- MedOne Spine
- ChapterSource: Nakaji P, Zaidi H, ed. Controversies in Neuroendoscopy. 1st Edition. Thieme; 2019. doi:10.1055/b-006-160132Comment: Lumbar microdiskectomy was originally described in the 1930s, and the surgical techniques have remained relatively standard over the following century. Approach-related morbidity of this technique necessitated the development of minimally invasive techniques to access the lumbar spine. In the last two decades, tubular retractors with paramedian incisions have become popular within the community. However, the narrow surgical corridor with poor light penetration and visualization has been cited as limiting factors in the efficacy of surgery. Recently, endoscopic approaches to lumbar diskectomy have been described. In this chapter, we discuss the advantages and disadvantages of endoscopic versus traditional microsurgical approaches to herniated lumbar disks.
Management of Traumatic Atlantoaxial Subluxations, selected from Cervical Trauma: Surgical Management, Robert F. Heary, 2019Source: Heary R, ed. Cervical Trauma: Surgical Management. 1st Edition. Thieme; 2019. doi:10.1055/b-006-163750Comment: Most patients with type I (posterior C-1 arch) fractures and type III (C-1 lateral mass) atlas fractures will not have any C1–C2 subluxation. Type I fractures can be treated in a soft collar and type III fractures can be treated in a standard rigid cervical collar for 6 weeks. Most patients with traumatic atlantoaxial subluxation due to type II atlas fractures (Jeﬀerson fractures) or transverse ligament injuries with a bony avulsion can be successfully treated with a rigid occipito-cervical-thoracic orthosis for 2 to 3 months. Surgery should be limited to patients with intrasubstance transverse ligament tears, patients with Jeﬀerson fractures and C1–C2 instability after failure of appropriate bracing, and patients with bony avulsion transverse ligament injuries who do not heal after conservative care. C1–C2 posterior instrumented fusion is the usual type of surgery when surgery is indicated, but O–C2 fusion is sometimes necessary for treatment of patients with type II atlas fractures as described within the text of this chapter.
Sagittal Balance: The Main Parameters, selected from Sagittal Balance of the Spine: From Normal to Pathology: A Key for Treatment Strategy, Pierre Roussouly, João Luiz Pinheiro-Franco, Hubert Labelle, and Martin Gehrchen, 2019Source: Roussouly P, Pinheiro-Franco J, Labelle H et al., ed. Sagittal Balance of the Spine: From Normal to Pathology: A Key for Treatment Strategy. 1st Edition. Thieme; 2019. doi:10.1055/b-006-161173Comment: While corrective surgeries that modify sagittal alignment and spinopelvic balance are highly complex and may remain the realm of specialized surgeons for the foreseeable future, a thorough understanding of these underlying concepts has become requisite for all spine surgeons to prevent iatrogenic deformities, even with very short fusions.
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