Minimally Invasive Spine Surgery: A Practical Guide to Anatomy and Techniques PDF
Preview Minimally Invasive Spine Surgery: A Practical Guide to Anatomy and Techniques
burak ozgur o z g edward benzel u r • steven garfin b e n z EDITORS e l • g a r f Minimally i n E D I T O Invasive Spine R S Surgery M in im A Practical Guide a lly I n v a s to Anatomy and iv e S p in e S u Techniques r g e r y Minimally Invasive Spine Surgery Burak Ozgur Edward Benzel l l Steven Garfin Editors Minimally Invasive Spine Surgery A Practical Guide to Anatomy and Techniques 1 3 Editors BurakOzgur EdwardBenzel DirectorofMinimallyInvasive Chairman SpineSurgery DepartmentofNeurosurgery AssistantProfessorofNeurosurgery ClevelandClinicSpineInstitute DepartmentofNeurosurgery Cleveland,OH,USA Cedars-SinaiMedicalCenter LosAngeles,CA,USA StevenGarfin ProfessorandChair DepartmentofOrthopaedicSurgery UniversityofCalifornia-SanDiego USCDMedicalCenter SanDiego,CAUSA Figures1.1,1.2,1.8–1.10,3.1(a)and(b),3.2,3.3,3.4,9.1,10.1,11.1–11.5,and16.2werecreatedby CasparHenselmann. Figure3.1(c)wascreatedbyAliceY.Chen. ISBN978-0-387-89830-8 e-ISBN978-0-387-89831-5 DOI10.1007/978-0-387-89831-5 SpringerDordrechtHeidelbergLondonNewYork LibraryofCongressControlNumber:2009930940 #SpringerScienceþBusinessMedia,LLC2009 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewrittenpermission of the publisher (SpringerScienceþBusiness Media,LLC, 233 SpringStreet,New York, NY 10013,USA), exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Useinconnectionwithanyformof information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyarenot identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoingtopress, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the materialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScienceþBusinessMedia(www.springer.com) I dedicate this book to the support and guidance of my parents, the patience and trust of my professors, teachers, and patients, and certainly to the boundless love, compassion, and encouragement of my wife, Iman, and kids, Omar, Ali, and Hala. Burak M. Ozgur I dedicate this book to my wife, Mary. She perpetually provides advice, guidance and friendship. Her unending support is the source of my strength. Edward C. Benzel I dedicate this book to my mentors, colleagues, and trainees, who helped me (taught, inspired, and tolerated me) treat patients and teach others. Steven R. Garfin Foreword Unlikeanyothersurgicalspecialty,spinesurgeryhasevolvedrapidlyoverthepastthree decades.Ihavebeenfortunatetoobservethisevolutionoverthepast40yearsfromthe timeIstartedmyinternship.Atthattimespinesurgerywasnotafavoriterotationforthe house staff and used to take the back seat to all other, more interesting orthopedic procedures.Diagnostickneearthroscopywasjustbeingintroduced,andthatwasallwe knewoftheconceptoflessinvasivesurgery.Duringmytrainingasaresidentand,later,as afellowinspinesurgery,thefocuswasonfusiontechniques,especiallyforspinalfractures anddeformities.Althoughmanyprinciplesofspinecarehaveremainedthesameoverthe years, methods and surgical techniques have changed dramatically, as evident in mini- mallyinvasivespinesurgery(MISS).Mostofthesetechniqueshavewithstoodthetestof time,thoughsomedidnot,butallhavecontributedtoourunderstandingandknowledge ofspinesurgery. MISShasbeenamongthelatestadvancesinspinecare,leavingagreatimpactonhow wewilltreatfuturepatientswithspinaldisorders.Althoughotherspecialtieshaveenjoyed applyingthesemethodsoftreatmentforsometime,progressinMISSslowlyevolved.It startedwiththetreatmentofdiscdiseaseandnowincludesfusions,motionpreservation techniques,andevenspinalreconstruction.Consideringtheprogressmadeoverthepast 40years,Ibelievethatthesetechniqueswillcontinuetoevolveandimproveovertime. Educationplaysagreatroleforprogressinanyfield,inparticularinafieldasnewand demanding as MISS. Today, increased knowledge and understanding about principles and treatment outcomes along with advanced technology allow us to manage more effectivelythemanyconditionsofthespine.Indeed,wecouldnothaveevendreamedof thisadecadeago.However,theeducationinMISSshouldemphasizeprinciplesfirst.We should not forget that patient selection should occur on the basis of surgical indication ratherthanontheavailabletechniques,eveniftheyarelessinvasive. Theeditorsofthispublicationhavesuccessfullyassembledthecurrentstateofknowl- edgeinMISSbymanyleadersinthisfield,coveringawidevarietyofconditionsinspine surgeryandincludingbothprinciplesandtechniques.Indicationsareclearlyoutlinedand techniques discussed in a cogent and concise manner. As spine surgery becomes one specialized field, there is no doubt that this important book will serve as a valuable resourcetobothneurologicalandorthopedicspinesurgeonsandtheirtrainees.Certainly, as advances continue to be made in our field, this text will serve as a basis for further innovations. LaJolla,California BehroozA.Akbarnia vii Foreword In the last 20 years, spinal surgery has changed tremendously. Progress has included advancedinstrumentation,theapplicationofimagingtechniquesbothinandoutofthe operatingroom,andimprovedunderstandingofbiomechanics.Minimallyinvasivespine surgery, which is becoming a subspecialty in the field of spine surgery, has grown explosivelyinthelastdecade. Minimally invasive spine surgery offers the benefits of decreased postoperative pain anddisruptionofnormalanatomy,andthelatterleadstoshorterhospitalstays.Theore- tically, all of these will also decrease the expense of care, but this point has yet to be documented.Aswithmostnewtechniques,alearningcurveisassociatedwithmastering minimally invasive spine surgery. In fact, for procedures such as thoracoscopic approaches to the spine, the learning curve is quite steep. Proficiency requires intensive courses, if not fellowships, to acquire the necessary surgical expertise to perform these elegantyetattimescomplexprocedures.Theeditorsofthisbookhaveassembledexperts in the field of minimally invasive spine surgery and produced a text that should be a standardforthatsubspecialty. The book addresses minimally invasive surgery for the entire spine, starting in the cervical area and proceeding to the thoracolumbar spine. The text includes an excellent introductory chapter and describes the multiple fusion techniques performed via mini- mallyinvasiveprocedures.Classically,thetwochapterson‘‘facetrhizotomy’’and‘‘facet and epidural steroid injection’’ would not be included under minimally invasive spine surgery.Nevertheless,theyarereasonableeditionstothebook. Although many of the procedures described in this book can be performed through traditionalopentechniques,theauthorsnicelydescribetheirminimallyinvasivecounter- points and often highlight the advantages of the minimal approach compared to the traditionalopenapproach.Surgeonsshouldfirstbecomeexpertsinopenapproachesto the spine. Once they have mastered this fundamental armamentarium and know the anatomywell,theycanapplytheminimallyinvasiveapproachestothespinethatareso welldescribedinthistext.Thisbook,whichisverywelldoneandtimely,willbecomea standardtextforanysurgeonwhoperformsminimallyinvasivespinesurgeryaswellas foranysurgeonwhoisdevelopinghisorherskillsinthisgrowingsubspecialty. Tuscon;Phoenix,Arizona VolkerK.H.Sonntag,MD ix Preface Theuseofminimallyinvasivespinesurgicalprinciplesandtechniquesisrapidlyescalat- ing. It is finding its way, to one degree or another, into the practice of many spine surgeons. The enthusiasm for its use, on the part of both the spine surgeon and the patient,isimpressiveanddominatesmedicalwebsitesandInternetdiscussionaswellas manysurgicalsocietymeetings. The reasons for thispopularity are myriad. They include safety, blood loss,pain, and popularityamongpatients.Withthisenthusiasm,however,someself-reflectionandcareful consideration are necessary. As physicians, we must always consider the best available evidencethatsupportstheuseofanynewtechnology.Inthistext,ouraimistoconsiderthe available evidence to support minimally invasive spine surgery. However, we must also considersafety,learningcurveissues,andthehighcostofthesetechnologies.Thelattertwo concerns may be more relevant for some conditions than for others. In varying degrees, therearealsoimportantconsiderationstobemadeforsurgeon-specificissues. We have attempted to assemble, in the pages that follow, a collection of works that provide the foundation for a minimalist approach to surgery of the spine. This should provideinsightintopathology-specificandtechnique-relatedconcerns.Withthiscomes an understanding of the limitations of minimally invasive surgery, as well as its advan- tages,onacase-by-casebasis.Onemustrememberthat‘‘throughsmallopeningscanlurk largecomplications.’’Withthisinmind,pleaseread,enjoy,andlearnfromthiscollection oftreatisesfromexperiencedauthors/practitionersonthesubject.Wehopethatyou,as do we, find them to provide an objective, honest, and balanced approach to minimally invasivesurgeryandalsotoofferausefulreferenceforyearstocome. LosAngeles,California BurakM.Ozgur Cleveland,Ohio EdwardC.Benzel LaJolla,California StevenR.Garfin xi Contents 1 GeneralIntroductionandPrinciplesofMinimallyInvasiveSpineSurgery..... 1 BurakM.Ozgur 2 Image-GuidedSpinalNavigation:PrinciplesandClinicalApplications ....... 7 IainH.Kalfas 3 AnteriorCervicalForaminotomy .................................... 23 DavidH.JhoandHae-DongJho 4 PosteriorCervicalForaminotomyandLaminectomy..................... 33 JohnE.O’Toole,KurtM.Eichholz,andRichardG.Fessler 5 PosteriorCervicalInstrumentationandFusion ......................... 43 FarbodAsgarzadie,Baro´nZa´rateKalfo´pulos,VartanS.Tashjian, andLarryT.Khoo 6 ThoracoscopicDiscectomy......................................... 59 RohitB.Verma,PabloPazmino,andJohnJ.Regan 7 ThoracicandLumbarKyphoplasty .................................. 67 ChristopherM.BonoandStevenR.Garfin 8 ThoracoscopicDeformityCorrection................................. 77 PeterO.NewtonandAndrewPerry 9 ParacoccygealTranssacralAccesstotheLumbosacralJunction forInterbodyFusionandStabilization................................ 87 IsadorH.LiebermanandAndrewCragg 10 FacetJointAnatomyandApproachforDenervation..................... 93 RalphF.RashbaumandDonnaD.Ohnmeiss 11 FacetJointandEpiduralInjections .................................. 99 MarkS.WallaceandTobiasMoeller-Bertram 12 DiscographyandEndoscopicLumbarDiscectomy....................... 105 MichaelA.Chang,ChristopherA.Yeung,AnthonyT.Yeung, andChollW.Kim 13 DiscectomyandLaminectomy ...................................... 115 BurakM.Ozgur,ScottC.Berta,andAndrewD.Nguyen 14 CombiningMinimallyInvasiveTechniquesforTreatingMultilevel DiseaseasWellasAdultDegenerativeScoliosis ........................ 121 BurakM.OzgurandLissaC.Baird xiii xiv Contents 15 TransforaminalLumbarInterbodyFusion(TLIF)....................... 129 BurakM.Ozgur,ScottC.Berta,andSamuelA.Hughes 16 LateralApproachforAnteriorLumbarInterbodyFusion(XLIFandDLIF)... 135 BurakM.OzgurandLissaC.Baird 17 AnteriorLumbarInterbodyFusion(ALIF) ............................ 143 HenryE.Aryan,SigurdH.Berven,andChristopherP.Ames 18 PercutaneousPedicleScrewPlacementforSpinalInstrumentation.......... 149 HormozSheikh,RamiroA.PerezdelaTorre,OksanaDidyuk, VickramTejwani,andMickJ.Perez-Cruet 19 IliacCrestBoneGraftHarvestandFusionTechniques ................... 159 JeffS.SilberandAlexanderR.Vaccaro 20 TechnologiesforUseinIndirectDistractionProcedures .................. 167 HansenA.Yuan,AdamK.MacMillan,andEdwardS.Ahn Index............................................................. 179
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