
intermedullary spinal cord tumor surgery, 174
lumbar/lumbosacral spine surgery
cerebrospinal fluid leak repair. 645. 645-646
lipoma resectioning, 671,672
myelomeningocele repair, 713, 713-714
midline tumor resectioning. transoral approach, 70
occipitocervical junction. retropharyngeal approach, 104-105
open spinal dysraphism, myelomeningocele, 735, 735-736, 737
split cord malformation, 761-763, 761-763
suboccipital craniectomy. 117.117
Dural sac. stenosis, 769, 772
Dura mater incisions
arteriovenous malformations. 482-483, 484
commissural myelotomy, 498-499, 499-500
congenital dermal sinus excision, 716, 721
dorsal spinal cord lipoma. 745, 746
encephaloceles. occipitocervical junction. 123, 123-126
extreme lateral transcondylar transtubercular approach.
anterior craniocervical junction, 147,151
intramedullary spinal cord tumor surgery, 282,283
midline tumor resectioning, transoral approach. 70, 70
sacral agenesis, posterior surgical approach, 766,768-769,769
transitional spinal cord lipoma. 746-747. 748
Durotomy. intradural extramedullary tumor resectioning, 491,
491
Dynamic studies, craniocervical junction abnormalities, 6, 10
Dysphagia and nasal regurgitation. craniocervicaljunction, post-
operative complications, 58
Dysplastic (congenital) spondylolisthesis, 369-370, 369-370
E
Electrocautery techniques, encephaloceles. occipitocervical
junction, 123,123-126
Electrode techniques
caudalis dorsal root entry zone, 516-519
dorsal root entry zone operation, 501-512. 503
Electrodiagnostic evaluation
carpal tunnel syndrome. 898
cubital tunnel syndrome. 901
Guyon's canal syndrome, 902, 902
median nerve entrapment
elbow and forearm, 897,897
supracondylar process and Struther's ligament. 896, 896
peripheral nerve trauma. 891-892
posterior interosseus nerve entrapment. 900
suprascapular neuropathy, 903, 903
tarsal tunnel syndrome. 906, 906
Electromyography (EMG)
lumbar/lumbosacral nerve roots, rhizotomy. 652-653, 655t
meralgia paresthetica diagnosis. 986
microendoscopically assisted transforaminallumbar
interbody
fusion, 859
peripheral nerve trauma. 892
Electrophysiological monitoring
peripheral nerve trauma, 893
spinal cord lipomas, 744
EINaggar right-angle caudalis DREZelectrodes, 50S, 505
Embolization. lumbar/lumbosacral tumors, 561,570
surgical complications. 577-578
Embryonic anatomy
craniocrevical junction, 51,52
limited dorsal myeloschisis, 751, 752-754, 753
open spinal dysraphism, myelomeningocele. 730. 730-733,
732
spinal cord lipomas. 742-743, 742-744
thoracic/thoracolumbar spine congenital abnormalities,
354-355
Encephaloceles, occipitocervical junction, surgical treatment,
122-127
advantages/disadvantages. 122-123
indications/contraindications,
122
outcomes, 127
surgical techniques, 123, 124-126
Endoscopic diskectomy
far-lateral microdiskectomy, 641-643
foraminal epidural endoscopic techniques. 826-830
Endoscopic foraminotomy, cervical spine. 785-789. 787-791
anesthesia and patient positioning, 786-787, 787
closure techniques, 791
diskectomy and anterior osteophyte decompression, 788,
789-791. 791
incision and approach, 787-788, 788-789
laminotomy and, 788,789-780
Endoscopic microdiskectomy. posterolateral surgical approach,
816-824
Endoscopic sympathectomy. thoracic region, 793-798
End plate preparation
anterior surgical approach
reconstruction following decompression, 333
vertebrectomy following, 329
anterolateral graft and plate reconstruction, 437,437
Enteropathic arthropathies
meralgia paresthetica, 904, 904-905
occipitocervical junction inflammation, 21
Enthesopathies
craniocrevical junction, transoral techniques, 53
occipitocervical junction inflammation, 21
Entrapment neuropathies
anterior interosseus nerve syndrome. 897-898
cubital tunnel syndrome. 900-901. 901
ilioinguinal neuralgia. 982, 982t
median nerve
carpal tunnel syndrome, 898, 898, 899t
elbow and forearm, 897,897
supracondylar process. humerus and Struther's ligament,
896,896
peripheral nerve compressive lesions, 895-906
posterior interosseus nerve. 900
radial nerve, 898. 900, 900
saphenous nerve. 905
suprascapular. 902-903, 903
sural nerve, 973.973
tarsal tunnel syndrome, 905-906, 906
thoracic outlet syndrome. 904
ulnar nerve compression. wrist. 901-902, 902
Environmental factors. rheumatoid arthritis pathogenesis, 14
Eosinophilic granuloma, thoracic/thoracolumbar spine. 391
Ependymal cysts, thoracic/thoracolumbar congenital
abnormalities. 371
Ependymomas, cauda equina, resection techniques, 658-659.659
Epidermoid cysts, thoracic/thoracolumbar congenital
abnormalities, 361, 361-362
Epidural abscess, thoracic/thoracolumbar spine. 456-461.
457-458, 460-461
etiology and pathogenesis, 456-457. 457
imaging studies, 457.458-459
Index
1005
management, 459
outcome, 461
pathophysiology and clinical manifestations, 458
surgical technique, 459-461, 460-461
EpidlJralbleeding, microforaminotomy, anterior approach, spinal
cord tumors, 215
Epidural hematoma, cervicothoracicjunction tumors, 303
Epidural needle placement, percutaneous spinal cord stimulator
implantation, 832-823, 833
Evokedpotentials monitoring, intramedullary spinal cord tumor
surgery, 287
Ewing's sarcoma, thoracic/thoracolumbar spine, 392
Expansion laminoplasty, thoracic/thoracolumbar spine, 454,
454-455
Extended maxillotomy reconstruction
advantages/disadvantages, 80
indications/contrainidications, 79, 80
LeFort Iosteotomy, 81,83, 85, 85-87
maxilla/nasal cavity exposure, 81,82-83
palatal split, 81,84-85, 85
patient positioning, 81
preoperative planning, 80-81, 81t
surgical techniques, 81,82-88, 85-88
tracheostomy, 81
vertical pharyngotomy, 85, 88
Extended transoral techniques, craniocervical junction, 49, 50
External bracing, epidural abscess, 457
External ventricular drain (EYO),open spinal dysraphism
surgery, myelomeningocele, cerebrospinal fluid leakage,
738-739
Extradural lumbar/lumbosacral tumors, classification,
567, 568t
Extradural meningeal cysts, thoracic/thoracolumbar congenital
abnormalities, 372
Extradural spinal cysts, thoracic/thoracolumbar congenital
abnormalities, 372
Extradural venous drainage, dural arteriovenous fistula, 481
Extraforaminal herniation, arthroscopic and endoscopic
microdiskectomy, posterolateral approach, 822-823
Extramedullary hematopoesis, cervicothoracic junction tumors,
303
Extramedullary tumors, posterior resectioning, 289-295
Extraspinal anatomy, cervicothoracic junction tumors, 298
Extreme lateral transcondylar transtubercular approach, anterior
craniocervical junction, 144-152
advantages/disadvantages, 145
anesthesia, 145
incision and dissection, 145-146, 146-149
indications/contra indications, 144
intradural exposure, 147,151
lateral suboccipital craniectomy and hemilaminectomy, 147,
148-149
occipital condyle and jugular tubercle reduction, 147,150
patient positioning, 145, 145
postoperative care, 152
radiological evaluation, 145
vertebral artery exposure, 146-147, 148-149
wound closure, 147,151
F
Facetcable fixation, titanium rectangle technique, 259-260,
259-260
Facet exposure and release, locked/perched facets, posterior
approach,263-266,264-266
Facetjoints
dysplastic (congenital) spondylolisthesis, 370
thoracic laminectomy, 449-450
Facialdeformities, Klippel-Feilsyndrome, 157
Facialpain, caudalis OREZ,515-519
Far-lateral microdiskectomy, 638-643
endoscopic diskectomy, 638t, 641-643
midline approach, 638t, 639-640, 639-640
paramedian approach, 638t, 640-642, 641
Fascialata grafts, transoral closures, 75
Fascialrelease, anterior cervicalspine dissection, 195-196,
197-199,198
Femoral nerve, anatomy, 946, 955, 956.See also Lateral femoral
cutaneous nerve
Filum terminale
intradural/extramedullary tumors, 567,568t
intramedullary spinal cord tumor surgery,284-285
sacral agenesis, posterior surgicalapproach, 765-766,
766-768
terminal spinal cord lipoma, 749, 750
Fixation techniques. See alsoScrew fixation
occipitocervical junction trauma, occipitoatlantalligament
dislocation, 31-32, 34
posterior atlantoaxial surgical techniques, cable fixation,
135-138, 135-138
titanium frame-rectangle technique, 261,262
Flexion-distraction injury, thoracic/thoracolumbar spine trauma
classification, 397,398, 398t, 399
etiology, 400 401
Fluoroscopic imaging, thoracic disk herniation, transpedicular
approach, 473 473-475
Foramen magnum
craniocrevical junction anatomy, 51,52
lesions, 55
extreme lateral transcondylar transtubercular approach,
144-152
advantages/disadvantages, 145
anesthesia, 145
incision and dissection, 145-146, 146-149
indications/contraindications,
144
intradural exposure, 147,151
lateral suboccipital craniectomy and hemilaminectomy, 147,
148-149
occipital condyle and jugular tubercle reduction, 147,150
patient positioning, 145, 145
postoperative care, 152
radiological evaluation, 145
vertebral artery exposure, 146-147, 148-149
wound closure, 147,151
retropharyngeal surgical approach, anterior rim, 98
surgical approach, 11,11t
transoral closure, posterior pharyngeal wall, 74, 74
Foraminal disk herniation
arthroscopic and endoscopic microdiskectomy, posterolateral
approach,822-823
epidural endoscopic diskectomy, 826-830,827-829
Foraminotomy
cervical spine, endoscopic foraminotomy, 785-789,787-791
anesthesia and patient positioning, 786-787, 787
closure techniques, 791
diskectomy and anterior osteophyte decompression, 788,
790-791, 791
incision and approach, 787-788,788-789
laminotomy and, 788, 789-790
lumbar/lumbosacral spine, 630-633
Formation errors, thoracic/thoracolumbar congenital
abnormalities, 364, 365-366
Four-poster brace, occipitocervical junction fractures, 39
Fracture-dislocation injuries, lumbar/lumbosacral spine trauma,
583,584,585
1006
Index
Fractures
occipitocervicaljunction trauma, 33t, 38-46, 39t
atlas-axis fractures, 32t, 39t, 44-45, 45-46
atlas fractures, 35-38,39, 39t, 40-42
c;2fractures, 39t, 43-44
hangman's fractures, 39t, 41,43, 44
odontoid fractures, 39, 39t, 41,42-43
posterior stabilization, Bohlman triple-wire technique,
254-256,255-257
thoracic/thoracolumbar spine trauma
burst fractures, 397,398t, 399-400, 400
fracture-dislocations, 401,402
wedge fracture, 397,399, 399
Fullysegmented hemivertebra, pathology and management, 365
Fusion techniques
Brooks fusion technique, (1-(2 junction, 139-143
advantages/disadvantages, 139-140
anesthesia, 140
bone graft harvest, 141-142, 142
closure, 143
complications, 143
graft placement, 142-143, 142-143
incisions, 141,141
indications, 139
patient positioning, 140, 140
postoperative care, 143
preoperative planning, 140
radiological evaluation, 140
sublaminar wire placement, 141,142
interbody fusion, transforaminallumbar
spine,
microendoscopic techniques, 859-865, 861-865
lumbar/lumbosacral spine
anterolateral retroperitoneal approach, 609, 609-610
hook-rod fusion instrumentation, 690-696
interbody fusion and transpedicular screw fixation,
681-689
Luque instrumentation, 697-703
transverse process fusion, 675-680
posterior atlantoaxial surgical anatomy and techniques,
128-138
anatomy, 128-129,129-130
anesthesia, 133
cable fixation, bony wedge compression, 135-136,
135-136
exposure and nuchal musculatures, 133, 134,135
Halifaxclamp fixation, 136, 137
patient positioning, 133
regional biomechanics, 130
screw fixation, 136-138, 137-138
surgical anatomy, 129, 131-132
posterior occipitocervical fusion and stabilization, 118-121,
119-120
rheumatoid arthritis
atlantoaxial subluxation, 18-19
basilar invagination, 16
natural history, 13-14
thoracic spine, posterior approach, 538-541
G
Gallie posterior fusion technique, atlantoaxial stabilization, 135,
135
Galveston surgical technique, lumbar/lumbosacral tumors,
posterior stabilization, 576,576
Ganglionectomy, thoracic/thoracolumbar spine, upper, 422, 423
Ganglioneuromas, cervicothoracic junction tumors, 300
Gastrointestinal adenocarcinoma, cervicothoracic junction
tumors, 300
Gastrulation, thoracic/thoracolumbar spine congenital
abnormalities, 354-355
Genitofemoral nerve
anatomy, 946, 983, 984
neuralgia, surgical management of,983-985
Genitourinary defects, Klippel-Feilsyndrome, 160,160
Giant cell tumors
cervicothoracic junction lesions, 302
thoracic/thoracolumbar spine, 390
Glia-tumor interface, intramedullary spinal cord tumor surgery,
283-284,285
Globular neurofibroma, removal techniques, 883, 883-884
Glomusjugulare tumor, occipitocervical junction, 29-30
Glomus region, arteriovenous malformations in,482-483,484
Glossotomy, caudal extension, midline tumor resectioning,
transoral approach, 68-69, 69-70
Goldenhar's syndrome, facial-ocular deformities and hearing
deficits, 157
Grafting procedures. See also Bonegraft harvesting; Nervegraft
harvesting
anterior cervical spine surgery complications, 205
anterior decompression surgery, reconstruction following,
330-334,331t,332,334
anterior diskectomy approach, 199-201,200
anterolateral graft and plate reconstruction, 437
axillary nerve repair, 927
Brooks fusion technique, (1-(2 junction, 141-142, 142-143
craniovertebral stabilization, retropharyngeal approach,105,
105
lumbosacral plexus, 948
tumor removal, 951-952
spinal accessory nerve grafts, 922, 922
suboccipital craniectomy, 117,117
supraclavicular surgery, brachial plexus, 910
sural nerve, 969-970,969-970
techniques, 990-993, 991-993
transoral closures, 73-74, 74
dermal fat grafts, 74,75
fascia lata grafts, 75
mucosal flaps, 75
Granulation tissue, rheumatoid arthritis pathogenesis and, 14
Great vessel injury, lumbar/lumbosacral disk surgery, 562
Grisel's syndrome, pathogenesis, 20, 20-21
Gunshot wounds (G5W),brachial plexus, supraclavicularsurgical
repair, 911
Guyon's canal syndrome, 901-902, 902
ulnar nerve incision and dissection, 942, 942
H
Hairy patch, thoracic/thoracolumbar congenital abnormalities
occult spinal dysraphism, 357,357t
split cord malformations, 360
Halifaxclamp fixation, atlantoaxial stabilization, 136, 137
Halo traction
occipitocervical junction trauma
atlas fractures, 39
odontoid fracture, 41
transverse ligament injuries, 35,38
rheumatoid arthritis, basilar invagination, 16
Hangman's fractures, occipitocervical junction, 39t, 41,43,44
Harms posterior screw fixation, atlantoaxial stabilization, 138,
138
Hartshill rectangle technique, cervical spine trauma, 190
Hearing deficits, Klippel-Feilsyndrome, 157
Hemangioma, thoracic/thoracolumbar spine, 390
Hematoma
cervicothoracic junction, epidural hematoma, 303
Index
1007
craniocervical junction, postoperative complications, 58
microforaminotomy, anterior approach, postoperative epidural
complications, 216
transoral closure and formation in wound bed, 74-75
Hemilaminectomy
dorsal root entry zone surgery, brachial plexus avulsion,
505-507
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 147,148-149
lumbar/lumbosacral spine, 625-629
Hemivertebra formation, thoracic/thoracolumbar congenital
abnormalities, 364-365,364-366,
364t
Hensinger classification, congenital mid- to lower cervical spine
osseous anomalies, 156
Herniated disks, cervicothoracic junction tumors, 304
Herpes infections, spinal cord lesions, dorsal root entry zone
operation, 511-512
High-speed craniotome, intramedullary spinal cord tumor
surgery, 281,281
Hindbrain herniation syndrome, craniocervicaljunction
abnormalities, 6, 8
Hook-rod instrumentation, lumbar/lumbosacral spine, posterior
fusion, 690-696, 691-695
Horner's syndrome, supraclavicular surgical technique and, 307
Horsley rongeur, cervical laminectomy, 234,234
Human leukocyte antigen (HLA)
occipitocervical junction disease
inflammatory conditions, 21
tumors, nasopharyngeal carcinoma, 28
rheumatoid arthritis pathogenesis and, 14
Hydrocephalus, congenital dermal sinus, 716
Hydromyelia, thoracic/thoracolumbar spinal defects, 373, 373
Hydrosyringomyelia, thoracic/thoracolumbar spinal defects, 373,
373
Hyoid bone, retropharyngeal approach, 95-96
Hyperhidrosis, endoscopic sympathectomy, 794-798
Hypoglossal nerve, retropharyngeal approach, 95, 96
Iliaccrest grafts
anterior decompression surgery, reconstruction following, 331,
332
posterior surgical technique, 776-781, 777-781
Iliohypogastric nerve, anatomy, 946
Ilioinguinal nerve
anatomy, 946, 979-981. 980-981
neuralgia, surgical management of,979-982, 982, 982t
Illumination equipment, anterior cervical spine surgery, 195
Impaired position sense, intramedullary spinal cord tumor
surgery, 287
Implantation techniques, percutaneous spinal cord stimulator
implantation, 831-836
Incarcerated hemivertebra, pathology and management, 365
Incision techniques
anterior surgical techniques, iliaccrest bone graft, 779
axillary nerve surgery, 926, 926
brachial exposure, 935, 936
Brooks fusion technique, (1-(2 junction, 141.141
cervical foraminotomy, 248, 248
costotransversectomy, 442-446, 442-446
endoscopic sympathectomy, 795-796, 795t, 796
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 145-146, 146-149
far-lateral microdiskectomy
endoscopic diskectomy, 641-643
midline approach, 639-640, 639-640
paramedian approach, 640-642, 641
genitofemoral neuralgia surgery,984-985
infraclavicular surgical technique, brachial plexus, 916-917,
916-917
intercostal nerve surgery, 976-977, 976-977
intradural extramedullary tumor resectioning,885, 886
intramedullary spinal cord tumor surgery,280
lateral transthoracic surgical approach,
thoracic/thoracolumbar spine,407,407
lower thoracic sympathectomy/splanchinectomy, 423,424
lumbar/lumbosacral spine surgery
anterolateral retroperitoneal approach, 606,606
cerebrospinal fluid leak repair, 644-645
congenital dermal sinus/dermoid excision,716,717-721,721
diastematomyelia repair, 761,761
hemilaminectomy, 625-629, 626
lipoma resectioning, 669-670, 669-673, 672
lumboperitoneal shunt, 649, 649-650
microdiskectomy, 634
posterior approach, 614-616, 614-616
dorsal rhizotomy, 771-772,772-775
hook-rod fusion instrumentation, 692-693, 693
interbody fusion and transpedicular screw fixation,
684-687
Luque instrumentation, 698, 699
retroperitoneal approach, 838, 839, 839-841. 841
rhizotomy, 653
sacrococcygeal teratoma resectioning, 724-725, 724-725
transverse process fusion, 676-678, 676-678
lumbosacral plexus surgery, 946, 947
tumor removal, 951.951-952
meralgia parasthetica management, lateral femoral cutaneous
nerve,987-988,988
microendoscopic surgery
assisted transforaminallumbar
interbody fusion, 865, 865
decompression, lumbar stenosis, 848, 849
foraminotomy, cervical spine, 787-788,788-789
microforaminotomy, anterior approach, cervical spine,
209-210, 209-211
musculocutaneous nerve surgery, 929, 929
posterior surgery
Bohlman triple-wire technique, 255
cervical spine, 229-230,229-231
diskectomy, 251-253,252
interfacet wire stabilization, 272
lateral mass plate stabilization, 275
subaxial stabilization sublaminar cable placement, 268
iliac crest bone graft, 777-778, 777-778
intradural extramedullary tumor resectioning, 290,291, 293
locked/perched facet exposure and release, 265
in situ fusion, thoracic spine, 539, 539
radial/ulnar nerve surgery, 937,938-942, 940-942
retroperitoneal approach and closure, thoracic/thoracolumbar
spine, 417-419,418-419
retropharyngeal approach, occipitocervical junction, 92-93, 93
spinal accessory nerve surgery, 921,921
supraclavicular surgery
brachial plexus, 909
cervicothoracic junction, 308, 308-310
syringopleural shunting, 522, 522
syringosubarachnoid shunting, 531
thoracic extension osteotomy, 464
thoracic laminoplasty, 452-454
thoracic spine, pedicle screw procedures, 543
thoracic vertebrectomy, 433, 433
thoracoabdominal approach and closure,
thoracic/thoracolumbar spine, 412,413-414
thoracoscopically-asssisted spinal surgery, 801.802
1008
Index
Incision techniques (Continued)
transmanubrial transclavicular surgery, cervicothoracic
junction,320-324,320-325
transsternalsurgery,cervicothoracicjunction,314,314-315
transthoracic surgery
diskectomy,427-428,428
lateral parascapular extrapleural exposure, upper thoracic
spine,344-345,344-346
thoracic/thoracolumbarspine,339,340
ulnarnerveschwannomaremoval,880-881,880-882
upper thoracic ganglionectomy, 422, 423
Infection
congenital dermal sinus, excision techniques, 716,717-721
craniocervical junction
postoperative complications, 58
transoralapproaches,54,54
open spinal dysraphism surgery, myelomeningocele, wound
infection,738
rheumatoid arthritis pathogenesis and, 14
Inflammatoryboweldisease(IBD),occipitocervicaljunction
inflammation, 21
Inflammatory disease, occipitocervical junction, 21,21
Infraclavicular approach, brachial plexus surgery, 914-918
In situ fusion techniques, thoracic spine, posterior approach,
538-541
Instability. See alsoStabilization
atlantoaxial
craniocervicaljunction,transoralapproaches,53
posterior fusion techniques, 128-138
anatomy,128-129,129
anesthesia,133
cablefixation,bonywedgecompression,135-136,135-136
exposure and nuchal musculatures, 133, 134,135
Halifaxclamp fixation, 136, 137
patient positioning,133
regionalbiomechanics,130
screwfixation,136-138,137-138
surgical anatomy, 129, 131-132
craniocervicaljunction,atlantoaxialinstability,53
craniovertebraljunction,as postoperativecomplication,58
Klippel-Feilsyndrome anomalies
evaluation of, 161-162
spinal stenosis and, 162
lumbar/lumbosacral spine trauma, 581,581t
occipitoatlantoaxial, rheumatoid arthritis, basilar invagination,
16
InstantaneousaxisofrotationOAR),thoracic/thoracolumbar
spinetrauma,397,397
Instrumentation.Seealsospecificapparatus,e.g.Plates,screws
anterior surgical approach, reconstruction following
decompression,333
anterolateralgraftand platereconstruction,439,439-440
arthroscopic and endoscopic microdiskectomy, posterolateral
surgical approach, 819-821, 819-822
endoscopicsympathectomy,795-796,795t,796
interfacet wire stabilization, cervical spine, 272,272
lateral mass plate. cervical spine stabilization, 275,276-277,
277
lumbarchemonucleolysis,817-818,817-818
lumbar/lumbosacralspine,transverseprocessfusion,678-679,
678t
lumbar/lumbosacral spine surgery
anteriorapproach,599
posterior fusion, hook-rod system, 691, 692
microendoscopically assisted transforaminallumbar
interbody
fusion,863-865,863-865
pedicle screws, thoracic spine, 542-544
subaxial cervical spine stabilization sublaminar cable
placement,268-269,268-269
thoracicextensionosteotomy,464,465
transoral approaches, craniocervical junction, 48-49, 49
transthoracic surgical approach, lateral parascapular
extrapleural exposure, upper thoracic spine, 348, 349
Interbody fusion
posterior lumbar spine, transpedicular screw fixation,681-689
transforaminallumbarspine,859-865,861-865
Intercostal nerve
anatomy,
974, 975
function, 975
meralgiaparesthetica,986-988,987-988
surgical techniques, 975-978, 976-977
Interfacet wire stabilization, posterior cervical spine, 271-273
Intermedullary tumors, spinal cord, 169-175
anesthesia, 171
complications, 175
neurophysiological monitoring, 171-172, 172
patient positioning, 172
postoperative care, 174
radiologicalevaluation,170,170-171
surgical techniques, 171-173, 174
treatment indications, advantages and disadvantages, 169
Internal fixation
anterior cervical spine plating, 203-204
anterior cervical spine surgery, complications, 205
Intervertebral disk, biportal access, arthroscopic and endoscopic
microdiskectomy, posterolateral approach, 823,823-824
Intervertebralforamen,foraminotomy,634,635
Intraduralarteriovenousmalformations,479
Intradural/estramedullary
tumors, classification, 567,568t
Intradural extramedullary tumors
posteriorresectioning,289-295
thoracic spine, resectioning, 487-491
Intradural spinal cysts, thoracic/thoracolumbar congenital
abnormalities, 370-372,371
Intradural surgical techniques
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 147,151
midline tumor resectioning, transoral approach, 69-70, 70
Intraduralvenousdrainage,duralarteriovenousfistula,479,482,
483
Intramedullary spinal cord tumors
classification, 567,568t
surgical management, 279-287, 280t
Intraoperative monitoring
lumbosacral plexus, nerve action potential recording, 948
percutaneous spinal cord stimulator implantation, 834
ultrasound
endoscopicsympathectomy,796-797
syringopleuralshunting,523,524
syringosubarachnoid shunting, 531
Intraspinal cysts, thoracic/thoracolumbar congenital
abnormalities,370
Intraspinallipomas,sacralagenesis,posteriorsurgicalapproach,
766,768-769,769
Ischemic syndromes, endoscopic sympathectomy, 794
Jugular tubercle, reduction, extreme lateral transcondylar
transtubercular approach, anterior craniocervical
junction,
147, 150
K
Kiloh-Nevinsyndrome, 897-898
Klippel-Feil syndrome
Index
1009
congenital mid- to lower cervical spine osseous anomalies
anomalies classification table. 159. 159t
cardiopulmonary defects. 159-160
cineradiography, 160
classification, 155-156
facial and ocular deformities and hearing deficits. 157
genitourinary defects. 160, 160
magnetic resonance imaging, 160-161. 161
neurological problems, 162
phenotypic features, 156. 156
plane radiography. 160
pterygium colli. 157,157
sagittal plane deformities. 158-159
scoliosis, kyphosis. and lordosis. thoracolumbar spine. 158
spinal stenosis and instability. 162
Sprengel's deformity. 157-158, 158
stenosis and instability evaluation, 161-162
tomograms and computed tomography, 160
torticollis, 157.157
treatment. 162
thoracic/thoracolumbar congenital abnormalities. 370
K-wire placement
lumbar/lumbosacral disk surgery, 559-561, 560
odontoid screw fixation. 220.220-223, 222
Kyphectomy,open myelomeningocele. 739-741.740-741
Kyphoplasty,866-874
complications, 873
outcomes, 873
surgical techniques, 870. 871-872
Kyphosis
anterior surgical approach. correction following
decompression, 333
cervical laminectomy, postoperative complications. 237-238
cervicallaminoplasty and risk of.244-245
intramedullary spinal cord tumor surgery. 287
mid- to lower-spine osseous anomalies, 158
open myelomeningocele, 739-741. 740-741
posterior fusion, Luque instrumentation, 701-702. 702
posterior surgery, cervical spine, risk of,231
segmental spinal dysgenesis, 368, 368
thoracic/thoracolumbar congenital abnormalities, 366-367.
366-367
L
Laboratory evaluation, thoracic/thoracolumbar spine tumors. 386
Laceration repair. brachial plexus. supraclavicular surgical
approach. 911
Lamina preparation
Bohlman triple-wire technique. 255.256
lumbar/lumbosacral laminectomy, 620-621. 620-622
rod fixation. posterior fusion, Luque instrumentation, 701, 701
titanium rectangle technique, 259. 259-260
Laminar hook insertion, lumbar/lumbosacral spine, hook-rod
fusion instrumentation. 693, 693-694
Laminectomy
cervical laminectomy
advantages/disadvantages, 233
Chiari malformation, 115-117.116-117
closure, 236
complications, 237-238
drilling technique, 234,235-237. 236
indications/contraindications, 233
lateral dissection. 233-234,234-236
epidural abscess. 457. 458
intradural extramedullary tumor resectioning, 489, 489
microendoscopically assisted transforaminallumbar
interbody
fusion. 862. 862
.
microendoscopic decompression. lumbar stenosis. 855,
855-856
microendoscopic diskectomy, 848, 848-849
posterior approaches
lumbar/lumbosacral spine. 618-624
split cord malformation, 761-763, 761-763
titanium rectangle technique. 260-261
syringopleural shunting, 523. 524
thoracic extension osteotomy. 463
thoracic/thoracolumbar congenital abnormalities. split cord
malformations, 360-361,361
thoracic/thoracolumbar spine, 448-450. 449-451
Laminoplasty
cervicallaminoplasty
advantages/disadvantages, 241
complications. 245
indications, 240-241
midline enlargement technique. 243,244
outcomes, 244-245
overview of techniques, 239, 240t
surgical techniques. 241-244
unilateral enlargement (open-door) technique. 241-243.
242-244
lumbar/lumbosacral spine surgery
dorsal rhizotomy. 775, 775
rhizotomy, 653, 654
syringopleural shunting. 526. 526
thoracic/thoracolumbar spine, 452-455
Laminotomy
intramedullary spinal cord tumor surgery. 281.281
microendoscopic foraminotomy, cervical spine, 788. 789-790
syringoperitoneal shunting. 535
syringopleural shunting, 522-523
syringosubarachnoid shunting. 531
Landmark identification, intramedullary spinal cord tumor
surgery. 282
Lap belt injuries, thoracic/thoracolumbar spine trauma, 398
Laryngeal nerve
supraclavicular surgery, 307-309, 309-311
transmanubrial transclavicular surgery, cervicothoracic
junction. 323-325
Laser techniques
far-lateral microdiskectomy, 642-643
intramedullary spinal cord tumor surgery, 282-283.283-284
Lateral extracavity approach. epidural abscess, 461,461
Lateral femoral cutaneous nerve
anatomy. 953. 954, 955. 986-987. 987
meralgia paresthetica. 904,904-905.986-988.987-988
Lateral mass plate stabilization. cervical spine. posterior
approach,274-278
Lateral pharyngeal flap, transoral closure, 75, 75
Lateral suboccipital craniectomy, extreme lateral transcondylar
transtubercular approach. anterior craniocervical
junction. 147,148-149
Lateral transthoracic surgical approach
parascapular extrapleural exposure, upper spine, 343-348,
344-349
closure techniques. 348
diskectomy, 347
musculocutaneous flap, 344-345, 344-346
vertebral reconstruction. 348. 349
thoracic/thoracolumbar spine. 405-412
advantages/disadvantages, 412t
complications. 411-412
indications/contraindications. 405-406
postoperative care. 411
surgical techniques, 406-411, 406-411
1010
Index
Lateralvertebrae exposure, transthoracic surgical approach,
upper thoracic spine, 347,347
Leadanchoring, percutaneous spinal cord stimulator
implantation, 834-836, 834-836
LeFort Iosteotomy, extended maxillotomy procedure
preparation, 81,83
reciprocating saw technique, 85, 85-87
LeFort osteotomy, extended maxillotomy reconstruction, 79
Ligamentous laxity,atlantoaxial subluxation, 16-19
Ligaments
microforaminotomy, anterior approach, cervical spine,
210-211,210-211
occipitocervical junction
trauma, 31-38
occipitoatlantal dislocations, 31-34, 32-34, 32t-33t
i"Otatory(1-C2 dislocations, 35, 38
transverse ligament injuries, 34-35, 35-38
tumor involvement, 23, 25, 25
posterior atlantoaxial surgical anatomy and techniques,
128-129,131-132
Light-emitting diodes (LEDs),computer-assisted fusion
techniques, 591-592,591-592
Limiteddorsal myeloschisis (LDM)
embryogenesis, 751,752-754, 753
posterior surgical approach, 751.751-755, 756-757
surgical management and treatment, 755, 756-757
Lipomas
intraspinal, sacral agenesis, posterior surgical approach, 766,
768-769,769
lumbar/lumbosacral spine, resectioning, 666-674
spinal cord
dorsal/transitional lipomas, 742,742-743
posterior surgical approach, 741-750
electrophysiological monitoring, 744
embryogenesis, 742-743, 743-744
outcomes, 750
terminal lipoma, 743, 744,749, 749,749-750
transitional lipomas, 745-749,747-749
thoracic/thoracolumbar congenital abnormalities, 359-360,
360
Lipomyelomeningocele
lumbar/lumbosacral spine lipomas, 666-674, 667-673
sacral agenesis, posterior surgical approach, 766, 768-769, 769
thoracic/thoracolumbar congenital abnormalities, 359, 359
Localizationtechniques
microendoscopically assisted transforaminallumbar
interbody
fusion, 862, 862
microendoscopic decompression, lumbar stenosis, 853, 854,
855
microendoscopic diskectomy, 847,848-849
Locked/perched facets, posterior exposure and release, 263-266,
264-266
Longuscollimuscles
anterior cervical spine dissection, 198, 199
retropharyngeal surgical approach, 96, 97
Lordosis
lumbar/lumbosacral spine trauma, 581-582, 582-583
mid- to lower-spine osseous anomalies, 158
thoracic/thoracolumbar congenital abnormalities, 367-368
Lowerextremity nerves, surgical techniques, 953-964, 954-965
Lowerthoracic sympathectomy/splanchinectomy, thoracic/
thoracolumbar spine, 423-425, 424-425
Lumbar chemonucleolysis, 811-815, 812-815
Lumbar/lumbosacral spine
anatomy, 583-584
anterolateral retroperitoneal surgical approach, 604-611,
605-609
.,
chemonucleolysis, 811-815, 812-815
computer-assisted fusion, 590-595
degenerative disk disease, 555-563
outcomes, 562-563
foraminotomy, 630-633
lumboperitoneal shunt, 648-650
lumbosacral junction, anterior transperitoneal approach,
596-602,597-599
microdiskectomy, 634-637
nerve root rhizotomy, 651-656
posterior surgical approach, 612-617
anesthesia and positioning, 613, 613
cauda equina ependymoma resection, 657-659
cerebrospinal fluid leaks, 644-646
congenital dermal sinus/dermoid excision, 715-722
diastematomyelia repair, 759-764,760-764
dorsal rhizotomy, cerebral palsy spasticity, 771-775
far-lateral microdiskectomy, 638-643
hemilaminectomy, 625-629
hook-rod fusion instrumentation, 690-696
iliac crest bone grafting, 776-781
interbody fusion and transpedicular screw fixation,
681-689
laminectomy, 618-624
Luque instrumentation, fusion with, 697-703
morphine/baclofen pump placement, 704-711
myelomeningocele repair, 712-714
operative exposure, 614-616, 614-616
radiological evaluation, 613-614, 614
sacral agenesis, 765-770
sacrococcygeal teratoma resection, 723-727
spinal cord lipomas, 741-750
dorsal/transitional lipomas, 742,742-743
electrophysiological monitoring, 744
embryogenesis, 742-743, 742-744
outcomes, 750
terminal lipoma, 743, 744,749, 749-750
transitional lipomas, 745-749,747-749
spinal dysraphism, 729-757
cerebrospinal fluid leakage, 738-739
classification, 730t
complications, 737-739
dural closure, 735, 735-736, 737
embryogenesis, 751,752, 753, 754
embryology, 730, 730-733, 732
kyphectomy and open myelomeningocele, 739-741,
740-741
limited dorsal myeloschisis, 751,751-757
myelomeningoceles, 730, 730t
neural placode, 732
open myelomeningocele, segmental placode, 739, 739
patient positioning and sterile preparation, 734
postoperative care, 737
sac opening procedure, 734, 735-736
skin and myofascial closure, 736,736-737
surgical indications and treatment, 755, 756-757
wound dehiscence, 737-738
wound infection, 738
tethered spinal cord release, 661-665
transverse process fusion, 675-680
retroperitoneal exposure, 837-845
advantages/disadvantages, 838
anterior instrumentation, 841.841-842
closure, 841
complications, 845
decompressive techniques, 841-843, 842-844
diskectomy, 841,841
Index
1011
incision and dissection, 838, 839-841, 839-841
indications, 837-838, 838
patient positioning, 838, 839
vertebral reconstruction, 841,842
vertebrectomy, 841-843, 842-843
spondylolisthesis, in children, 549-553
stenosis, microendoscopic decompression, 852-858
trauma
anatomy, 580-581
classification, 581,581,581t
diagnosis, 585, 585t
injury mechanisms, 581-583,581-585, 583t
treatment, 586, 587
tumors
anterior/anterolateral
approaches, 573-574
classification, 568, 568t
clinical presentation, 567-568
complications, 577-578
diagnosis, 569
dissection, 571-573, 572
embolization, 570, 571
indications for surgery, 569-570, 569t
lipoma resection, 666-674
metastatic tumors, 569
posterior/posterolateral
approach, 571,571t
posterior stabilization, 574-576, 575-576, 575t
primary tumors, 569-570, 569t, 570
radiological evaluation, 568-569
retroperitoneal approach, 573
simultaneous combined anterior-posterior approach/total
en bloc spondylectomy, 576-577
total en bloc spondylectomy, 572-573
transperitoneal approach, 573-574
vertebral body reconstruction, 574
vertebrectomy, 574
Lumbar plexus
anatomy, 945, 946
surgical technique, 946, 947.948
Lumbar sympathectomy, lumbar/lumbosacral spine, 609
Lumboperitoneal shunt, lumbar/lumbosacral spine, 648-650
Lumbosacral plexus
anatomy, 888, 889, 945, 945-946
surgical technique for,946, 947.948
trauma, 944-948
tumors, 950-952, 951-952
Lungcancer, cervicothoracicjunction tumors, 299, 299t
Luque instrumentation, posterior fusion with, 697-703
Luschkajoints, diskectomy, vertebrectomy following anterior
approach, 327.327-328
Lymphoma
cervicothoracic junction tumors, 299t, 300
occipitocervical junction, 28
thoracic/thoracolumbar spine, 391
M
Magnetic resonance angiography (MRA)
craniocervical junction abnormalities, transoral approaches, 55
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 145
thoracic/thoracolumbar spine tumors, 385
Magnetic resonance imaging (MRI)
Brooks fusion technique, (1-(2 junction, 140
cavernous angiomas, 485, 486
cervical stenosis evaluation, 168
cervicothoracic junction tumors, 298
craniocervical junction abnormalities, 6, 8
transoral approaches, 54, 55
epidural abscess, 458, 458-459
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 145
foraminal epidural endoscopic diskectomy, 827
intermedullary spinal cord tumors, 170,170-171
Klippel-Feilsyndrome anomalies, 160-161, 161
lumbar/lumbosacral disk surgery, 557
microforaminotomy, anterior approach, cervical spine,
210-211, 211
spinal cord decompression, 213,213
neurenteric cysts, 358, 358
occipitocervical junction trauma
occipitoatlantalligament
dislocation, 31-34, 32-34, 33t
rotatory (1-(2 dislocation, 34, 35,38
transverse ligament injuries, 34-35, 35-38
occipitocervical junction tumors, 26
meningioma, 29, 29
odontoid fractures, screw placement, 219
peripheral nerve trauma, 892
rheumatoid arthritis
atlantoaxial subluxation, 18,18-19
basilar invagination, 15
spondylolisthesis, in children, 550-551
syringosubarachnoid shunting, 530, 531
thoracic disk herniation, 470
thoracic/thoracolumbar spine
metastatic tumors, 393
tumor imaging, 384
thoracic/thoracolumbar spine trauma, 403
transoral odontoidectomy, 61
Magnetic resonance neurography (MRN),peripheral nerve
trauma, 892
Magnification equipment, anterior cervical spine surgery, 195
Mandibular dislocation, craniocervical junction, postoperative
complications, 58
Mandibulotomy reconstruction
caudal extension, midline tumor resectioning, transoral
approach,68-69,
69-70
transoral closure technique, 76
Manubrium, cervicothoracic junction, transsternal surgery and,
312,313
Marfan's syndrome,lateral/anterior
meningoceles, 372
Maxillaexposure, extended maxillotomy procedure, 81,82-83
Maxillotomy reconstruction
extended approach
advantages/disadvantages, 80
indications/contrainidications, 79, 80
LeFort Iosteotomy, 81,83, 85, 85-87
maxilla/nasal cavity exposure, 81,82-83
palatal split, 81,84-85, 85
patient positioning, 81
preoperative planning, 80-81, 81t
surgical techniques, 81,82-88, 85-88
tracheostomy, 81
vertical pharyngotomy, 85, 88
transoral closure technique, 75-76
Median mandibulotomy and/or glossotomy, caudal extension,
midline tumor resectioning, transoral approach, 68-69,
69
Median nerve
anatomy, 932, 933t, 935t
brachial exposure, 935-936, 936
surgical technique, 933-936, 934-936
Median nerve entrapment, supracondylar process, humerus and
Struther's ligament, 896, 896
Median tubercle (1 anterior arch, retropharyngeal surgical
approach, 98,98
1012
Index
Medical evaluation
occipitocervicaljunction tumors, 26
thoracic/thoracolumbar spine tumors, 385-388, 386, 386t
Meningioma
intradural extramedullary tumor resectioning, 290,291,
491-493,492-493
occipitocervical junction, 29,29
Meningitis, congenital dermal sinus excision, 716, 720
Meningoceles, thoracic/thoracolumbar spinal defects, 357
lateral/anterior location, 372
Meralgia paresthetica, 904, 904-905
lateral femoral cutaneous and intercostal nerves, 986-988,
987-988
Mesh cylinder implantation, lumbar/lumbosacral spine,
computer-assisted fusion, 593-594
Metabolic disorders, craniocervical junction, transoral
approaches, 53-54
Metastatic tumors
cercicothoracic junction, 299-300, 299t
lumbar/lumbosacral tumors, 569, 569t
thoracic/thoracolumbar spine, 391,392t
Methyl methacrylate grafts, anterior decompression surgery,
reconstruction following, 331,332
Microdiskectomy
arthroscopic and endoscopic, posterolateral surgical approach,
816-824
anatomy, 817-818, 817-818
far-lateral microdiskectomy, 641-643
lumbar/lumbosacral spine, 562-563, 634-637
Microendoscopically assisted transforaminallumbar
interbody
fusion, 859-865, 861-865
Microendoscopic decompression, lumbar stenosis, 852-858
Microendoscopic diskectomy (MED),846-850
Microendoscopic foraminotomy (MEF),cervical spine, 785-789,
787-791
anesthesia and patient positioning, 786-787, 787
closure techniques, 791
diskectomy and anterior osteophyte decompression, 788,
790-791,791
incision and approach, 787-788, 788-789
laminotomy and, 788,789-790
Microforaminotomy (transuncal), anterior surgical approach
cervical spine, 207-216
cord decompression, spondylotic myelopathy/OPLL,
211-213,212-213
radiculopathy, 208-211,209-211
spinal cord tumors, 213-216,214
correct level identification, 215-216
Midline enlargement laminoplasty, surgical techniques, 243,244
Midline incision, far-lateral microdiskectomy, 639-640, 639-640
Midline intradural tumor resectioning, extended transoral proce-
dure, 64-71
Midline posterior pharyngeal incision, transoral odontoidectomy,
61-62,61-62
Minimally invasiveprocedures
arthroscopic and endoscopic microdiskectomy, posterolateral
approach,816-824
cervical endoscopic foraminotomy, 785-789, 787-791
foraminal epidural endoscopic diskectomy, 826-830
lumbar chemonucleolysis, 811-815, 812-815
mcroendoscopically assisted transforaminallumbar
interbody
fusion, 859-865, 861-865
microendoscopic decompression, lumbar stenosis, 852-858
microendoscopic diskectomy, 846-850
percutaneous spinal cord stimulator implantation, 831-836
thoracic endoscopic sympathectomy, 793-798
thorascopically assisted spinal surgery, 799-810
Mobilization techniques, sacrococcygeal teratoma resectioning,
725-726,725-726
Morbidity and mortality
anterior decompression surgery, reconstruction following,331
arthroscopic and endoscopic microdiskectomy, posterolateral
approach,824
encephaloceles, occipitocervical junction, 127
endoscopic sympathectomy, 797
epidural abscess, 459
foraminal epidural endoscopic diskectomy, 830
intercostal nerve surgery, 978
lumbar/lumbosacral spine surgery
microdiskectomy, 630, 635t
posterior lumbar interbody fusion/screw fixation, 688-689,
688t-689t
transverse process fusion, 676
retropharyngeal approach, occipitocervical junction,
106t-108t, 108
rheumatoid arthritis, natural history, 13-14
spinal cord lipoma surgery, 750
thoracic/thoracolumbar spine tumors, 387
vertebroplasty/kyphoplasty,873
Morphine pump, lumbar placement, 704-711
Motor evoked potentials (MEPs)
craniocervical junction, transoral preoperative evaluation,56
intermedullary spinal cord tumor surgery
anesthesia, 171
neurophysiological monitoring, 171.172
intramedullary spinal cord tumor surgery, 287
Motor system syndrome, cervical spine symptoms, 166
Mouth floor repair, transoral closure technique, 76
Mucosal flaps, transoral closures, 75
Multiple myeloma
cervicothoracicjunction plasma cell dyscrasias, 302-303
occipitocervical junction, 29
thoracic/thoracolumbar spine, 391-392
Muscle wasting, craniocervical junction, transoral approaches,55
Musculocutaneous flap
iliac crest bone graft
anterior approach, 779
posterior approach, 777-778, 777-778
in situ fusion, thoracic spine, 539, 539
syringoperitoneal shunting, 535
syringosubarachnoid shunting, 531
thoracic spine, pedicle screw procedures, 543
transthoracic surgical approach, lateral parascapular
extrapleural exposure, upper thoracic spine, 344-345,
344-346
Musculocutaneous nerve
anatomical variations, 928-931, 929t
surgery on, 928-931. 929-930, 929t
Musculoskeletal anomalies, Klippel-Feilsyndrome, 159,159t
Myelocystocele, limited dorsal myeloschisis, 753, 754
Myelodysplasia, syringopleural shunting, 521-523, 522
Myelography
cervicallaminoplasty and risk of,244-245
cervical stenosis, 168
cervicothoracic junction tumors, 298
conus medullaris avulsion, dorsal root entry zone surgery,506
Myelomeningocele
open spinal dysraphism, 730-741
complications, 737-739
dural closure, 735, 735-736, 737
embryology, 730, 730-733, 732
kyphectomy, 739-741, 740-741
neural placode management, 732
positioning and sterile preparation, 734
1
I
I
Index
1013
postoperative care, 737
sac opening, 734, 735-736
segmental placode, 739, 739
skin and myofascial closure, 736-737, 736-737
surgical technique, 734-737
surgical repair, 712-714
thoracic/thoracolumbar
spine congenital abnormalities, 356,
356-357
Myelopathy
cervical spondylosis, 166
craniocervical junction, transoral approaches, 54-55
dural arteriovenous fistula, 479
spondylotic, spinal cord decompression, 211-213,212-213
thoracic/thoracolumbar
spine, disk disease, 378-379
thoracoscopically-asssisted spinal surgery, 802
Myelotomy techniques
commissural myelotomy, 498-499, 499-502
intermedullary spinal cord tumor surgery, 172-173, 173
intramedullary spinal cord tumor surgery, 282-283, 283-284
Myofascial closure, open spinal dysraphism, myelomeningocele,
736, 736-736
N
Nasal cavity exposure, extended maxillotomy procedure, 81,
82-83
Nasal septum, transoral closure, 75, 75
Nasopharyngeal carcinoma, occipitocervical junction, 28
Neckpain
caudalis DREZ,innervation table, 515,516t
occipitocervical junction tumors, 26
Needle insertion, lumbar chemonucleolysis, 814-815, 814-815
Nerve action potential (NAP)
axillary nerve decompression, 927
brachial plexus, supraclavicular surgical repair, 911
lumbosacral plexus, intraoperative recording, 948
spinal accessory nerve surgery, 921
Nerve graft harvesting
brachial plexus, supraclavicular surgical approach, 910
lumbosacral plexus, 948
tumor removal, 951-952
spinal accessory nerve grafts, 922, 922
sural nerve, 969-970, 969-970
techniques for,990-993, 991-993
Nerve palsy, retropharyngeal approach, occipitocervicaljunction,
106t-108t, 108
Nerve root injury
lumbar/lumbosacral spine, rhizotomy, 651-656
microforaminotomy, anterior approach, spinal cord tumors,
215
Nerve sheath tumors, intradural extramedullary tumor resec-
tioning, 294
Neural decompression, occipitocervical junction, retropharyngeal
closure, 104, 104
Neuralgia
genitofemoral nerve, surgical management of,983-985,
984-985
ilioinguinal nerve, surgical management of,979-981, 980-981
Neural placode, open spinal dysraphism, myelomeningocele, 732,
733
sac opening, 734, 735-736
Neural tube defects (NTD)
congenital dermal sinus, excision, 715-722
systemic anomalies with, 356,356-357
thoracic/thoracolumbar spine congenital abnormalities, 355,
355t
Neurenteric cysts, thoracic/thoracolumbar spine congenital
abnormalities, 358, 358
Neuroblastomas, cervicothoracic junction tumors, 300
Neurofibromas
intradural extramedullary tumor resectioning, 293, 293-294
peripheral nerves, 881-873, 883
Neurofibromatosis type 1,ulnar nerve neurofibromas, 881-873,
883
Neurological evaluation
anterior cervical spine surgery, complications and avoidance,
205
cervical laminectomy, postoperative complications, 237-238
intermedullary spinal cord tumor surgery, neurophysical
monitoring, 171-172, 172
Klippel-Feilsyndrome anomalies, 162
lumbar/lumbosacral spine
lipomas, 668-669, 668-669
nerve roots, rhizotomy, 652, 654
tethered spinal cord release, 662, 662
meralgia paresthetica diagnosis, 986
occipitocervical junction tumors, 25-26
Neurological injury. See alsoTrauma
intramedullary spinal cord tumor surgery, 287
thoracic/thoracolumbar spine trauma, 400-401, 401t
Neurolysis
axillary nerve decompression, 927
lumbosacral plexus surgery, 948
spinal accessory nerve surgery, 921
Neuroma, sural nerve, 972, 972
Neuronavigation systems, craniocervical junction, 55-56, 56
Neuropraxia, characteristics of, 891
Neurotmesis, characteristics of,891
Neurulation, open spinal dysraphism, myelomeningocele, 730,
730-732,732
Nonmigrated sequestered disk herniation, arthroscopic and
endoscopic microdiskectomy, posterolateral approach,
819,822
Nonsegmented hemivertebra, pathology and management, 365
Nonspinallesions, cervicothoracic junction tumors, 300
Nuchal musculature
cervicallaminoplasty and preservation of,245
posterior atlantoaxial surgical techniques, 133, 134,135
Nuclear shunt-o-gram, syringopleural shunting, 522
Nucleus pulposis
biomolecular structure, 165
cervical spine structure, 165
lumbar chemonucleolysis, 812,812-813
Nutritional support, retropharyngeal procedures, 106
o
Oblique facet wiring, interfacet wire stabilization, cervical spine,
272-273
Obturator nerve
anatomy, 946, 954, 957
surgical techniques, 957
Occipital condyle, reduction, extreme lateral transcondylar
transtubercular approach, anterior craniocervical
junction, 147,150
Occipitoatlantalligament
dislocation, 31-34, 32-34, 32t-33t
Occipitoatlantoaxial instability, rheumatoid arthritis, basilar
invagination, 16
Occipitocervical junction
degenerative and rheumatologic diseases
inflammatory conditions, 21,21
rheumatoid arthritis, 13-20
atlantoaxial rotatory subluxation, 19
atlantoaxial subluxation, 15,16-19
basilar invagination, 14-16, 15,17
clinical presentation, 14
1014
Index
Occipitocervicaljunction (Continued)
epidemiology, 13
natural history, 13-14
outcomes, 19-20
pathogenesis, 14
posterior atlantoaxial rotatory subluxation, 19
spontaneous atlantoaxial rotatory fixation, 20, 20-21
encephaloceles, surgical treatment, 122-127
advantages/disadvantages, 122-123
indications/contraindications, 122
outcomes, 127
surgical techniques, 123, 124-126
posterior occipitocervical fusion and stabilization, bent
titanium rods and cables, 118-121, 119-120
posterior suboccipital/upper cervical exposure
advantages/disadvantages, 110-113, 111-112
indications, 110
retropharyngeal approach, 89-101, 93
advantages/disadvantages, 90-91
anesthesia, 93
anterior arch preservation of (1, 99
anterior rim foramen magnum, 98
bone resectioning, 98, 98-99
cervical fascia, planes of,91-92
clinical series, 99, 100-101 t
cIival/pharyngeal tubercle, 98
closure techniques
advantages/disadvantages, 103-104
airway control, 106
(1 arch to (3 strut arthrodesis, 105, 106
cerebrospinal fluid diversion, 105
complete neural decompression, 104, 104
complications, 106t-l08t, 108
craniovertebral stabilization, 105, 105
dural closure, 104-105
indications/contraindications,
103
nutritional support, 106
outcomes, 106, 106t-l08t
retraction, 104
contraindications, 90
deep anatomical landmarks, 96-99
digastric muscle and tendon, 94-95
hyoid bone, 95-96
hypoglossal nerve, 95, 96
incision techniques, 93, 93
indications, 89-90
longus colli-capitis muscles, 96, 97
median tubercle (1 anterior arch, 98, 98
patient positioning, 92, 93
patient selection, 91
platysma muscle, 94, 94-95
submandibular gland, 94, 95
superficial anatomical landmarks, 94-96
superior pharyngeal constrictor muscle, 96, 97
tectorial membrane, 99
transverse cervical ligament, 98, 99
trauma, 31-46
isolated fractures, 33t, 38-46, 39t
atlas-axis fractures, 32t, 39t, 44-45,45-46
atlas fractures, 35-38, 39, 39t, 40-42
(2 fractures, 39t, 43-44
hangman's fractures, 39t, 41,43,44
odontoid fractures, 39, 39t, 41,42-43
isolated ligamentous injuries, 31-38
occipitoatlantal dislocations, 31-34, 32-34, 33t
rotatory (1-(2 dislocations, 35, 38
transverse ligament injuries, 34-35, 35-38
nonoperative treatment, failure of,46
tumors, 23-30, 30t
anatomy and biomechanics, 23-25,24-25
benign tumors, 28
chondrosarcoma, 28
chordoma, 27-28, 27t, 28
differential diagnoses, 26-27
glomus jugulare, 29-30
intradural tumor resection, extended transoral
procedures, 64-71
lymphoma, 28
malignant tumors, 28-30
medical evaluation, 26
meningioma, 29
multiple myeloma, 29
nasopharyngeal carcinoma, 28
neurological evaluation, 25-26
radiological evaluation, 26
solitary plasmocytoma, 29
Ocular deformities, Klippel-Feilsyndrome, 157
Ocular injury, posterior surgery, cervical spine, 231
Odontoidectomy, transoral approaches
advantages/disadvantages, 60
contraindications, 60
indications, 60
objectives, 60
outcome, 62
radiological evaluation, 60-61
surgical techniques, 61-62
midline posterior pharyngeal incisions, 61-62, 61-62
resection, 62, 62
retractor insertion, 61
Odontoid fractures
craniocrevical junction, 53
occipitocervical junction, 39, 39t, 41,42-43
screw placement
advantages/disadvantages, 218-219
anesthesia, 219
indications/contraindications, 218
outcomes, 223-224
patient positioning, 219,219
postoperative care, 223
surgical technique, 219-220,220-223, 222
Open anterolateral cordotomy, thoracic/thoracolumbar spine,
495-497, 496
Open-door laminoplasty, surgical technique, 241-243,242-244
"Open-door" maxilIotomy
craniocervical junction, 49, 50-51
midline tumor resectioning, 65-68, 65-68
Open surgical techniques, percutaneous spinal cord stimulator
implantation VS.,832-836
Oral cavity dysfunction, transoral closure procedures,
postoperative assessment, 77
Oral cavity roof repair, transoral closure technique, 76
Organ system disorders, thoracic/thoracolumbar spine congenital
abnormalities, 354
Orthopedic complications, intramedullary spinal cord tumor
surgery, 287
Orthosis
craniovertebral stabilization, retropharyngeal
approach, 105, 105
occipitocervical junction fractures, 39, 39t
rheumatoid arthritis, basilar invagination, 16
Os odontoideum, craniocrevical junction, 53
Ossification of the posterior longitudinal ligament (OPLL),
microforaminotomy, anterior approach, spinal cord
decompression, 210-213,212-213
Index
1015
Osteoblastoma
cervicothoracic junction tumors, 301
thoracic/thoracolumbar spine, 390
Osteochondroma
cervicothoracic junction tumors, 300-301
thoracic/thoracolumbar spine, 389-390
Osteoclasis, thoracic extension osteotomy, 466, 467
Osteoid osteoma
cervicothoracic junction tumors, 301
thoracic/thoracolumbar spine, 390
Osteophyte decompression, microendoscopic foraminotomy,
cervical spine, 788, 790-791, 791
Osteosarcoma
cervicothoracic junction tumors, 302
thoracic/thoracolumbar spine, 392
Osteotome, lumbar/lumbosacral spine, foraminotomy, 632-633,
632-633
Osteotomy, thoracic extension, 463-467, 464-467
Outcomes. See Morbidity and mortality
p
Palatal split, extended maxillotomy procedure, 81,84, 85, 85
Palate repair, transoral closure technique, 75-76, 76
Palmar hyperhidrosis, endoscopic sympathectomy, 794
Pancoast's tumor, cervicothoracic junction tumors, 300
Pancreatic carcinoma, endoscopic sympathectomy, 794
Pang's unified theory, split cord malformations, 360
Pannus formation, rheumatoid arthritis pathogenesis and, 14
Paramedian incision, far-lateral microdiskectomy, 638t, 640-642,
641
Paraplegia, with cyst, dorsal root entry zone operation, 511-513,
512-513
Paraspinal soft tissue sarcoma, thoracic/thoracolumbar spine,
391
Pars injury, spondylolisthesis in children, 551
Pathway techniques, computer-assisted lumbar fusion, 592,592
Patient positioning
anterior approach, cervical spine surgery, 195, 196
arteriovenous malformation surgery, 480
arthroscopic and endoscopic microdiskectomy, posterolateral
surgical approach, 819
axillary nerve surgery, 925
Brooks fusion technique, (1-(2 junction, 140, 140
cervical foraminotomy, 247-248
microendoscopic procedure, 786-787, 787
costotransversectomy, 442
dorsal root entry zone surgery, brachial plexus avulsion, 504,
504
dumbbell neurofibroma removal, 886, 886
endoscopic diskectomy, 639
endoscopic sympathectomy, 795, 795
extended maxillotomy, 81
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 145, 145
foraminal epidural endoscopic diskectomy, 828
genitofemoral neuralgia surgery, 984, 984
ilioinguinal neuralgia surgery, 982, 982
infraclavicular surgical technique, brachial plexus, 916
intermedullary spinal cord tumor surgery, 172
intradural extramedullary tumor resectioning, 488, 488-489
intramedullary spinal cord tumor surgery, 280, 281
lower thoracic sympathectomy/splanchinectomy, 423
lumbar chemonucleolysis, 813, 813
lumbar/lumbosacral spine surgery
anterolateral retroperitoneal approach, 606
cerebrospinal fluid leaks, 644
congenital dermal sinus/dermoid excision, 716
disk surgery, 558
dorsal rhizotomy, cerebral palsy spasticity, 771, 772
laminectomy, 619,619
lipoma resectioning, 669, 669
lumboperitoneal shunt, 649
morphine/baclofen pump placement, 706, 707
nerve root rhizotomy, 652-653, 654
posterior approach, 613, 613
hook-rod fusion instrumentation, 692
interbody fusion and trans pedicular screw fixation, 684
Luque instrumentation, 698
retroperitoneal approach, 838, 839
sacrococcygeal teratoma resectioning, 724, 724
tethered spinal cord release, 662-663, 663-664
transverse process fusion, 676, 676-677
lumbosacral plexus tumor surgery, 950-952, 951-952
median nerve survery, 933, 934-935
microendoscopically assisted transforaminallumbar
interbody
fusion, 860, 860
microendoscopic decompression, lumbar stenosis, 852-853,
853
microendoscopic diskectomy, 847,847
microforaminotomy, anterior approach, cervical spine,
208-211. 209-210
midline tumor resectioning, transoral approach, intradural
surgery, 69-70
musculocutaneous nerve surgery, 929, 929
odontoid screw placement, 219,219
percutaneous spinal cord stimulator implantation, 832
posterior surgical techniques
atlantoaxial techniques, 133
Bohlman triple-wire technique, 255
cervical spine, 228-229,229
diskectomy, 250
interfacet wire stabilization, 271-273
lateral mass plate stabilization, 275
subaxial stabilization sublaminar cable placement,
267-268
diastematomyelia repair, 760
iliac crest bone graft, 777
intradural extramedullary tumor resectioning, 289-290
locked/perched facet exposure and release, 265
myelomeningocele repair, 713, 713
open spinal dysraphism, 734
sacral agenesis, 765,765-766
in situ fusion, thoracic spine, 538-539
suboccipitocervical exposure, 110-113, 111-112
thoracic spine, pedicle screw procedures, 543
retroperitoneal approach and closure, thoracic/thoracolumbar
spine, 415,416
retropharyngeal approach, occipitocervical junction, 92, 93
supraclavicular surgery
brachial plexus, 909
cervicothoracic junction, 308
syringoperitoneal shunting, 535
syringopleural shunting, 522
syringosubarachnoid shunting, 531
thoracic extension osteotomy, 464, 464
thoracic laminectomy, 449, 449
thoracoabdominal approach and closure,
thoracic/thoracolumbar spine, 413-414, 414
thoracoscopically-asssisted spinal surgery, 801, 802
transmanubrial transclavicular surgery, cervicothoracic
junction, 319-320
transsternal surgery, cervicothoracic junction, 314
transthoracic diskectomy, 427,428
transthoracic surgical approach
1016
Index
Patient positioning (Continued)
lateral approach, thoracic/thoracolumbar spine, 406,
406-407
lateral parascapular extrapleural exposure, upper thoracic
spine, 344
thoracic/thoracolumbar spine, 338-339, 339
vertebrectomy, 432, 432-433
ulnar nerve schwannoma removal, 880
upper thoracic ganglionectomy, 422
vertebroplasty, 867,868
Patient selection, lumbar/lumbosacral disk surgery, 556
Pedicle'hook insertion, lumbar/lumbosacral spine, hook-rod
fusion instrumentation, 694-695, 694-695
Pedicle screw instrumentation, microendoscopically assisted
transforaminallumbar
interbody fusion, 863-865,
864-866
Percutaneous gastrostomy (PEG),craniocervical junction,
transoral techniques, 56-57
Percutaneous lumbosacral fusion, computer-assisted techniques,
590-595
Percutaneous spinal cord stimulator implantation, 831-836
Perimedullary arteriovenous malformations, 481, 484, 485
Peripheral nerve
anatomy, 888, 889
compressive lesions, 895-906
anterior interosseus nerve syndrome, 897-898
carpal tunnel syndrome, 898, 898, 899t
cubital tunnel syndrome, 900-901, 901
median nerve entrapment
elbow and forearm, 897,897
supracondylar process, humerus and Struther's ligament,
896,896
meralgia paresthetica, 904, 904-905
posterior osseus nerve entrapment, 900
radial nerve entrapment, 898, 900, 900
saphenous nerve entrapment, 905
suprascapular neuropathy, 902-903, 903
tarsal tunnel syndrome, 905-906, 906
thoracic outlet syndrome, 904
ulnar nerve compression, 901-902, 902
trauma, 888-894
axonotmesis, 891
electrodiagnostic evaluation, 891-892
electrophysiological monitoring, 893
grading, 891
neurapraxia, 891
neurotmesis, 891
postoperative management, 894
preoperative evaluation, 890, 890
radiological evaluation, 892-893, 892-893
surgical management, 893. 893-894
tumors, 879-886
Peritoneal exposure
lumbosacral junction, anterior trans peritoneal approach,
596-602,597-599
syringoperitoneal shunting, 535 536
Peroneal nerve, surgical techniques, 963, 964-965
Phalen's test, carpal tunnel syndrome, 898
Phenotypic features, congenital mid- to lower cervical spine
osseous anomalies, 156, 156
Philadelphia collar
atlas fractures, 39
(2 fractures, 43-44
Plain radiography
arthroscopic and endoscopic microdiskectomy, posterolateral
surgical approach, 814, 814
atlantoaxial subluxation, 17-19, 18
Brooks fusion technique, (1-(2 junction, 140
cervical spine
stenosis, 168
trauma, 176-177
cervicothoracic junction tumors, 298, 298t
congenital dermal sinus, 716
craniocervical junction, transoral approaches, 55
craniocervical junction abnormalities, 6, 7-8
intramedullary spinal cord tumors, 280
Klippel-Feilsyndrome anomalies, 160
lumbar/lumbosacral spine
chemonucleolysis, 812
disk surgery, 556, 556-557
lipomas, 668-669
posterior approach, 613-614, 614
tumor evaluation, 568
occipitocervical junction trauma
occipitoatlantalligament
dislocation, 31-34,32-34, 33t
transverse ligament injuries, 35, 36-38
occipitocervical junction tumors, 26
spondylolisthesis, in children, 550-551, 551-553
thoracic disk herniation, 470
thoracic/thoracolumbar spine
disk disease, 380
pedicle screw procedures. 543
tumor imaging, 384-385, 385t
thoracic/thoracolumbar spine congenital abnormalities, 354
thoracic/thoracolumbar spine trauma, 401
transoral odontoidectomy, 60-61
Plantar hyperhidrosis
endoscopic sympathectomy, 794
thoracoscopic sympathectomy, 797, 797t
Plasma cell dyscrasias, cervicothoracicjunction lesions,302-303
Plasmacytoma
occipitocervical junction, 29
thoracic/thoracolumbar spine, 389-390
Plate construction. See also End plate preparation
anterior surgical approach
cervical spine plating, 201-203,202-204
reconstruction following decompression, 333,334
anterolateral graft and plate reconstruction, 436-440, 437-440
cervical spine, trauma, 180-188, 181-187
lateral mass plates, cervical spine stabilization, 274-278
lumbar/lumbosacral spine, stabilization techniques, 610
rheumatoid arthritis, basilar invagination, 16
"Plated bayonet" technique, intermedullary spinal cord tumor
surgery, 172-173
Platysma muscle, retropharyngeal approach, occipitocervical
junction. 94, 94
Pleural entry site. syringopleural shunting, 522-523, 523
Pleural flap removal
thoracic vertebrectomy, 433
transthoracic diskectomy, 427-428, 428
Polymethyl methacrylate (PMMA)
anterolateral graft and plate reconstruction, 437-440, 438
lumbar/lumbosacral tumor dissection, 572,572
thoracic extension osteotomy, 466, 466-467
vertebroplasty, 868-870, 869
Polymorphonuclear leukocytes (PMNs),rheumatoid arthritis
pathogenesis and, 14
Pontomedullary compression, craniocervical junction, transoral
approaches, 55
Postdrainage ultrasound, syringopleural shunting, 524.526
Posterior atlantoaxial subluxation, pathogenesis, 19
Posterior atlantodental interval (PADI)
atlantoaxial subluxation, 15.18-19
rheumatoid arthritis
Index
1017
basilar invagination, 15
surgical outcomes, 20
Posterior interosseus nerve (PIN)entrapment, 900
Posterior longitudinal ligament (PLL),anterior surgical approach
corpectomy, 328-329, 328-329
diskectomy, 193, 194,198-199, 198-199
Posterior lumbar interbody fusion (PLIF)
Brantigan cages, 686, 686-687
noninstrumental technique, 684-685
Tangent technique, 687, 687
threaded fusion cages, 685-686, 686
transpedicular screw fixation, 681-689
Posterior pharyngeal wall, transoral closure, 74, 74
Posterior surgical approach
atlantoaxial fusion, 128-138
anatomy, 128-129, 129
anesthesia, 133
cable fixation, bony wedge compression, 135-136, 135-136
exposure and nuchal musculatures, 133, 134,135
Halifaxclamp fixation, 136, 137
patient positioning, 133
regional biomechanics, 130
screw fixation, 136-138,137-138
surgical anatomy, 129, 131-132
axillary nerve surgery, 923-927, 925-926
cervical spine, 225-231
advantages/disadvantages, 225
anatomy, 225-226,227-228
anesthesia, 228
closure and postoperative management, 230-231
complications, 231
diskectomy, 250-253,251-252,
251-253
foraminotomy, 247-249,248-249
indications, 225, 226t
interfacet wire stabilization, 271-273
lateral mass plate stabilization, 274-278
patient positioning, 228-229,229
subaxial stabilization, sublaminar cables, 267-270
surgical techniques, 229-230,229-231
trauma, 181-190
anterior technique vs., 177
clamp and hook system, 188
combined posterior-anterior stabilization, 190
facet wiring, 188
Hartshill rectangle, 190
interspinous wiring, 188, 189,190
lateral mass plates and screws, 181-188, 182-187
femoral nerve, 955, 956
intradural extramedullary tumor resectioning, 289-295
lateral femoral cutaneous nerve, 953, 954, 955
locked/perched facet exposure and release, 263-266, 264-266
lumbar/lumbosacral spine, 612-617
anesthesia and positioning, 613,613
cauda equina ependymoma resection, 657-659
cerebrospinal fluid leaks, 644-646
congenital dermal sinus/dermoid excision, 715-722
diastematomyelia repair, 759-764
dorsal rhizotomy, cerebral palsy spasticity, 771-775
hemilaminectomy, 625-629
hook-rod fusion instrumentation, 690-696
iliac crest bone grafting, 776-781
interbody fusion and transpedicular screw fixation,
681-689
laminectomy, 618-624
Luque instrumentation, fusion with, 697-703
morphine/baclofen pump placement, 704-711
myelomeningocele repair, 712-714
operative exposure, 614-616, 614-616
radiological evaluation, 613-614, 614
sacral agenesis, 765-770
sacrococcygeal teratoma resection, 723-727
spinal cord lipomas, 741-750
dorsal/transitional lipomas, 742,742-745, 745-746
electrophysiological monitoring, 744
embryogenesis, 742-743, 742-744
outcomes, 750
terminal lipoma, 743, 744,749. 749-750
transitional lipomas, 745-749. 747-749
spinal dysraphism. 729-757
cerebrospinal fluid leakage, 738-739
classification, 730t
complications. 737-739
dural closure, 735.735-736, 737
embryogenesis, 751.752. 753. 754
embryology, 730. 730-733, 732
kyphectomy and open myelomeningocele. 739-741.
740-741
limited dorsal myeloschisis. 751.751-757, 755-757
myelomeningoceles, 730
neural placode. 734-735. 735
open myelomeningocele, segmental placode. 739, 739
patient positioning and sterile preparation, 734
postoperative care, 737
sac opening procedure, 734,735-736
skin and myofascial closure. 736, 736-737
surgical indications and treatment, 755, 756-757
wound dehiscence. 737-738
wound infection. 738
tethered spinal cord release, 661-665
transverse process fusion, 675-680
lumbar/lumbosacral tumors. 571t
stabilization techniques, 574-576, 575-576, 575t
occipitocervical fusion and stabilization. bent titanium rods
and cables. 118-121. 119-120
stabilization
Bohlman triple-wire technique, 254-256.255-257
titanium rectangle technique, 258-261. 259-262
suboccipitocervical exposure, occipitocervical junction
advantages/disadvantages. 110-113. 111-112
indications, 110
thoracic/thoracolumbar spine, in situ fusion, 538-541
Posterolateral surgical approach
arthroscopic and endoscopic microdiskectomy. 816-824
lumbar/lumbosacral spine
bone grafting. 590-591. 591
tumor management, 571.571t
thoracotomy. anterolateral graft and plate reconstruction,
436-440,437-440
Postoperative management
Brooks fusion technique. (1-(2 junction, 143
cervical foraminotomy. 249
cervical spine surgery. 230-231
diskectomy, 253
interfacet wire stabilization, 273
lateral mass plate, stabilization. 278
subaxial stabilization sublaminar cable placement, 270
extreme lateral transcondylar transtubercular approach.
anterior craniocervical junction, 152
foraminal epidural endoscopic diskectomy. 829
intermedullary spinal cord tumor surgery, 174-175
lateral transthoracic surgical approach.
thoracic/thoracolumbar spine. 411
lumbar/lumbosacral spine surgery
anterolateral retroperitoneal approach, 610-611
1018
Index
Postoperative management (Continued)
congenital dermal sinus/dermoid excision, 721
diastematomyelia repair, 764
lipoma resectioning, 674
myelomeningocele repair, 714
nerve root rhizotomy, 655-656
posterior lumbar interbody fusion/screw fixation, 688
tethered spinal cord release, 663
transverse process fusion, 678
tumor surgery complications, 577
microforaminotomy, anterior approach, cervical spine, 211,211
midline tumor resectioning, transoral approach, 71
odontoid screw fixation, 223
open spinal dysraphism, myelomeningocele, 737
percutaneous spinal cord stimulator implantation, 836
peripheral nerve trauma, 889
syringoperitoneal shunting, 536
syringopleural shunting, 526
syringosubarachnoid shunting, 531
thoracic extension osteotomy, 465
thoracic spine, posterior surgery, in situ fusion, 541
transmanubrial transclavicular surgery, cervicothoracic
junction, 325
transoral closure procedures, 76-77
Pott's disease, iliac crest bone graft, 776
Power's ratio, occipitocervical junction trauma assessment, 32
Preoperative evaluation
Brooks fusion technique, CI-C2junction, 140
cervicothoracic junction surgery, transmanubrial
transclavicular approach, 319
craniocervical junction, transoral approach, 56, 57
extended maxillotomy, 80-81, 81t
foraminal epidural endoscopic diskectomy, 828
lumbar/lumbosacral spine surgery
anterolateral retroperitoneal approach, 605-606
disk surgery, 557-558
microendoscopically assisted transforaminallumbar
interbody
fusion, 859
myelomeningocele repair, 713
peripheral nerve trauma, 890, 890
spinal arteriography, 479-480, 479t
thoracoscopically-asssisted spinal surgery, 800
Presacral tumor extension, sacrococcygeal teratoma resectioning,
726,727
"Press fit" technique, craniovertebral stabilization, Cl arch to C3
strut arthrodesis, 105, 105-106
Primary tumors, lumbar/lumbosacral tumors, 569-570, 570
Prostate cancer, cervicothoracicjunction tumors, 299-300, 299t
Proximal extrapelvic sciatic nerve, surgical exposure, 958, 959
"Pseudodura" formation, lumbar/lumbosacral spine surgery,
cerebrospinal fluid leak repair, 644
"Pseudogout," occipitocrevical junction inflammation, 21,21
Pseudotumor, odontoid resection and presence of,62
Psoriasis, craniocrevical junction, 53
Psoriatic arthropathy, occipitocervical junction inflammation, 21
Pterygium colli, congenital mid- to lower cervical spine osseous
anomalies, 157,157
Pudendal nerve, anatomy, 946
Pulse generator/receiver, percutaneous spinal cord stimulator
implantation, 836
R
Radial nerve
entrapment neuropathies, 898, 900, 900
surgical techniques, 937-942, 938-942
Radiation therapy, thoracic/thoracolumbar spine tumors, 384
chordoma, 392-393
lymphoma, 393
metastatic tumors, 393
multiple myeloma/plasmacytoma, 391-392
Radiculopathy
cervical laminectomy, postoperative complications, 237-238
cervical spine, 166
lumbar/lumbosacral disk surgery, 557
thoracic/thoracolumbar spine, disk disease, 379
thoracoscopically-asssisted spinal surgery, 802
Radioisotope bone scans
lumbar/lumbosacral tumors, 568
thoracic/thoracolumbar spine, tumor imaging, 383
Radiological evaluation. See specific techniques, e.g. Plain
radiography, MRI,cr
Raynaud's disease, endoscopic sympathectomy, 794
Reciprocating saw, extended maxillotomy, LeFortIosteotomy,
85,85-87
Recklinghausen's disease
lateral/anterior meningoceles, 372
occipitocervical junction meningioma, 29
Recurrence risk, lumbar degenerative disk herniation, 562
Reducibility
of craniocervical junction abnormalities, 6
treatment options, 11,11t
posterior surgery, locked/perched facet exposure and release.
265-266,266
Reduction techniques, lateral mass plate, cervical spine
stabilization, 275
Reflexsympathetic dystrophy (RSD),endoscopic sympathectomy,
793-798
Registration procedures, computer-assisted fusion techniques,
591-592,591-592
Reiter's syndrome, occipitocervical junction inflammation, 21
Renal cell carcinoma, cervicothoracic junction tumors, 300
Resectioning techniques
intermedullary spinal cord tumor surgery, 173,174
intradural extramedullary tumor
posterior approach, 289-295
thoracic spine approach, 489-493
limited dorsal myeloschisis, 755,756-757
midline intradural tumor resection, extended transoral
procedures, 64-71
retropharyngeal surgical approach, bone resectioning, 98,
98-99
sacrococcygeal teratoma, posterior approach, 723-727
split cord malformation, 761-763, 761-764
tethered cord syndrome, 363
thoracic/thoracolumbar spine tumors
Ewing's sarcoma, 392
osteosarcoma, 392
praspinal soft tissue sarcoma, 393
thoracoscopically-asssisted spinal surgery, disk resection,
804-805
transoral odontoidectomy, 62, 62
transthoracic surgical approach, lateral parascapular
extrapleural exposure, upper thoracic spine, 345,
346-347. 347
Retraction techniques
anterolateral retroperitoneal surgical approach, anterolateral
retroperitoneal approach, 606, 610
lumbar/lumbosacral spine
disk surgery, 558-560,559-561, 561t
hemilaminectomy, 625-626, 626
posterior approach, 614-616, 614-616
microforaminotomy, anterior approach, cervical spine,
209-211
occipitocervical junction, retropharyngeal closure, 104, 104
Index
1019
odontoid screw placement, 220,220-223, 222
posterior suboccipitocervical exposure, 111,112
transmanubrial transclavicular surgery, cervicothoracic
junction, 320, 322,324
transthoracic surgical approach, thoracic/thoracolumbar spine,
339, 340
Retroperitoneal surgical approach
lumbar/lumbosacral spine
anterior exposure, vertebrectomy, 841-843, 841-843
anterolateral approach combined with, 604-611, 605-609
exposure, 837-845
advantages/disadvantages, 838
anterior instrumentation, 841,841-842
closure, 843
complications, 845
decompressive techniques, 841-844
diskectomy, 841,841
incision and dissection, 838, 839-841,839-841
indications, 837-838, 838
patient positioning, 838, 839
vertebral reconstruction, 843, 844
tumor surgery, 573
lumbosacral plexus surgery, 946, 947
thoracic/thoracolumbar spine, 417-420, 418-420
Retropharyngeal approach, occipitocervical junction, 89-101, 93
advantages/disadvantages, 90-91
anesthesia, 93
anterior arch preservation of (1, 99
anterior rim foramen magnum, 98
bone resectioning, 98, 98-99
cervical fascia, planes of, 91-92
clinical series, 99, 100-101t
clival/pharyngeal tubercle, 98
closure techniques
advantages/disadvantages, 103-104
airway control, 106
(1 arch to (3 strut arthrodesis, 105, 106
cerebrospinal fluid diversion, 105
complete neural decompression, 104, 104
complications, 106t-l08t, 108
craniovertebral stabilization, 105, 105
dural closure, 104-105
indications/contraindications, 103
nutritional support, 106
outcomes, 106, 106t-108t
retraction, 104
contraindications, 90
deep anatomical landmarks, 96-99
digastric muscle and tendon, 94-95
hyoid bone, 95-96
hypoglossal nerve, 95, 96
incision techniques, 93, 93
indications, 89-90
longus colli-capitis muscles, 96, 97
median tubercle (1 anterior arch, 98, 98
patient positioning, 92, 93
patient selection, 91
platysma muscle, 94, 94-95
submandibular gland, 94, 95
superficial anatomical landmarks, 94-96
superior pharyngeal constrictor muscle, 96, 97
tectorial membrane, 99
transverse cervical ligament, 98, 99
Rheumatoid arthritis
craniocervical junction pathology, 53
occipitocervical junction, 13-20
atlantoaxial rotatory subluxation, 19
..
atlantoaxial subluxation, 15,16-19
basilar invagination, 14-16, 15,17
clinical presentation, 14
epidemiology, 13
natural history, 13-14
outcomes, 19-20
pathogenesis, 14
posterior atlantoaxial subluxation, 19
Rhizotomy
dorsal rhizotomy, cerebral palsy spasticity, 771-775,773-775
lumbar/lumbosacral nerve roots, 651-656
Rib head removal
thoracic vertebrectomy, 433-434, 434
transthoracic diskectomy, 428-429, 429
Ribs/spinal column anatomy, transthoracic surgical approach,
thoracic/thoracolumbar spine, 337,337-338
Right- vs. left-sided approach, anterior cervical spine surgery,
195,195-196
Riskfactors
carpal tunnel syndrome, 898, 899t
lumbar degenerative disk disease, recurrence risk, 562
Rodselection criteria
lumbar/lumbosacral spine surgery, Luque instrumentation,
698
subaxial cervical spine stabilization sublaminar cable
placement, 269,269
Rostral extension, midline tumor resectioning, 65-68, 65-68
S
Sacral agenesis, posterior surgical management, 765-770
anesthesia and patient positioning, 765, 766
dural sac stenosis, 769, 772
lipomyelomeningocele and intraspinal lipomas, 766,768-769,
769
tethered cord and filum terminale, 765-766,766-768
Sacral dimples, congenital dermal sinus/dermoid excision,
721-722,722
Sacral plexus
anatomy, 945, 946
surgical technique, 946, 947,948
Sacrococcygealteratoma, posterior resection, 723-727
Sagittal plane deformities
cervical spine, 158-159
thoracic extension osteotomy, 463-467, 464-467
Saphenous nerve entrapment, 905
Schwannomas
cervical, intradural extramedullary tumor resectioning,
290-293,292-293
peripheral nerves, 879-881, 880-881
Sciatic nerve
anatomy, 946, 957-958, 959-960
lumbosacral plexus surgery, 948
surgical techniques, 958, 959
Scleroderma, craniocrevical junction, 53
Sclerotome cells, thoracic/thoracolumbar spine congenital
abnormalities, 355
Scoliosis
congenital anomalies, 363, 363t-364t
intramedullary spinal cord tumor surgery, 287
mid- to lower-spine osseous anomalies, 158
Screw fixation
anterior surgical approach
cervical spine plating, 202-203,202-204
reconstruction following decompression, 333
anterolateral graft and plate reconstruction, 439, 439-440
cervical spine, trauma, 181-188, 182-187
lateral mass plate, cervical spine stabilization, 275,276-277, 277
1020
Index
Screw fixation (Continued)
lumbar/lumbosacral spine
posterior interbody fusion and trans pedicular screw
fixation, 681-689
tumors
complications, 577-578
posterior stabilization, 575-576, 576
microendoscopically assisted transforaminallumbar
interbody
fusion, 863-865, 864-865
odontoid fractures, 41
advantages/disadvantages, 218-219
anesthesia, 219
indications/contra indications, 218
outcomes, 223-224
patient positioning, 219,219
postoperative care, 223
surgical technique, 219-220, 220-223, 222
posterior atlantoaxial stabilization, 136-138, 137-138
rheumatoid arthritis
atlantoaxial subluxation, 18-19
basilar invagination, 16
thoracic spine, pedicle screw instrumentation, 542-544,
543-544
SCSlead placement, percutaneous spinal cord stimulator
implantation, 837,838
Seat-belt injuries, lumbar/lumbosacral spine trauma, 583, 583
Seddon classification system, peripheral nerve trauma, 891,891
Segmental placode, open myelomeningocele, 739, 739
Segmental spinal dysgenesis, pathophysiology, 368, 368
Segmentation errors, thoracic/thoracolumbar congenital
abnormalities, 364-365, 364-366, 364t
Selective dorsal rhizotomy (SDR),lumbar/lumbosacral nerve
roots, 651-656
Semisegmented hemivertebra, pathology and management, 365
Sensorimotor deficits, spinal cord lipoma surgery, 750
Septum resection, split cord malformation, 765-767,765-767
Sequestered disk fragments, arthroscopic and endoscopic
microdiskectomy, posterolateral approach
nonmigrated disk herniation, 819,822
transforaminal access, 819,822, 823
Serial dilation
microendoscopically assisted transforaminallumbar
interbody
fusion, 860, 861-862
microendoscopic decompression, lumbar stenosis, 853, 854,855
microendoscopic diskectomy, 847-848, 848-849
Shunt techniques
lumboperitoneal shunt, 648-650
open spinal dysraphism surgery, myelomeningocele,
cerebrospinal fluid leakage, 738-739
syringoperitoneal shunting, 534-536
syringopleural shunting, 519-526
syringosubarachnoid shunting, 530-533
Simultaneous combined anterior-posterior approach,
lumbar/lumbosacral spine tumors, total en bloc
spondylectomy and, 576-577
Single photon emission Cf (SPECf),thoracic/thoracolumbar
spine tumors, 382
Skin closure, open spinal dysraphism, myelomeningocele, 736,
736-737
Skull base techniques, foramen magnum surgery, 11,l1t
Softtissue incision, intramedullary spinal cord tumor surgery,
280
Soft tissue swelling, craniocervical junction, transoral
complications, 58
Solitary plasmacytoma of bone (SPB),cervicothoracicjunction
plasma cell dyscrasias, 302-303
Somatosensory evoked potentials (SSEPs)
.,
intermedullary spinal cord tumor surgery, 171,172
intramedullary spinal cord tumor surgery, 287
meralgia paresthetica diagnosis, 986
microendoscopically assisted transforaminallumbar interbody
fusion, 859
microforaminotomy, anterior approach, cervical spine,208
spinal cord lipomas, 744
transmanubrial transclavicular surgery, cervicothoracic
junction, 319-320
transoral preoperative evaluation, craniocervicaljunction, 56,
57
transsternal surgery, cervicothoracic junction, 314
Somite formation, thoracic/thoracolumbar spine congenital
abnormalities, 355
Spasticity, lumbar/lumbosacral nerve roots, rhizotomy,652-656
Spina bifida aperta
dysplastic (congenital) spondylolisthesis, 369-370
thoracic/thoracolumbar spine congenital abnormalities, 356,
356-357
Spinal accessory nerve (SAN)
anatomy, 919-920, 920
surgical approach to, 919-922
injury repair, 922, 922
Spinal anatomy
cervicothoracic junction tumors, 297-298
thoracoscopically-asssisted spinal surgery, 803-804, 803-804
Spinal cord
arteriovenous malformations, 481-484, 482-483
cervical stenosis and, 167, 167
in children, 402, 403t
decompression, microforaminotomy, anterior approach,
211-213,212-213
injury
craniovertebral junction trauma, 32t
dorsal root entry zone surgery, 509-511, 510-511
intermedullary tumors, 169-175
anesthesia, 171
complications, 175
neurophysiological monitoring, 171-172, 172
patient positioning, 172
postoperative care, 174
radiological evaluation, 170, 170-171
surgical techniques, 171-173, 174
treatment indications, advantages and disadvantages, 169
intramedullary spinal cord tumors, surgical management,
279-287,280t
lipomas, posterior surgical approach, 741-750
dorsal/transitional lipomas, 742,742-745, 745-746
electrophysiological monitoring, 744
embryogenesis, 742-743, 742-744
outcomes, 750
terminal lipoma, 743,744,749,749-750
transitional lipomas, 745-749,747-749
normal vascular anatomy, 479-480, 479
postherpetic pain in, dorsal root entry zone operation, 513-514
segmental placode, open myelomeningocele, 739, 739
stimulation, percutaneous spinal cord stimulator implantation.
831-836
syringopleural shunting, exposure of, 525
trauma, microforaminotomy, anterior approach, 215
tumors, microforaminotomy, anterior approach, 213-216.215
Spinal cord injury without radiographic abnormalities
(SClWORA),in children, 402, 403t
Spinaldysraphism.SeealsoSpinalcord,Lipomas
embryology of, 355
posterior surgical approach, 729-757
cerebrospinal fluid leakage, 738-739
Index
1021
classification, 730t
complications, 737-739
dural closure, 735,735-736, 737
embryogenesis, 751, 752,753, 754
embryology, 730, 730-733, 732
kyphectomy and open myelomeningocele, 739-741, 740-741
limited dorsal myeloschisis, 751,751-755, 756-757
myelomeningoceles, 730
neural placode, 734-735, 736
open myelomeningocele, segmental placode, 739, 739
patient positioning and sterile preparation, 734
postoperative care, 737
sac opening procedure, 734,735-736
skin and myofascial closure, 736.736-737
surgical indications and treatment, 755, 756-757
wound dehiscence, 737-738
wound infection, 738
terminal syringohydromyelia, 374
thoracic/thoracolumbar spine congenital abnormalities, 355,
355t
occult conditions, 357,357t
Spinal meningeal cyst (MC),thoracic/thoracolumbar congenital
abnormalities, 372
Spine. See Cervical spine
Spinous process
Bohlman triple-wire technique, 255,256
lumbar/lumbosacral laminectomy, 620-621, 620-622
posterior fusion, Luqueinstrumentation, 702, 702
titanium rectangle technique, 260,261
Splanchinectomy, lower thoracic region, 423-425, 424-425
Split cord malformations (diastematomyelia), 360-361, 361
posterior surgical repair, 759-764,760-764
Spondylolisthesis
in children, 549-553
definitions, 549-550
dysplastic (congenital), 369-370,369-370
Spondylolysis
craniocrevical junction, transoral techniques, 53
hangman's fractures, occipitocervicaljunction, 43
Spondyloptosis
in children, 552
dysplastic (congenital) spondylolisthesis, 369-370. 369-370
Spondylosis
cervical spine degenerative disease, 165-168
cervical stenosis and, 167,167
Spondylotic myelopathy, microforaminotomy, anterior approach,
cervical spine, spinal cord decompression, 211-213,
212-213
Spontaneous atlantoaxial rotatory fixation, occipitocervical
junction, 20, 20-21
Sprengel's deformity, Klippel-Feilsyndrome, 157-158, 158
Stabilization. SeealsoInstability
cervical spine, trauma
anterior techniques, 178-181
combined posterior-anterior technique, 190
initial assessment with, 176
posterior techniques, 181-190
clamp and hook systems, 188
facet wiring, 188
Hartshill rectangle, 190
interspinous wiring, 188, 189,190
lateral mass plates and screws, 181-188, 182-187
sublaminar wiring, 190
of craniocervical junction abnormalities, treatment
options, 11,11t
lumbar/lumbosacral spine
plate stabilization, 610
tumor management, 574-576,575-576, 575t
posterior approaches
Bohlman triple-wire technique, 254-256,255-257
interfacet wire stabilization, cervical spine, 271-273
lateral mass plates, cervical spine, 274-278
occipitocervical fusion, 118-121, 119-120
subaxial cervical spine, sublaminar cable placement,
267-270
titanium rectangle technique, 258-261,259-262
thoracoscopic anterior internal stabilization, 806-807,
808-809
Staging system, thoracic/thoracolumbar spine tumors, 386-388,
386-387, 386t
Stenosis
cervical spine degenerative disease and, 164-168, 167
dural sac, posterior surgical approach, 769, 772
Klippel-Feilsyndrome anomalies
evaluation of, 161-162
spinal stenosis and instability, 162
lumbar/lumbosacral spine, 618,618t
microendoscopic decompression, 852-858
Stereotactic techniques, lateral mass plate, cervical spine
stabilization, 275,276-277, 277
Sternal-occipital-mandibular-immobilization
(SOMI)brace
atlas fractures, 39
occipitocervical junction fractures, 39
Sternocleidomastoid (SCM)muscle
spinal accessory nerve (SAN)anatomy, 919-922
supraclavicular surgical technique and, 307-310, 309-311
transmanubrial transclavicular surgery, cervicothoracic
junction, 320, 322
Sternotomy,transsternal surgery, cervicothoracicjunction, 315,316
Stretch injury, brachial plexus, supraclavicular surgical repair,
911-921, 912-913
Strut grafts, anterior decompression surgery, reconstruction
following, 330-334, 331t, 332, 334
Struther's ligament, median nerve entrapment, 896, 896
Subaxial cervical spine stabilization, sublaminar cables, posterior
approach,267-270
Subcutaneous pocket formation, percutaneous spinal cord
stimulator implantation, 834-836, 834-836
Sublaminar cables
cervical spine trauma, 190
posterior cervical spine stabilization, 267-270
Sublaminar wire placement
Brooks fusion technique, C1-C2junction, 141,141
titanium rectangle technique, 260,261
Sublaminar wire preparation and passage, posterior fusion,
Luque instrumentation, 698-699, 700
Submandibular gland, retropharyngeal approach, occipitocervical
junction, 94, 95
Suboccipital craniectomy, Chiari malformation, 115-117, 116-117
Superior laryngeal nerve (SLN),retropharyngeal surgical ap-
proach, 95-96
Superior pharyngeal constrictor muscle, retropharyngeal surgical
approach, 96, 97
Supraclavicular surgical approach, cervicothoracic junction,
306-310,307-311
Supracondylar process, median nerve entrapment, 896, 896
Suprascapular neuropathy, 902-903, 903
Sural nerve
anatomy, 966, 967
biopsy, 967-969, 968
entrapment neuropathy, 973, 973
harvesting techniques, 969-970, 970
injury, 971-972
neuromas, 972,972
1022
Index
Surgical techniques. See alsospecific approaches, e.g. Anterior
surgical approach
anterolateral graft and plate reconstruction, 436-440, 437-440
axillary nerve surgery, 923-927
Bohlman triple-wire technique, posterior stabilization,
255-256,255-257
caudalis DREZ,515-520, 516-519
cavernous angiomas, 485-488, 486-487
cervical foraminotomy, 248-249,248-249
cervical laminectomy, 233-234,235-237, 236
congenital kyphosis, 366-367, 367
congenital lordosis, 367-368
dorsal root entry zone operation, 503-505, 504
paraplegia with cyst, 511-513, 512-513
postherpetic pain management, 513-514
spinal cord injury, 509-511
dorsal root entry zone surgery
brachial plexus avulsion, 505-507, 505-507
conus medullaris avulsion, 507-509, 508-509
encephaloceles, occipitocervical junction, 122-127
advantages/disadvantages, 122-123
indications/contraindications, 122
outcomes, 127
surgical techniques, 123, 124-126
epidural abscess, 456-458, 457
femoral nerve, 955, 956
hemivertebra management, 365-366
intramedullary spinal cord tumors, 280-286,281-286
kyphoplasty, 870, 871-872
laminoplasty, thoracic/thoracolumbar spine, 452-455,
453-454
lateral femoral cutaneous nerve, 953, 954, 955
lipomas, 359-360, 360
lipomyelomeningocele, 359, 359
lower extremity nerves, 953-964, 954-965
lumbar/lumbosacral spine
cauda equina ependymoma resectioning, 658-659, 659
degenerative disk disease, 555-563
foraminotomy, 630-633, 631-633
laminectomy, 619-624, 619-624
lipoma resectioning, 669-670, 669-673, 672
rhizotomy, 652-656
tethered spinal cord release, 662-663, 662-664
trauma management, 586, 587
tumors, 571-577, 571t, 572, 575-578, 575t
lumbosacral plexus, 946, 947,948
musculocutaneous nerve, 928-931
nerve graft harvesting and repair, 990-993, 991-993
neurenteric cyst removal, 358, 358
obturator nerve, 957
odontoid screw placement, 219-223,220-223
peripheral nerve trauma, 893, 893-894
peroneal nerve, 963,964-965
rheumatoid arthritis
atlantoaxial subluxation, 18-19
basilar invagination, 16
outcomes, 19-20
sciatic nerve, 958, 959-960
segmental spinal dysgenesis, 368, 368
spinal accessory nerve, 919-922, 921-922
spondylolisthesis, in children, 552-553
syringopleural shunting, 522-526, 522-526
terminal syrongohydromyelia, 374
tethered cord syndrome, 362-363, 363
thoracic/thoracolumbar spine tumors, 388, 389
chondrosarcoma, 393
chordoma, 392-393
.
metastatic tumors, 393-394
transthoracic surgical approach, 427-430
vertebroplasty, 867-870, 868-870
Suture repair
axillary nerve decompression, 927
lumbosacral plexus surgery, 948
Sympathectomy
via costotransversectomy, 446-447
lumbar/lumbosacral spine, 609
thoracic/thoracolumbar spine, 421-425, 422-425
endoscopic sympathectomy, 793-798
Sympathetic chain exposure
endoscopic sympathectomy, 794, 794
lower thoracic sympathectomy/splanchnicectomy, 423-425,
424-425
upper thoracic ganglionectomy, 422-423, 422-423
Synthes cervical spine locking plate, reconstruction following
decompression, 333, 334
Syringomyelia
choice of surgery, 536, 536t
etiology, 521t
lumbar/lumbosacral spine lipomas, 667-673, 667-674
syringopleural shunting, 521-529,522-528
syringosubarachnoid shunting, 530-533
thoracic/thoracolumbar spinal defects, 373, 373-374
Syringoperitoneal shunting, thoracic/thoracolumbar spine,
534-536
Syringopleural shunting, thoracic/thoracolumbar spine, 521-529
Syringosubarachnoid shunting, thoracic/thoracolumbar spine,
530-533
Systemic complications, lumbar/lumbosacral tumor surgery,578
T
Tarlov's perineural cysts, thoracic/thoracolumbar congenital
abnormalities, 372
Tarsal tunnel syndrome, 905-906, 906
Tectorial membrane
occipitocervical junction tumor mechanics and, 25,25
retropharyngeal surgical approach, 99
Tension band reconstruction, posterior surgery, locked/perched
facet exposure and release, 266
Terminal spinal cord lipoma
classification, 741-742
embryogenesis, 743, 744
surgical management, 749, 750
Terminal syringohydromyelia, 374
Tethered cord syndrome
posterior release techniques, 661-665
sacral agenesis, 765-766,766-768
thoracic/thoracolumbar congenital abnormalities, 362-363,
362
Thecal sac exposure, transthoracic surgical approach, upper
thoracic spine, 347,347
Therapeutic algorithm, thoracic disk herniation, 470, 471
Thoracic cage opening, transthoracic surgical approach, lateral
parascapular extrapleural exposure, upper thoracic spine,
345,346-347, 347
Thoracic inlet, cervicothoracic junction, transsternal surgery and,
312,313
Thoracic outlet syndrome (TOS),904
Thoracic/thoracolumbar spine
anterolateral graft and plate reconstruction, 436-440, 437-440
arteriovenous malformations, 478-488
cavernous angiomas, 485-488, 486-487
classification, 479t
dural AVFs,480, 480-481
intradural AVMs,481
Index
1023
normal vascular anatomy, 479, 479-480
intradural (perimedullary) AVFs,484, 485
spinal cord AVMs,481-484, 482-483
surgical technique, 480
caudalis dorsal root entry zone, 515-519
commissural myelotomy, 498-502, 499-502
congenital abnormalities
dermoids, epidermoids, and dermal sinus tracts, 361-362,
361-362
diastematomyelia (split cord malformations), 360-361, 361
dysplastic (congenital) spondylolisthesis, 369-370,
369-370
embryology, 354-355
epidemiology, 353-354
extradural arachnoid cysts, 372
extradural meningeal cysts, 372
extradural spinal cysts, 372
formation errors, 364 365-366
hydrosyringomyelia, 373-374,373
intradural spinal cysts, 370-372, 371
intraspinal cysts, 370
Klippel-Feilsyndrome, 370
kyphosis, 366-367, 367-367
lipomas, 359-360, 360
lipomyelomeningocele, 359, 359
lordosis, 367-368
meningoceles, 357
lateral/anterior, 372-373
neuroenteric cysts, 358
radiological evaluation, 354
scoliosis, kyphosis, and lordosis, 158
segmental spinal dysgenesis, 368, 368
segmentation defects, 364-365,364-365
spina bifida aperta (myelomeningocele), 356,356-357
spinal dysraphism, 355, 355t
occult, 357, 357t
Tarlov's perineural cysts, 372
terminal syringohydromyelia, 374
tethered cord syndrome (tight filume terminale), 362,
362-363
vertebral bodies, 363, 363t-364t
costotransversectomy, 441-447
diskectomy via, 441-442
surgical technique, 442-446, 442-446
sympathectomy via, 446-447
disk disease, 378-381
disk herniation management, 469-477
diagnostic algorithm, 470, 471-472
radiological evaluation, 470
surgical technique, 472-475,473-475
transpedicular approach, 472
DREZoperation,503-514,503-513
brachial plexus avulsion, 505-507, 506-507
conus medullaris avulsion, 507-509, 508-509
paraplegia with cyst, 511-513, 512-513
postherpetic pain, 513-514
spinal cord injury, 509-511, 510-511
surgical technique, 504-505, 505
endoscopic sympathectomy, 793-798
epidural abscess, 456-462, 457-458, 460-461
etiology and pathogenesis, 456-457, 457
imaging studies, 458-459, 458
management, 459
outcomes, 461
pathophysiology and clinical manifestations, 458
surgical technique, 459-461, 460-461
extension osteotomy, 463-468, 464-467
=..;a:;:;~
intradural extramedullary tumor, resectioning, 489-494,
490-493
laminectomy, 448-451, 449-451
laminoplasty, 452-455, 453-455
lateral transthoracic approach, 405-412
advantages/disadvantages, 406
complications, 411-412
indications/contraindications, 405-406
postoperative care, 411
surgical techniques, 406-411, 406-411
open anterolateral cordotomy, 495-497, 496
posterior surgical approach
pedicle screw instrumentation, 542-544
in situ fusion, 538-541
retroperitoneal approach and closure, 417-420,
418-420
sympathectomy, 421-425, 422-425
syringoperitoneal shunting, 534-536
syringopleural shunting, 521-529
syringosubarachnoid shunting, 530-533
thoracoabdominal approach and closure, 413-416,
414-416
transthoracic surgical approach
cervicothoracic junction, 335-342, 336t
chest wall anatomy, 336
complications, 342
decompressive techniques, 340-342, 341
ribs/spinal column, 337-338, 337-339
surgical technique, 338-340, 339-340
diskectomy, 426-430
trauma, 396-404, 397
anatomy and biomechanics, 397.397-398
burst fracture, 398t, 398-400, 400
flexion-distraction injuries, 400, 401
fracture-dislocations, 401, 402
injury classification, 398-399, 399t
neurological injury, 402-403, 403t
radiological evaluation, 403
wedge compression fracture, 399-400
tumors, 383-395
aneurysmal bone cyst, 390
benign, 389-391, 389t
biopsy, 385
chondrosarcoma, 393
chordoma, 392-393
differential diagnosis, 389-394
eosinophilic granuloma, 391
epidemiology, 383, 383t
Ewing's sarcoma, 392
giant cell tumor, 390
hemangioma, 390
laboratory evaluation, 386
lymphoma, 393
malignant, 391-393, 394t
metastases, 393, 394t
multiple myeloma and plasmacytoma, 391-392
osteochondroma, 389-390
osteoid osteoma and osteoblastoma, 390
paraspinal soft tissues sarcoma, 393
primary osteosarcoma, 392
prognosis, 389
radiological evaluation, 384-385
staging systems, 386-388
symptoms, 384
treatment, 388, 389
Thoracoabdominal approach and closure, thoracic/
thoracolumbar spine, 413-416, 414-416
!JI!!I!!I!!I!!!
1024
Index
Thoracoscopically-asssisted spinal surgery
advantages/disadvantages, 800
contraindications. 800
diskectomy,801-805, 803-804
indications, 799-800
patient preparation, 800-801
portal placement, 801,802
preoperative planning, 800
spinal anatomy and spinal canal exposure, 803-804, 803-804
surgical technique, 801, 802
thoracoscopic anterior internal stabilization, 806-810,
808-809
thorascopic corpectomy and vertebral reconstruction,
805-806
Thoracoscopic sympathectomy
complications, 798, 798t
techniques and outcomes, 797, 797t
Thoracotomy, transsternal surgery, cervicothoracic junction,
315-316,316-317
Threaded fusion cages, posterior lumbar interbody fusion,
lumbar/lumbosacral spine, 684-685, 686
Threaded fusion posterior lumbar interbody fusion, cage
instrumentation, 685-686. 686
Thyroid cancer, cervicothoracic junction tumors, 300
Tibial nerve, surgical techniques, 958, 961-962, 963
Tight filum terminale, 362. 362-363
Tinel's sign
carpal tunnel syndrome, 898
ilioinguinal neuralgia, 981
Titanium loop, occipitocervical fixation, 11,11t
Titanium miniplates, cervicallaminoplasty, 242,243-244
Titanium rectangle technique, posterior stabilization, 258-261.
259-261
Tomograms, Klippel-Feilsyndrome anomalies, 160
Torticollis,congenital mid- to lower cervical spine osseous
anomalies, 157,157
Total en block spondylectomy, lumbar/lumbosacral tumors
dissection techniques, 572-573
simultaneous combined anterior-posterior approach, 576-577
Tracheostomy, extended maxillotomy and, 81
Traction techniques
intradural extramedullary tumor resectioning, 492, 492
occipitocervical junction trauma, occipitoatlantalligament
dislocation, 34
Transarticular screw fixation, posterior atlantoaxial stabilization,
137,137
Transfacet pedicle-sparing approach, thoracic disk herniation,
473-475.472-474
Transforaminal access
arthroscopic and endoscopic microdiskectomy, posterolateral
approach, sequestered disk fragments, 819.822, 823
microendoscopically assisted transforaminallumbar
interbody
fusion, 859-865
Transient catheter burial, syringoperitoneal shunting, 535
Transitional spinal cord lipoma
classification, 741
embryogenesis, 742.742-743
surgical management, 745-747, 747-748
Transmandibular approach, craniocervical junction, 49, 50
Transmanubrial transclavicular approach. cervicothoracic
junction surgery, 318-325, 320-324
Transoral surgical approach
closure techniques, 73-78
advantages/disadvantages, 73
objectives, 73
postoperative bulbar function and oral cavity dysfunction,
77-78
postoperative management, 76-77
surgical techniques, 73-76
craniocervical junction, 57.57-58
advantages, 52
anatomy, 51.52
anesthesia protocols, 56-57
bone softening diseases and metabolic disorders. 53-54
classic approach, 48-49, 49
clinical presentation, 54-55
complications, 58
congenital malformations, 53, 54
contraindications, 52
disadvantages, 52
extended approach, 49, 50
indications, 52
infections, 54
nonrheumatoid cranial settling and atlantoaxial instability,
53
objectives, 52-53
odontoid fractures and os odontoideum, 53
outcomes, 58
preoperative evaluation, 56-57,57
radiological evaluation, 54. 55, 56
rheumatoid arthritis, 53
surgical techniques, 57.57-58
tumors. 54, 54
midline tumor resectioning, 64-71
odontoidectomy
advantages/disadvantages, 60
contraindications, 60
indications, 60
objectives, 60
outcome. 62
radiological evaluation, 60-61
surgical techniques, 61-62
midline posterior pharyngeal incisions, 61-62, 61-62
resection, 62, 62
retractor insertion, 61
Transpectoral dissection, musculocutaneous nerve surgery,
929-930,930-931
Transpedicular approach
epidural abscess, 459, 460
posterior lumbar interbody fusion and screw fixation,
681-689
thoracic disk herniation, 472-475, 473-475
Transperitoneal surgical approach, lumbar/lumbosacral tumors,
573-574
Transsternal surgical approach, cervicothoracic junction,
312-317,313-317
Transthoracic surgical approach
cervicothoracic junction
lateral parascapular extrapleural exposure, upper spine,
343-348,344-349
closure techniques, 348
diskectomy, 347
musculocutaneous flap, 344-345, 344-346
vertebral reconstruction, 348, 349
thoracic spine, 335-342, 336t
chest wall anatomy, 336-337
complications, 342
decompressive techniques, 340-342,341
ribs/spinal column, 337-338, 337-338
surgical technique, 338-340, 339-340
diskectomy, 426-430
vertebrectomy, 431-435
Transverse cervical ligament, retropharyngeal surgical approach,
98,99
Index
1025
Transverse lesion syndrome, cervical spine symptoms, 166
Transverse ligament
occipitocervical junction trauma, 34-35,35-38
occipitocervical junction tumor mechanics and, 25,25
Transverse process fusion, lumbar/lumbosacral spine, 675-680
hook-rod fusion instrumentation, 695
Trauma. See alsospecific types of trauma, e.g. Fractures
brachial plexus avulsion, dorsal root entry zone surgery,
505-507, 506-507
cervical spine
anterior plating, 180-181, 181
anterior stabilization, 178-181
decompression and arthrodesis, 178-179, 178-181
anterior vs. posterior surgical technique, 177
combined posterior-anterior stabilization, 190
initial assessment and stabilization, 176
patient positioning and anesthesia, 177-178
posterior stabilization, 181-190
clamp and hook systems, 188
facet wiring, 188
Hartshill rectangle, 190
interspinous wiring, 188, 189,190
lateral mass plates and screws, 181-188, 182-187
sublaminar wiring, 190
radiological evaluation, 176-177
conus medullaris avulsion, dorsal root entry zone surgery,
507-509,508-509
Klippel-Feilsyndrome anomalies and, 162
lumbar/lumbosacral spine
anatomy, 580-581
classification, 581,581, 581t
diagnosis, 585, 585t
injury mechanisms, 581-584, 581-585, 583t
treatment, 586, 587
occipitocervical junction, 31-46
isolated fractures, 33t, 38-46, 39t
atlas-axis fractures, 32t, 39t, 44-45, 45-46
atlas fractures, 35-38,39, 39t, 40-42
C2 fractures, 39t, 43-44
hangman's fractures, 39t, 41,43, 44
odontoid fractures, 39, 39t, 41,42-43
isolated ligamentous injuries, 31-38
occipitoatlantal dislocations, 31-34, 32-34, 32t
rotatory C1-C2dislocations, 35,38
transverse ligament injuries, 34-35, 35-38
nonoperative treatment, failure of,46
peripheral nerve, 888-894
axonotmesis, 891
electrodiagnostic evaluation, 891-892
electrophysiological monitoring, 893
grading, 891
neurapraxia, 891
neurotmesis, 891
postoperative management, 889
preoperative evaluation, 890, 890
radiological evaluation, 892-893, 892-893
surgical management, 893, 893-894
sural nerve injury, 971-973
thoracic/thoracolumbar spine, 396-404, 397
anatomy and biomechanics, 397,397-398
burst fracture, 397,398t, 399-400, 400
flexion-distraction injuries, 400, 401
fracture-dislocations, 401,402
injury classification, 397-399,398-399,
398t
neurological injury, 402-403, 403t
radiological evaluation, 400, 403
wedge compression fracture, 399, 399
Tumors
anterolateral graft and plate reconstruction, 438-440
cervicothoracic junction, 297-304
anatomy, 297-298
chondroscarcoma, 301
chordoma, 303
extraspinal anatomy, 298
laboratory analysis, 299
metastatic lesions, 299-300, 299t
nonneoplastic mass lesions, 303-304
nonspinal metstatic lesions, 300
osteoblastoma, 301
osteochondroma, 300-301
osteoid osteoma, 301
osteosarcoma, 302
plasma cell dyscrasias, 302-303
radiological evaluation, 298, 298t
spinal anatomy, 297-298
craniocervical junction, transoral approaches, 54, 54
intradural extramedullary tumors, posterior resectioning,
289-295
intramedullary spinal cord tumors, surgical management,
279-287,280t
intraspinal lipomas, sacral agenesis, posterior surgical
approach, 766, 768-769, 769
lumbar/lumbosacral spine
anterior/anterolateral approaches, 573-574
classification, 567,568t
clinical presentation, 567-568
complications, 577-578
diagnosis, 569
dissection, 571-573, 572
embolization, 570, 571
ependymoma resection, 657-659
indications for surgery, 569-570, 569t
lipoma resection, 666-674
metastatic tumors, 569
posterior/posterolateral approach, 571,571t
posterior stabilization, 574-576, 575-576, 575t
primary tumors, 569-570, 569t, 570
radiological evaluation, 568-569
retroperitoneal approach, 573
sacrococcygeal teratoma resectioning, 723-727
simultaneous combined anterior-posterior approach/total
en bloc spondylectomy, 576-577
transperitoneal approach, 573-574
vertebral body reconstruction, 575
vertebrectomy, 575
lumbar/lumbosacral spine total en bloc spondylectomy,
572-573
lumbosacral plexus, 950-952, 951-952
occipitocervicaljunction, 23-30, 30t
anatomy and biomechanics, 23-25,24-25
benign tumors, 28
chondrosarcoma, 28
chordoma, 27-28, 27t, 28
differential diagnoses, 26-27
glomus jugulare, 29-30
lymphoma, 28
malignant tumors, 28-30
medical evaluation, 26
meningioma, 29
multiple myeloma, 29
nasopharyngeal carcinoma, 28
neurological evaluation, 25-26
radiological evaluation, 26
solitary plasmocytoma, 29
1026
Index
Tumors (Continued)
peripheral nerves, 879-886
spinal cord
anterior microforaminotomy, 213-216,215
intermedullary tumors, 169-175
anesthesia, 171
complications, 175
neurophysiological monitoring, 171-172, 172
patient positioning, 172
postoperative care, 174
radiological evaluation, 170, 170-171
surgical techniques, 171-173. 174
treatment indications, advantages and disadvantages, 169
lipomas, posterior surgical approach, 744-750
dorsal/transitional lipomas, 742.742-745, 745-746
electrophysiological monitoring, 744
embryogenesis, 742-743.742-744
outcomes, 750
terminal lipoma, 743-744, 744.749, 749-750
transitional lipomas, 745-749,747-749
sural nerve neuromas. 972, 972
thoracic/thoracolumbar spine, 383-393, 394t
aneurysmal bone cyst, 390
benign, 389-391, 391t
biopsy, 385
chondrosarcoma, 393
chordoma, 392-393
differential diagnosis. 389-393, 394t
eosinophilic granuloma, 391
epidemiology, 383, 383t-384t
Ewing's sarcoma, 392
giant cell tumor, 390
hemangioma. 390
intradural extramedullary tumor, resectioning, 489-493
laboratory evaluation. 386
lymphoma, 393
malignant. 389-393
metastases. 391,394t
multiple myeloma and plasmacytoma, 391-392
osteochondroma, 389-390
osteoid osteoma and osteoblastoma, 390
paraspinal soft tissue sarcoma, 393
primary osteosarcoma, 392
prognosis, 389
radiological evaluation, 384-385, 385t
staging systems, 386-387, 386-388. 386t, 394t
symptoms, 384
treatment, 388, 389
transoral closure, 73-78
Tunnel techniques
computer-assisted lumbar fusion, 592-593, 593
percutaneous spinal cord stimulator implantation, 834-836,
834-836
U
Ulnar nerve
compression (Guyon's canal syndrome). 901-902, 902
fibroma, surgical removal, 881-873, 883
schwannoma, surgical removal, 880-881. 880-882
surgical techniques, 937-942, 938-942
Ultrasound techniques
aspirator and laser, intramedullary spinal cord tumor surgery,
280
navigation, intramedullary spinal cord tumor surgery,
281.282
syringopleural shunting, 523. 524, 526
syringosubarachnoid shunting, 531
Unilateral canal enlargement, cervicallaminoplasty, 241-243,
242-244
Unilateral laminectomy, syringopleural shunting, 523, 524
Upper extremity pain syndromes, endoscopic sympathectomy,
794
Upper thoracic ganglionectomy, thoracic/thoracolumbar spine,
422-423,422-423
V
Vascular injury
anterior cervical spine surgery, 205
craniocervical junction, transoral complications. 58
microforaminotomy, anterior approach, spinal cord tumors,
215
trans manubrial transclavicular surgery, cervicothoracic
junction. 322-323, 324
Vascular tumors, cervicothoracic junction plasma cell dyscrasias,
303
Velopharyngeal dysfunction
craniocervical junction, postoperative complications, 58
transoral closure procedures, postoperative assessment, 77-78
Vertebral artery exposure
extreme lateral transcondylar transtubercular approach,
anterior craniocervical junction, 146-147, 148-149
microforaminotomy, anterior approach, spinal cord tumors, 215
Vertebral axis tumors, classification, 567, 568t
Vertebral bodies
congenital anomalies, 363, 363t, 364t
lumbar/lumbosacral tumors, reconstruction, 575
Vertebral compression fractures (VCFs)
natural history and conservative management, 866-867
vertebroplasty/kyphoplasty, 866-874
patient evaluation and selection, 867
Vertebral reconstruction
lumbar/lumbosacral spine, 599, 601
nerve root rhizotomy, 653, 654-655
retroperitioneal approach, 843, 844
thoracoscopically-asssisted spinal surgery, 805-806, 807
transthoracic surgical approach, lateral parascapular
extrapleural exposure, upper thoracic spine, 348, 349
Vertebrectomy
lumbar/lumbosacral spine
anterolateral retroperitoneal approach, 610
decompressive techniques, 599
retroperitioneal approach, 841.842-843. 843
tumor surgery, 575
transthoracic surgical approach, 326-329,327-329
anesthesia, 433
closure, 435
diskectomies and corpectomy. 434, 434-435
incision and dissection, 433, 433
indications/contraindications, 431
lateral parascapular extrapleural exposure, upper thoracic
spine, 348, 348
patient positioning, 432. 432-433
rib head removal, 433-434, 434
thoracic/thoracolumbar spine, 335, 336t
thoracic vertebrectomy, 341,341-342
Vertebrobasilar ischemia. craniocervical junction, transoral
approaches, 55
Vertebroplasty, 866-874
complications, 873
outcomes, 873
surgical techniques, 867-868, 868-870
Vertical pharyngotomy, extended maxillotomy, 85. 88
Visceral injury, anterior cervical spine surgery, 205
Vocalcord paralysis, microforaminotomy, anterior approach, 216
Index
1027
W
Wackenheim's line, occipitocervicaljunction trauma, 32
Wedge fracture, thoracic/thoracolumbar
spine trauma, 397,399,
399
White/Panjabi grading, lumbar/lumbosacral spine instability
classification, 581, 581t
Wholey dens-basion method, occipitocervical junction trauma
assessment, 32-33
Wildervank syndrome, facial-ocular deformities and hearing
deficits, 157
Wiltse classification, dysplastic (congenital) spondylolisthesis,
369-370,369-370
Winter classification, congenital kyphosis, 366-367, 366-367
Wire/cable passage, Bohlman triple-wire technique, 255-256,257
Wire techniques
Bohlman triple-wire technique, wire/cable passage,255-256, 257
cervical spine trauma
facet wiring, 188
interspinous wiring, 188, 189.190
sublaminar wiring, 190
interfacet wire stabilization, cervical spine, 271-273
lumbar/lumbosacral spine surgery, Luque instrumentation,
698-699,700
Work-related injuries, lumbar/lumbosacral disk surgery, 557
Wound infection, open spinal dysraphism surgery,
myelomeningocele, 738
y
V-shaped incision, suboccipital craniectomy, 115-117,116
Z
Z-shaped enlargement, cervicallaminoplasty, 241-243,242-244
A landmark work for all neuro- surgeons operating on the spine and peripheral nerves... Atlas of Neurosurgical Techniques: Spine and Peripheral Nerves presents complete state-of-the-art coverage of surgical techniques for the spine and peripheral nerves. This atlas engages the full range of approaches- anterior, anterolateral, posterior, and spanning posterolateral- for these operations. Each of the seven sections of the atlas opens with an in-depth discussion of pathology. etiology, and differential diagnosis that helps the practitioner master the underlying scientific principles of diseases and conditions of the spine and peripheral nerves. The authors then present technique-oriented chapters containing step-by-step descrip- tions of surgical procedures. These chapters delineate the goals, indications, contrain- dications, anesthesia considerations, positions, as well as the advantages and disad- vantages of each technique in a concise manner, ideal for the busy practitioner seeking review. Lavishly illustrated with more than 1,200 images, Atlas of Neurosurgical Techniques covers all of the critical issues involved in surgeries for the spine and peri- pheral nerves. Features of this text: • Easy-to-digest chapters address specific techniques • Clear outlines of indications, contraindications, as well as advantages and disad- vantages of each technique illuminate the rationale behind surgical management • Over 1,200 illustrations, including 811 beautiful four-color photographs and drawings aid the understanding of important concepts • Detailed discussion of disease pathology, etiology, and differential diagnosis Written by experts in the field, Atlas of Neurosurgical Techniques: Spine and Peri- pheral Nerves is an invaluable asset to neurosurgeons, orthopedic surgeons, and residents seeking a carefully edited, didactic atlas. With this text and its companion volume, Atlas of Neurosurgical Techniques: Brain, the authors provide a veritable encyclopedia of operative techniques in neurosurgery that clinicans can references repeatedly. Richard Glenn Fessler, M.D., Ph.D., is John Harper Seeley Professor and Chief, Section of Neurosurgery in the Department of Surgery, University of Chicago Hospitals, Chicago, Illinois. Laligam Sekhar, M.D., F.A.C.S., is Professor and Vice Chairman, Department of Neuro- surgery, University of Washington, Harborview Medical Center, Seattle, Washington. The Americas Rest of World ISBN 0-86577-987-2 ISBN 0-86577-987-2 (TNY) ISBN 3-13-127531-6 (GTV) ISBN 3-13-127531-6 9 780865 779877 9 783131 275318