Spinal Deformities: The Essentials

264 Pages·2014·11.637 MB·English

by  Robert F. Heary, Todd J. Albert

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Spinal Deformities
The Essentials
Second Edition
RobertF.Heary,MD
Professor
DepartmentofNeurologicalSurgery
Director,SpineResearchLaboratory
Rutgers,TheStateUniversityofNewJersey
Newark,NewJersey
ToddJ.Albert,MD
RichardH.RothmanProfessorandChair
DepartmentofOrthopaedics
ProfessorofNeurosurgery
ThomasJeffersonUniversityandHospitals
President,TheRothmanInstitute
Philadelphia,Pennsylvania
Thieme
NewYork(cid:1)Stuttgart(cid:1)Delhi(cid:1)RiodeJaneiro
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ToddJ.Albert.–Secondedition. contraindicationsforadministration.Thisrecommendationisof
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Includesbibliographicalreferences. referred to in this book are in fact registered trademarks or
ISBN 978-1-60406-411-7 (alk. paper) – ISBN 978-1-60406- proprietarynameseventhoughspecificreferencetothisfact is
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without designation as proprietary is not to be construed as a
I.Heary,RobertF.,editorofcompilation.II.Albert,ToddJ.,editorof
representationbythepublisherthatitisinthepublicdomain.
compilation.
[DNLM:1. SpinalCurvatures–surgery.2. SpinalInjuries–surgery.
3. Spine–surgery. WE735]
RD594.3
617.4'820441–dc23
2014002450
Copyright©2014byThiemeMedicalPublishers,Inc.
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Iwould liketodedicate thisbookto my wifeCaraand mychildrenDeclan, Maren, andConor.
Theyprovide somuchjoytomeandsupport forallprojects.Without their energies,it would not
bepossible to findthemotivationtocomplete anendeavorsuchasthis.
Robert F.Heary,MD
To my wifeBarbaraforalways beingmy biggestsupporter,my bestcheerleader,
my trustedadvisor, and my special love.
Todd J.Albert, MD
Heary_FM 04/26/2014 12:51:11 Page6
Acknowledgments
Iwouldliketorecognizeandthankalloftheneurosurgical Tothespinefellowswhohaveworkedsohardtomasterthe
residentswhohaveworkedsohardinourtrainingprogram science and art of spinal deformity and surgery for spinal
overthepastsevenyears.Theirenergyandenthusiasmare disorders.
limitless,andtheirunendingcommitmenttoprovidingthe
highest quality of care makes the performance of these Todd J.Albert, MD
complex, reconstructive spine surgeries safe and effective.
Iwouldliketospecificallythank RemonS.Bebawee,BS,who
is a future physician, who put an unbelievable amount of
time and energy into helping expedite the review process
for thistextbook tohelp itcometofruition.
Robert F.Heary,MD
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Contents
Acknowledgments ............................................................................. vi
Foreword ..................................................................................... xv
Preface ........................................................................................ xvi
Contributors ................................................................................. xvii
PrinciplesofSpinalDeformities .............................................................................1.
1 TheHistoryandOverviewofSpinalDeformity ............................................... 2
RobertF.HearyandRemonS.Bebawee
1.1 TheHistoryofSpinalDeformity............ 2 1.7 PostoperativeConsiderations ............. 10
1.2 OverviewofSpinalDeformity.............. 3 1.8 ResultsandComplications ................ 10
1.3 SpinalDeformityTermsandPrinciples ..... 5 1.9 FutureDevelopments..................... 11
1.4 EvaluationofthePatientwithaSpinal 1.10 Conclusion............................... 12
Deformity................................ 8
References................................. 12
1.5 IndicationsforAdultSpinalDeformity
Surgery .................................. 9
1.6 OperativeTreatments..................... 9
2 MeasuringValueinSpinalDeformityCare .................................................... 14
PaulC.Celestre,LeahY.Carreon,andStevenD.Glassman
2.1 TheImportanceofHealthCare 2.4 QALYs,ICER,andValueinHealthCare
Economics................................ 14 DecisionMaking.......................... 15
2.2 OutcomeMeasuresinSpinalDeformity 2.5 ValueinSpinalDeformityCare ............ 16
Surgery .................................. 14
2.6 Conclusion............................... 17
2.3 MinimumClinicallyImportantDifference
andSubstantialClinicalBenefit ............ 15 References................................. 17
3 IntraoperativeNeuromonitoringinSpinalDeformitySurgery.............................. 18
DanielM.Schwartz,VidyaM.Bhalodia,andAnthonyK.Sestokas
3.1 Introduction.............................. 18 3.3 TheRoleofIONMinMonitoringPatient
Positioning............................... 22
3.2 NeurophysiologicalMonitoring
Techniques............................... 18 3.4 PathophysiologyofEvokedPotentialand
ElectromyographyChanges ............... 22
3.2.1 SomatosensoryEvokedPotentials ............ 18
3.2.2 TranscranialElectricMotorEvoked 3.5 EffectsofAnestheticson
Potentials................................. 19 NeurophysiologicalSignals................ 24
3.2.3 TheH-Reflex .............................. 19
3.2.4 Electromyography.......................... 20 3.6 Conclusion............................... 27
3.2.5 StimulatedElectromyography................ 21
3.2.6 TheTranspsoasApproach ................... 21 References................................. 27
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Contents
4 AnatomyandEvaluationofSpinalAlignment ................................................. 29
CharlesKuntzIV
4.1 Introduction.............................. 29 SagittalAlignmentAnglesandDisplacements....... 32
RegionalSpinalAlignment...................... 34
4.2 ClinicalandRadiographicEvaluationof PelvicAlignment............................. 34
Deformity................................ 29 GlobalSpinalAlignment ....................... 34
4.2.1 CoronalAlignmentAnglesandDisplacements . 31 4.3 Conclusion................................ 34
RegionalSpinalAlignment..................... 32
PelvicAlignment............................. 32 References.................................. 34
GlobalSpinalAlignment....................... 32
5 AnatomicalVariantswithSpinalDeformity.................................................... 36
ChristopherM.BonoandAndrewJ.Schoenfeld
5.1 Introduction.............................. 36 5.5 SpinousProcesses......................... 39
5.2 VertebralBody ........................... 36 5.6 FacetJointsandParsInterarticularis........ 39
5.2.1 IdiopathicScoliosis......................... 36 5.7 SpinalCord ............................... 40
5.2.2 Congenital/DysplasticandIsthmicSpondylolysis
andSpondylolisthesis ...................... 37 5.8 VascularStructures........................ 41
5.2.3 ScheuermannKyphosis..................... 37
5.8.1 Aorta ..................................... 41
5.3 Ribs...................................... 38 5.8.2 SegmentalVessels .......................... 41
5.4 Pedicles.................................. 38 References.................................. 42
6 TheImportanceoftheSacrumandPelvisinDeformityEvaluation
andTreatment .................................................................................... 43
FrankJ.Schwab,JeffreyH.Weinreb,andVirginieLafage
6.1 Introduction.............................. 43 6.5 Treatment ................................ 47
6.2 PelvicRadiographicParametersand 6.6 Conclusion................................ 47
Compensation............................ 43
References.................................. 47
6.3 Evaluation................................ 44
6.4 Classification............................. 45
7 TheLenkeClassificationSystemforAdolescentIdiopathic
Scoliosis............................................................................................ 49
JeffreyL.Gum,LawrenceG.Lenke,andShayBess
7.1 Introduction.............................. 49 7.5.1 Type1:MainThoracicCurves ................ 54
7.5.2 Type2:DoubleThoracicCurves............... 55
7.2 RadiographicMeasurements.............. 49 7.5.3 Type3:DoubleMajorCurves................. 56
7.5.4 Type4:TripleMajorCurves.................. 56
7.3 ClassificationSchemesforAdolescent 7.5.5 Type5:Thoracolumbar/LumbarCurves........ 56
IdiopathicScoliosis ....................... 49 7.5.6 Type6:Thoracolumbar/Lumbar–Main
ThoracicCurves ............................ 56
7.4 LenkeAISClassificationSystem............ 50
7.6 Conclusion................................ 56
7.5 OperativeTreatmentofAISAccordingto
CurveTypes.............................. 54 References.................................. 58
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