Spinal deformity a case based approach to managing and avoiding complications

Praveen V Mummaneni Paul Park Charles H Crawford III Adam S Kanter Steven D Glassman Editors Spinal Deformity A Case-Based Approach to Managing and Avoiding Complications 123 Spinal Deformity Praveen V Mummaneni  •  Paul Park Charles H Crawford III  •  Adam S Kanter Steven D Glassman Editors Spinal Deformity A Case-Based Approach to Managing and Avoiding Complications Editors Praveen V Mummaneni, MD Joan O’Reilly Endowed Professor in Spinal Surgery, Vice Chairman, Department of Neurosurgery University of California, San Francisco, CA, USA Charles H Crawford III, MD University of Louisville, Norton Leatherman Spine Center Louisville, KY, USA Steven D Glassman, MD Department of Orthopedic Surgery University of Louisville, Norton Leatherman Spine Center Louisville, KY, USA Paul Park, MD Professor Director of Spinal Surgery, Department of Neurosurgery University of Michigan Ann Arbor, MI, USA Adam S Kanter, MD Chief, Division of Spine Surgery, Associate Professor of Neurological Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA ISBN 978-3-319-60082-6    ISBN 978-3-319-60083-3 (eBook) DOI 10.1007/978-3-319-60083-3 Library of Congress Control Number: 2017951047 © The Editor(s) (if applicable) and The Author(s) 2018 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To my family for their love and support To our patients, for their trust and understanding Charles H Crawford III, MD With gratitude to the Leatherman spine fellows, who have made me a better surgeon Steven D Glassman, MD To my sons Jared and Jeremy, for teaching me that one man’s weakness can be another man’s strength, as fortitude comes in many forms Adam S Kanter, MD To the ones that matter the most, my wife and two boys Paul Park, MD For my wife and children for their love and support For my residents and fellows whose work ethic is inspiring Praveen V Mummaneni, MD Contents 1 A Historic Overview of Complications in Spinal Deformity Surgery   1 Steven D Glassman Part I  Cervical 2 Occipitocervical Surgery Complication   7 Todd Vogel and Dean Chou 3 Transoral Odontoidectomy and C1-2 Posterior Fusion Complication  17 Andrew K Chan, Michael S Virk, Andres J Aguirre, and Praveen V Mummaneni 4 Mid-Cervical Kyphosis Surgery Complication  29 Dan Harwell and Frank La Marca 5 Cervical Kyphosis (Post-­laminectomy) Surgery Complication  35 Domagoj Coric and Tyler Atkins 6 Cervical Osteomyelitis and Kyphosis Complication  43 Priscilla S Pang, Jason J Chang, and Khoi D Than 7 Cervical Traumatic Deformity (Bilateral Facet Dislocation) Complication  53 Young M Lee, Joseph Osorio, and Sanjay Dhall 8 Cervical Kyphosis (Neuromuscular) Surgery Complication  59 Salazar Jones and Charles Sansur 9 Cervicothoracic Kyphosis (Dropped Head Deformity) Surgery Complication  67 Subaraman Ramchandran, Themistocles S Protopsaltis, and Christopher P Ames 10 Iatrogenic Cervicothoracic Kyphosis Surgery Complication  75 Frank Valone III, Lee A Tan, Vincent Traynellis, and K Daniel Riew vii viii Part II  Thoracolumbar 11 Thoracic Scoliosis (AIS) Posterior Surgery Complication  93 Elizabeth W Hubbard and Daniel J Sucato 12 Scheuermann’s Kyphosis Surgery Complication 115 Abhishek Kumar, Dante Leven, Yuan Ren, and Baron Lonner 13 Thoracic Deformity (Pott’s Disease) Surgery Complication 123 Kin Cheung Mak and Kenneth M.C Cheung 14 Thoracolumbar Scoliosis (AIS) Posterior Surgery Complication 137 Chewei Liu, Lee A Tan, Kathy M Blanke, and Lawrence G Lenke 15 Congenital Thoracolumbar Deformity Complication 145 Thomas Kosztowski, Rafael De la Garza Ramos, C Rory Goodwin, and Daniel M Sciubba 16 Thoracolumbar Deformity (Trauma) Surgery Complication 155 Robert F Heary and M Omar Iqbal 17 Thoracic Deformity (Tumor) Surgery Complications 167 William C Newman and Nduka M Amankulor 18 Thoracic/Lumbar Deformity (Tumor) MIS Surgery Complication 173 Todd Vogel, Junichi Ohya, and Dean Chou 19 Lumbar Deformity (Vascular) Surgery Complication 181 Gurpreet S Gandhoke, Adam S Kanter, and David O Okonkwo 20 Lumbar Scoliosis (Degenerative) Posterior Surgery Complication 185 Travis Loidolt, Jeffrey L Gum, and Charles H Crawford III 21 Lumbar (Degenerative) Scoliosis: Complication in Anterior/Posterior Surgery 199 Martin C Eichler, Ryan Mayer, and S Samuel Bederman 22 Thoracolumbar Deformity MIS (Palsy) Surgery Complication 211 Neel Anand, Jason E Cohen, and Ryan B Cohen 23 Lumbar Scoliosis (Degenerative) and MIS (Lateral) Surgery Complications 219 Yusef I Mosley and Juan S Uribe 24 Lumbar Scoliosis (Degenerative) MIS Surgery (PSO/TLIF) Complication 225 Peng-Yuan Chang and Michael Y Wang Contents Contents ix 25 Lumbar Scoliosis (Degenerative) MIS Surgery (PJK) Complication 233 Jacob R Joseph and Paul Park 26 Lumbar Deformity MIS Lateral (Visceral) Surgery Complication 239 Kourosh Tavanaiepour and Adam S Kanter 27 Thoracolumbar Deformity: MIS ACR Complications 245 Gregory M Mundis Jr and Pooria Hosseini 28 Lumbar Deformity (Infection) Surgery Complication 259 Sasha Vaziri and Daniel J Hoh 29 Sagittal Plane Deformity Surgery: Pedicle Subtraction Osteotomy (PSO) Complication 269 Hongda Bao, Sravisht Iyer, and Frank J Schwab 30 Sagittal Plane Deformity Surgery (VCR) Complication 281 John C Quinn, Avery L Buchholz, Justin S Smith, and Christopher I Shaffrey 31 Lumbar Deformity Spondylolisthesis (Moderate–High Grade) Complication 291 Randall B Graham, Sohaib Hashmi, Joseph P Maslak, and Tyler R Koski 32 Pediatric Moderate-/High-Grade Spondylolisthesis Surgery Complication 301 Michael P Kelly 33 High-Grade Dysplastic Spondylolisthesis Surgery Complication 311 Alexander A Theologis, Yazeed M Gussous, and Sigurd H Berven 34 Sacral Insufficiency Fracture Surgery Complication 321 Michael LaBagnara, Durga R Sure, Christopher I Shaffrey, and Justin S Smith 35 Sacral Tumor Surgery Complications 329 Peter S Rose Index   343 Contributors Andres J. Aguirre, MD  Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA Nduka M. Amankulor, MD Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Christopher P. Ames, MD  Department of Neurological Surgery, University of California, San Francisco, USA Neel Anand, MD  Department of Surgery, Cedars-Sinai Spine Center, Los Angeles, CA, USA Tyler Atkins, MD  Department of Neurosurgery, Carolinas Medical Center, Charlotte, NC, USA Hongda Bao, MD, PhD  Hospital for Special Surgery, Weil-Cornell School of Medicine, New York, NY, USA S. Samuel Bederman, MD, PhD, FRCSC  Restore Orthopedics and Spine Center, Orange, CA, USA Sigurd H. Berven, MD  Department of Orthopaedic Surgery, University of California – San Francisco (UCSF), San Francisco, CA, USA Kathy M. Blanke, RN Department of Orthopedics, The Spine Hospital, NewYork Presbyterian, New York, NY, USA Avery L. Buchholz, MD, MPH Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA Andrew K. Chan, MD  Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA Jason J. Chang, MD  Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA Peng-Yuan Chang, MD Neuroregeneration Center, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan Departments of Neurosurgery & Rehabilitation Medicine, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA xi xii Kenneth M.C. Cheung, MD, FRCS, FHKAM(Orth) Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong, SAR, China Dean Chou, MD Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA Jason E. Cohen, BS  Albert Einstein College of Medicine, Bronx, NY, USA Ryan B. Cohen, BS  Boston University School of Medicine, Boston, MA, USA Domagoj Coric, MD Department of Neurosurgery, Carolinas Medical Center/Carolina Neurosurgery and Spine Association, Charlotte, NC, USA Charles H. Crawford III, MD  University of Louisville, Norton Leatherman Spine Center, Louisville, KY, USA Rafael De la Garza Ramos, MD Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA Sanjay Dhall, MD Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA Martin C. Eichler, MD Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland Gurpreet S. Gandhoke, MD, MCH  Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Steven D. Glassman, MD  Department of Orthopedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, KY, USA C. Rory Goodwin, MD, PhD  Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA Randall B. Graham, MD Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, Chicago, IL, USA Jeffrey L. Gum, MD Norton Leatherman Spine Center, Louisville, KY, USA Yazeed M. Gussous, MD  Department of Orthopaedic Surgery, Ohio State University, Columbus, OH, USA Dan Harwell, MD  Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA Sohaib Hashmi, MD Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Robert F. Heary, MD Department of Neurological Surgery, University Hospital, Rutgers University, Newark, NJ, USA Daniel J. Hoh, MD Department of Neurological Surgery, University of Florida, Gainesville, FL, USA Contributors 338 Fig 35.9 (a) PET CT scan of high-grade undifferentiated sarcoma of the sacropelvic region (b) 3D model of tumor used for preoperative planning Green represents P.S Rose extraosseous tumor and blue represents further tumor involvement of bone without extraosseous extension Fig 35.10 (a) Radiograph of resected specimen (b) Reconstruction of hemisacral and pelvic resection with unilateral vascularized free fibula transfer place until initial wound healing is in place Note that these drains are often in continuity with the peritoneal space Thus, they are expected to have a high volume, and this high volume is not seen as an impediment to drain removal once the initial epithelialization of the wound is in place An incisional wound VAC is commonly used to minimize the risk of contamination of the wound Patients recover initially on an air mattress to minimize tension on the wound As soon as their level of recovery allows, they are permitted to stand and walk an unlimited amount Beginning 3–7 days postoperatively (depending upon the magnitude of the surgical resection and the local swelling/congestion of the tissues), patients are allowed to sit on a ROHO wheelchair cushion Initial sitting is 30 min at a time and this is increased as the wound is monitored In patients who undergo a unilateral spino-­ pelvic reconstruction, they are asked to be partial 35  Sacral Tumor Surgery Complications weight bearing upon that side for approximately 6–8 weeks Patients who undergo a total sacrectomy typically have a slower mobilization because of the magnitude of the procedure and the loss of at least partial sciatic nerve function postoperatively They are allowed and encouraged to ambulate as tolerated to minimize the morbidity of prolonged bedrest, understanding that this does place a higher stress upon their spinal instrumentation It is common for patients to have delayed oral intake after these procedures A nasogastric tube is placed at the time of surgery and kept on suction for several days postoperatively to decompress the enteric system At that time, the nasogastric tube is kept in place, and initial tube feeds are run at a slow continual rate to supplement nutrition as patients take in oral nutrition at will This is removed once patients have taken in a reasonable amount of nutrition orally Patients undergo oncologic surveillance every 3–4 months for the first 2 years, then every 6 months through 5 years, and annually through 10 years to survey for local or distant tumor recurrence This most typically involves CT chest and CT or MR of the abdomen and pelvis MR is the preferred local imaging modality to survey for tumor recurrence, but in patients with extensive instrumentation, CT is often a better imaging modality Outcomes The outcomes of oncologic sacrectomy are difficult to quantify because of the variable oncologic outcome expected for different histologies under treatment For example, most chordomas have a relatively slow disease progression but a very high risk of local recurrence In contrast, high-­grade osteosarcomas or Ewing’s sarcomas have an unfortunate high risk of developing distant metastases Thus, the survival varies by the disease under treatment However, for all primary malignancies which undergo sacrectomy as a part of their curative treatment, the best results are seen when a true margin-negative en bloc resection is performed For example, Fuchs and colleagues reported uni- 339 form survival in patients with sacrococcygeal chordoma when a wide oncologic margin was obtained but very poor results in patients in whom less than a wide margin was obtained [7] Neurologic function varies with the level of sacrifice performed at the time of operation In our experience, patients who preserve both L5 nerve roots can have excellent ambulatory function Patients in whom both S2 and a single S3 nerve root are preserved often retain functional bowel, bladder, and sexual capacity Our group has favored colostomy at the time of surgical resection in patients with high levels of neurologic sacrifice who have no meaningful hope of regaining bowel function Estimates have been published as to the likelihood of regaining bowel and bladder function based upon the extent and pattern of neurologic sacrifice [11, 12, 19] Complications Unfortunately, complications are very frequently seen in patients undergoing en bloc sacrectomy [23] Patients who have relatively limited dorsal procedures for low sacral transections generally have a favorable postoperative course and a modest risk of local wound healing difficulties However, as procedures expand to total sacrectomies with high-level neurologic sacrifice and transection through the dural tube and often radiated and other compromised environments, complications remain quite frequent Complications may generally be divided into several categories: Perioperative medical complications Older adults undergoing staged sacral resections have significant physiologic stress In an internal review of morbidity associated with spino-­p elvic resections in our group, we identified unanticipated cardiovascular disease as a frequent source of morbidity and at times perioperative mortality in patients undergoing large oncologic sacral resections Our group now performs a dobutamine stress echocardiogram on any adult patient undergoing a staged sacrectomy to evaluate their cardio- 340 vascular fitness for surgery This has identified patients with previously “silent” cardiovascular disease who would be at high risk for unanticipated cardiac complications When identified, these patients either are treated nonoperatively or undergo angioplasty with a bare metal stent and treatment with antiplatelet agents for 4 weeks followed by a surgical resection Since this protocol has been in place over 5 years, we have had no perioperative cardiac events in patients undergoing these procedures (P Rose, personal data) Perioperative surgical/ICU morbidity Large spino-pelvic resections (resections which sever continuity between the spine and pelvis and require reconstruction) are typically performed using both anterior and posterior approaches Previously our group had executed these operations in a single long surgical procedure which could approach or even exceed 24 h in total length However, our group has shifted its practice toward staging these procedures by approximately 48 h between an anterior and a posterior approach A critical analysis of a sequential cohort of patients undergoing staged procedures c­ompared with a previous sequential cohort of patients undergoing simultaneous procedures demonstrated significant decreases in perioperative morbidity [3] Most striking in clinical practice is the avoidance of coagulopathy in patients near the end of the procedure Additionally, patients are typically extubated postoperative day #1 following the final portion of a staged resection In patients who had previously undergone a single-stage “marathon surgical procedure,” the period of postoperative intubation often lasted many days With this came an unfortunate cascading set of pulmonary and other ICU complications Wound healing complications Large sacral resections remove a significant portion of the posterior pelvis with the resultant empty space and compromised soft tissue envelop with a high risk for wound healing difficulties The use of a pedicle rectus abdominis flap and/or gluteal advancement flaps has significantly improved our ability to heal wounds That said, wound healing complications remain P.S Rose the most common complication which is seen following oncologic sacral resections The use of pedicled vascularized flaps to bring in healthy muscle as well as cutaneous flaps to allow decreased tension on skin after biopsy tract resection has been demonstrated to decrease the risk of wound healing complications in this patient population [10] When wound healing complications are identified, rapid and early intervention for superficial wound problems is advocated to minimize the potential for these to track deep and lead to true intrapelvic infections When infection is identified intrapelvically, this is most commonly managed with percutaneous drainage procedures and IV antibiotics Different surgical incisions have been proposed for sacral resections The midline vertical incision is the classic incision but often ends distally near the anus, an obvious risk for wound contamination Some centers utilize a triradiate (“Mercedes”) incision This can maintain greater distance from the incision to the anal verge but has a relatively ischemic area where the three limbs of the incision meet Horizontal incisions may be used for low sacral resections but are not extensile and may lead to greater dissection of the gluteal muscles than would otherwise be necessary for resection of low tumors Bony nonunion Lumbopelvic reconstruction techniques currently rely upon semi-anatomic restoration of the lumbopelvic junction and are at high risk for pseudarthrosis We have increased our use of vascularized bone grafts in these areas, particularly in patients who have undergone or will undergo radiotherapy, to minimize the risk of healing difficulties [1] Additionally, we have increased our use of spinal instrumentation to span these gaps Particular attention has been placed in using dual rod constructs in areas of spino-pelvic reconstruction to minimize the risk that a single rod breakage would lead to catastrophic failure; in addition to clinical experience, this has been shown in biomechanical studies to increase the rigidity of sacral reconstruction constructs [15, 22] We have not employed the 35  Sacral Tumor Surgery Complications use of biologic agents to enhance bone healing (we have specifically not used bone morphogenetic proteins) because of the risk of employing these in an oncologic field Miscellaneous strategies All patients are screened for the presence of MSSA or MRSA preoperatively Patients who are colonized undergo a decolonization protocol Patients undergoing anterior procedures have external ureteral stents placed preoperatively to allow rapid identification and protection of the ureters in the pelvis While this is rarely a problem during the anterior approach, the posterior approach, and delivery of a large tumor, the position of the ureters can become very nonintuitive, and the placement of stents decreases the risk of inadvertent injury These stents are removed at the bedside several days postoperatively once the risk for return to surgery for bleeding or other immediate complications has passed Patients additionally undergo a mechanical bowel preparation preoperatively to decompress the colon All patients have nutrition labs checked preoperatively to verify they have adequate nutritional stores to undergo the anticipated operation Conclusions Oncologic sacrectomy remains a challenging but rewarding endeavor to affect curative treatment of patients with rare malignancies and few other options for care The surgical procedures span a spectrum from relatively limited all-posterior approaches to large resections and reconstruction around the spine and pelvis More extensive operations (beyond the scope of this chapter) will include a concurrent hemipelvectomy for tumors with extensive pelvic involvement Compound resections with concurrent en bloc removal of pelvic organs for tumors with extensive involvement also are beyond the scope of this chapter but a logical extension of these procedures While these are high complication surgeries, they can be tremendously rewarding and give the 341 opportunity to provide a hope of cure and life for patients with few other options Summary Points • Oncologic sacrectomy represents a family of procedures performed for curative treatment of primary sacral malignancies and select pelvic visceral malignancies which extend to the sacrum These surgeries are considered only for patients with no evidence of metastatic disease • Resections are resource intensives and are associated with significant perioperative as well as permanent post-resection morbidity for patients • Complications unfortunately are frequent Preoperative patient evaluation can minimize the risk of surgical complications as can staging large resections Infectious/wound healing complications remain the highest risk complications in this patient population References Ackerman DB, Rose PS, Moran SL, Dekutoski MB, Bishop AT, Shin AY. The results of vascularized-­ free fibular grafts in complex spinal reconstruction J Spinal Disord Tech 2011;24:170–6 Beadel G, McLaughlin C, Aljassir F, et al Iliosacral resection for primary bone tumors: is pelvic reconstruction necessary? Clin Orthop Relat Res 2005;438:22–9 Brown MJ, Kor DJ, Curry TB, Warner MA, Rodrigues ES, Rose SH, Dekutoski MB, Moriarty JP, Long KH, Rose PS. Sacral tumor resection : the effect of surgical staging on patient outcomes, resource management, and hospital cost Spine 2011;26:1570–8 Chen YL, Liebsch N, Kobayashi W, et al Definitive high-dose photon/proton radiotherapy for unresected mobile spine and sacral chordomas Spine 2013;38:E930–6 Dickey ID, Higate RR Jr, Fuchs B, Yaszemski MJ, Simg FH. Reconstruction after total sacrectomy: early experience with a new technique Clin Orthop Relat Res 2005;438:42–50 Eck JC, Yaszemski MJ, Sim FH. Sacretomy and spinopelvic reconstruction Semin Spine Surg 2009;21(2):99–105 Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma J Bone Joint Surg Am 2005;87:2211–6 342 Fuchs B, Yaszemski MJ, Sim FH. Combined posterior pelvis and lumbar spine resection for sarcoma Clin Orthop Relat Res 2002;397:12–8 Gallia G, Haque R, Garonzik I, et al Spinal-pelvic reconstruction after total sacrectomy for en bloc resection of a giant sacral chordoma: technical note J Neurosurg Spine 2005;3:501–6 10 Glatt BS, Disa JJ, Mehrara BJ, et al Reconstruction of extensive partial or total sacrectomy defects with a transabdominal vertices rectus abdominus flap Ann Plast Surg 2006;56:526–30 11 Gunterberg B, Kewenter J, Petersen I, Stener B Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves Br J Surg 1976;63:546–54 12 Gunterberg B, Norlen L, Stener B, Sundin T Neurologic evaluation after resection of the sacrum Investig Urol 1975;13:183–8 13 Gunterberg B. Effects of major resection of the sacrum: clinical studies on urogenital and anorectal function and a biomechanical study on pelvic strength Acta Orthop Scand 1976;162:1–38 14 Hugate RR Jr, Dickey ID, Phimolsarnti R, Yaszemski MJ, Sim FH. Mechanical effects of partial ­sacrectomy: when is reconstruction necessary? Clin Orthop Relat Res 2006;450:82–8 15 Kelly B, Shen F, Schwab J, et al Biomechanical testing of a novel four-rod technique for lumbopelvic reconstruction Spine 2008;33:E400–6 16 Lis E, Bilsky MH, Pisinsky L, Boland P, Healey JH, O’Malley B, Krol G. Percutaneous CT-guided biopsy of osseous lesions of the spine in patients with known P.S Rose or suspected malignancy AJNR Am J Neuroradiol 2004;25:1583–8 17 Mankin HJ, Mankin CJ, Simon MA. The haz ards of biopsy revisited J Bone Joint Surg Am 1996;78:656–63 18 O’Connor M, Sim F. Salvage of the limb in the treatment of malignant pelvic tumors J Bone Joint Surg Am 1989;71:481–94 19 Todd LT Jr, Yaszemski MJ, Currier BL, Fuchs B, Kim CW, Sim FH. Bowel and bladder function after major sacral resection Clin Orthop Relat Res 2002;397:36–9 20 Wuisman P, Lieshout O, van Disk M, van Diest P. Reconstruction after total en bloc sacrectomy for osteosarcoma using a custom-made prosthesis: a technical note Spine 2001;26:431–9 21 Yu B, Zheng Z, Zhuang X, et al Biomechanical effects of transverse partial sacrectomy on the sacroiliac joints: an in vitro human cadaveric investigation of the borderline of sacroiliac joint instability Spine 2009;34:1370–5 22 Yu B, Zhuang X, Li Z, et al Biomechanical effects of the extent of sacrectomy on the stability of lumbo-­iliac reconstruction using iliac screw techniques: what level of sacrectomy requires the bilateral dual iliac screw technique? Clin Biomech 2010;25:867–72 23 Zileli M, Hoscuskun C, Brastianos P, Sabah D Surgical treatment of primary sacral tumors: complications associated with sacrectomy Neurosurg Focus 2003;15:1–8 Index A Abdominal wall paresis, 219, 220 ACCF, see Anterior cervical corpectomy and fusion (ACCF) Acute vascular injury, 181, 183 Adhesiolysis, 127 ADI, see Anterior atlantodental interval (ADI) Adjacent segment disease, 234 Adjuvant stereotactic radiosurgery, 171 Adolescent idiopathic scoliosis (AIS) abdominal reflexes, 98 adding-on phenomenon, 137 bilateral lower extremities, tcMEP signals, 100 complications, 137 dermatomes, 100 forward bend testing, 101 implant failure/curve progression, 104 intrathecal abnormality, 104 Lenke 2BN and 4AN curve, thoracic lordosis, 98, 101 Lenke classification, 137, 138 LIV, 139 patient’s neuromonitoring signals, 100 Ponte osteotomies, 104 posterior spinal fusion, 101 proximal thoracic curve, 100 PSF, 137 PSVL, 141 signals monitoring, 100 skeletal immaturity, 137 STV, 141 thoracic deformity, 140 thoracolumbar kyphosis, 138, 139 thoracoscopic discectomies, 101 Adult cervical deformity, 67 Adult degenerative scoliosis (ADS), 181, 185 Adult scoliosis, coronal decompensation, 220 Adult spinal deformity (ASD), 185, 199, 225, 239, 269 back pain and/or radiculopathy, 211 CoCr rods, 287, 288 complications, 284–289 CSVL, 283 epidural/selective nerve root blocks, 211 etiologies, 185 kyphoscoliosis, 282, 283 left retroperitoneal lateral transpsoas approach, 212 lumbar stenosis, 283 lumbosacral junction, 286–288 mechanisms, 211 patient's history, 212 PCOs, 282 physical examination, 282, 283 post-op quadriceps palsy, 212 prevalence, 185, 281 PSO, 282 rod fracture, 284–289 sagittal and coronal alignment, 284, 285 SSEP, MEP and EMG, 212 surgical intervention, 211 symptoms/signs, 281 TLIF, 282 VCR, 282 Aggressive facetectomy, 40 Alar ligaments, Ankle clonus exam, 93, 94 Ankylosing spondylitis (AS) acute airway obstruction, 72 C5 palsy, 70, 73 complications, 69, 70 decreased cognitive function, 70 dysphagia, 71–73 patient’s quality of life improvement, 69 thoracolumbar deformity correction, 72 Anterior atlantodental interval (ADI), 18 Anterior cervical corpectomy and fusion (ACCF), 78 Anterior cervical discectomy and fusion (ACDF), 44, 76–78 Anterior column realignment (ACR), 245 Anterior longitudinal ligament (ALL), 215, 245 Anterior lumbar interbody fusion (ALIF), 245, 270 Anterior osteotomy (ATO), 76–81 Anterocollis, 60 cervical myopathy (CM), 67 chin-on-chest deformities, 67 clinical examination, 68 defined, 67 DHD, 67 neuro-foraminal compression, 68 neurology work-up, 68 preoperative evaluation, 68 Anteroposterior diameter (APD), 71 © The Author(s) 2018 P Mummaneni et al (eds.), Spinal Deformity, DOI 10.1007/978-3-319-60083-3 343 344 Antituberculous therapy, 126 Aorta diskitis-osteomyelitis, 181–183 repair techniques, 183 thoracic pedicle screws, 183 Apical ligament, Arachnoid cysts, 306–308 Arachnoiditis, 159, 160 Arthrodesis, 321, 327 AS, see Ankylosing spondylitis (AS) ASD, see Adult spinal deformity (ASD) Atlantoaxial subluxation (AAS) ADI and PADI, 18 anatomy, 17, 18 anterior subluxation treatment, 19 anterior transoral odontoidectomy, 19 causes, categories, 17 cervical spine plain radiographs, 18 CT and MRI, 22 Fielding and Hawkins classification, 19 Grisel syndrome, 19 halo pin placement, complications, 22, 24 pathology types, 19, 20 patient's history, 20 posterior wiring techniques, 20 Rhoton micro instruments, 24 rotatory subluxation, 19 signs and symptoms, 18 skull fracture with halo pins, 24 stability, 18 surgical plans, 22 TAL integrity, 18 VA dissection management, 25 ventral CSF leak management, 24, 25 Wang classification, 19, 20 B Back pain, 176, 177 Basilar invagination, 9, 10 Basion-axial interval (BAI), Basion-dental interval (BDI), Bone morphogenetic protein (BMP), 64 Bowel injury, 239, 242, 243 Bowel perforation, 220 C Cauda equina syndrome, 302, 307 CBVA, see Chin-brow vertebral angle (CBVA) Central sacral vertical line (CSVL), 283 Cerebrospinal fluid (CSF) case presentation, 145–150 complications, 152, 153 diagnosis of, 150 dural tears, 150 non-operative treatment, 151, 152 non-surgical treatment, 152 risk factors, 150 symptoms, 150 Index β-2 transferrin assay, 150 transoral odontoidectomy, 26 unrecognized durotomies, 150 Cervical fusion anterior cervical discectomy, 37 posterior osteotomy, 41 Cervical kyphosis adjacent segment degeneration, 30, 31 advanced multi-planar spinal neuroimaging, 30 anterior bony elements, spine, 29 bilateral facetectomies, 39 cervical curvature, 36 complaints, 35 complications, 30 corpectomy and fusion extension, 30, 32 C5 palsy prevention, 32 causes, 30, 32 risk factors, 31, 32 CT myelography, 37, 38 decompression and fusion, 35 defined, 29 deformity assessment, 36, 37 disc degeneration, 29 EMG, SSEPs and MEP, 32 IAR, 29 iatrogenic pathophysiology, 35 imaging techniques, 36 neural decompression, degenerative pathologies, 35 neuro-compressive symptoms, 36 neurological symptoms, 67 (see also Neuromuscular diseases) patient's history, 36 physical exam, 36 posterior tension band, loss of, 29 progressive anterior wedging deformity, 35 single-stage anterior-posterior surgery, 37 spinal canal narrowing, 30, 31 spinal and spinal cord conditions, 35 stand-alone zero-profile interbody cage, 39 surgical decompression, 30 surgical treatment options, 36 symptomatic degenerative, 30 Cervical osteomyelitis alignment evaluation, 49 biofilm formation, 46 bony destruction and fusion failure, 45, 46 cervical lordosis and sagittal balance, 49 Denis classification, 49 early stages, 43 epidural enhancement, cord compression, 44, 45 esophageal perforation, 48 global sagittal balance maintenance, 49 hardware placement complications, 48 laboratory testing, 44 less-invasive biopsy methods, 44 MRI and CT, 44 nonspecific symptoms, 43 nuchal musculature activation, 49 PEEK and DBM, 45 Index progressive cervical kyphosis, 49 recurrent/refractory infections, 46 single-staged debridement, 46 SSEPs, MEPs and EMG, 48 surgical debridement and reconstruction, 45 surgical management, 44, 48 VAC systems, 48 Cervical spine deformity ACCF and ACDF, 78 ATO, 78–81 CBVA, 76 chin-on-chest deformity, 76 Cobb method, 76 complications, 85, 86 cosmetic dissatisfaction, 76 dehisced muscles, 77 fusion mass, 77 goals of, 76 Harrison posterior tangent method, 76 kyphotic deformation, 77 lateral flexion/extension cervical x-rays, 77 mean total cervical lordosis, 75 measurement methods, 76 occipital condyles, 75 pathology and biomechanics, 76 posterior ankylosis, 77 posterior cervical instrumentation and fusion, 81 pseudarthrosis prevention, 76 PSO, 82–84 soft tissues integrity, 77 spine surgery, 85 SPO, 81, 82 surgical interventions, 86–88 ventral compression, 77 Cervical traumatic deformity complications, 55, 56 CT and MRI, 53 C7/T1 spondyloptosis and bilateral facet dislocation, 55, 56 description, 53 floating vertebra formation, 53 fracture-dislocation injuries, 54 patients history, 55 rotational forces, 53 sensory function, 56 symptoms, 53 treatment closed reduction, 54 open reduction, 54, 55 Cervico-thoracic kyphosis instrumented fusion, 85, 87 junction, 75 motor strength, sensations and deep tendon reflexes, 69 nonspecific myopathy, 69 posterolateral fusion, 69 sagittal plane stable vertebra selection, 69 slope-cervical lordosis mismatch, 69 Chiari malformation, 101 Chin-brow vertebral angle (CBVA), 49, 76 345 Chin-on-chest deformities, 35, 67 Chordoma, 332, 335 Closed reduction method, 54, 55 Cobb method, 76 Complication avoidance, surgical acute kyphosis prevention, 178 antibiotics, 178 chemical prophylaxis, 178 dexamethasone, 178 lesion biopsy, 177 oncology and radiation oncology, 178 patient care improvement, 178 preoperative and postoperative, 177, 178 signs, 178 steroids, 178 surgery, role of, 177 surgical indications, 177 Congenital disorders, 7, Conradi syndrome, 10 Contralateral psoas hematoma, 220–222 Conus medullaris syndrome, 306, 308 Cord lamina angle (CLA), 71 Corpectomy decompressions, 30 and fusion extension, 30, 32 C5 palsy acute and delay palsies, 32 age, male patients and multiple corpectomy levels, 31 causes, 32 postoperative, 30 preventive algorithms, 32 risk factors, 32 C-reactive protein (CRP), 44 Cruciate/cruciform ligament, CSF fistula conservative measures, 151 CSF-cutaneous, 150 diagnosis, 150 postoperative pseudomeningocele, 151 risks of, 145 CSVL, see Central sacral vertical line (CSVL) D Deformity cervical spine, 48 infectious etiology, 48 initial trauma assessment, 155 kyphotic, 49 Degenerative lumbar scoliosis case based approach anterior-posterior combined surgery, 201, 202 complication management, 203, 204 DPND, 207 LLIF approach, 206 neurological deficit, 206 outcomes, 204 pertinent history, 200 radiographic imaging, 201 TcMEPs, 206 Index 346 Degenerative lumbar scoliosis (cont.) imaging, 199 postoperative, 203 preoperative, 202 spinal conditions, 199 symptoms, 199 treatment, 200 Degenerative scoliosis, 233, 234 lateral lumbar interbody fusions, 223 operative intervention, 219 Degenerative spine disease, see Cervical kyphosis Delayed aortic injuries, 183 Delayed postoperative neurological deficits (DPND), 207 Delayed vascular injuries, 183 DEXA scans, 68 Distal junctional kyphosis (DJK), 69–73 Dorsal sacrectomy, 334 Dropped head deformity (DHD), 67 Dural sealants, 152 DVT, progressive clinical deformity complications, 247 medical history, 246 outcomes, 247 physical findings, 246 radiographic findings, 246 Surgical Treatment, 247 E Early-onset scoliosis (EOS), Electromyographic (EMG) monitoring continuous free-running/stimulus-evoked, 97 muscle groups, 97 SRS, 98 stimulus-evoked, 97, 98 “Encroaching” screws, 183 Erythrocyte sedimentation rate (ESR), 44 European Spinal Deformity Society (ESDS), 95 Expandable cage technique expandable tubular retractor, 175 Jamshidi needles, 175 Kirschner wires, 175 laminectomy, 175 motor-evoked potentials, 175 posterior longitudinal ligament, 176 postoperative epidural hematoma, 176 trap-door rib-head osteotomy, 176 External orthoses, 171 F Fielding and Hawkins classification, 19 Floating vertebra formation, 53 Foraminal diameter (FD), 71 Foraminotomy and corpectomy decompressions, 30 prophylactic, 32 Forced vital capacity (FVC), 134 Fracture dislocations, 156 Fusion noninfectious etiologies, 46 PEEK and DBM, 45 posttreatment instability, 44 G Gastrointestinal (GI) hemorrhage, 178 Goldenhar syndrome, 10 Grisel syndrome, 18, 19 H Halo-gravity traction (HGT), 134 Halo pin cranial penetration, 25–26 Halo traction FVC, 134 HGT, 134 Harrison posterior tangent method, 76 Health-related quality of life (HRQOL), Hemisacrectomy, 334, 336 Herbiniaux, 311 High-grade spondylolisthesis (HGS), 291 adjacent segment degeneration, 294 complications, 292 interbody fusion, 297 lumbosacral angle, 292 lumbosacral kyphosis, 292 nerve root deficit, 292, 294 patient-specific approach, 297 pseudoarthrosis, 294 reduction, 297, 299 spinal sagittal balance, 292 spondyloptosis, 297 High-grade dysplastic spondylolisthesis abnormal gait and posture, 316 anterior fibular grafting, 317 bone graft, 315 complications, 312, 318 iliac bicortical grafts, 317 imaging, 313 in situ fusion, 315, 316 interbody fusion, 318 postoperative, 314, 315 radiographic sagittal parameters, 312 reduction technique, 317 SRS-22 total score, 316 surgical management, 313, 314 treatment, 312 Hip osteoarthritis, 188 Historic overview, see Spinal deformity I Iatrogenic vascular injury, 183 Incidental durotomy, 145 CSF (see Cerebrospinal fluid (CSF)) fistula formation, 145 scoliosis surgery, 145 Incomplete release/end plate fracture complications, 256 Index medical/surgical history, 254 outcomes, 256 physical and radiographic findings, 254 surgery, 254 Infection cervical osteomyelitis, 43 recurrent, 46 spinal, 43 sporadic occurrence, 43 Instantaneous axis of rotation (IAR), 29 Instrumentation hardware malposition and iatrogenic fracture, 48 instability after debridement, 48 recurrent infection, 46 resistant organisms, 46 Instrumented fusion, 167, 168, 170 Interbody fusion, 313, 318 Interfacet allograft spacers, 81 Intracranial hypotension, 152 Intraoperative neuromonitoring (IONM) baseline signal amplitude/latency, 106 hypothermia, prolonged hypotension and blood loss, 106 inpatient unit, 110 modes of, 106 neurophysiologist and surgical team, 107 spine surgery, 107 surgical teams, 107 video projection screen, 107 wake-up test, 109 Intraoperative vascular injuries, 181 Ischemic damage and cord tension, 29 reperfusion injury, spinal cord, 30 Isthmic spondylolisthesis, 311, 316 J Jamshidi needles, 175 K Kirschner wires, 175 Klippel-Feil syndrome, 10 Kyphoplasty, 171 Kyphosis, see Cervical spine deformity Kyphotic deformity, 127 L Labelle classification, 312, 318 Laminoplasty, pediatric tumors, 40 Lateral interbody fusion, 221 Lateral lumbar interbody fusion (LLIF), 200, 206, 215, 216, 219, 239, 243 Lateral MIS adult spinal deformity, 239 ALIF, 243 bowel injury, 239, 242, 243 LLIF, 239, 243 lumbar lordosis, 240, 241 347 minimally invasive right lateral approach, 241 sagittal imbalance, 240 TLIF, 243 Ligamentous chance fracture, 156 Locked facets bilateral, 53 neurologic decompensation, 56 Lowest instrumented vertebra (LIV), 139 Lumbar deformity, 266 Lumbar discitis/osteomyelitis, 181 Lumbar drain complications, 151 CSF leak treatment, 152 subarachnoid, 151 Lumbar lordosis (LL), 225, 245 Lumbar plexopathy hip flexion and knee extension weakness, 214 LLIF, 215 quadriceps palsy, 217 Lumbar spine, 292 Lumbar spondylolisthesis, 107 Lumbosacral biomechanics, 299 Lumbosacral kyphosis, 292, 301, 312 Lumbosacral plexus, 211 Lumbosacral spondylolisthesis, binary classification scheme, 311 M Marchetti and Bartolozzi classification, 301 Metastatic epidural spinal cord compression (MESCC), 167, 168 Methicillin-resistant S aureus (MRSA), 44 Minimally invasive spinal surgery (MISS), 174 Minimally invasive surgery (MIS), 229, 238 complications, 215 deep tendon reflexes, 213 patient’s functional assessment, 213 patients’ weakness, 214 pedicle instrumentation, 212 post-op exam, 212 post-op radiographs, 214 quadriceps palsy, 216 work-up and treatment, 216–217 Mini-open transpedicular corpectomy, see Expandable cage technique Morquio and Lesch-Nyhan syndromes, 10 Morquio syndrome, 10 Motor-evoked potentials (MEPs), 48, 177 Mucopolysaccharidoses, 10 Myelopathy, see Cervical kyphosis N Nerve root deficit, 292, 294 Neurogenic motor-evoked potentials (NMEPs) epidural, spinous and percutaneous methods, 96 false-positive rates, 97 motor tracts monitoring, 96 ventral motor tracts monitoring, 97 348 Neurologic complications and proximal junctional kyphosis complications, 251 IOM, 251 LLIF procedure, 251 outcomes, 251 patient history, 249, 250 physical and radiographic findings, 250 SAP, 251 SSEP and MEP, 251 surgical treatment, 250 Neuromonitoring, intraoperative, 30, 32 Neuromuscular diseases history and physical examination, 59 muscle contraction and spasms, 59 pathologic changes, 59 rectus abdominis muscle contraction, 59 spine deformities, 59 spine surgeons, 59 symptoms, 59 treatment, 60 Non-small cell lung cancer, 170, 171 O Occipital condyles, Occipitocervical fusion, see Occipitocervical junction Occipitocervical junction anatomy, 12 autograft and allograft, 14 basilar invagination, 10 chronic and recurrent surgical site infections, 13 description, Down’s syndrome, 9, 10, 12 endovascular coiling, 13 instrumentation placement, 12 ligaments, 7, Morquio syndrome, 10 mucopolysaccharidoses, 10 myelopathy, 10 occipital condyles, odontoid, peg-like structure, osseous structures, patient populations, instability, postoperative complications, 13 Power’s ratio, spinal instability parameters, type III fractures, vascular anatomy, vertebral arteries, Open reduction method anterior approach, 54 circumferential approach, 55 posterior approach, 54–55 Ossification of the posterior longitudinal ligament (OPLL), 31 Osteogenesis imperfecta, 10 Osteopenia, 170, 324 Osteoporosis, 322, 324, 327 Osteotomy, 277 Index P Paraplegia active disease, 131 healed disease, 131 Parkinson’s disease bent-forward/stooped posture, 60 BMP, 64 bony degenerative changes, 60 cervical lordosis loss, 60, 61 clinical severity, 60 complications and management, 61, 63 DBS therapy, 64 grade I spondylolisthesis and spinal cord compression, 60, 61 hardware complications, 63 patient's history, 60 proper attention, 64 pseudarthrosis development, 64 scoliosis, 59 spinal deformity, 59, 64 spine surgeon, 59 surgical options, 61, 64 symptoms, 59 wound dehiscence, 63 Pedicle screw fixation, 164 Pedicle subtraction osteotomies (PSO), 76, 77, 82–84, 200, 225, 227, 229, 245, 282 complication management, 271 pelvic fixation, 278 pertinent history and physical findings, 269, 270 PI, 274 sagittal malalignment compensatory mechanisms, 276 driver identification, 276 PT, 277 surgical planning and formulas, 276 sagittal realignment failure, 271 surgery, 270 treatment, 274, 275 Pelvic fixation, 278 Pelvic incidence (PI), 225, 245, 274 Peripherally inserted central catheter (PICC), 263 PJF, see Proximal junctional failure (PJF) PJK, see Proximal junctional kyphosis (PJK) Plain films, 189 Polyether ether ketone (PEEK), 45 Ponte osteotomies, 81 Posterior atlantodental interval (PADI), 18 Posterior cervical fusion, 30 Posterior cervical instrumentation and fusion, 81 Posterior column osteotomies (PCOs), 282 Posterior ligamentous complex (PLC), 155 Posterior sacral vertical line (PSVL), 138, 141 Posterior spinal fusion (PSF), 137, 190, 192, 193, 196 Posterolateral fusion (PLF), 190 Posterolateral muscle-splitting technique, 314 Postoperative complication avoidance, 178 Postoperative kyphosis, 164 Postoperative sagittal malalignment, 188 Postoperative scoliosis, 168 Index Pott’s disease adhesiolysis, 127, 130 anterior and posterior compartments, 125 antituberculous therapy, 126 Halo traction, 134, 135 kyphus, 126–128 neurological deficit bony destruction/concomitant deformity, 133 complete vs incomplete paraplegia, 132 critical vascular zone, 125 epidural abscess, 133 late-onset paraplegia, 132 middle path regime, 132 neurological impairment, 124, 125 paraplegia active disease, 131 late onset, 127 paraplegia/tetraplegia, 124 soft/hard kyphus, 123, 133 spinal deformity, 124 TB spine, 123 type of pathology, 133, 134 Pott’s paraplegia of late onset, 127 Power’s ratio, Preoperative complication avoidance, 178 Preoperative posteroanterior (PA), 322 Progressive kyphotic deformity, 169 Proximal junctional failure (PJF), 120 Proximal junctional kyphosis (PJK), 72, 275 adjacent segment disease, 234 cantilever technique, 120 degenerative scoliosis, 233 end vertebra, 120 hypolordosis, 235, 236 minimally invasive surgery, 238 pediatric, 121 PI, 121 PJF, 120 revision fusion, 120 revision surgery, 233, 234, 237, 238 thoracic and lumbar spine, 119 thoracolumbar deformity, 233, 234 UIV, 120 Pseudarthrosis, 61, 63, 64, 162, 164, 186, 189, 190, 286, 287, 289 age, 187 algorithm, 196 bilateral rod fracture, 228 characteristics, 188 clinical setting, 226 complications, 229, 230 CT scan, 230 diagnosis, 188 hip osteoarthritis, 188 history and physical exam, 188, 190, 191 imaging studies, 191 implantation failure, 230 incidence, 186 informed consent, 193 initial postoperative, 192 instrumentation size and positioning, 164 349 laminotomies and foraminotomies, 192 number of fused vertebra, 187 ODI and SRS score, 230 postoperative sagittal malalignment, 188 PSO, 227, 229 radiographic factors CT, spinal fusion, 189 metabolic bone activity, 190 MRI, 189 PET, 190 plain films, 189 spine pseudarthroses, 189 radiographic finding, 188, 225, 227 recommendations, 195 risk factors, 186, 193, 194, 226 sacrum/pelvis fixation, 187 sagittal balance, 230 sagittal imbalance, 227 smoking, 187 spinal alignment, 226 spino-pelvic parameters, 227 thoracolumbar junction (T10–L2), 186 thoracolumbar kyphosis, 187–188 treatment, 190 Pseudarthrosis, hardware failure, 313, 317 Pseudoarthrosis, 294 Pseudohernia, 219, 220 Pseudomeningocele dura and, 160 initial, 160 laminectomies, 160 resection of, 160 second, 162 Q Quadriceps palsy etiologies, 216 femoral nerve injury/compression, 217 minimally invasive transpsoas LLIF technique, 211 neurological injury risk, 216 paresthesia and/or paralysis, 216 spinal surgeons, 217 R Rectus abdominis muscle contraction, 59 Reduction technology, 312, 316, 317 Retroperitoneal hematoma, 182 Revision fusion, 120 Rheumatoid arthritis, 9, 10 Rotary scoliosis, 242 S Sacral insufficiency fractures case history, 322 complications, 322 imaging, 321, 322 instrumentation and fusion, 324 intraoperative treatment, 324 350 Sacral insufficiency fractures (cont.) management, 324 postoperative treatment, 326 preoperative treatment, 324 risk factors, 321, 324 surgery and hospital course, 322 treatment options, 322, 327 Sacral osteotomy, 271, 273 Sacral surgery, 333 Sacral tumors biopsy, 331, 332 clinical examination, 330 complications bony nonunion, 340, 341 MSSA/MRSA, 341 perioperative medical, 339, 340 surgical incisions, 340 wound healing, 340 dorsal sacrectomy, 334 hemisacrectomy, 334, 336 imaging, 330 neurologic deficits, 329 oncologic sacrectomy, outcomes, 339 perioperative antibiotics, 336 postoperative care, 336, 338, 339 sacrum, 329 surgical treatment, 333 symptoms, 329 total sacrectomy, 334 treatment options, 332 Sacrectomy, see Sacral tumors Sacrum/pelvis fixation, 187 Sagittal alignment cervical, 49 scoliosis survey demonstration, 47 Sagittal plane malalignment, 245 Sagittal realignment failure, 271–274 Sagittal spinopelvic balance, 292 Sagittal stable vertebra (SSV), 117, 118, 138 Sagittal vertical axis (SVA), 49, 225 Scheuermann’s kyphosis (SK), 81 acute pain and physical therapy, 116 adolescents, 115 complication management, 119 diagnosis, 116–118 physical examination, 116 PJK, 119–121 spondylolysis/scoliosis, 115 thoracic/thoracolumbar spine, 115 treatment, 117, 118 Schwab Grade II osteotomies, 168 Scoliosis, 59, 60, 63, 115 de novo adult degenerative, 212 and spinal deformity, 211 total right knee replacement, 212 Scoliosis Research Society (SRS), 95, 98, 204 Short tau inversion recovery (STIR) signal, 9, 156 Skull fracture, with halo pins, 24 Slip angle, 312, 313, 316, 317 Index Smith-Petersen osteotomy (SPO), 76, 77, 81, 82 Soft and hard kyphus, 123, 133 Somatosensory-evoked potentials (SSEPs), 48 drawbacks, 95 false-positive results rates, 95 focal changes, 107 intraoperative wake-up test, 95 medial lemniscal pathway, 94 neurophysiologic signals, 107 in popliteal fossa, 94 postoperative neurologic deficit rate, 95 response protocol, 106 scalp leads, 94 spinal cord monitoring, 94 spine deformity surgery, 95 SRS and ESDS, 95 Spinal cord ischemia, 106 Spinal cord monitoring deformity correction, surgical and anesthetic teams, 95 during scoliosis, 94 intraoperative wake-up test, 93, 95, 106 Spinal deformity aggressive osteotomies, anterior/posterior deformity correction procedures, complications, EOS, Harrington rod instrumentation, HRQOL, impaired pulmonary function, neuromonitoring techniques, SSEPs and wake-up test, surgical treatment, thoracoplasty, Spinal Deformity Study Group (SDSG), 302 Spinal infections fungal/tubercular etiologies, 43 gram-positive organisms, 43 immunocompromised patients, 43 small epidural abscesses, 43 spine surgeons, 43 Spinal metastasis anterior approaches, 174 anticancer therapies, 173 CT and PET, 173 dynamic films, 173 MISS, 174 MRI, 174 plain radiographs, 173 posterior fixation, 174 surgical intervention, 173 symptomatic lesions, 174 symptoms, 173 Spinal sagittal balance, 292 Spinal surgeons anterior-to-psoas trajectory/ante-psoas approach, 217 careful attention, 217 EMG monitoring and SSEP, 217 LLIF, 217 Index lumbar plexopathy and quadriceps palsy, 217 surgical site visualization, 217 Spine deformity, 168 Spine metastases adjuvant radiation treatment, 168 adjuvant stereotactic radiosurgery, 171 anterior column reconstruction, 168 anterior transcavitary approaches, 167 case presentations, 168–171 incidence of, 167 kyphoplasty and external orthoses, 171 MESCC tumors ressection, 168 non-small cell lung cancer, 170, 171 osteopenia and osteoporosis, 170 patient-specific factors, 167 posterolateral approaches, 168, 171 postoperative spinal deformity and associated hardware insufficiency, 168 progressive kyphotic deformity, 169, 170 radiosensitive tumors, 171 surgical decompression plus radiation treatment, 167 symptomatic patients, 168 symptoms, 167 vertebral body tumor invasion, 168, 169 Spine surgical site infection (SSI) bone graft, 265 CT and MRI, 260 deep infections, 259, 262 ESR and CRP, 260 imaging modalities, 264 intraoperative, 263 patient history, 263 postoperative, 263 risk, 259 superficial infections, 259, 262, 265 symptoms and signs, 260 treatment, 261, 262 Spino-pelvic continuity, 333, 336 Spinopelvic parameters, 292 Spondylodiscitis and ankylosing spondylitis, 183 aortic injuries risks, 184 Spondylolisthesis arachnoid cysts, 307 complications avoidance and management, 304–308 Gill laminectomy, 302 grading systems and classifications, 291 HGS, 291 high-grade spondylolisthesis, 303 imaging, 305 lumbosacral kyphosis, 301 Marchetti and Bartolozzi classification, 301 radiographic examination, 303 SDSG classification, 302 surgical treatment, 291 symptoms, 301 treatment options, 302, 303, 306 types, 302 Spondylolysis, 115 351 Spondyloptosis, 297 SSV, see Sagittal stable vertebra (SSV) STIR, see Short tau inversion recovery (STIR) signal Subsidence adjacent vertebral bodies, 223 informed surgeon, 223 lateral lumbar interbody fusion, 222 operative intervention, 223 risks of, 223 Substantially touched vertebra (STV), 141 Surgical teams, 109 SVA, see Sagittal vertical axis (SVA) Swan-neck deformity, 35 Sympathetic dysfunction complications, 248 medical/surgical history, 248 physical and radiographic findings, 248 surgical procedure, 248 T TB spine (spinal tuberculosis) acute/chronic, 131 granuloma, 123 lytic spinal lesions, 123 neurological deficits, 123 tcMEP, see Transcranial motor-evoked potentials (tcMEP) Tethered cord management, 162, 163 operating room and release, 161 syndrome, 160 work-up, 163, 164 Thoracic deformity, see Pott’s disease Thoracic spine, 116, 120, 121 Thoracolumbar deformity, 233, 234 Thoracolumbar fracture, 155 Thoracolumbar Injury Classification Severity (TLICS) system, 155–157 Thoracolumbar junction bicortical Kaneda screws, 158 case presentation, 156–158 discectomies and corpectomies, 158 distal nerve root (S3–S5), 155 extrapleural, retroperitoneal approach, 158 fracture dislocations and patterns, 155, 156 fusionless techniques, 156 hospital emergency department, 155 imaging techniques, 155, 161, 162 initial pseudomeningocele, 159, 160 L1–L2 subluxation, 158 ligamentous Chance fracture, 156 meticulous dissection, 160 nonoperative treatment, 156 operative treatment, 156 pedicle screw hook rod system, 158, 159 pedicle-to-pedicle decompression, 158 PLC, 155 posterior instrumentation removal, 160, 161 Index 352 Thoracolumbar junction (cont.) restoration and maintenance, 155 spinal instrumentation, 160 stackable carbon fiber cages, 158 STIR signal, 156 tethered cord work-up and management, 162–164 TLICS flowchart, 156 traumatic spinal injury, 155 Thoracolumbar kyphosis, 187–188 Thoracolumbar spinal orthosis (TLSO), 156 Thoracolumbar spine, 115, 174, 178 Thoracoplasty, Titanium alloy (TA), 190 TLICS, see Thoracolumbar Injury Classification Severity (TLICS) system Total sacrectomy, 334 Transcranial motor-evoked potentials (tcMEP) complications, 96 leads monitoring, 95, 96 safety and efficacy, 95 seizures in patients, 96 and SSEP function, 95, 97 tibialis anterior and soleus muscle leads, 95, 96 ventral motor tracts monitoring, 95 Transforaminal interbody fusion, 200, 202 Transforaminal lumbar interbody fusion (TLIF), 282 Transoral odontoidectomy, 26 Trans-psoas approach, 200, 201, 206 Transverse ligament (TAL), 17 Traumatic bilateral facet dislocation, see Cervical traumatic deformity Traumatic kyphosis, 164 U Unified Parkinson’s Disease Rating Scale, 60 Unrecognized durotomies, 150 V Vacuum-assisted closure (VAC) systems, 48 Vascular injuries adult scoliosis, 220 bipolar under direct visualization, 222 coagulation/hemostatic agent, 221 complications, 253 contralateral psoas hematoma, 222 history, 252 lateral interbody fusion, 221 outcome, 253 physical findings, 252 surgical treatment, 252 vessels, 221 Vertebral artery (VA) injury, 11, 13, 25 Vertebral body fracture, 219, 222, 223 Vertebral column resection (VCR), 146, 245 ASD, 281 thoracolumbar junction, 284 Visual analog scale (VAS), 160 W Wang classification, 20 Whipstitches, 182 Wound dehiscence, 63