Practice of Spinal Surgery
Published on 12. September 1983
Book
Hardback
XX, 321 pages
978-3-211-81738-4 (ISBN)
Description
It is not long since surgery of the spine dealt with fracture-dislocation and tuberculosis, little else. With the advent of contrast X-ray and anatomical study a wide range of disease entities has been categorized and become the subject of corrective and ameliorative treatment. The principal author of the present book has played a distinguished part in widening knowledge of the anatomy of the bones, ligaments, blood vessels, neural features and the natural history of diseases relevant to hard structure disorder. He has done this in relation to the development of highly refined surgical techniques based strictly upon structural requirements in relation to the disease processes under treatment. The result is a comprehensive account of his integrative conceptualisation and the relevant principles of the methods used. His component, the major part of the book, is in the tradition of John Hunter, Bland Sutton, Kanavel and others who improved their understanding and treatment by the discipline enforced by the discipline of basic investigation. In the era of proliferation of specialties and books of single author chapters it is refreshing to meet one man's mind extended. By Sir George Bedbrook adding the fruits of his years of experience and thought about the treatment of spinal injury the book is enriched. As the best of two investigative practitioners, it reflects the best features of the surgical calling and should be studied not only for its material but especially for its reflection of high professional endeavour.
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Henry V. Crock
A Short Practice of Spinal Surgery
With a Contribution on Medical Aspects in the Management of Spinal Surgical Patients by Bryan P.Galbally
Book
12/1992
2nd Edition
Springer
€208.60
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Content
1. Nerve Root Canal Stenosis.- 1.1. Isolated Lumbar Disc Resorption.- a) Natural History.- b) Anatomy of Nerve Root Canals.- i) Normal.- ii) Pathological.- c) Venous Obstruction.- d) Clinical Studies.- e) Investigations.- i) Plain X-Rays.- ii) Lumbar Myelography.- iii) Lumbar Discography.- iv) Computerized Axial Tomography.- v) Epidural Venography.- f) Operations.- i) Types.- ii) Technique of Lumbar Nerve Root Canal Decompression at L5/S1 Level.- 1.2. Miscellaneous Causes of Nerve Root Canal Stenosis.- a) Congenital Abnormalities.- b) Space Occupying Lesions.- c) Localized Degeneration.- 2. Internal Disc Disruption.- 2.1. Clinical Features.- a) Symptoms.- b) Spinal Movements.- c) Body Weight Loss.- d) Neurological Signs.- e) Psychiatric Disturbances.- i) Acute Psychotic Reaction.- ii) Reaction to Prolonged Disease.- 2.2. Pathology.- a) Macroscopic Changes.- b) Genesis of Symptoms.- 2.3. Investigations.- a) Plain X-Ray.- b) Discography.- c) Myelography.- 2.4. Surgical Treatment.- a) Types.- i) Total Disc Excision and Interbody Fusion.- ii) Bilateral Nerve Root Canal Decompression Laminectomy.- iii Posterior Spinal Fusion.- b) Technique of Anterior Lumbar Interbody Fusion.- i) Indications.- ii) General Pre-Operative Preparation.- iii) Positioning.- iv) Abdominal Incision.- v) Haemostasis.- vi) Preparation of the Interspace for Graft Insertion.- vii) Graft Impaction.- viii) Post-Operative Care.- ix) Complications.- c) Results of Anterior Interbody Fusion.- 3. Lumbar Disc Prolapses.- 3.1. Introduction.- 3.2. Pathology.- 3.3. Clinical Features.- 3.4. Investigations.- a) Plain X-Rays.- b) Myelography.- c) C.S.F. Examination.- d) Epidurography.- e) Discography.- f) Intra-Osseous Spinal Venography.- g) Electrodiagnostic Tests.- 3.5. Indications for Surgical Treatment.- 3.6. Treatment for Lumbar Disc Prolapses.- a) Discussion.- i) Surgery.- ii) Chymopapain.- b) Technique.- i) Pre-Operative Preparation.- ii) Anaesthesia.- iii) Positioning.- iv) Instruments.- v) Incision.- vi) Separation of Spinal Muscles.- vii) Opening of Spinal Canal.- viii) Extending Exposure.- ix) Management of Venous Haemorrhage.- x) Excision of Disc Tissue.- xi) Disc Prolapses Associated With Other Spinal Problems.- xii) Upper Lumbar Disc Prolapse.- xiii) Preserving the Bony Canal.- xiv) Wound Closure.- 4. Intervertebral Disc Calcification.- 4.1. Introduction.- 4.2. Complications.- 4.3. Patterns in Children.- 4.4. Patterns in Adults.- a) Clinical Features.- b) Pathological Findings.- c) Surgical Treatment.- 5. Spondylolisthesis.- 5.1. Planning of Treatment.- a) History.- b) Physical Parameters.- i) Role of Laminal Pseudarthroses in Symptom Production.- ii) State of Discs Adjacent to Slip.- iii) Shape of Spinal Canal.- iv) Degree of Vertebral Slip.- 5.2. Technique of Postero-Lateral Inter-Transverse-Alar Spinal Fusion.- a) Indications.- b) Preliminary Preparation.- c) Positioning.- d) Incisions.- e) Exposure of the Graft Bed.- f) Preparation of Graft Bone.- g) Placement of the Grafts.- h) Post-Operative Care.- i) Complications.- j) Infections.- k) Graft Site Problems.- 5.3. Spinal Canal and Nerve Root Canal Decompression With Foraminal Enlargement.- 5.4. Direct Repair of the Bony Defects in Spondylolysis and Spondylolisthesis.- 6. The Surgical Management of Spinal Canal Stenosis.- 6.1. Lumbar Canal Stenosis.- a) Congenital.- b) Acquired.- 6.2. Clinical Features.- a) Symptoms.- b) Physical Signs.- 6.3. Radiological Investigations.- a) Plain X-Rays.- b) Computerized Axial Tomography.- c) Lumbar Myelography.- 6.4. Conservative Treatment.- 6.5. Surgical Treatment.- a) Positioning.- b) Surgical Pathology.- c) Technique.- i) Exposure.- ii) Enlargement of Bony Canal.- iii) Haemostasis.- iv) Dural Opening 174 6.6. Results of Surgical Treatment for Arachnoiditis.- 6.7. Recognition and Treatment of Associated Pathological Conditions.- 7. Surgery of the Cervical Spine.- 7.1. Introduction.- 7.2. Indications for Surgery.- a) Cervical Spondylosis.- b) Cervical Disc Lesions.- c) Spinal Injuries.- d) Inflammatory Disorders.- e) Infective Lesions.- f) Tuberculous Infection.- g) Congenital Abnormalities.- 7.3. Controversial Indications for Surgery After Spinal Injury Without Spinal Cord Damage.- 7.4. Cervical Discography.- 7.5. Technique of Anterior Cervical Interbody Fusions.- a) Instruments.- b) Positioning.- c) Incisions.- d) The Thyroid Gland.- e) Control X-Rays to Identify Individual Intervertebral Discs.- f) Preparation of the Dowel Cavity.- g) Graft Preparation.- h) Graft Impaction.- i) Wound Closure.- j) Post-Operative Management.- 7.6. Radiological Changes After Interbody Fusion.- 7.7. Complications.- a) Minor.- b) Major.- 7.8. Results of Operation.- 7.9. Posterior Cervical Spinal Fusion.- 7.10. Cervical Laminectomy.- a) Positioning.- b) Exposure.- c) Post-Operative Care.- 8. Spinal Infections.- 8.1. Acute Vertebral Osteomyelitis.- a) Introduction.- b) Clinical Findings.- c) Investigations.- d) Radiological Examinations.- i) Plain X-Ray.- ii) Computerized Axial Tomography.- iii) Myelography.- e) Needle Biopsy.- f) Treatment.- i) Bed Rest and Chemotherapy.- ii) Drainage of Abscesses.- 8.2. Tuberculous Disease of the Spine.- 8.3. Post-Operative Infections.- 9. The Management of Failed Spinal Operations.- 9.1. Introduction.- 9.2. Investigation.- 9.3. Outright Failure.- a) Unrecognized Conditions.- b) Error in Diagnosis of the Spinal Condition.- c) Technical Errors.- i) In Operations for Disc Prolapse.- ii) In Operations for Internal Disc Disruption.- 9.4. Temporary Relief.- a) Failure After Operation for Disc Prolapse.- b) Failure After Operation for Internal Disc Disruption.- c) Failure After Operation for Isolated Disc Resorption.- 9.5. Surgical Techniques for Re-Exploring the Spinal Canal.- a) Preparation.- b) Radiology.- c) Positioning.- d) Instruments.- e) Exposure.- f) Orientation.- g) Timing of Retractor Application.- h) Re-Opening the Spinal Canal.- i) Dural and Epidural Problems.- i) Meningocoeles.- ii) Unrecognized Epidural Infection.- j) Re-Exploration of the Spine Following Spinal Fusion Operations.- i) Non-Union of Spinal Grafts.- ii) Graft Overgrowth After Posterior Spinal Fusion.- iii) Development of Secondary Stenosis Beneath the Graft.- iv) Disc or Facet Joint Lesions Above or Below the Fused Spinal Segment.- v) Fusion at the Wrong Level.- vi) Infections.- vii) Spondylolysis acquisita.- viii) Ligamentum flavum Atrophy.- 9.6. Summary.- 9.7. Post-Operative Care.- 10. Basic Principles in the Management of Spinal Injuries (by Sir George Bedbrook).- 10.1. Introduction.- 10.2. Historical.- 10.3. Pathogenesis of the Injury.- 10.4. Recognition of the Injury.- a) Clinical Examination.- i) History.- ii) General Assessment.- iii) Examination of the Spine.- iv) C.N.S. Examination.- b) Radiological.- c) Special Problems.- d) Associated Injuries.- 11. The Management of Spinal Injuries With and Without Neural Damage (by Sir George Bedbrook).- 11.1. Introduction.- 11.2. Transport.- 11.3. Prevention of Secondary and Tertiary Complications.- 11.4. Early Care in the Resuscitation Unit and/or Spinal Cord Injury Centre.- 11.5. General Considerations.- 11.6. The Role of Special Procedures in Specific Areas of Spinal Injury.- a) Postural Reduction of the Fracture.- b) Traction, Including Flexion and Extension, Effecting Reduction of the Fracture-Dislocation.- c) Manipulative Reduction.- d) Open Reduction and Internal Fixation.- e) Laminectomy.- f) Use of Exoskeletons.- 11.7. Management in Specific Areas.- a) Cervico-Dorsal Fractures and Fracture-Dislocations in Early Stages.- i) Acceleration/Deceleration Injury.- ii) Fractures and Fracture-Dislocations from C3 to T1.- b) Lumbo-Dorsal Injuries.- 11.8. Surgical Technique.- 11.9. Indications and Contra-Indications for Specific Surgical Procedures.- a) Anterior Decompression of Acute Fractures of the Cervical Spine.- b) Open Reduction and Internal Fixation of Lumbo-Dorsal Fractures.- c) Antero-Lateral Decompression.- d) Spinal Fusion.- 11.10. Management of Problem Cases.- 11.11. Summary.- 11.12. Conclusions.- References.