Operative Techniques: Spine Surgery

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Title Page
Operative Techniques: Spine Surgery, 4th edition
Copyright
Dedication
Contributors
Foreword to the First Edition
Preface
Contents​
Video Contents
I. Cervical Spine
	1 Closed Cervical Skeletal Tong Placement and Reduction Techniques
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4: Reduction of Unilateral Facet Dislocation
			Step 5: Reduction of Bilateral Facet Dislocation
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	2 Halo Placement in the Adult and Pediatric Patient
		ADULT PATIENT
			INDICATIONS
				Examination/Imaging
			SURGICAL ANATOMY
			POSITIONING
			PROCEDURE: HALO APPLICATION
				Step 1: Crown and Pin Placement
				Step 2: Vest Application
				Step 3: Construct Alignment
				Step 4: Follow-up
		PEDIATRIC PATIENT
			INDICATIONS
				Examination/Imaging
			SURGICAL ANATOMY
			POSITIONING
			PROCEDURE: HALO APPLICATION IN THE CHILD OR INFANT
			POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	3 Anterior Odontoid Resection: The Transoral Approach
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
		EVIDENCE
	4 Odontoid Screw Fixation
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
		EVIDENCE
		EVIDENCE
	5 Anterior C1-C2 Arthrodesis: Lateral Approach of Barbour and Whitesides
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
			Step 5
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	6 Anterior Cervical Corpectomy/Diskectomy
		INDICATIONS
		EXAMINATION/IMAGING
		SURGICAL ANATOMY
		SET-UP AND POSITIONING
		PROCEDURE
			Step 1: Approach
			Step 2: Retractor Placement and Initial Diskectomy
			Step 3: Complete Diskectomy
			Step 4: Removal of Posterior Longitudinal Ligament, Foraminal Decompression
			Step 5: Graft Insertion
				Workflow for Three or More Levels
			Step 6: Plate Application (Fig. 6.7)
			Step 7: Closure
		POSTOPERATIVE CARE
		CERVICAL CORPECTOMY
		EVIDENCE
	7 Anterior Resection of Ossification of the Posterior Longitudinal Ligament
		INTRODUCTION
		INDICATIONS
		EXAMINATION/IMAGING
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Preparation of Disk Spaces and/or Cervical Corpectomy
			Step 2: Takedown of Ossification of the Posterior Longitudinal Ligament
			Step 3: Graft Placement, Anterior Plating
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	8 Cervical Total Disk Replacement
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Anterior Cervical Diskectomy
			Step 2: Foraminal Decompression
			Step 3: Total Disk Replacement Trialing for Size Selection
			Step 4: Preparation of End Plates and Final Implant Insertion
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	9 Occipital-Cervical Fusion​
		INDICATIONS
		EXAMINATION/IMAGING
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2: Exposure of Inion to C5
			Step 3: Instrumentation and Fusion
			Step 4: Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	10 C2 Translaminar Screw Fixation
		INDICATIONS
		EXAMINATION/IMAGING
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Making the Entry Hole for the First Translaminar Screw
			Step 2: Drilling the Contralateral Lamina
			Step 3: Verification of Safe Preparation of the Lamina
			Step 4: Placement of the First Screw
			Step 5: Placement of the Second Screw
			Step 6: Connection of the C2 Laminar Screws to C1 Lateral Mass Screws
			Step 7: Arthrodesis
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	11 C1-C2 Posterior Fusion Harms and Magerl Techniques
		C1-C2 POSTERIOR FUSION
			Contemporary Techniques
		INDICATIONS
		EXAMINATION
		IMAGING
		POSITIONING
		C1-C2 POSTERIOR SEGMENTAL SCREW AND ROD FIXATION (HARMS TECHNIQUE)
			EXPOSURE
				Exposure Steps
			PROCEDURE
				C1 Drilling and Screw Placement Steps
				C2 Drilling and Screw Placement Steps
				Reduction Steps
				Rod Placement Steps
				Grafting Steps
				Wound Closure and Immobilization Steps
			POSTOPERATIVE CARE AND EXPECTED OUTCOMES
				Postoperative Care
				Complications
		POSTERIOR C1-C2 TRANSARTICULAR FACET SCREWS (MAGERL TECHNIQUE)
			EXPOSURE
				Open Exposure Steps
				Percutaneous Exposure Steps
			PROCEDURE
				Grafting and Sublaminar Wiring Steps
				Reduction and Fixation Steps
				Wound Closure and Immobilization Steps
			POSTOPERATIVE CARE AND COMPLICATIONS
				Postoperative Care
				Complications
			SUMMARY
		EVIDENCE
	12 Cervical Spine: Lateral Mass Screw Fixation
		INTRODUCTION
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY (FIG. 12.2)
		PATIENT POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Determine the Entry Point for Screw Insertion
			Step 2: Drill Screw Hole
			Step 3: Tapping and Screw Insertion
			Step 4: Rod Insertion
			Step 5: Placement of Screw Caps
		POSTOPERATIVE CARE
		EVIDENCE
	13 Cervical Pedicle Screw Fixation
		OVERVIEW
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		SURGICAL PROCEDURE
			Step 1: Screw Placement
				Manual Screw Placement
				Computer-Assisted Screw Placement
				Screw Placement Using Template Systems
			Step 2: Longitudinal Connection
				Step 3: Correction of Deformities
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
			Complications Directly Attributable to Screw Insertion
			Complications Not Directly Attributable to Screw Insertion
		SUMMARY
		EVIDENCE
	14 Cervical Osteotomy Techniques
		INDICATIONS/CONTRAINDICATIONS
		PREOPERATIVE PLANNING
			Patient Evaluation
			Preoperative Radiographic Evaluation
		SURGERY
			Anesthetic Considerations
			Osteotomy Considerations
		CERVICOTHORACIC PEDICLE SUBTRACTION OSTEOTOMY
			Stage I: Positioning
			Stage II: Exposure and Instrumentation
			Stage III: Osteotomy
			Stage IV: Correction of the Deformity
			Stage V: Bone Grafting and Wound Closure
		MIDCERVICAL EXTENSION OSTEOTOMY
			Stage I: Anterior Release and Osteotomy
			Stage II: Posterior Exposure and Instrumentation
			Stage III: Osteotomy
			Stage IV: Correction of Deformity
			Stage V: Bone Grafting and Closure
			Stage VI: Anterior Instrumentation
		POSTOPERATIVE MANAGEMENT
		CONCLUSION
		EVIDENCE
	15 Posterior Cervical Laminoplasty
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	16 Posterior Cervical Foraminotomy, Microdiskectomy
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1: Laminar and Mesial Inferior Facet Resection
			Step 2: Foraminal Decompression and Superior Articular Facet Tip Resection
			Step 3: Free Fragment Diskectomy
			Step 4: Incision of Posterior Longitudinal Ligament and Diskectomy
			Step 5: Osteophyte Decompression
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	17 Subaxial Cervical Trauma Classification and Treatment
		INTRODUCTION
		MECHANISTIC CLASSIFICATION SYSTEMS
		MORPHOLOGIC CLASSIFICATION SYSTEMS
		TREATMENT
		CONCLUSIONS
		EVIDENCE
II. Thoracic Spine
	18 Anterior Thoracic Diskectomy and Corpectomy
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS AND EXPOSURES
		PROCEDURE
			Step 1: Superficial Exposure and Rib Resection
			Step 2: Transthoracic Retropleural Deep Exposure
			Step 3: Diskectomy
			Step 4: Hemicorpectomy (or Corpectomy) and Spinal Cord Decompression
			Step 5: Arthrodesis, Cage Preparation, and Insertion
			Step 6: Screw-Plate Instrumentation
			Step 7: Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EXPECTED OUTCOMES
		EVIDENCE
	19 Anterior Thoracolumbar Spinal Fusion via Open Approach for Idiopathic Scoliosis
		INDICATIONS
			Examination/Imaging
		POSITIONING
		PORTALS/EXPOSURES
			Thoracic
			Thoracolumbar
			Lumbar
		PROCEDURE: THORACOLUMBAR SPINE FUSION VIA AN OPEN APPROACH USING SINGLE-ROD INSTRUMENTATION
			Step 1: Anterior Release and Diskectomy
			Step 2: Placement of the Anterior Vertebral Body Screws
			Step 3: End-Plate Ablation
			Step 4: Placement of Anterior Interbody Structural Supports
			Step 5: Rod Placement
			Step 6: Placement of Chest Tube and Wound Closure
		PROCEDURE: THORACOLUMBAR SPINE FUSION VIA AN OPEN APPROACH USING DUAL-ROD
			Step 1: Anterior Release and Diskectomy
			Step 2: Placement of the Anterior Vertebral Body Screws
			Step 3: End-Plate Ablation
			Step 4: Placement of Anterior Interbody Supports
			Step 5: Rod Placement
			Step 6: Placement of Chest Tube and Wound Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	20 Operative Management of Scheuermann Kyphosis
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1: Anterior Release and Fusion
			Step 2: Posterior Spinal Fusion
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	21 Resection of Intradural Intramedullary or Extramedullary Spinal Tumors
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	22 Endoscopic Image-Guided Thoracic Diskectomy
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		SURGICAL OUTCOMES
		COMPLICATIONS AND AVOIDANCE
		EVIDENCE
	23 Adolescent Idiopathic Scoliosis: Lenke Classification and Surgical Indications
		INTRODUCTION
		LENKE ADOLESCENT IDIOPATHIC SCOLIOSIS AIS CLASSIFICATION SYSTEM
			Step 1: Determination of Curve Type
			Step 2: Determination of Lumbar Modifiers
			Step 3: Determination of Sagittal Modifiers
		VALIDATION OF THE LENKE ADOLESCENT IDIOPATHIC SCOLIOSIS CLASSIFICATION SYSTEM
		SURGICAL INDICATIONS BASED ON THE LENKE ADOLESCENT IDIOPATHIC SCOLIOSIS CLASSIFICATION SYSTEM
			Nonoperative Management
			Operative Intervention
			Upper Instrumented Vertebra Selection
			Lower Instrumented Vertebra Selection
		CONCLUSION
		EVIDENCE
	24 Posterior Thoracolumbar Fusion Techniques for Adolescent Idiopathic Scoliosis
		INDICATIONS
		SURGICAL ANATOMY
			Choosing Levels for Fusion
			Examination/Imaging
			Selection of Fusion Levels
		POSITIONING
		EXPOSURE
		PROCEDURE
			Step 1: Facetectomies
			Step 2: Release of the Spine
			Step 3: Pedicle Screw Placement
			Step 4: Rod Placement and Correction of Deformity, Including Vertebral Derotation
			Step 5: Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	25 Complete Vertebral Resection for Primary Spinal Tumors
		INDICATIONS
			Examination/Imaging/Initial Workup
		SURGICAL ANATOMY
		POSITIONING
		EXPOSURES
		PROCEDURE
			Step 1: En Bloc Laminectomy
			Step 2: En Bloc Corpectomy
			Step 3: Anterior Reconstruction and Posterior Stabilization
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	26 Hybrid Therapy for Metastatic Spine Tumors in the Context of the NOMS Decision Framework
		INDICATIONS
		Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1 Instrumentation and PMMA augmentation
			Step 2 Decompression (Amankulor et al., 2014)
			Step 3 Radiation planning and treatment
		EVIDENCE
	27 Surgical Treatment of Spinal Arachnoid Cysts and Arachnoid Web
		INDICATIONS
		Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Laminectomy
			Step 2: Localization
			Step 3: Aspiration, Resection, or Fenestration
			Step 4
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	28 Surgical Management of Adult Syringomyelia
		INDICATIONS
			Examination/Imaging
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: General Review of Procedure
			Step 2: Details of intradural portion of procedure and lysis of adhesions
			Step 3: Exposure of the Pleural Space for Placement of a Syringopleural Shunt
			Step 4: Myelotomy and Proximal Shunt Placement
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	29 Surgical Treatment of Dural Arteriovenous Fistulas and Arteriovenous Malformations
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Pial Incision
			Step 2: Correlation of Vascular Anatomy
			Step 3: Coagulation or Ligation of Arterial Feeders
			Step 4: Ligation of Draining Vein
			Step 5: Excision of Lesion
			Step 6: Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	30 Adult Scoliosis: Classification and Treatment
		CLASSIFICATION OF ADULT SCOLIOSIS
		INDICATIONS
			Adult Scoliosis Classification
				Aebi Classification
				Scoliosis Research Society Classification
				Berjano and Lamartina Classification
				Schwab-Scoliosis Research Society Classification
				Sagittal Modifier
				Pelvic Modifier
				Global Alignment Modifier
			Treatment of Adult Scoliosis
		INDICATIONS
			Surgical Management of Adult Scoliosis
				Technique: Surgical Decompression Without Fusion
					Indications
					Case 1
					Radiographic evaluation
					Surgical technique
				Technique: Surgical Decompression With Limited Fusion
					Indications
					Case 2
					Radiographic evaluation
					Surgical technique
				Extensive Realignment Procedures
					Indications
					Case 3
					Radiographic evaluation
					Surgical technique
		CONCLUSION
		EVIDENCE
	31 Spinopelvic Balance: Preoperative Planning and Calculation
		INTRODUCTION
		PREOPERATIVE MEDICAL CONSIDERATIONS
		PREOPERATIVE RADIOGRAPHIC ANALYSIS
		RADIOGRAPHIC ANALYSIS
			Global Sagittal Alignment
		CONSIDERATIONS WITH PREDICTING POSTOPERATIVE SAGITTAL MEASUREMENTS
		SAGITTAL PLANE CORRECTION TECHNIQUES: BASIC PRINCIPLES
		INTERBODY GRAFTING OR PROSTHESIS PLACEMENT
		OSTEOTOMIES
			Case Example
		CONCLUSIONS
		EVIDENCE
III. Lumbar Spine
	32 Sacropelvic Fixation
		INDICATIONS
		NEUROMUSCULAR SCOLIOSIS
		DEGENERATIVE SPINAL DEFORMITIES
		SPONDYLOLISTHESIS (HIGH GRADE)
		SACRECTOMY
		TRAUMA
		BIOCHEMICAL CONSIDERATIONS
			Lumbosacral Pivot Point
			Zones of Sacropelvic Fixation
			Spinopelvic Alignment
		Examination/Imaging
		SURGICAL ANATOMY
			Important Bony Anatomic Features
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE A: S1 PEDICLE SCREWS
			Technique
		PROCEDURE B: SACRAL ALAR SCREWS
			Technique
		PROCEDURE C: ILIOSACRAL SCREWS
		PROCEDURE D: GALVESTON RODS
			Technique
		PROCEDURE E: ILIAC SCREWS (ILIAC BOLTS)
			Technique
		PROCEDURE F: TRANSILIAL BAR
			Technique
		PROCEDURE G: S2 ALAR ILIAC SCREWS (S2AI)
			Technique (Authors’ Preference)
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
			Complications of Pelvic Fixation
			Implant Prominence and Loosening
			Wound Complications and Infection
			Nonunion and Implant Failure
			Biomechanical Studies of Sacropelvic Fixation
		EVIDENCE
	33 Posterior Far Lateral Diskectomy
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
			Step 5
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	34 Pedicle Subtraction Osteotomy for Fixed Sagittal Imbalance
		INDICATIONS
			Examination/Imaging
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Identification of Spinal Levels and Placement of Pedicle Screw Fixation
			Step 2: Bony Decompression and Identification of Neurologic Elements
			Step 3: Resection of Pedicle and Decancellation/Osteotomy
			Step 4: Closure of Osteotomy/Correction
			Step 5: Final Rod Placement and Arthrodesis (Often Performed in Combination With Step 4)
		ADDITIONAL STEPS
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	35 Spondylolysis Repair
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
			Open
			Minimally Invasive Technique
		PROCEDURE
			Step 1 Preparing the Pars Defect
			Step 2 Instrumentation
				Open
				Alternative Open Technique
				Minimally Invasive Technique
		INSTRUMENTATION/IMPLANTATION
			Step 3 Alternative Dynesys Based technique
				Minimally Invasive Technique
			Step 4 Wound Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	36 Surgical Treatment of High-Grade Spondylolisthesis
		INDICATIONS
			Examination
			Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE A: SACRAL DOME OSTEOTOMY
			Step 1
			Step 2: Decompression
			Step 3
			Step 4
			Step 5
			Step 6
		PROCEDURE B: TRANSACRAL SCREW/FIBULAR DOWEL
			Step 1
			Step 2
		PROCEDURE C: GAINES PROCEDURE
			Step 1
			Step 2
		EVIDENCE
	37 Interspinous Process Motion-Sparing Implant
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE (COFLEX INTERSPINOUS DEVICE)
			Step 1: Positioning
			Step 2: Incision
			Step 3: Preparing Interspace
			Step 4: Laminotomy
			Step 5: Implantation
		PROCEDURE (SUPERION INTERSPINOUS DEVICE)
			Step 1: Positioning
			Step 2: Incision
			Step 3: Preparing Interspace
			Step 4: Implantation
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	38 Vascular Exposure for Anterior Lumbar Interbody Fusion
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING (Fig. 38.3)
		PROCEDURE (Fig. 38.4)
			Step 1: Entry into the Retroperitoneal Space
			Step 2: Mobilization of the Peritoneum and Exposure of the Retroperitoneal Vasculature
			Step 3: Exposure of L5-S1 Vertebral Interspace
			Step 4: Exposure of L4-L5 Vertebral Interspace
			Step 5: Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	39 Transforaminal Lumbar Interbody Fusion
		INDICATIONS
			Examination/Imaging
		POSITIONING
		SURGICAL ANATOMY
		PORTALS AND EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
			Step 5
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		ACKNOWLEDGMENTS
		EVIDENCE
	40 The Transpsoas Approach for Thoracolumbar Interbody Fusion
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1: Exposure
			Step 2: Docking of Tubular Retractor and Dilation
			Step 3: Diskectomy
			Step 4: Interbody Graft Placement
			Step 5: Closure
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	41 Antepsoas Approach for Lumbar Interbody Fusion
		INDICATIONS
			Examination and Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
		ADDITIONAL STEPS
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	42 Lumbar Total Disk Arthroplasty
		INDICATIONS
			Examination/Imaging
		TREATMENT OPTIONS
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Diskectomy
			Step 2: Remobilization
			Step 3: Trial Insertion
			Step 4: Keel Preparation (Device Dependent)
			Step 5: Device Insertion
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	43 Kyphoplasty
		INDICATIONS
			Examination and Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	44 Minimally Invasive Exposure Techniques of the Lumbar Spine
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		GENERAL ASPECTS TO POSTERIOR TUBULAR RETRACTO SURGERY
		RADIATION
		TUBULAR MICRODISCECTOMY AND DECOMPRESSION TECHNIQUES
		SPINAL FUSION
		TRANSFORAMINAL LUMBAR INTERBODY FUSION
		ANTERIOR LUMBAR INTERBODY FUSION
		LATERAL TRANSPSOAS INTERBODY FUSION
		PERCUTANEOUS PEDICLE SCREW INSTRUMENTATION
		MINI-OPEN
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	45 Hemivertebrae Resection
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE A: LATERAL-POSTERIOR LUMBAR HEMIVERTEBRAE RESECTION AND CORRECTION WITH SEGMENTAL ANTERIOR INSTRUMENTATION
			Step 1: The Patient Is Positioned in the Lateral Decubitus Position
			Step 2: Anterior Incision Is Performed
		PROCEDURE B: HEMIVERTEBRA RESECTION AND FUSION: ANTERIOR AND POSTERIOR
			Step 1: Anterior Approach
			Step 2
		PROCEDURE C: POSTERIOR HEMIVERTEBRAE RESECTION AND CORRECTION
			Step 1
			Step 2
			Step 3
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	46 Lumbar Internal Laminectomy
		INDICATIONS
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
			Step 5
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	47 Cortical Screw Fixation in the Lumbar Spine
		INDICATIONS
			Examination and Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1: Exposure
			Step 2: Start Point and Trajectory
			Step 3: Preparation of the Screw Tract
			Step 4: Screw Insertion
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	48 Spinal Navigation: Setup and Workflow
		INDICATIONS
		SURGICAL ANATOMY
		POSITIONING
		REFERENCE FRAME
		PROCEDURE
			Step 1: Image Acquisition, Instrument Calibration, and Navigation Confirmation
			Step 2: Navigated Instrumentation
			Step 3: Navigated Disk Preparation and Interbody Placement
		EVIDENCE
	49 Robotically Assisted Spinal Surgery: Setup and Workflow
		INDICATIONS
			Examination and Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1
			Step 2
			Step 3
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	50 Virtual and Augmented Reality in Spinal Surgery: Setup and Workflow
		INDICATIONS
			Examination and Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1: Place Reference Marker-Arrays
			Step 2: Obtain Intraoperative Three-Dimensional Imaging
			Step 3: Posterior Instrumentation
			Step 4: Rod Placement and Posterior Fusion
		ADDITIONAL STEPS: CLOSURE
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	51 Thoracolumbar Trauma Classification and Surgical Treatment
		BACKGROUND
			Modern Classification Systems
		EVIDENCE
	52 Sacral Fixation: Iliosacral Screws and Sacral Fixation
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
			Open Fracture Reduction
		PROCEDURE A: SACROILIAC STYLE SCREWS
			Step 1: Intraoperative Radiographs and Closed Reduction
			Step 2: Guidewire Insertion
			Step 3: Guidewire Advancement and Drilling
			Step 4: Screw Insertion
		PROCEDURE B: POSTERIOR ILIOSACRAL PLATING: TENSION BAND PLATING
			Step 1: Posterior Iliosacral Plating Technique
		PROCEDURE C: DIRECT DORSAL-SACRAL PLATING
			Step 1: Direct Dorsal Plating Technique
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	53 Sacroiliac Joint Fusion
		INDICATIONS
		CONTRAINDICATIONS
			Examination
			Imaging
		SURGICAL ANATOMY
		POSITIONING
		PROCEDURE
			Step 1: Obtain Starting Point
			Step 2: Steinman Pin Insertion
			Step 3: Drill and Broach Screw Path
			Step 4: Insert Implant
			Step 5: Additional Implants
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	54 Endoscopic Lumbar Diskectomy and Foraminotomy: Indications and Techniques
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		TRANSFORAMINAL APPROACH
			Step 1: Incisional Planning
			Step 2: Targeting, Dilator and Endoscopic Retractor Placement
			Step 3: Confirming location and establishing orientation
			Step 4: Removing the superior articular process
			Step 5: Removing Disc Material
		INTERLAMINAR PROCEDURE
			Step 1
			Step 2: Incision and Dilator Placement
			Step 3: Endoscope Placement and Laminotomy
			Step 4: Ligament removal and extension of the laminotomy
			Step 5: Disc Material Removal
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
	55 Awake Spinal Surgery: Indications and Technique
		INDICATIONS
			Examination/Imaging
		SURGICAL ANATOMY
		POSITIONING
		PORTALS/EXPOSURES
		PROCEDURE
			Step 1
			Step 2
			Step 3
			Step 4
			Step 5
		POSTOPERATIVE CARE AND EXPECTED OUTCOMES
		EVIDENCE
Index