Surgical Anatomy and Techniques to the Spine

514 Pages·2005·88.15 MB·English

by  Daniel H. Kim

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SURGICAL ANATOMY AND TECHNIQUES TO THE SPINE ISBN-13: 978-1-4160-0313-7
ISBN-10: 1-4160-0313-4
Copyright © 2006, Elsevier Inc. All rights reserved.
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NOTICE
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are
advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of the practitioner, relying on their own
experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for
each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither
the Publisher nor the Editors assume any liability for any injury and/or damage to persons or property arising
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Library of Congress Cataloging-in-Publication Data
Surgical anatomy and techniques to the spine / Daniel H. Kim...[et al.].
p. ; cm.
ISBN 1-4160-0313-4
1. Spine—Surgery. 2. Spine—Anatomy. 3. Anatomy, Surgical and topographical. I. Kim, Daniel H.
[DNLM: 1. Spinal Diseases—surgery. 2. Neurosurgical Procedures—methods. 3. Spinal Cord
Injuries—surgery. 4. Spine—surgery. WE 725 S96185 2006]
RD533.S888 2006
617.5¢6059—dc22
2005046536
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Editorial Assistant: Suzanne Flint
Working together to grow
Project Manager: David Saltzberg
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Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedications
Daniel H. Kim:
I dedicate this book to all of the residents and fellows that I have had the privilege and honor to work with
over the years at the Stanford University Medical Center.
Jeffrey S. Henn:
I would like to dedicate this book to my wife, Deana, my inspiration and support.
Alexander R. Vaccaro:
I wish to dedicate this book to my wife, Midge, and three children, Max, Alex, and Juliana. Without their
love and support my contributions tothis project would not have been possible.
Curtis A. Dickman:
I would like to dedicate this book to my wife, Celeste; my children, Alexander, Rachel, and Jacob; and my
entire family. Thank you for enriching my life, for teaching me, and for your love.
v
Acknowledgments
Daniel H. Kim:
I would like to acknowledge the following individuals whose combined hard work, long hours, and dedicated
resolve made this book possible: Max C. Lee, Karen M. Shibata, Thelma M. Prescott, and medical illustra-
tors Christine M. Field, Justin Greene, and Curtis Mothershed.
Jeffrey S. Henn:
I would like to acknowledge my parents, Don and Eileen, for their support throughout my education and
career.
vi
Preface
The fundamentals of spine surgery revolve around a thorough understanding of anatomy and
surgical technique. With new instrumentation and minimally invasive techniques, spinal
surgery has become complex in the 21st century. From occipital cervical fusions to sacroiliac
fixation, the spine surgeon of today is confronted with an extensive array of surgical options.
The rapid pace of technological change in this field has left many spine surgeons and
colleagues struggling to keep up. The increasing variety of options for surgical treatments of
spinal injury and disease renders the decision-making process regarding the use of any par-
ticular approach, procedure, or technology more and more difficult.
In addition to instrumentation, minimally invasive spine (MIS) techniques are becoming
common. With smaller and smaller incisions, spine surgeons find themselves working with a
smaller aperture and, subsequently, a limited view. Without exposure of the adjacent anatom-
ical structures, these MIS techniques can create a challenge. This challenge occurs not only
with decompressions but also with percutaneous instrumentation placement.
This instrumentation and these techniques are being used for an increasing patient base.
Spinal instrumentation is used not only for trauma and degenerative disease, but also, with
new techniques, increasingly in cases of tumor and infection.
In light of the myriad advancements, we sought to cover the topics of occipital cervical
fusion—including cervical plating techniques along with atlantoaxial fixation devices. In addi-
tion, we provide a review of fusions of the cervicothoracic and thoracolumbar regions, as these
transition zones have led to a new level of complexity. Last, longer fusion constructs have led
to sacroiliac fixation.
Whether confronted with new instrumentation or minimally invasive techniques, the spine
surgeon has to rely on the fundamentals of anatomy and technique. Thus, we wished to review
these essential items to provide the spinal surgeon with an armamentarium to approach
increasingly complex issues facing medicine today.
Max C. Lee
vii
Contributors
Frank Acosta, Jr., MD Ashok Biyani, MD
Department of Neurosurgery Assistant Professor
University of California, San Francisco Spine Center Department of Orthopaedic Surgery
San Francisco, CA Medical College of Ohio
Secondary Metastatic Tumors of the Spine Toledo, OH
Laminoplasty Techniques
Christopher J. Aho, MD
Christopher M. Bono, MD
Resident
Assistant Professor
Department of Neurological Surgery
Department of Orthopaedic Surgery
University of Southern California Keck School of
Boston University Medical Center
Medicine
Boston, MA
Los Angeles, CA
Posterior Approaches to the Sacrum
Lateral Lumbar Interbody Fusion
Ungkyu Chang, MD
Todd J. Albert, MD Research Fellow
Vice Chairman and Professor Department of Neurosurgery
Department of Orthopaedic Surgery Stanford University Medical Center
Jefferson Medical College of Thomas Jefferson Stanford, CA
University High Cervical Retropharyngeal Approach to the
Co-Director of Reconstructive Surgery and Spine Craniocervical Junction;Anterior Approach to the
Fellowship Program Midcervical Spine; Posterior Approach to the Midcervical
Thomas Jefferson University Spine;Anterior Corpectomy and Fusion
The Rothman Institute
Philadelphia, PA Fady T. Charbel, MD
Anterior Retroperitoneal Approach Professor and Head
Chief of Neurovascular Section
Department of Neurological Surgery
Howard S. An, MD University of Illinois at Chicago
The Morton International Professor of Orthopaedic Chicago, IL
Surgery Vascular Lesions of the Spinal Cord
Director
Division of Spine Surgery and Spine Fellowship Won-Ho Choo, MD
Program Visiting Assistant Professor
Department of Orthopaedic Surgery Department of Neurosurgery
Rush University Medical Center Stanford University Medical Center
Chicago, IL Stanford, CA
Laminoplasty Techniques Posterior and Far-Lateral Approaches to the
Craniovertebral Junction
D. Greg Anderson, MD
Dean Chou, MD
Associate Professor
Assistant Clinical Professor
Jefferson Medical College
Department of Neurological Surgery
The Rothman Institute
University of California, San Francisco
Philadelphia, PA
San Francisco, CA
Transperitoneal Approaches to the Lumbosacral
Primary Malignant and Benign Tumors of the Vertebral
Junction
Column; Secondary Metastatic Tumors of the Spine
Todd Applegate, DO Andrew Dailey, MD
Senior Assistant Resident Associate Professor
Department of Orthopaedic Surgery Department of Neurological Surgery
Boston University Medical Center University of Washington School of Medicine
Boston, MA Seattle, WA
Posterior Approaches to the Sacrum Ossification of the Posterior Longitudinal Ligament
viii
Contributors ix
Matthew D. Eichenbaum, MD L. Fernando Gonzalez, MD
Spine Research Fellow Research Fellow
Department of Orthopaedic Surgery Surgical Neuroanatomy Laboratory
Thomas Jefferson University Division of Neurological Surgery
The Rothman Institute Barrow Neurological Institute
Philadelphia, PA St. Joseph’s Hospital and Medical Center
Ankylosing Spondylitis—Posterior Approaches Phoenix, AZ
(Osteotomy) to the Cervical and Lumbar Spine in the Surgical Technique for Resection of Intradural Tumors
Management of a Fixed Sagittal Plane Deformity
Nitin Goyal, MD
Ron El-Hawary, MD, MSc Jefferson Medical College
Fellow Thomas Jefferson University
Department of Orthopaedics Philadelphia, PA
Texas Scottish Rite Hospital for Children Minimal Access Exposure for Posterior Lumbar
Dallas, TX Instrumented Fusions
Anterior Treatment for Thoracolumbar/Lumbar
Scoliosis Alan S. Hilibrand, MD
Assistant Professor and Director of Medical Education
Azadeh Farin, MD Department of Orthopaedic Surgery
Resident Physician Thomas Jefferson University
Department of Neurological Surgery The Rothman Institute
University of Southern California Keck School of Philadelphia, PA
Medicine Ankylosing Spondylitis—Posterior Approaches
Los Angeles, CA (Osteotomy) to the Cervical and Lumbar Spine in the
Posterior Keyhole Cervical Foraminotomy; The Transoral Management of a Fixed Sagittal Plane Deformity
Approach for Ventral Cervicomedullary Decompression in
Rheumatoid Arthritis Langston Holly, MD
Assistant Professor and Co-Director
Farrokh R. Farrokhi, MD UCLA Comprehensive Spine Center
Chief Resident Division of Neurosurgery
Department of Neurological Surgery Department of Orthopedic Surgery
University of Washington Medical Center University of California, Los Angeles Medical Center
Seattle, WA Los Angeles, CA
Ossification of the Posterior Longitudinal Ligament Anterior Retroperitoneal Approach to the Lumbar Spine;
Posterior and Posterolateral Approaches to the Thoracic
Amir H. Fayyazi, MD and Lumbar Spine
Assistant Professor
Division of Spine Surgery Jin-Woo Hur, MD
Department of Orthopedic Surgery Staff Neurosurgeon
State University of New York Upstate Medical University Cheongju St. Mary's Hospital
Syracuse, NY Chungbuk, Korea
Laminoplasty Techniques Surgical Anatomy and Operative Techniques of Lumbar
Stenosis
Iman Feiz-Erfan, MD
Neurosurgical Resident Dean G. Karahalios, MD
Division of Neurological Surgery Chicago Institute of Neurosurgery and Neuroresearch
Barrow Neurological Institute (CINN)
St. Joseph’s Hospital and Medical Center Neurologic and Orthopedic Institute of Chicago
Phoenix, AZ Chicago, IL
Surgical Therapy for Fractures and Dislocations of the Thoracic Diskectomy
Craniocervical Junction and Upper Cervical Spine
Larry T. Khoo, MD
Maurice L. Goins, MD Assistant Professor and Co-Director
Department of Orthopaedic Surgery UCLA Comprehensive Spine Center
Balboa Naval Medical Center Division of Neurosurgery
San Diego, CA Department of Orthopedic Surgery
Ankylosing Spondylitis—Posterior Approaches University of California, Los Angeles Medical Center
(Osteotomy) to the Cervical and Lumbar Spine in the Los Angeles, CA
Management of a Fixed Sagittal Plane Deformity Anterior Retroperitoneal Approach to the Lumbar Spine
x Contributors
Jeffrey D. Klopfenstein, MD G. Michael Lemole, Jr., MD
Neurosurgical Resident Assistant Professor
Division of Neurological Surgery Department of Neurosurgery
Barrow Neurological Institute University of Illinois at Chicago
St. Joseph’s Hospital and Medical Center; Neuropsychiatric Unit
Phoenix, AZ Chicago, IL
Surgical Therapy for Fractures and Dislocations of the Vascular Lesions of the Spinal Cord
Craniocervical Junction and Upper Cervical Spine
Lawrence G. Lenke, MD
Timothy R. Kuklo, MD The Jerome S. Gilden Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery Washington University of St. Louis
Walter Reed Army Medical Center Co-Chief, Pediatric and Adult Scoliosis and Spinal
Washington, DC Reconstruction
Surgical Management of Flatback Syndrome Department of Orthopaedic Surgery
Barnes-Jewish Hospital
St. Louis, MO
Surgical Treatment of Adolescent Idiopathic Scoliosis:
Carl Lauryssen, MD
Lenke Curve Types 1 to 6
Medical Director of Research and Education
Cedars-Sinai Institute for Spinal Disorders
Department of Neurological Surgery
Brian M. Leo, MD
Cedars-Sinai Medical Center
Resident
Los Angeles, CA
Department of Orthopaedic Surgery
Anterior Lumbar Interbody Fusion
University of Virginia Health System
Charlottesville, VA
Transperitoneal Approaches to the Lumbosacral Junction
Hoang N. Le, MD
Department of Neurosurgery
Stanford University Medical Center
K. Charles Y. Liu, MD, PhD
Stanford, CA
Assistant Professor
Anterior Approaches to the Cervicothoracic Junction
Department of Neurological Surgery
(Low Cervical-Supraclavicular, Transclavicular-
University of Southern California Keck School of Medicine
Transmanubrial, Trans-sternal-Transthoracic);Anterolateral
Los Angeles, CA
Transthoracic Approaches to the Cervicothoracic Junction
The Transoral Approach for Ventral Cervicomedullary
(Transaxillary Approach, Transpleural Transthoracic Third
Decompression in Rheumatoid Arthritis
Rib Resection Approach);Posterolateral Approaches to
the Cervicothoracic Junction (Transpedicular,
Costotransversectomy, Lateral Extracavitary, and
Parascapular Extrapleural Approaches);Thoracoabdominal Amir A. Mehbod, MD
Approach;Cervicothoracic Junction Fractures;Thoracic Twin Cities Spine Center
and Thoracolumbar Fractures Minneapolis, MN
Spondylolisthesis Reduction
Max C. Lee, MD
Ronnie I. Mimran, MD
Clinical Instructor
Staff Physician
Department of Neurosurgery
Pacific Brain and Spine Medical Group
Stanford University Medical Center
Eden Medical Center
Stanford, CA
Castro Valley, CA
Transoral Approach to the Craniocervical Junction and
Minimally Invasive Lumbar Decompression
Upper Cervical Spine;Transmaxillary Approach to the
Clivus and Upper Cervical Spine;High Cervical
Retropharyngeal Approach to the Craniocervical Junction;
Posterior and Far-Lateral Approaches to Craniovertebral Sergey Neckrysh, MD
Junction;Anterior Approach to the Midcervical Spine; Resident
Posterior Approach to the Midcervical Spine;Anterior Department of Neurological Surgery
Corpectomy and Fusion;Burst Fractures of the Cervical University of Illinois at Chicago
Spine;Subaxial Cervical Spinal Injuries and Facet Chicago, IL
Dislocation Injuries Vascular Lesions of the Spinal Cord
Contributors xi
Bryan C. Oh, MD Eric A. Potts, MD
Resident Indianapolis Neurosurgical Group
Department of Neurological Surgery Indianapolis, IN
University of Southern California Keck School of Medicine Thoracic Diskectomy
Los Angeles, CA
Lateral Lumbar Interbody Fusion
Kian Raiszadeh, MD
Resident
Department of Orthopaedic Surgery
Adebukola Onibokun, MD
University of Medicine and Dentistry of New Jersey—
Senior Resident
New Jersey Medical School
Division of Neurological Surgery
Newark, NJ
University of California, Los Angeles Medical Center
Bacterial, Fungal, and Tuberculosis Diskitis and
Los Angeles, CA
Osteomyelitis of the Cervical, Thoracic, and Lumbar Spine
Anterior Retroperitoneal Approach to the Lumbar Spine;
Posterior and Posterolateral Approaches to the Thoracic
and Lumbar Spine Albert L. Rhoton, Jr., MD
R.D. Keene Family Professor and Chairman Emeritus
Department of Neurosurgery
Michael A. Pahl, MD
University of Florida
Orthopaedic Spine Research Fellow
McKnight Brain Institute
Thomas Jefferson University
Gainesville, FL
The Rothman Institute
Transoral Approach to the Craniocervical Junction and
Philadelphia, PA
Upper Cervical Spine;Transmaxillary Approach to the
Minimal Access Exposure for Posterior Lumbar
Clivus and Upper Cervical Spine;High Cervical
Instrumented Fusions
Retropharyngeal Approach to the Craniocervical Junction
Jon Park, MD, FRCSC Erich O. Richter, MD
Assistant Professor Resident
Department of Neurosurgery Department of Neurological Surgery
Stanford University Medical Center University of Florida
Stanford, CA Gainesville, FL
Thoracoabdominal Approach; Thoracic and Thoracolumbar Lumbar Microdiskectomy: Midline Open and Far-Lateral
Fractures Techniques;Percutaneous and Endoscopic Diskectomy
Stephen I. Ryu, MD
David A. Peace, MS
Resident
Medical Illustrator
Department of Neurosurgery
Department of Neurosurgery
Stanford University Medical Center
University of Florida
Stanford, CA
Gainesville, FL
Transmaxillary Approach to the Clivus and Upper Cervical
Lumbar Microdiskectomy: Midline Open and
Spine
Far-Lateral Techniques;Percutaneous and Endoscopic
Diskectomy
Darren B. Schneider, MD
Assistant Professor of Surgery and Radiology
Randall W. Porter, MD
Division of Vascular Surgery
Chief, Intradisciplinary Skull Base Section
University of California, San Francisco
Division of Neurological Surgery
San Francisco, CA
Barrow Neurological Institute
Secondary Metastatic Tumors of the Spine
St. Joseph’s Hospital and Medical Center
Phoenix, AZ
Surgical Technique for Resection of Intradural Tumors Fernando E. Silva, MD
Visiting Spinal Fellow
Department of Orthopaedics
Benjamin K. Potter, MD Pediatric and Adult Spinal, Scoliosis and Reconstructive
Resident Surgery
Department of Orthopaedics and Rehabilitation Washington University Medical Center
Walter Reed Army Medical Center St. Louis, MO
Washington, DC Surgical Treatment of Adolescent Idiopathic Scoliosis:
Surgical Management of Flatback Syndrome Lenke Curve Types 1 to 6
xii Contributors
Carl Spivak, MD, FRCSC Vassilios I. Vougioukas, MD
Clinical Instructor Department of Neurosurgery
Department of Neurological Surgery Neurocenter
Jackson-Madison County General Hospital Albert Ludwigs University of Freiburg
Jackson, TN Freiburg, Germany
Laminotomy and Laminectomy for Cervical Stenosis Surgical Therapy for Fractures and Dislocations of the
Craniocervical Junction and Upper Cervical Spine
Daniel J. Sucato, MD
Assistant Professor Michael Y. Wang, MD
Department of Orthopaedic Surgery Assistant Professor
University of Texas Southwestern Medical Center at Department of Neurological Surgery
Dallas University of Southern California Keck School of Medicine
Department of Orthopedics Los Angeles, California
Texas Scottish Rite Hospital for Children Posterior Keyhole Cervical Foraminotomy; Anterior
Dallas, TX Lumbar Interbody Fusion; Lateral Lumbar Interbody
Anterior Release and Fusion Techniques for Thoracic Fusion;The Transoral Approach for Ventral
Scoliosis;Anterior Treatment for Thoracolumbar/Lumbar Cervicomedullary Decompression in Rheumatoid
Scoliosis Arthritis
Issada Thongtrangan, MD Kirkham B. Wood, MD
Fellow Chief of Orthopaedic Spine Service
Department of Orthopaedic Surgery Department of Orthopaedic Surgery
Virginia Commonwealth University Medical Center Massachusetts General Hospital
Richmond, VA Orthopaedic Associates
Thoracoabdominal Approach; Thoracic and Thoracolumbar Boston, MA
Fractures The Surgical Management of Scheuermann’s Kyphosis
Ensor E. Transfeldt, MD Steven C. Zeiller, MD
Associate Professor Resident
Cervical Spine Disorders, Scoliosis, and Spondylolisthesis Department of Orthopaedic Surgery
University of Minnesota, Twin Cities Thomas Jefferson University
Twin Cities Spine Center Philadelphia, PA
Minneapolis, MN Anterior Retroperitoneal Approach
Spondylolisthesis Reduction
Ho-Yeol Zhang, MD, PhD
Arthur J. Ulm, III, MD Clinical Associate Professor
Resident Chief, Department of Neurosurgery
Department of Neurosurgery National Health Insurance Corporation
University of Florida Ilsan Hospital
Gainesville, FL Yonsei University College of Medicine
Lumbar Microdiskectomy: Midline Open and Far-Lateral Kyonggi-do, Korea
Techniques;Percutaneous and Endoscopic Diskectomy Anterior Cervical Diskectomy and Fusion; Anterior
Cervical Microforaminotomy; Anterior Cervical Fusion and
Michael J. Vives, MD Instrumentation Techniques; Transpedicular Screw
Assistant Professor Fixations; Posterior Lumbar Interbody Fusion; Unilateral
Department of Orthopaedic Surgery Transforaminal Lumbar Interbody Fusion; Lumbar and
University of Medicine and Dentistry of New Jersey— Sacral Fractures
New Jersey Medical School
Newark, NJ
Bacterial, Fungal, and Tuberculosis Diskitis and
Osteomyelitis of the Cervical, Thoracic, and Lumbar
Spine