Indications Spondylolisthesis that is symptomatic, progressive, or requiring decompression that necessitates stabilization. Degenerative disk disease with low back pain that can benefit from fusion at the symptomatic level or levels. Pseudarthrosis of a previous intertransverse fusion that requires a fusion technique with higher success at achieving a solid arthrodesis. Correction of degenerative scoliosis. Recurrent disk herniation. You’re Reading a Preview Become a Clinical Tree membership for…

Indications Anterior lumbar interbody fusion (ALIF) is indicated as a treatment of chronic, incapacitating low back pain secondary to degenerative disk disease, such as collapsed disk and Modic changes, or degenerative spondylolisthesis in the absence of severe neural element compression. Patients are generally not considered for operation until at least 6 months of conservative nonsurgical therapies have failed to yield adequate amelioration of symptoms. ALIF may…

Indications Patients with back pain, sciatic pain, Lasègue sign (pain with straight leg raise), or sensory deficit that fails to improve with conservative measures. Referable foraminal stenosis from posterolateral disk herniation. New or progressive motor deficits require more urgent surgical intervention. Contraindications Large disk herniation causing central canal stenosis requires a laminectomy. A more extensive procedure, such as interbody fusion, may be beneficial to patients with…

Indications Patients with low-back pain, neurogenic claudication, or weakness with referable radiographic spinal stenosis and who have failed 3 to 6 months of conservative management. Motor deficits or symptoms of cauda equina syndrome are indications for a more expeditious decompression. Patients with extended stenosis or spondylosis causing compression but who have contraindications or comorbidities preventing an anterior or extended posterior fusion. Contraindications MRI findings of herniated…

Indications Treatment of degenerative disease. Acute traumatic instability. Iatrogenic destabilization. Congenital and idiopathic scoliosis. 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 Correction of multiplanar spinal deformity. Correction of fixed sagittal and coronal imbalance. Correctable imbalance through mobile segments. 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 The thoracic transpedicular approach provides access to the lateral spinal canal, the neural foramina, and a portion of the posterolateral vertebral body. A bilateral transpedicular approach can provide up to 270 degrees of decompression. Common pathologies treated by thoracic transpedicular corpectomy include lateral disk herniations, epidural tumor, osteomyelitis or diskitis with or without abscess, and lateral canal compression from trauma. Adjunct posterior segmental fixation can…

Indications Costotransversectomy provides a posterolaterally directed corridor of access to the costovertebral joints, lateral spinal canal, and neural foramina and to a portion of the posterolateral vertebral body located from T1-12. Lateral or paracentral soft disk herniations. Epidural or bony tumor debulking or removal. Thoracic sympathectomy. Osteomyelitis or diskitis with or without abscess. Canal decompression for trauma. Epidural metastasis in which palliation rather than en bloc…

Indications Unstable burst fractures with anterior spinal cord compression. Primary or metastatic vertebral tumors. Osteomyelitis or diskitis. Severe spinal deformities. Sequestered thoracic disk herniation with migration dorsal to the vertebral body, leading to spinal cord impingement and neurologic deficits. Failed previous stabilization surgery (anterior or posterior) resulting in pseudarthrosis, instability, or both. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy…

Indications Progressive myelopathy or symptomatic spinal cord compression caused by disk herniation or disk osteophyte complex. Radiculopathy unresponsive to conservative management. 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

The authors wish to thank Timothy Link and Volkner Sonntag for their work on the previous edition’s version of this chapter. Indications Severe kyphotic deformity at the cervicothoracic spine that causes radiculopathy, myelopathy, pain, restriction of gaze, or dysphagia. The deformity may arise from postlaminectomy destabilization, junctional kyphosis above a fused level, or primary diseases affecting the spine (particularly ankylosing spondylitis). C7 plumb line may be…

The authors would like to thank Mike Yue Chen and Matthew J. Duenas for their work on the previous edition’s version of this chapter. Indications Indications for later mass fixation among vertebrae between C3 and C7 include cervical instability from multilevel anterior cervical diskectomies or corpectomies and occipitocervical instability due to occipitalization of the atlas, C1. As with other related approaches, lateral mass fixation can help…

The authors would like to thank Stephen S. Scibelli, Kamal R.M. Woods, Shoshanna Vaynman, and J. Patrick Johnson for their work on the previous edition’s version of this chapter. Indications Multilevel cervical stenosis with preservation of normal lordotic curvature. Diffuse ossification of posterior longitudinal ligament. Posterior cord compression resulting from buckling of thickened ligamentum flavum Posterior exposure of intraspinal pathology (e.g., tumor, vascular malformation, infection, hematoma).…

The authors would like to thank Carmina F. Angeles for work on the previous edition’s version of this chapter. Indications Correction of cervical kyphotic deformity to restore lordotic alignment. Decompression of the cervical spinal cord in degenerative spondylotic myelopathy. Excision of ossified posterior longitudinal ligament (PLL) that often bridges past disk spaces and cannot be adequately removed with diskectomies alone. Treatment of osteomyelitis that fails nonoperative…

The authors wish to thank Benjamin M. Zussman, Peter G. Campell, and James S. Harrop for their work on the previous edition’s version of this chapter. Indications Cervical disk herniation with persistent radiculopathy and/or myelopathy following conservative measures. Cervical disk herniation with spinal cord compression. Cervical disk herniation with significant narrowing of the spinal canal. Multilevel cervical spondylosis with multiple disk herniations. You’re Reading a Preview…

The authors wish to acknowledge Daniel S. Hutton and Kee D. Kim for their work on the previous edition’s version of this chapter. Indications Patients with acute type II odontoid fractures (< 6 months) and patients with fractures with either a transverse or an anterosuperior to posteroinferior fracture plane are the most favorable surgical candidates. Subacute, unstable type II odontoid fractures (for which alignment cannot be…

The authors would like to thank Matthew J. Tormenti, Ricky Madhok, and Adam S. Kanter for their work on the previous edition’s version of this chapter. Indications Irreducible atlantoaxial subluxation with compression of cervicomedullary junction. Ventrally located pathology of the lower clivus or atlantoaxial complex. Unstable odontoid fractures or os odontoideum with spinal canal stenosis. You’re Reading a Preview Become a Clinical Tree membership for Full…

The authors wish to thank Nestor D. Tomycz and David O. Okonkwo for their work on the previous edition’s version of this chapter. Indications Occipitocervical fusion is performed for craniovertebral junction (CVJ) instability. Posttraumatic: Atlantooccipital dislocation, complex fractures involving CVJ, unstable odontoid fractures with incompetence of the posterior ring of C1. Acquired instability secondary to infectious or inflammatory disease: rheumatoid arthritis, ankylosing spondylitis, Down syndrome, inflammatory…

Indications C1-2 posterior cervical fusion is indicated in patients with odontoid fractures that cannot be repaired with an odontoid screw, including (1) type II odontoid fractures with atlantoaxial joint fracture, (2) type II odontoid fractures with oblique fractures in the sagittal plane that preclude odontoid screw placement, (3) type II odontoid fractures with significant irreducible displacement that may not heal with immobilization (and are too displaced…

The authors wish to thank Vincent Y. Wang and Dean Chou for their work on the previous edition’s version of this chapter. Indications Indications for C1-2 transarticular screw fixation, also known as Magerl’s method, are atlantoaxial instability, tumor formation, ligamentous abnormality, acute fracture, os odontoideum such as nonunion, rheumatoid arthritis with severe pain resistant to conservative treatments, or congenital abnormality such as incomplete ossification or previously…