Indications Indications include palmar hyperhidrosis, axillary hyperhidrosis, craniofacial hyperhidrosis and blushing, reflex sympathetic dystrophy, Raynaud disease, splanchnic pain, vascular insufficiency, angina pectoris, and heart arrhythmias such as long QT syndrome. The indication for which the results are most satisfactory is palmar hyperhidrosis. Patients undergoing thoracic sympathectomy should have previously completed and failed a trial of nonoperative therapy including topical therapy (primarily aluminum chloride hexahydrate [AlCl 3…

Indications “Failed back syndrome”, i.e., pain despite maximal medical and surgical therapies. Radiculopathy in the absence of compressive pathology. Neuropathic pain due to nerve root avulsion, postherpetic neuralgia, iatrogenic nerve injury, or complex regional pain syndrome. Phantom limb and stump pain, myelogenic pain. Painful peripheral neuropathy refractory to medical management. Ischemic pain from refractory angina or peripheral vascular disease. Successful completion of at least a several-day…

Indications Some experts advocate surgical resection for intramedullary spinal cord cavernous malformation only after progressive neurologic deterioration or for pain, which is often the presentation seen in adults. Others recommend surgical treatment after hemorrhage within the spinal cord, which is more commonly seen in children. Some neurosurgeons support early surgical intervention in symptomatic patients to halt neurologic decline. Resection of a lesion within 2 to 3…

Indications Symptomatic spinal dural arteriovenous fistula (SDAVF) should be treated. Symptoms often develop insidiously and progress over time and include weakness, sensory loss, and bowel/bladder dysfunction. High cervical fistulas can even present with basilar insufficiency–like symptoms. Dermatomal and myotomal symptoms may be distant from the actual level of the fistula. Surgery or embolization should be pursued in a timely manner to halt and potentially to reverse…

Indications Spinal cord arteriovenous malformations (AVMs) causing: Positive neurologic symptoms—pain, neurogenic claudication, myelopathy, radiculopathy, and progressive motor and sensory dysfunction. Positive radiologic signs for imminent damage to the spinal cord—venous hypertension, subarachnoid or intramedullary hemorrhage, edema, and significant mass effect. Presentation is often acute, after a bleeding episode. Close to 50% will experience at least one bleeding episode, especially children (> 80% will present with acute…

Indications Any situation or condition requiring interbody fusion at the level of L1-L2 through L4-L5 including adult spinal deformity, degenerative disk disease, adjacent segment disease, low-grade spondylolisthesis, and even foraminal stenosis where direct neural decompression is not required. The direct lateral approach can be used to correct coronal imbalance or degenerative disease by restoring alignment and providing indirect foraminal decompression. The patient must have favorable anatomy…

Indications Lumbar fusion for symptomatic isthmic, degenerative, or traumatic spondylolisthesis; intractable discogenic back pain; or correction of symptomatic degenerative scoliosis. As an adjunct to direct lateral, transforaminal, posterior, or anterior interbody fusion. To supplement a posterolateral arthrodesis. As a posterior adjunct to an anterior decompression or stabilization procedure for any of the following conditions: Trauma (e.g., burst fracture, Chance fracture). Neoplasms (resulting in instability). Infection (e.g.,…

Indications Thoracoscopic diskectomy is employed for treatment of herniated disks in the thoracic spine anterior to the spinal cord using a minimally invasive anterior approach. Patients typically present with spinal myelopathy and cord compression. This approach can be used to treat thoracic radicular pain, diskitis, and other similar conditions best treated from the front of the spine. You’re Reading a Preview Become a Clinical Tree membership…

Indications Conditions requiring ventral decompression of the spinal cord with removal of one to two vertebral bodies at any level of the thoracic spine. Extradural tumors. Infection (e.g., diskitis, osteomyelitis). Fractures or trauma. Degenerative disease or focal deformity. Patients for whom open thoracotomy or traditional open lateral extracavitary approaches may present excessive morbidity. You’re Reading a Preview Become a Clinical Tree membership for Full access and…

Indications Appropriate patient selection is an essential element when planning spine surgery to optimize patient outcome. The decision to pursue surgery is based on the history, physical examination, and radiographic findings. Radiographic evidence of a disk herniation in the absence of corresponding clinical signs or symptoms is insufficient to warrant operative intervention. Radiculopathy that is secondary to compression of neural structures by a herniated disk and…

Indications Approximately 50% of the normal rotation of the cervical spine occurs at the atlantoaxial motion segment. Factors that lead to instability at the atlantoaxial junction include traumatic injury to the axis or atlas and traumatic ligamentous injury. Other pathologic processes that lead to instability at C1-2 include inflammatory conditions such as rheumatoid arthritis, congenital lesions, malignancy, and severe osteoarthritis. Because of the high degree of…

Indications Primary sacral tumors, many of which benefit from en bloc removal. Locally advanced rectal cancer with sacral involvement, for which pelvic exenteration is indicated. Nonunion of symptomatic sacral fracture. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Procedure notes Fusion to the pelvis in spine surgery can be difficult because of the complex anatomy of the lumbosacral region, the decreased bone density of the sacrum, and the large biomechanical stress placed on fixation at this transitional zone between the mobile lumbar spine and the far less mobile sacrum. Nevertheless, rigid fixation to the pelvis is crucial in many situations, particularly when maintaining sagittal…

Indications Lumbar disk arthroplasty (LDA) is indicated as a treatment of chronic, incapacitating low back pain that is diskogenic in origin at the L4-5 or L5-S1 level and not accompanied by neural element compression resulting in claudication or radiculopathy. Diagnosis should be documented with magnetic resonance imaging (MRI), plain lumbar spine x-rays, and positive results of provocative diskography of the pathologic level. To be considered for…

Indications Fixed sagittal deformity (e.g., demonstrate poor correction on bending radiographs) secondary to previous surgery with an anterior fusion mass, traumatic deformity, neoplastic disease, or congenital anomalies. The need to introduce up to 35 degrees of lumbar lordosis, the need to introduce 10 cm of posterior trunk translation, or correction of a sharp angular kyphosis or flat back syndrome. Symptoms including inability to maintain horizontal gaze,…

Indications Tumor, fracture, tuberculosis, or other pathology of the vertebral body requiring direct decompression of the spinal canal with resection of anterior pathology. Instability of anterior spinal elements requiring restoration of height and stability to prevent progressive deformity and kyphosis. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Indications Segmental instability requiring fusion for stabilization. Recurrent disk herniation and broad-based herniation. Symptomatic spinal stenosis with a significant back pain component that would benefit from fusion. Degenerative disk disease with a significant back pain component. Spondylolisthesis that is progressive, is symptomatic, or requires decompression with a need to fuse spondylolisthetic level. Correction of degenerative scoliosis requiring fusion segments. Salvage for pseudarthrosis of a previous intertransverse…