Corrective Osteotomies for Rigid Spinal Deformities

Foreword
Preface
Introduction
Acknowledgments
Contributors
1 Introduction to Anatomic Systems and Terminology
1.1 Introduction
1.2 Deciding on Surgery
1.3 Prognosis
1.4 Congenital Kyphosis and Kyphoscoliosis
1.5 Further Perioperative Considerations
1.6 Treatment Options and Principles
1.6.1 Observation
1.6.2 Epiphysiodesis
1.6.3 Hemivertebra Resection
1.6.4 Pedicle Subtraction Osteotomy
1.6.5 Vertebral Column Resection
1.6.6 Vertebral Column Decancellation
1.7 Conclusion
2 Neuromuscular Spinal Deformities
2.1 Introduction
2.2 Clinical Problems Associated with Spinal Deformity
2.3 Etiology and Natural History of Spinal Deformity
2.4 Patterns of Spinal Deformity
2.5 Specific Types of Spinal Deformity
2.5.1 Spina Bifida (Myelomeningocele)
2.5.2 Neurofibromatosis
2.6 Treatment Principles
2.6.1 Nonoperative Treatment
2.6.2 Surgical Treatment
2.7 Medical Considerations—Preoperative Assessment
2.8 Complications during and after Scoliosis Surgery
2.9 Deformity Correction Techniques
2.9.1 First- and Second-Generation Instrumentation Techniques
2.9.2 Third-Generation Instrumentation
2.10 Additional Surgical Considerations
2.10.1 Intraoperative Management
2.10.2 Levels of Fusion
2.10.3 Anterior Correction
2.10.4 Posterior Vertebral Column Resection
2.10.5 Growth Preservation/Modulation Techniques
2.11 Quality of Life Assessment/Life Expectancy after Scoliosis Surgery
2.12 Conclusion
3 Idiopathic Spinal Deformities Treated with Spinal Osteotomies
3.1 Introduction
3.2 Posterior Column Osteotomy
3.2.1 Indications in Idiopathic Deformity
3.2.2 Technique
3.2.3 Case Illustration
3.3 Pedicle Subtraction Osteotomy
3.3.1 Indications in Idiopathic Deformity
3.3.2 Technique
3.3.3 Case Illustration
3.4 Preoperative Considerations and Postoperative Complications
3.4.1 PCO versus PSO
3.4.2 Complications
3.5 Conclusions
4 The Natural History of Rigid Spinal Deformities
4.1 Definition and Measurement
4.2 Natural History, Physiopathology
4.3 Natural History, Assessment of Flexibility/Rigidity
4.3.1 Reduction of the Deformity Will Be Checked: Locally and Globally
4.4 Natural History According to the Growing Spine and Etiologies
4.5 Natural History According to the Mature Spine and Etiologies
5 Surgical Management of Children with Congenital Deformities of the Upper Thoracic Spine and Vertebral Malformations
5.1 Introduction
5.2 Outcomes of Surgical Management
6 Osteotomies in Children under the Age of 10 Years
6.1 Background
6.2 Overall Management of the Rigid Spine Deformity
6.3 Halo Traction
6.3.1 Halo Placement Technique
6.3.2 Complications with Halo Frames
6.4 Osteotomies for Correction of Rigid Spinal Deformities
6.4.1 Partial Facet Joint Resection
6.4.2 Complete Facet Joint Resection (Posterior Elementectomy)
6.4.3 Three-Column Osteotomies
6.5 Outcome and Complications
7 Surgical Treatment of Rigid Spinal Deformities in Patients with Thoracic Insufficiency Syndrome
7.1 Thoracic Insufficiency Syndrome
7.2 Care
7.3 Treatment Options
7.3.1 Casting
7.3.2 Surgery
7.4 Conclusion
8 Vertebral Column Resection as a Treatment for Neurologic Deficit in Severe Spinal Deformity
8.1 Introduction
8.2 Preoperative Evaluation
8.2.1 History and Physical Examination
8.2.2 Imaging
8.3 Halo-Gravity Traction
8.4 Surgical Technique
8.5 Spinal Cord Monitoring
8.6 Vertebral Column Resection for Progressive Myelopathy
8.7 Case Illustration
8.8 Conclusion
9 Osteotomies in Syndromic Patients
9.1 Introduction
9.2 Definition, Classification, and Indication
9.3 Rigid Deformities in Syndromic Patients
9.4 Choice of Osteotomy: Type and Goal
9.5 PreoperativeWorkup
9.5.1 Patient History and Physical Findings
9.5.2 Imaging Studies
9.6 Surgical Aspects and Technique
9.6.1 Positioning and Perioperative Measures
9.7 Surgical Technique
9.7.1 Smith–Petersen Osteotomy and Ponte Osteotomy
9.7.2 Pedicle Subtraction Osteotomy
9.7.3 Bone–Disk–Bone Osteotomy
9.7.4 Vertebral Column Resection
9.8 Postoperative Care
9.9 Complications
9.10 Outcome
9.11 Conclusion
10 Rigid Spine Deformities in Early-Onset Scoliosis
10.1 Introduction
10.2 Clinical and Radiographic Evaluation
10.2.1 History and Physical Examination
10.2.2 Plain Radiographs
10.2.3 EOS Imaging System/Three-Dimensional Modeling Techniques
10.2.4 CT Scan
10.2.5 MRI
10.3 Treatment of Rigid Spine Deformities in EOS
10.3.1 Nonoperative Treatments
10.3.2 Operative Treatments
10.4 Extra Procedures Considered in the Treatment of Rigid Curves
10.4.1 Traction
10.4.2 Surgical Release of Soft Tissues
10.4.3 Temporary Internal Distraction Rod
10.4.4 Osteotomies
10.5 Discussion
11 Secondary Correction of Rigid Spinal Deformity after Failed Instrumentation
11.1 Introduction
11.2 Preoperative Evaluation
11.2.1 History
11.2.2 Physical Examination
11.2.3 Imaging Studies
11.3 Surgical Technique
11.3.1 Correction of Scoliosis Deformity
11.3.2 Correction of Kyphoscoliosis Deformity
11.3.3 Correction of Kyphosis Deformity
11.3.4 Correction of Lordosis/Lordoscoliosis Deformity
11.3.5 Correction of Severe Rigid Pelvic Obliquity in Neglected Congenital Scoliosis
11.3.6 Reconstruction Laminectomy Defect following Posterior Vertebral Column Resection
11.4 Complications
11.5 Conclusion
12 Kyphectomy in Patients with Myelomeningocele
12.1 Introduction
12.2 Kyphectomy
12.3 Surgical Technique
12.4 Outcome
13 Pitfalls and Difficulties in the Surgical Management of Severe Adolescent Idiopathic Scoliosis
13.1 Definition of Severe Idiopathic Scoliosis
13.1.1 Preoperative Study
13.1.2 Preoperative Halo Traction
13.2 Surgical Treatment
13.2.1 Introduction
13.3 Posterior-Only Procedures
13.3.1 Pedicle Screws
13.3.2 Posterior Staged Technique
13.4 Preferred Operative Technique
13.4.1 Magnetically Controlled Growing Rod
13.4.2 Intraoperative Monitoring of Spinal Cord Function
13.4.3 First Posterior Surgery
13.4.4 Second Stage of Posterior Surgery
13.5 Conclusion
14 Posttraumatic Spine Deformity
14.1 Introduction
14.2 Epidemiology
14.3 Evaluation of Posttraumatic Deformity
14.3.1 Normal Thoracolumbar Alignment
14.3.2 Classification
14.3.3 Biomechanics and Pathology
14.3.4 Presentation and Physical Exam
14.3.5 Radiographic Evaluation
14.4 Nonoperative Management
14.5 Operative Management
14.5.1 Surgical Indications and Planning
14.5.2 Anterior Surgical Approaches
14.5.3 Combined Anterior–Posterior Surgical Approaches
14.5.4 Posterior Surgical Approaches
14.5.5 Technical Considerations
14.5.6 Complications
15 Osteoporotic Rigid Spinal Deformities
15.1 Introduction
15.2 Epidemiology and Etiology of Osteoporotic Deformities
15.3 Our Philosophy of Treatment in Osteoporotic VCFs and Related Kyphotic Deformities
15.4 How to Improve Pedicle Screw Stability
15.5 Osteoporotic Spine Deformity Correction
15.6 Complications and Conclusions
16 Spinal Deformities in Patients with Parkinson’s Disease
16.1 Introduction
16.2 Surgical Considerations
16.3 Surgical Technique
16.4 Conclusion
17 Surgical Planning for En Bloc Resection of Spinal Tumors: Tailoring the Osteotomy to Tumor Extensions
17.1 Introduction
17.2 Planning En Bloc Resection
17.2.1 Steps for Surgical Planning
17.2.2 Essential Surgical Criteria
17.2.3 Surgical Tips and Techniques
17.2.4 Surgical Approach
17.2.5 Osteotomy of the Spine to Finalize the En Bloc Resection
17.3 Case Report
17.4 Discussion and Conclusions
17.4.1 Conflicts of Interest
17.4.2 Acknowledgments
18 Corrective Osteotomies in the Cervical Spine
18.1 Introduction
18.2 Clinical Symptoms and Natural History
18.3 Physical Exam
18.4 Radiographic Evaluation
18.5 Assessment and Preoperative Planning
18.5.1 Location of the Deformity
18.5.2 Previous Surgery
18.5.3 Curve Rigidity and Degree of Deformity
18.5.4 Neurologic Status
18.6 Osteotomy Types
18.6.1 Anterior Osteotomies
18.6.2 Posterior Osteotomies
18.6.3 Combined Osteotomies
18.7 Conclusion
19 Junctional Corrective Osteotomies (Cervicothoracic, Thoracolumbar, Lumbosacral)
19.1 Introduction
19.2 Preoperative Evaluation
19.3 Cervicothoracic Kyphotic Deformity and Corrective Osteotomies
19.3.1 Patient Preparation
19.3.2 Technical Considerations
19.4 Thoracolumbar Corrective Osteotomies
19.4.1 Patient Preparation
19.4.2 Technical Considerations
19.5 Lumbosacral Corrective Osteotomies
19.5.1 Patient Preparation
19.5.2 Technical Considerations
20 Corrective Strategies and Management of Rigid Sacropelvic Pathologies
20.1 Introduction
20.2 Presenting Symptoms
20.3 Radiographic Evaluation
20.4 Management
20.4.1 Reconstruction of the Pelvic Girdle
20.4.2 Sacral Osteotomies
20.4.3 Pelvic Osteotomies
20.4.4 Other Salvage Procedures
20.4.5 Computer-Assisted Surgery
20.5 Summary
21 Ankylosing Spinal Disorders
21.1 Introduction
21.2 Ankylosing Spondylitis with Fracture
21.3 Ankylosing Spondylitis with Kyphotic Deformity
21.4 Diffuse Idiopathic Skeletal Hyperostosis with Fracture
22 Osteotomies in Revision Surgery
22.1 Introduction
22.2 General Indications
22.3 Osteotomies
22.3.1 Grade 1 Osteotomies
22.3.2 Grade 2 Osteotomies
22.3.3 Grade 3 Osteotomies
22.3.4 Grade 4 Osteotomies
22.3.5 Grade 5 and 6 Osteotomies
22.4 Difficulties in Performing Osteotomies in Revision Cases
22.5 Conclusions
23 Classification and Definition of Rigid Spine Deformity
23.1 Introduction
23.2 Definition
23.2.1 Pediatric Rigid Spinal Deformity
23.2.2 Idiopathic Scoliosis
23.2.3 Congenital Deformity
23.2.4 Neuromuscular and Paralytic Scoliosis
23.2.5 Scheuermann’s Kyphosis
23.2.6 Adult Spinal Deformity
23.3 Classification
23.3.1 Pediatric Spinal Deformity Classifications
23.4 Conclusions
24 Strategies in the Correction of Rigid Spinal Deformities—Controversies between Anterior and Posterior Approach
24.1 Introduction
24.2 Patient Assessment and Surgical Strategy
24.2.1 Location of the Deformity
24.2.2 Shape and Severity of the Deformity
24.2.3 Flexibility of the Deformity and Balance of the Trunk
24.3 Conclusion
25 Anesthesia for Spinal Surgery
25.1 Introduction
25.2 Spinal Cord
25.3 Blood Supply
25.4 Preoperative Assessment
25.4.1 Preexisting Conditions
25.4.2 Airway
25.4.3 Respiratory System
25.4.4 Cardiovascular System
25.4.5 Neurologic System
25.4.6 Trauma
25.5.1 Neurophysiologic Monitoring
25.5.2 Bispectral Index (BIS) Monitoring
25.5.3 Other Monitoring
25.6 Positioning
25.7 Blood Conservation Techniques
25.8 Wake-Up Test
25.9 Postoperative Considerations and Complications
25.10 Conclusions
26 Neuromonitoring in Rigid Spine Deformity Correction
26.1 Introduction
26.2 NIOM Tools
26.2.1 Somatosensory Evoked Potentials
26.2.2 Transcranial Electric Motor Evoked Potentials
26.2.3 Electromyography
26.2.4 Multimodality Approach
26.3 Clinical Applications
26.4 Conclusion
27 Neurological Complications after Surgery or Trauma to the Rigid Spine
27.1 Introduction
27.2 Spondyloarthropathies
27.3 Scoliosis
28 Importance of the Sagittal Balance in Correction of Rigid Spine
28.1 Introduction
28.2 Pelvic Sagittal Parameters: The Plinth of Sagittal Balance
28.3 Spinal Sagittal Parameters: AreWe Speaking the Same Language?
28.4 Spinal Balance Parameters: Metric versus Angular
28.5 Spinal Shapes in the Normal Population
28.6 Degenerative Spinal Evolution
28.7 Surgical Strategies in Correcting Rigid Spinal Sagittal Deformity
28.7.1 When the Pelvic Incidence Is Small (<50 degrees)
28.7.2 When the Pelvic Incidence Is High (>50 degrees)
28.8 Proximal Junctional Kyphosis: A Complication of Faulty Surgical Strategy
28.9 Conclusion
29 Robot-Guided Surgery in Rigid Spinal Deformities
29.1 Introduction
29.2 Robotic Guidance in Spine Surgery
29.2.1 Robotic Systems in Clinical Use
29.3 Robotic Surgery in Spinal Deformity
29.4 Special Considerations
29.4.1 Pelvic Fixation
29.4.2 Revision Spinal Surgery—Redrilling Pedicles, Retained Instrumentation
29.5 Case Illustrations
29.5.1 Case 1
29.5.2 Case 2
29.5.3 Case 3
29.5.4 Case 4
29.5.5 Case 5
29.6 Robot-Guided Osteotomies for Rigid Deformities
29.7 Conclusion
30 Biological Aspects of Spine Fusion—Methods to Enhance Fusion Rates
30.1 Introduction
30.2 Fusion Formation
30.3 Properties of Bone Grafts
30.4 Types of Grafts
30.4.1 Autograft
30.5 Osteoinductive Agents
30.5.1 Bone Morphogenetic Proteins
30.5.2 Demineralized Bone Matrix
30.6 Osteoconductive Agents
30.6.1 Allograft Bone
30.6.2 Synthetic Bone Grafts
30.7 Osteopromotive Agents
30.8 Systemic Agents
30.8.1 Bisphosphonates
30.8.2 Parathyroid Hormone
30.9 Conclusions
31 Role of Anterior Approach in the Correction of Adult Spinal Deformities
31.1 Introduction
31.2 Adult Spinal Deformity
31.3 Reconstruction of the Lower Lumbar Spine and Lumbosacral Junction
31.3.1 Access to the Lower Lumbar Spine
31.3.2 Restoration of Anterior Column Support
31.3.3 Reconstruction of Lumbosacral Segmental Sagittal Alignment
31.4 Thoracolumbar Kyphoscoliosis and Anterior Release
31.4.1 Complications of the Anterior Approaches
31.4.2 Comparative Studies: Combined Approaches
31.5 Case Studies
31.5.1 Case 1
31.5.2 Case 2
31.5.3 Case 3
31.5.4 Case 4
31.5.5 Case 5
31.6 Conclusion
32 Osteotomies in Spinal Tuberculosis—Adult Care
32.1 Introduction
32.2 Pathophysiology of Kyphosis in Spinal Tuberculosis
32.2.1 Kyphosis during the Acute Phase of Tuberculosis
32.2.2 Healing Patterns in Spinal Tuberculosis
32.2.3 Kyphosis Progression in the “Healed” Phase
32.3 Surgical Treatment of Kyphosis in Spinal Tuberculosis
32.3.1 Principles of Surgery in Active Tuberculosis
32.3.2 Single-Stage Kyphosis Correction by Anterior Approach and Stabilization
32.3.3 Single-Stage Transpedicular Approach and Posterior Correction (Posterior Closing Wedge Osteotomy)
32.3.4 Single-Stage Kyphosis Correction by Posterior-Only Transforaminal Approach and Interbody Fusion
32.3.5 Single-Stage Kyphosis Correction by Posterior Costotransversectomy or Anterolateral Approach and Posterior Stabilization
32.3.6 Kyphosis Correction by Combined Anterior and Posterior Approach
32.4 Surgery for Kyphosis Correction in Healed Tuberculosis
32.4.1 Transpedicular Decancellation Osteotomy
32.4.2 Pedicle Subtraction Osteotomy
32.4.3 Single-Stage Kyphosis Correction through Extrapleural Approach
32.4.4 Closing OpeningWedge Osteotomy (Vertebral Column Resection)
32.5 Conclusion
33 Osteotomies in Tuberculosis—Pediatric Care
33.1 Introduction
33.2 Diagnosis of Spinal Tuberculosis in Children
33.3 Principles of Treatment
33.3.1 Surgical Treatment of the Consequences of Tuberculosis Spondylitis in Children
34 Osteotomies for Adult Degenerative Scoliosis
34.1 Introduction
34.2 Selection of Fusion Levels
34.3 Spine with Mobile Disks
34.3.1 Two Main Surgical Techniques Described in This Category
34.4 Spine with Decreased Disk Mobility
34.4.1 Pedicle Subtraction Osteotomy
34.5 Complications
34.5.1 Early Complications
34.5.2 Late Complications
34.6 Conclusion
Index