Cervical spine : minimally invasive and open surgery

Contents
1: Anatomy of the Cervical Spine
	Introduction
	Superior Cervical Spine
	Inferior Cervical Spine
	Cervical Spine Joints and Muscles
	Vessels
		Arteries
		Veins
		Lymphatics
	Innervation
	Vertebral Canal
	Topographic Organization
	Dissection Anatomy
	References
2: Functional Anatomy and Biomechanics of the Cervical Spine
	Introduction
	Summary of Biomechanical Terms Used in the Text
	Basic Concepts
		Principles of Kinematics
	Functions of the Cervical Spine
	Occipitoatlantoaxial Complex (C0–C2)
		Biomechanically Relevant Anatomy
		Normal Kinematics
		C0–C1 Joint
		C1–C2 Joint
	C2–C3 Junction or Vertebroaxial Joint [33]
	Mid and Lower Cervical Spine (C3–C7)
		Biomechanically Relevant Anatomy and Kinematics
	Soft Tissues
		Ligaments and Joint Capsules
		Intervertebral Discs
		Muscles of Neck and Shoulders
	Normal Global Motion of the Cervical Spine
	Alignment, Sagittal Balance and ROM Disorders
	Neutral Zone and Cervical Spine Stability
	References
3: Diagnostic Imaging in the Degenerative Diseases of the Cervical Spine
	Introduction
	Basic Anatomy
		Cranio-Cervical Junction
		Subaxial Cervical Spine
	Technical Approach
		Radiography
		Computed Tomography
		Magnetic Resonance Imaging
	Basic Findings in the Degenerative Disease of the Cervical Spine
		The Disk
		Spondilosys
		Cervical Facet Arthropathy
		Ligament Degeneration
	Degenerative Cervical Spine Instability
		Phase of Functional Derangement
		Phase of Instability
		Phase of Fixity
	Cranio-Cervical Junction Degenerative Disease
		Imaging
	Subaxial Cervical Spine Degenerative Disease
		Cervical Disk Herniation
			Terminology
			Bulging Disk (Fig. 3.6)
			Cervical Herniation: Subtypes
			Cervical Herniation: Imaging
		Stenosis
			Imaging
	Specific Degenerative Diseases
		Rheumatoid Arthritis
			Imaging
		Diffuse Idiopathic Skeletal Hyperostosis Syndrome
			Imaging
		Ossification of the Posterior Longitudinal Ligament
			Imaging
		Destructive Spondyloarthropathy of the Cervical Spine in Long-Term Hemodialyzed Patients
			Imaging
		Ossification of Flaval Ligaments
			Imaging
		Calcium Pyrophosphate Deposition Disease
			Imaging
		Crowned Dens Syndrome
			Imaging
		Cranio Cervical Junction Pseudotumor
			Imaging
	References
4: Anesthesia and Perioperative Care in Cervical Spinal Surgery
	Anesthetic Management and Prevention of Complications
		Preoperative Assessment
		Airway Assessment
		Intraoperative Neurological Monitoring
		Patient Positioning and Related Complications
		Prophylaxis of Surgical Site Infection
		Deep Venous Thrombosis and Pulmonary Embolism Prevention
		Postoperative Pain Management
		PONV Prevention and Treatment
	Other Complications
		Postoperative Airway Compromise
		Dysphagia, Laryngeal Palsy and Aspiration
		Postoperative Delirium
		Intracranial Complications
	References
5: Clinical Neurophysiology of the Cervical Spine: Indication for Surgery
	Introduction
	Clinical Approach to Cervical Spine Pathology
		Spinal Cord Anatomy and Pathophysiology
			Motor Functions of the Spinal Cord
			Sensory Functions of the Spinal Cord
		Spondylotic Cervical Radiculopathy
			Pathophysiology of Spondylotic Cervical Radiculopathy
			Symptomatology of Spondylotic Cervical Radiculopathy
			Differential Diagnosis of Spondylotic Cervical Radiculopathy
				Differential Diagnosis of Radiculopathy and Carpal Tunnel Syndrome (CTS)
				Differential Diagnosis of Radiculopathy and Shoulder Pathology
				Differential Diagnosis of Radiculopathy and Parsonage Turner Syndrome
				Differential Diagnosis of Radiculopathy and Thoracic Outlet Syndrome
		Cervical Spondylotic Myelopathy
			Cervical Myelopathy Symptoms
			Differential Diagnosis of CSM
		Chronic Neck Pain
	Cervical Spine Pathology: Neurophysiological Approach
	Neurophysiological Studies
		Electromyography
			EMG in Cervical Spine Pathology
				Acute Complete Injury of the Motor Root
				Partial Acute/Subacute Motor Radiculopathy
					Surgical Indications of Acute and Subacute Radiculopathy
				EMG in Chronic Active Motor Radiculopathy
				EMG in Elapsed Radiculopathy
				Limits of EMG
		Nerve Conduction Study
		Evoked Potentials
			SEP
				Anatomo-Physiological Premises for the SEP Study
				SEP in Cervical Radiculopathy
				SEP in Spinal Cord Injuries
				Contribution of SEP to Myelopathy Treatment
			MEP
				Instruments and Methods
				Contribution of SEP + MEP to Myelopathy Treatment
	References
6: Role of Radio Frequency for Cervical Facet Pain: Indication and Results
	Introduction
	Epidemiology and Clinical Features
	Anatomy of Facet Joints (FJs)
	Interventional Management
		Blocks
	Physical Neurolysis
		A: Principle
		B: Technique
		C: Adverse Events
		D: Results
	References
7: Biomechanical Approach to Stability of Intersomatic Implants in Cervical Spine
	Introduction
	Natural Vertebral Endplate
	Illustration of Endplate’s Sensitivity
	Natural Vertebral Disc
	Surgical Treatments
	Cages
	Basic Engineering Approach
	Complication Subsidence
	Comparison of Materials
	Conclusion
	References
8: Role of Materials in Cervical Spine Fusion
	Introduction
	Cervical Spine Devices
		Carbon Fiber Implants
		Polyetheretherketone (PEEK)
		Titanium
		Tantalum
	Bone Graft Substitutes
		Autograft
		Allograft
			Demineralized Bone Matrix (DBM)
	Synthetic Bone Graft Substitutes
		Ceramics
			Beta Tricalcium Phosphate (βTCP)
			Hydroxyapatite (HA)
			Coralline Hydroxyapatite
			Calcium Sulfate
			Calcium Phospate
			Silicate Substituted Calcium Phosphate (Si-CaP)
			Bioactive Glass Ceramic (BGC)
			Biphasic Calcium Phosphate (BCP)
			Polymer-Based Bone Substitutes
	Factor and Cell-Based Approaches for Bone Graft Substitutes
		Bone Morphogenetic Proteins (BMPs)
		Platelet Rich Plasma (PRP)
		Mesenchymal Stem Cells (MSCs)
	Synthetic Peptides
	Conclusion
	References
9: Endoscopic Cervical Spine Surgery
	Introduction
		History of Spinal Endoscopy
		Terminology of the Endoscopic Cervical Spine Equipment and Techniques
	Selection of Surgical Approach and Surgical Technique
	Posterior Approaches
		Posterior Cervical Laminoforaminotomy (PCLF)
			Indications
			Contraindication
			Surgical Equipment for Full-Endoscopic PCLF
			Surgical Equipment for Tube-Based PCLF
			Surgical Technique for Posterior Endoscopic Cervical Laminoforaminotomy
			Clinical Success of EPCLF
			Possible Complications of EPCLF
			Reoperation Following Endoscopic PCLF
			Advantages of Endoscopic PCLF Compared to Open PCLF
		Microendoscopic Cervical Laminotomy and Hemilaminectomy
			Indications
			Contraindications
			Surgical Equipment for MECL
			Surgical Technique for Microendoscopic Cervical Laminotomy and Hemilaminectomy
			Clinical Success of MECL
			Possible Complications of MECL
			Advantages of MECL Compared to Open Cervical Laminotomy
	Anterior Approach
		Cervical Microendoscopic Discectomy and Fusion
			Indications
			Contraindications
			Surgical Equipment for MECDF
			Surgical Technique for Microendoscopic Cervical Discectomy and Fusion
			Clinical Success of MECDF
			Possible Complications of MECDF
			Advantages of MECDF Compared to Open ACDF
		Anterior Percutaneous Endoscopic Cervical Discectomy via Transdiscal or Transcorporeal Approach
			Indications
			Contraindication
			Surgical Equipment for APECD
			Surgical Technique of Anterior Transdiscal Percutaneous Endoscopic Cervical Discectomy
			Surgical Technique of Anterior Transcorporeal Percutaneous Endoscopic Cervical Discectomy
			Clinical Outcome of APECD
			Possible Complications of APECD
			Advantages of APECD Compared to Open ACDF
			Disadvantages of APECD Compared to Open ACDF
	References
10: Arthroplasty in the Cervical Spine
	Introduction
	History and Implant Design
	Indications for Use and Contraindications
	Clinical Studies
		BRYAN Disc
		ProDisc-C
		PRESTIGE Disc
	Complications
	Biomechanics
	Cost Analysis
	Conclusions
	References
11: Cervical Spine Fractures and Dislocations, Classification and Treatment
	Introduction
		Epidemiology
	Classification Systems
		Allen and Ferguson Classification
		Magerl’s Classification
		Subaxial Injury Classification (SLIC)
		AO Spine Subaxial Cervical Spine Injury Classification System
	Treatment
		Anterior Approach
		Posterior Approach
		Combined Approach
	Illustrative Cases
	Discussion
	References
12: Tissue Sparing Posterior Fixation as a Treatment Option for Degenerative Disc Disease
	Background on Cervical Spondylosis
	Posterior Microendoscopic Foraminotomy
	Decompression and Fusion
		Nicotine Use
		Advanced Age
	DTRAX System
	Indications and Contraindications
		EEA Market
		US Market
	Surgical Technique
		Operating Room and Patient Preparation
		C-Arm Preparation and Tips
		Skin Markings and Sterile Field
		Establish Trajectory and Access the Facet Joint
		Decorticate the Lateral Masses and Establish Working Channel
		Decorticate the Facet Joint
	Implant the Cervical Cage
	Deploy the Inferior Bone Screw (Cage-B and Cage-X Only)
	Deploy the Superior Bone Screw (Cage-X Only)
	Apply Bone Graft Material to Decortication Bed
	Sutures, Contralateral Procedure, and Final Patient Preparation
	Clinical Evidence for Decompression and Fusion When Using Posterior Cervical Stabilizers
	Biomechanical Performance of DTRAX Cervical Cages Alone and When Integrated with Anterior Constructs
	Conclusion
	References
13: Anterior Cervical Decompression and Fusion with Autologous Bone Graft
	Surgical Techniques
		Anesthesia and Positioning
		Incision and Soft Tissue Dissection
		Smith-Robinson Technique
		Cloward Technique
		Corpectomy
		Bony Reconstruction with Autograft
		Donor Site Complications
		Anterior Instrumentation After Autologous Bone Graft
	Conclusion
	References
14: Anterior Cervical Approaches: Decompression and Fusion with Cages
	Introduction
	Indications and Limits
	Patient’s Positioning and Draping
	Side Making Decision
	Anterior Cervical Approach
	Discectomy and Decompression Technique
	Implant Selection
	Locking Stand-Alone Cage Technique
	Post-operative Cares
	References
15: Axial Instability of Cervical Spine: Posterior Surgical Approach
	History
	Conservative Treatment
	Biomechanical Analysis of Surgical Treatments
	Posterior Wiring and Clamps
	C1–C2 Trans-articular Screw Technique
	C1 Lateral Mass Screws and C2 Pedicle Fixation
	Conclusion
	References
16: Lateral Mass Screw Fixation of the Subaxial Cervical Spine
	Background
	Introduction
	Surgical Techniques
		The LMS Techniques
			Approach to the Posterior Cervical Spine
			Roy-Camille
			Magerl
			An
			Anderson
		The TFS Technique
	Comparison of the Four LMS and the TFS Techniques
		LMS Techniques
			Safety of LMS Techniques
		TFS Technique
	Conclusions
	References
17: Craniocervical Anomalies: Chiari Malformation
	Introduction
	Definition
	Pathophysiology
	Signs and Symptoms
	Syringomyelia
	Surgical Treatment
	References
18: Endoscopic Endonasal Odontoidectomy
	Introduction
	Anterior Versus Posterior Approach
	Transoral Approach and Transnasal Approach
	Indications
	Feasibility of the Endoscopic Endonasal Odontoidectomy
		Nasopalatine Line
		Naso-Axial Line
		Hard-Palate Line
		Rhinopalatine Line
			Operative Tecnique
			Patient Positioning and Preparation
			Nasal Phase
	Nasopharynx Phase
	C1 Anterior Arch Preservation in Selected Cases
	Craniovertebral Junction Phase and Closure
		Posterior Fusion
	Series Presentation
	Postoperative Management
	References
19: Basilar Invagination and Atlanto-Axial Dislocation
	Treatment Algorithm for BI and AAD
	Transoral Approach
		Preoperative Assessment, Anesthesiologic Considerations and Positioning
		Incision and Soft Tissue Dissection
		Transoral Atlas-Sparing Technique
		Transoral Trans-atlas Technique
	Postoperative Management
	Postoperative Complications and Their Avoidance
	Conclusion
	References
20: Cervical Spine Tumors
	Introduction
	Intramedullary Spinal Cord Tumors
		Epidemiology
		Genetic Factors
			Neurofibromatosis
			Von Hippel-Lindau Disease
		Clinical Presentation
		Histology and Clinical-Radiologic Correlation
			Ependymomas
			Astrocytomas
			Hemangioblastomas
			Germ Cell Tumors
			Intramedullary Metastases
		Diagnosis
	Treatment
		Surgery
		Adjuvant Therapies
			Radiosurgery
			Radiotherapy
			Chemotherapy
	Intradural Extramedullary Cervical Spine Tumors
		Meningiomas
		Nerve Sheath Tumors
		Surgical Technique
	Illustrative Cases
		Case 1
		Case 2: Intradural Spinal Meningioma
	References
21: Neck Pain Rehabilitation
	Neck Pain
		Definition
		Epidemiology
		Functional Anatomy
		Etiology
		Classification
		Clinical Evaluation
		Red Flags
		Diagnostic Imaging
		Prognosis
	Therapy
		Medical Therapy
		Rehabilitation Treatment
		Therapeutic Exercise
		Manual Therapy
		Stretching
		Proprioceptive Exercise
		Physical Therapy
	References
Index