E-Book, Englisch, 676 Seiten, ePub
Baaj / Mummaneni / Uribe Handbook of Spine Surgery
3. Auflage 2024
ISBN: 978-1-68420-678-0
Verlag: Thieme Medical Publishers
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)
E-Book, Englisch, 676 Seiten, ePub
ISBN: 978-1-68420-678-0
Verlag: Thieme Medical Publishers
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)
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Weitere Infos & Material
I: Anatomy 1. Craniovertebral Junction 2. Cervical Spine 3. Thoracic Spine 4. Lumbar Spine 5. Sacral–Iliac Spine II: Clinical Spine Surgery 6. Physical Examination 7. Spinal Imaging 8. Radiation Exposure in Spine Surgery 9. Electrodiagnostic Testing in Spine Surgery 10. Intraoperative Neuromonitoring in Spine Surgery 11. Bedside Procedures 12. Orthotics in Spine Surgery 13. Pharmacology of Antithrombrotics, Antifibrinolytics, and Osteoporosis Medications 14. Spine Biologics III: Spinal Pathology 15. Congenital Anomalies 16. Cervical Trauma 17. Thoracolumbar Trauma 18. Sacropelvic Trauma 19. Infection 20. Primary Bony Spinal Column Tumors 21. Surgical Managment of Spinal Metastases 22. Intradural Extramedullary and Intramedullary Spinal Tumors 23. Cervical and Thoracic Spine Degenerative Disease 24. Degenerative Lumbar Spine Disease 25. Congenital and Neuromuscular Scoliosis 26. Scheuermann's Kyphosis 27. Adolescent Idiopathic Scoliosis 28. Adult Degenerative Deformity 29. Radiographic Parameters of Spinal Deformity 30. Vascular Pathology of the Spine 31. Spondyloarthropathies 32. Spinal Emergencies IV: Surgical Techniques 33. Occipitocervical Fusion 34. Transoral Odontoidectomy 35. Endoscopic Endonasal Odontoidectomy 36. C1–C2 Fixation Techniques 37. Odontoid Screw Fixation 38. Cervical Arthroplasty 39. Anterior Cervical Diskectomy 40. Anterior Cervical Corpectomy 41. Cervical Laminectomy with and without Fusion 42. Cervical Laminoplasty 43. Posterior Cervical Foraminotomy 44. Cervical Open Reduction Techniques: Anterior and Posterior Approaches 45. Surgical Resection of Spinal Vascular Lesions 46. Freehand Thoracic Pedicle Screw Insertion 47. Navigation in Spine Surgery 48. Robotics in Spine Surgery 49. Posterolateral Thoracic Approaches 50. Minimally Invasive Lateral Retropleural Approach for Thoracic Diskectomy 51. Lateral Approaches to the Thoracolumbar Spine 52. Open and Minimally Invasive Spinal Lumbar Microdiskectomy 53. Lumbar Laminectomy 54. Endoscopic Lumbar Techniques 55. Open Transforaminal Lumbar Interbody Fusion 56. Minimally Invasive Transforaminal Lumbar Interbody Fusion 57. Lateral Lumbar Interbody Fusion 58. Single-Position Lateral Lumbar Interbody Fusion 59. Pedical Subtraction Osteotomy/Smith-Petersen Osteotomy 60. Vertebral Body Tethering for Scoliosis 61. Percutaneous Pedicle Screw Placement 62. Awake Spine Surgery 63. Anterior Lumbar Interbody Fusion 64. Sacroiliac Joint Fusion 65. Sacrectomy 66. Vertebral Body Augmentation
1 Craniovertebral Junction
Nader S. Dahdaleh Summary The craniocervical junction is composed of two joints, the atlanto-occipital and atlantoaxial joints along with their surrounding ligamentous and muscular attachments. 1.1 Key Points
The craniovertebral junction (CVJ) is composed of the occiput (O), atlas (C1), and axis (C2) along with the atlantoaxial and atlantooccipital joints ( ? Fig. 1.1). Fig. 1.1 Craniovertebral junction (CVJ) anterior (top) and lateral (bottom) views. The CVJ is a very flexible junction accounting for at least 50% of the range of motion of the cervical spine in all planes. The joint orientation determines the direction of motion, and the ligaments determine the biomechanical stability of this junction ( ? Fig. 1.2). Fig. 1.2 Craniovertebral junction (CVJ) range of motion. 1.2 Bony Anatomy
The CVJ consists of the base of the occiput, the atlas (C1), and the axis (C2). The foramen magnum boundaries consist of the basion anteriorly, the opisthion posteriorly, and the occipital condyles anterolaterally. The atlas (C1) is composed of an anterior arch, a posterior arch, and two lateral masses ( ? Fig. 1.3). Fig. 1.3 The atlas. The atlantooccipital joint is cup like in the coronal and sagittal plane allowing for flexion/extension and little axial rotation. The C1 anterior tubercle is the attachment site of the anterior longitudinal ligament (ALL) and the longus coli muscle. The vertebral artery (VA) and C1 nerve run along the superior lateral groove on C1 (sulcus arteriosus). In less than 15% of the population, the groove is roofed, forming the arcuate foramen. The axis (C2) consists of the body, odontoid process (dens), articulating surfaces, pedicles, pars interarticularis lamina, and large, bifid spinous process ( ? Fig. 1.4). Fig. 1.4 The axis. The atlantoaxial joint is convex in orientation allowing for axial rotation about the dens. 1.3 Neural Anatomy
Cervical nerve roots exit above their corresponding level (e.?g., the C2 nerve root exits above the C2 pedicle). C1 nerve root: The posterior division (suboccipital nerve) is more prominent than the anterior division. It innervates suboccipital muscles and occasionally branches to the lesser/greater occipital nerve. C2 nerve root: Posterior, medial (greater occipital nerve), and lateral divisions innervate suboccipital muscles and scalp from occiput to vertex. It may be sacrificed during atlantoaxial or occipitocervical fusions to enhance the exposure of the lateral mass for lateral mass screw placement and/or to access the atlantoaxial joint for direct arthrodesis. The lesser occipital nerve is formed by dorsal divisions of C2 and C3. 1.4 Vascular Anatomy
The voluminous vertebral venous plexus that surrounds the horizontal portion of the V3 segment of the VA is encased in the suboccipital fascia. If the planes of dissection are respected, the plexus can be preemptively coagulated during exposure of the CVJ. The VA leaves the C2 transverse foramen (becoming V3). It takes a 45 degrees lateral projection and ascends (vertical portion of V3) into the C1 transverse foramen. The VA then courses medially (horizontal portion of V3) along the C1 sulcus arteriosus and then anteriorly through the atlantooccipital membrane, where it becomes intradural (beginning of V4 segment). Blood is supplied to the CVJ primarily through branches of the vertebral and occipital arteries. Blood supply to the CVJ emanate from extensions of the VA from the subaxial spine. The anterior and posterior ascending arteries branch from the VA at C2–C3, entering the vertebral column supplying the axis before anastomosing to form the apical odontoid arcade that supplies the atlas and dens. The occipital artery completes the superior portion of the arcade. Lymphatic drainage of the CVJ is through retropharyngeal and deep cervical nodes. 1.5 Muscular Anatomy ( ? Table 1.1 )
Table 1.1 Craniovertebral junction musculature: their attachments and modes of action Muscle Attachments Action Trapezius Origin: Occipital bone, the ligamentum nuchae, and the spinous processes of T01–T12 Insertion: Lateral third of the clavicle and the scapula (acromion and scapular spine) Stabilize and move the scapula Sternocleidomastoid muscle (SCM) Origin: Sternum, clavicle Insertion: Temporal bone (mastoid process), occipital bone Contralateral head rotation, neck flexion Splenius capitis Origin: Lower half of the nuchal ligament and the spinous processes of C7–T3 vertebrae Insertion: Temporal bone (mastoid process), occipital bone Unilaterally: Lateral bending and rotation of head to ipsilateral side Bilaterally: Extension of the head and cervical spine Semispinalis capitis Origin: Transverse and articular processes of C4–C7, transverse processes of T1–T6 Insertion: Between superior and inferior nuchal lines of occipital bone Unilaterally: Lateral bending and rotation of head to ipsilateral side Extension, rotation, and lateral bending of head and cervical spine Rectus capitis posterior major and minor Origin: Posterior tubercle of atlas (minor), spinous process of C2 (major) Insertion: Medial part of inferior nuchal line of occipital bone Bilateral contraction at the atlantooccipital joint: Head extension Unilateral contraction at the atlantoaxial joint: Head rotation (ipsilateral) Obliquus capitis superior muscle of occipital bone (between superior and inferior nuchal lines) Origin: Transverse process of atlas Insertion: Occipital bone (between superior and inferior nuchal lines) Bilateral contraction at atlantooccipital joint: Head extension Unilateral...