Minimally Invasive Spine Surgery: A Surgical Manual PDF
Preview Minimally Invasive Spine Surgery: A Surgical Manual
H.M.Mayer(Ed.)MinimallyInvasiveSpineSurgery SecondEdition H.M. Mayer (Ed.) Minimally Invasive Spine Surgery A Surgical Manual SecondEdition With492Figuresin851Partsand36Tables H.MichaelMayer,M.D.Ph.D. HeadandMedicalDirector,AssociateProfessor SpineCenterMunich,OrthozentrumMünchen,OrthopädischeKlinik HarlachingerStrasse51 81547Munich,Germany ISBN3-540-21347-3 Springer-VerlagBerlinHeidelbergNewYork LibraryofCongressControlNumber:2005924331 Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations, recitation,broadcasting,reproductiononmicrofilmorinanyotherway,andstorageindata banks.Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisions oftheGermanCopyrightLawofSeptember9,1965,initscurrentversion,andpermissionfor usemustalwaysbeobtainedfromSpringer-Verlag.Violationsareliabletoprosecutionunder theGermanCopyrightLaw. Springer-VerlagBerlinHeidelbergNewYork SpringerisapartofSpringerScience+BusinessMedia http://www.springeronline.com ˇ Springer-VerlagBerlinHeidelberg2006 PrintedinGermany Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformationaboutthe applicationofoperativetechniquesandmedicationscontainedinthisbook.Ineveryindividual casetheusermustchecksuchinformationbyconsultingtherelevantliterature. Editor:GabrieleSchröder DeskEditor:IrmelaBohn ProductionEditor:JoachimW.Schmidt Coverdesign:eStudioCalamar,Spain Typesetting:FotoSatzPfeiferGmbH,D-82166Gräfelfing Printedonacid-freepaper–24/3150–543210 To Frizzi, Lukas and Isabel for all their love and support Preface to the Second Edition Fiveyearshavepassedsincethefirsteditionofthisbook.Minimallyinvasivesurgi- caltechniqueshavebecomeasignificantpartofthedailyroutineinspinesurgery. Someofthetechniqueswhichhavebeendescribedinthefirsteditionhavebecome standardinspinecentresallaroundtheworld,othershavebeenstrugglingtostand thetestoftime. Threeimportanttrendscouldbeobservedinthepastfiveyears: 1.Microsurgical and endoscopic surgical techniques have been improved. The applicationspectrumhasbeenenlargedandtheresultsarenowmorereliableand predictable. 2.So-called“semi-invasive”techniques,mainlyforthetreatmentoflowbackpain, have become more popular although evidence-based data concerning efficacy andsuccessarestilllacking. 3.Spine arthroplasty is the term for a significant change of paradigms in spinal surgery.Minimallyinvasivepartialortotaldiscreplacementinthedegenerated cervical and lumbar spine, “dynamic” fixation, or disc-unloading techniques withinnovativeimplantsarebeingtestedinvariousclinicalstudiesallaroundthe world. Autologous percutaneous disc chondrocyte transplantation is the first clinicalattempttoachieveabiologicalregenerationofthedegenerateddisc. Thisnew,revisedandextendededitionof MinimallyInvasiveSpineSurgerycon- tainsallcurrentapplicationsofminimallyinvasivetechniquesforspinesurgery.A totalof 70authorsandco-authorshavecoveredallaspectsofminimallyinvasive spinesurgeryin51chapters,whichhasmorethandoubledthevolumeofthefirst edition. Againwemustpointoutthatthebookconcentratesonsurgicaltechniquesand thatitwasouraimtoprovidethereaderwiththeinformationnecessarytoperform thesetypesofsurgery.However,someofthetechniquesdescribedarestillpartofan ongoingprocessofdevelopmentand,althoughwehavetriedtogivethereadera mainlyunbiasedandneutraldescriptionofthetechniques,weareawareofthefact thatthiscouldnotberealizedforallchapters. I thank all my colleagues for againspendingtheir time to produce high-quality chapters,tosharetheirtremendousexperiencewithusandtoprovideuswiththe newestinformation. Isincerelyhopethatoureffortswillbehonouredbyanumberofreadersandthat againwecanallcontributetothedevelopmentofminimallyinvasivetechniquesin spinesurgery. Munich,Summer2005 H.MichaelMayer Foreword to the First Edition Thisbookcontainsawealthofinformationonaspectsofminimallyinvasivespinal surgery.Forasurgeonofmyvintage,nearingtheendofacareerspanningthepast fortyyears,Iamreassuredbytheenthusiasm,dedicationandseriousnessofpurpose ofthisnewgenerationofsurgeonsandscientistswhoseworkisoutlinedinthebook. In 1957 Walter Blount deliveredhis Presidential Address entitled: “Don’t Throw AwaytheCane”totheAmericanAcademyofOrthopaedicSurgeons.Thegistofthis monumentaladdresswasthat,ashipsurgerywasevolving,thelessonsofconverva- tisminmanagementofhipdisordersshouldnotbeforgotten.Whilepreparingthis ForewordIwasremindedofitsmainmessagebecauseitremainspertinenttopre- senttrendsinthepracticeofspinalsurgery. The advanced techniques described in Dr. Mayer’s book must not be attempted withoutintensivestudyofanatomyandathoroughunderstandingofspinalpathol- ogy.Throughoutthetextindividualauthorsusetheterm“learningcurve”,aterm whichcanspelldisasterforthepatientwhomaybeonthe“curve”.Spinalsurgeryis potentially dangerous. Mastery of it is best gained by personal tuition under the guidanceofabusyexperiencedsurgeon.Thetrendtowardslearningsurgicaltech- niquesinworkshopsettingsorinshortcoursesorganisedbymanufacturersofsur- gicalequipment,usingplasticmodelsorcadaversisnotentirelygoodfortraineesor forsurgeonsaimingtoexpandtheirpracticesintominimalinvasivesurgeryofthe spine,asitmayleadtothetriumphoftechnologyoverreason.Byfocussingonhow tousethewiderangeofequipmentrequiredtoperformtheseoperations,biological factorswhichmayadverselyaffecttheiruseshouldnotbeneglected.Forexample evenintheoutstandingchapter“MicrosurgeryoftheCervicalSpine”theStatement ismadethat:“Retracterbladesmaystickaftermanyhoursofsurgery:theyshould beremovedunderirrigationandindividually”.Oneofthemostimportantleasons tohaveemergedinrecentyearsinspinalsurgeryhasbeenthatretractorsshouldbe releasedatregularintervalsthroughoutanoperationtopreventirreversibledamage tothebloodsupplyofthemusclesatthesiteofsurgery. AtthebeginningofthisnewmillenniumDr.MichaelMayerhasshowngreatforesight inassemblingsuchanarrayofinternationalexpertstopresentaclearpictureofwhat hasbeenachievedintheleastdecadeofthe20thCenturyandaviewofwhatliesahead assurgeonsstrivetoharnesstherapidlychangingtechnologiesinthefieldsofimag- ing,optics,endoscopyandinstrumentdesignfortheirwideruseinminimalinvasive spinalsurgery.Thisbookshouldbecomethevademecumforspinalsurgeonsinthis decade.Thewiderangeofinformationinitcoverstechnicaldetails,logisticalfactsand manyinformativeandbalancedviewsonaspectsofthesenewtechniques.Theseau- thors form a worthy cohort of surgeons and scientists from differing backgrounds withcommonaims.Theyarevoyagersheadingintopreviouslyunchartedwaters. “Butfarforwardvoyagers”. T.S.Elliot,FourQuarters,p40.TheFolioSocietyLondon,MCMI.XVIII February2000 HenryVernonCrock DirectoroftheSpinalDisordersUnit TheCromwellHospitalLondon Preface to the First Edition “Thereisnodarkness–thereisjustabsenceoflight.” “Minimallyinvasivesurgery”hasbeenthekeyphrasedominatingclinicalandsci- entificeffortsinallsurgicalspecialtiesoverthelastdecade.Therehasneverbeena comparableperiodinsurgerywhere,withinashortspanoftime,surgicaltechnolo- gyhasundergonesuchwidespreadandfundamentalchanges.Thesedevelopments areduetothesynergismproducedbyaparallel“explosion”ofknowledgeandtech- nologicalabilitiesinmodernradiologicalimagingtechniques,inadvancedsurgical instrumentationandimplanttechnology,aswellasinintraoperativevisualization usingmoderndigitalandconventionalopticalsystems.Althoughthereiscontro- versyregardingthesemanticcorrectnessoftheterm“minimallyinvasivesurgery” (becauseinthemajorityofthetechniquesonlythesurgicalapproachis“minimally invasive”),itisstillsynonymousofallsurgicaltechniqueswhichare“less”or,bet- ter,“suitably”invasivecomparedtoconventionalsurgicalapproaches. Spinalsurgeryisprobablythesubspecialtywhichhasundergonethemostrevolu- tionarychangestriggeredbylessinvasiveprocedures.Itallstartedwiththeinaugu- rationofmicrosurgicalandendoscopicproceduresforthetreatmentoflumbardisc herniationsinthemid-1970s.Todaywearewitnessingavarietyofmicrosurgicaland endoscopictechniques,aswellasprocedures,whichrequirenodirectvisualcontrol. Mostofthesetechniquesareusedinclinicalstudiesbutarestilllackingbasicsci- entificevidence,sometechniqueshavealreadyreplacedstandardtechniques,while othershavebeengenerallyacceptedatleastasalternativestoconventionalsurgical procedures.Themajorityofthesetechniquesarehighlysophisticatedandrequire specialsurgicaltrainingorevenlaboratorytraining,whichposesproblemsinpar- ticularforthesurgeonnotspecializedinspinesurgery.Scientificmeetingsaredom- inatedworldwidebythepresentationofminimallyinvasivespinesurgery;however, itisdifficultforthesurgeontokeepabreastoftherapiddevelopmentsandtobeable todecidewhichtechniqueheshouldadoptforhisdailywork. Itwasourintentiontopresentanoverviewofthemostimportantandrelevantmi- crosurgicalandendoscopictechniqueswhichhavebeeninauguratedoverthelast twodecades.Thisbookisneitheratextbooknorasurgicalatlas.Itwasouraimto providethereaderwithclearinformationregardingterminology,history,indica- tions,surgicalprinciples,aswellasacriticalevaluationofthespecifictechnique.It doesnotattempttopassfinaljudgementonthevalueandnecessityofthevarious procedures;however,itmayenablethereadertomakeher/hisownassessmentof thevalueandacceptabilityofeachtechnique. Thebookconcentratesonsurgicaltechniqueandprovidesthereaderwiththerele- vantinformationnecessarytobepreparedfortheuseofthedifferentprocedures. Iwouldliketoexpressmydeepestthankstoallcolleagueswhohavecontributedto thisbookandwhohaveprovideduswithatremendousamountofnewinformation. Itismysincerehopethatthisbookwillcontributetothefurtherunderstandingand acceptanceofminimallyinvasivephilosophiesintheemergingfieldofspinalsurgery. Munich,February2000 H.MichaelMayer Contents General 1 MinimallyInvasiveSpineSurgery H.M.Mayer........................................................ 3 2 TechnologicalAdvancesofSurgicalMicroscopesforSpineSurgery W.Rulffes ......................................................... 8 3 SpinalMicrosurgery:AShortIntroduction H.M.Mayer....................................................... 12 4 MicrosurgicalInstruments A.Korge.......................................................... 16 5 OperatingRoomSetupandHandlingofSurgicalMicroscopes K.Wiechert....................................................... 23 6 Computer-assistedMinimallyInvasiveSpineSurgery–StateoftheArt F.Langlotz,L.P.Nolte .............................................. 26 Cervical Spine Odontoid 7 TechniqueofTransoralOdontoidectomy P.J.Apostolides,A.G.Vishteh,R.M.Galler,V.K.H.Sonntag ............... 35 8 MicrosurgicalTreatmentofOdontoidFractures P.KlimoJr,G.Rao,R.I.Apfelbaum ................................... 42 DiscSurgery/Decompression 9 MicrosurgeryoftheCervicalSpine:TheAnteriorApproach L.Papavero ....................................................... 54 10 AnteriorCervicalForaminotomy(MicrosurgicalandEndoscopic) W.F.Saringer...................................................... 82 11 FunctionalSegmentalReconstructionwiththeBryanCervical DiscProsthesis J.Goffin .......................................................... 92 12 MicrosurgicalTotalCervicalDiscReplacement H.M.Mayer...................................................... 100 13 MicrosurgicalPosteriorApproachestotheCervicalSpine P.H.Young,J.P.Young,J.C.Young ................................... 107 14 MicrosurgicalC1–1Stabilization D.Fassett,R.I.Apfelbaum.......................................... 118 XII Contents Thoracic/ThoracolumbarSpine GeneralTechniques 15 MicrosurgicalAnteriorApproachtoT5–10(Mini-TTA) H.M.Mayer...................................................... 129 16 MicrosurgicalAnteriorApproachtotheThoracolumbarJunction H.M.Mayer...................................................... 138 17 AnatomicPrinciplesofThoracoscopicSpineSurgery U.Liljenqvist .................................................... 144 18 PrinciplesofEndoscopicTechniquestotheThoracicandLumbarSpine 149 G.M.McCullen,A.A.Criscitiello,H.A.Yuan........................... 149 19 BiomechanicalRequirementsinMinimallyInvasiveSpinalFracture Treatment M.Schultheiss,E.Hartwig,L.Claes,L.Kinzl,H.-J.Wilke ............... 156 Deformities 20 ThoracoscopicApproachesinSpinalDeformitiesandTrauma M.Dufoo-Olvera ................................................. 164 21 ThoracoscopicTechniquesinSpinalDeformities D.Sucato ........................................................ 176 22 Mini-openEndoscopicExcisionofHemivertebrae R.Stücker ....................................................... 197 Fractures 23 ThoracoscopicallyAssistedAnteriorApproachtoThoracolumbarFractures R.Beisse ........................................................ 203 24 AMinimallyInvasiveOpenApproachforReconstructionoftheAnterior ColumnoftheThoracicandLumbarSpine B.Knowles,I.Freedman,G.Malham,T.Kossmann .................... 215 25 PercutaneousVertebroplastyinOsteoporoticVertebralFractures G.M.Hess,H.M.Mayer ............................................ 222 26 MicrosurgicalOpenVertebroplastyandKyphoplasty B.M.Boszczyk,M.Bierschneider,B.Robert,H.Jaksche................. 230 27 PercutaneousKyphoplastyinTraumaticFractures G.Maestretti,P.Otten ............................................. 239 LumbarSpine LowBackPain 28 InterventionalandSemi-invasiveProceduresforLowBackPain andDiscHerniation M.K.Schäufele ................................................... 249 Disc 29 IntradiscalElectrothermalTherapy J.Saal ........................................................... 260 30 MicrotherapyinLowBackPain A.T.Yeung,C.A.Yeung ............................................ 267
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