Contents
Videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxiii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxv
Richard G. Fessler
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxvii
Todd J. Albert
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xli
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xliii
I: Anatomy
1. Craniovertebral Junction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Nader S. Dahdaleh
1.1 Key Points . . . . . . . . . . . . 3
1.2 Bony Anatomy . . . . . . . . . 4
1.3 Neural Anatomy. . . . . . . . 4
1.4 Vascular Anatomy . . . . . . 5
1.5 Muscular Anatomy. . . . . . 6
1.6 Ligamentous
Anatomy . . . . . . . . . . . . . 6
1.7 Surgical Pearls. . . . . . . . . . 10
Common Clinical
Questions . . . . . . . . . . . . . 11
Answers to Common
Clinical Questions . . . . . . . 11
References . . . . . . . . . . . . 11
2. Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Ivan Angelov, Ebubechi Adindu, Woralux Phusoongnern, and Comron Saifi
2.1 Key Points . . . . . . . . . . . . 12
2.2 Bony Anatomy . . . . . . . . . 12
2.2.1 Bony Landmarks . . . . . . . 12
2.2.2 Vertebrae Anatomy . . . . . 13
2.2.3 Geometric
Measurements . . . . . . . . . 14
2.2.4 Biomechanics and
Mobility . . . . . . . . . . . . . . 14
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2.3 Neural Anatomy . . . . . . . . 14
2.3.1 Geometric Orientation . . . . 14
2.3.2 Cervical Plexus and Phrenic
Nerve . . . . . . . . . . . . . . . . 15
2.3.3 Brachial Plexus . . . . . . . . . 15
2.3.4 Sympathetic Ganglia . . . . . 16
2.4 Vascular Anatomy . . . . . . . 17
2.4.1 Vertebral Artery Segments:
V1 to V4 . . . . . . . . . . . . . . 17
2.4.2 Blood Supply to Spinal
Cord . . . . . . . . . . . . . . . . . 17
2.4.3 Venous Drainage . . . . . . . . 17
2.4.4 Transverse Foramen and
the Vertebral Artery . . . . . 18
2.5 Ligamentous and Muscular
Anatomy . . . . . . . . . . . . . 19
2.5.1 Ligamentous Anatomy . . . 19
2.5.2 The Carotid Triangle . . . . . 19
2.5.3 Muscular Anatomy . . . . . . 20
2.6 Variations in Anatomy . . . 20
2.7 Surgical Pearls . . . . . . . . . 20
Common Clinical
Questions. . . . . . . . . . . . . 21
Answers to Common
Clinical Questions . . . . . . . 21
References . . . . . . . . . . . . 22
3. Thoracic Spine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Lance Villeneuve, Xiaochun Zhao, and Zachary A. Smith
3.1 Key Points. . . . . . . . . . . . . 23
3.2 Bony Anatomy . . . . . . . . . 23
3.3 Neural Anatomy . . . . . . . . 25
3.4 Vascular Anatomy . . . . . . . 26
3.5 Ligamentous and Muscular
Anatomy. . . . . . . . . . . . . . 27
3.6 Surgical Pearls . . . . . . . . . 27
Common Clinical
Questions. . . . . . . . . . . . . 29
Answers to Common
Clinical Questions . . . . . . . 29
References . . . . . . . . . . . . 30
4. Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Azeem A. Rehman and Cara Sedney
4.1 Key Points. . . . . . . . . . . . . 31
4.2 Bony Anatomy . . . . . . . . . 31
4.3 Neural Anatomy . . . . . . . . 33
4.4 Vascular Anatomy . . . . . . . 34
4.5 Ligamentous and Muscular
Anatomy. . . . . . . . . . . . . . 38
4.6 Surgical Pearls . . . . . . . . . 40
Common Clinical
Questions. . . . . . . . . . . . . 43
Answers to Common
Clinical Questions . . . . . . . 43
References . . . . . . . . . . . . 43
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5. Sacral–Iliac Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Pedro Aguilar-Salinas and Mauricio J. Avila
5.1 Key Points . . . . . . . . . . . . 44
5.2 Bony Anatomy . . . . . . . . . 44
5.3 Neural Anatomy. . . . . . . . 46
5.4 Vascular Anatomy . . . . . . 47
5.5 Ligamentous and Muscular
Anatomy . . . . . . . . . . . . . 48
5.6 Surgical Pearls. . . . . . . . . . 49
Common Clinical
Question. . . . . . . . . . . . . . 50
Answer to Common Clinical
Question. . . . . . . . . . . . . . 50
References . . . . . . . . . . . . 50
II: Clinical Spine Surgery
6. Physical Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Mark S. Greenberg
6.1 Key Points . . . . . . . . . . . . 53
6.2 Main Components of the
Spinal-Related
Examination . . . . . . . . . . 53
6.3 Clinical Pearls . . . . . . . . . 59
Common Clinical
Questions . . . . . . . . . . . . . 59
Answers to Common
Clinical Questions . . . . . . . 60
References . . . . . . . . . . . . 61
7. Spinal Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Melissa Yunting Tang, James D. Whaley, Edward L. Baldwin III, Jeremy D. Shaw, and
Joon Υ. Lee
7.1 Key Points . . . . . . . . . . . . 62
7.2 Description . . . . . . . . . . . 62
7.3 Surgical Pearls . . . . . . . . . 68
Common Clinical Questions 68
Answers to Common
Clinical Questions . . . . . . . 69
References . . . . . . . . . . . . 69
8. Radiation Exposure in Spine Surgery . . . . . . . . . . . . . . . . . . . . . . 71
Javier Quillo-Olvera, Javier Quillo-Reséndiz, and Michelle Barrera-Arreola
8.1 Key Points . . . . . . . . . . . . 71
8.2 Description . . . . . . . . . . . 72
8.3 General Principles of
Radiation Protection . . . . . 73
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8.4 Evidence-Based Medicine
Statements . . . . . . . . . . . . 75
8.5 Surgical Pearls. . . . . . . . . . 75
Common Clinical
Questions . . . . . . . . . . . . . 76
Answers to Common
Clinical Questions . . . . . . . 76
References . . . . . . . . . . . . 76
9. Electrodiagnostic Testing in Spine Surgery . . . . . . . . . . . . . . . . 78
Kamakshi Patel and Holli A. Horak
9.1 Key Points. . . . . . . . . . . . . 78
9.2 Description . . . . . . . . . . . . 79
9.2.1 Nerve Conduction Study . . . 79
9.2.2 Electromyogram (EMG) . . . 79
9.2.3 Pathophysiology of
Radiculopathy . . . . . . . . . . 81
9.3 EMG/NCS Pearls . . . . . . . . 82
Common Clinical
Questions. . . . . . . . . . . . . 82
Answers to Common
Clinical Questions . . . . . . . 83
References . . . . . . . . . . . . 83
10. Intraoperative Neuromonitoring in Spine Surgery . . . . . . . . . 84
Alexander T. Yahanda, Miguel A. Ruiz-Cardozo, and Camilo A. Molina
10.1 Introduction . . . . . . . . . . . 84
10.2 Key Points. . . . . . . . . . . . . 84
10.3 Methods . . . . . . . . . . . . . . 85
10.4 Somatosensory Evoked
Potentials . . . . . . . . . . . . . 85
10.5 Transcranial Electrical
Motor Evoked Potentials . . . 87
10.6 Free-Run EMG . . . . . . . . . . 87
10.7 Triggered EMG . . . . . . . . . 88
10.8 H Reflex . . . . . . . . . . . . . . 88
10.9 Neuromonitoring in Spinal
Deformity Surgery . . . . . . 88
10.10 Neuromonitoring for the
Detection of Radiculopathy
in Three-Column
Osteotomies. . . . . . . . . . . 89
10.11 Mechanomyography . . . . . 90
10.12 Epidural D Wave
Monitoring for Intradural/
Intramedullary
Pathology . . . . . . . . . . . . 90
Common Clinical
Questions. . . . . . . . . . . . . 91
Answers to Common
Clinical Questions . . . . . . . 91
References . . . . . . . . . . . . 91
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11. Bedside Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Muhamed Hadzipasic, Ian David Connolly, John H. Shin, and Theresa Williamson
11.1 Key Points . . . . . . . . . . . . 93
11.2 Indications. . . . . . . . . . . . 93
11.3 Technique . . . . . . . . . . . . 94
11.3.1 Halo Orthosis and
Traction . . . . . . . . . . . . . . 94
11.3.2 Lumbar Puncture or
Lumbar Drain . . . . . . . . . 97
11.4 Complications . . . . . . . . . 99
11.4.1 Halo Orthosis and
Traction . . . . . . . . . . . . . . 99
11.4.2 Lumbar Puncture or
Lumbar Drain . . . . . . . . . 99
11.5 Postprocedure Care . . . . . 100
11.5.1 Halo Orthosis and
Traction . . . . . . . . . . . . . . 100
11.5.2 Lumbar Puncture or
Lumbar Drain . . . . . . . . . . 100
11.6 Outcomes . . . . . . . . . . . . . 100
11.7 Surgical Pearls. . . . . . . . . . 100
11.7.1 Halo Orthosis and
Traction . . . . . . . . . . . . . . 100
11.7.2 Lumbar Puncture or
Lumbar Drain . . . . . . . . . . 101
Common Clinical
Questions . . . . . . . . . . . . . 101
Answers to Common
Clinical Questions . . . . . . . 101
References . . . . . . . . . . . . 102
12. Orthotics in Spine Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Melissa MJ Chua and Yi Lu
12.1 Key Points . . . . . . . . . . . . 103
12.2 Indications. . . . . . . . . . . . 103
12.3 Biomechanics of Spinal
Orthoses , . . . . . . . . . . . . . 103
12.4 Classifications . . . . . . . . . 104
12.5 Cervical Orthoses (CO) . . . 104
12.6 Cervicothoracic Orthoses
(CTO) . . . . . . . . . . . . . . . 106
12.7 Cervicothoracolumbosacral
Orthoses (CTLSO) . . . . . . . 106
12.8 Thoracolumbosacral
Orthoses (TLSO) . . . . . . . . 106
12.9 Lumbosacral Orthoses
(LSO) . . . . . . . . . . . . . . . . 106
12.10 Sacroiliac Orthoses (SIO) . . . 107
Common Clinical
Questions . . . . . . . . . . . . . 107
Answers to Common
Clinical Questions . . . . . . . 107
References . . . . . . . . . . . . 107
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13. Pharmacology of Antithrombotics, Antifibrinolytics, and
Osteoporosis Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Omar Sorour, Mohamed Macki, Alysha Jamieson, Praveen V. Mummaneni, and
Leslie Robinson
13.1 Key Points. . . . . . . . . . . . . 109
13.2 Prophylactic
Anticoagulation . . . . . . . . 109
13.3 Treatment of Preoperative
Thromboembolic Events . . . 110
13.4 Treatment of Postoperative
Thromboembolic Events . . . 110
13.5 Reversal of
Anticoagulation . . . . . . . . 110
13.6 Antifibrinolytic Agents . . . 115
13.7 Osteoporosis
Medications . . . . . . . . . . . 115
13.8 Surgical Pearls . . . . . . . . . 118
Common Clinical
Questions. . . . . . . . . . . . . 118
Answers to Common
Clinical Questions . . . . . . . 119
References . . . . . . . . . . . . 119
14. Spine Biologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Raj Swaroop Lavadi, Alexander Yahanda, Galal A. Elsayed, and Nitin Agarwal
14.1 Key Points. . . . . . . . . . . . . 121
14.2 Introduction . . . . . . . . . . . 121
14.2.1 Evolution and Market
Growth . . . . . . . . . . . . . . . 121
14.2.2 Basic Properties . . . . . . . . 122
14.3 Classification. . . . . . . . . . . 122
14.4 Autologous Biologics . . . . . 123
14.4.1 Autografts . . . . . . . . . . . . . 123
14.4.2 Bone Marrow Aspirate . . . . 124
14.4.3 Growth Factors . . . . . . . . . 124
14.5 Allogenic Biologics . . . . . . 124
14.5.1 Allografts . . . . . . . . . . . . . 124
14.5.2 Demineralized Bone
Matrix . . . . . . . . . . . . . . . 125
14.5.3 Bone Morphogenetic
Protein . . . . . . . . . . . . . . . 125
14.5.4 Synthetic Biologics . . . . . . 125
14.6 Pediatric . . . . . . . . . . . . . 130
14.7 BOnE Classification . . . . . . 130
14.8 MISS and Biologics . . . . . . 130
14.9 Current Developments and
Trends . . . . . . . . . . . . . . . 131
14.10 Surgical Pearls . . . . . . . . . 132
Common Clinical
Questions. . . . . . . . . . . . . 132
Answers to Common
Clinical Questions . . . . . . . 132
References . . . . . . . . . . . . 132
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III: Spinal Pathology
15. Congenital Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Mark Stephens, Jared Fridley, Eric Momin, and Andrew Jea
15.1 Key Points . . . . . . . . . . . . 137
15.2 Vertebral Developmental
Abnormalities . . . . . . . . . 137
15.2.1 Congenital Scoliosis . . . . . 137
15.2.2 Klippel-Feil Syndrome
(KFS) . . . . . . . . . . . . . . . . 139
15.3 Anomalies of Notochord
Formation . . . . . . . . . . . . 140
15.3.1 Split Cord Malformations
(SCMs) . . . . . . . . . . . . . . 140
15.4 Anomalies of
Dysjunction . . . . . . . . . . . 141
15.4.1 Spinal Lipomas . . . . . . . . . 141
15.4.2 Myelomeningocele . . . . . . 141
15.5 Surgical Pearls. . . . . . . . . . 142
Common Clinical
Questions . . . . . . . . . . . . . 145
Answers to Common
Clinical Questions . . . . . . . 145
References . . . . . . . . . . . . 145
16. Cervical Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Gregory D. Schroeder and Alexander R. Vaccaro
16.1 Key Points . . . . . . . . . . . . 147
16.2 General Principles . . . . . . 147
16.3 Upper Cervical Spine
Trauma . . . . . . . . . . . . . . 149
16.3.1 Atlantooccipital
Dissociation . . . . . . . . . . . 149
16.3.2 Atlas (C1) Fracture . . . . . . 151
16.3.3 Axis (C2) Fracture and
Traumatic
Spondylolisthesis of C2
(Hangman’s Fracture) . . . . 152
16.3.4 Dens Fracture (C2) . . . . . . 154
16.3.5 Subaxial Cervical Spine
Trauma (C3–C7) . . . . . . . . 156
Common Clinical
Questions . . . . . . . . . . . . . 158
Answers to Common
Clinical Questions . . . . . . . 159
References . . . . . . . . . . . . 159
17. Thoracolumbar Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Anirudh Penumaka and Martina Stippler
17.1 Key Points . . . . . . . . . . . . 161
17.2 General Principles . . . . . . 161
17.3 Thoracolumbar Fracture . . 162
17.3.1 Key Concepts . . . . . . . . . . 165
17.4 Bracing . . . . . . . . . . . . . . . 168
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17.5 Conus Medullaris and
Cauda Equina
Syndromes . . . . . . . . . . . . 168
17.6 Spinal and Neurogenic
Shock . . . . . . . . . . . . . . . . 169
Common Clinical
Questions. . . . . . . . . . . . . 170
Answers to Common
Clinical Questions . . . . . . . 170
References . . . . . . . . . . . . 170
18. Sacropelvic Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Emiliano Vialle
18.1 Key Points. . . . . . . . . . . . . 173
18.2 Sacral Fractures. . . . . . . . . 173
18.2.1 Background . . . . . . . . . . . 173
18.2.2 Signs, Symptoms, and
Physical Examination . . . . 175
18.2.3 Workup . . . . . . . . . . . . . . 175
18.2.4 Neuroimaging . . . . . . . . . . 176
18.2.5 Treatment . . . . . . . . . . . . . 176
18.2.6 Surgical Pearls . . . . . . . . . . 176
18.3 Type B Injuries. . . . . . . . . . 177
18.3.1 Background . . . . . . . . . . . 177
18.3.2 Signs, Symptoms, and
Physical Examination . . . . 177
18.3.3 Workup . . . . . . . . . . . . . . 177
18.3.4 Neuroimaging . . . . . . . . . . 177
18.3.5 Treatment . . . . . . . . . . . . . 177
18.3.6 Surgical Pearls . . . . . . . . . . 178
18.4 Type C Injuries. . . . . . . . . . 178
18.4.1 Background . . . . . . . . . . . 178
18.4.2 Signs, Symptoms, and
Physical Examination . . . . 179
18.4.3 Workup . . . . . . . . . . . . . . 179
18.4.4 Neuroimaging . . . . . . . . . 179
18.4.5 Treatment . . . . . . . . . . . . 179
18.4.6 Surgical Pearls . . . . . . . . . 180
18.5 Traumatic Spinopelvic
Dissociations
(Type C3 Injuries) . . . . . . . 180
18.5.1 Background . . . . . . . . . . . 180
18.5.2 Signs, Symptoms, and
Physical Examination . . . . 181
18.5.3 Workup . . . . . . . . . . . . . . 181
18.5.4 Neuroimaging . . . . . . . . . 181
18.5.5 Treatment . . . . . . . . . . . . 181
18.5.6 Surgical Pearls . . . . . . . . . 181
Common Clinical
Questions. . . . . . . . . . . . . 182
Answers to Common
Clinical Questions . . . . . . . 182
References . . . . . . . . . . . . 182
19. Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Wilson E. Vaughan, Brian Q. Hou, W. Hunter Waddell, and Byron F. Stephens
19.1 Key Points. . . . . . . . . . . . . 184
19.2 Pyogenic Vertebral
Osteomyelitis and
Diskitis . . . . . . . . . . . . . . . 185
19.2.1 Etiology, Epidemiology, and
Pathogenesis . . . . . . . . . . 185
19.2.2 Patient Presentation . . . . . 186
19.2.3 Diagnostic Workup . . . . . . 186
19.2.4 Treatment . . . . . . . . . . . . 186
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Complications . . . . . . . . . 187
19.3 Epidural Infections . . . . . . 187
19.3.1 Etiology, Epidemiology, and
Pathogenesis . . . . . . . . . . 187
19.3.2 Patient Presentation . . . . . 187
19.3.3 Diagnostic Workup . . . . . 187
19.3.4 Treatment . . . . . . . . . . . . 188
19.3.5 Prognosis/
Complications . . . . . . . . . 188
19.4 Intradural Infections. . . . . 188
19.4.1 Etiology, Epidemiology, and
Pathogenesis . . . . . . . . . . 188
19.4.2 Patient Presentation . . . . . 189
19.4.3 Diagnostic Workup . . . . . 189
19.4.4 Treatment . . . . . . . . . . . . 189
19.4.5 Prognosis/Complications . . . 189
19.5 Postoperative Infections . . . 190
19.5.1 Etiology, Epidemiology, and
Pathogenesis . . . . . . . . . . . 190
19.5.2 Prophylaxis . . . . . . . . . . . . 190
19.5.3 Patient Presentation . . . . . 190
19.5.4 Diagnostic Workup . . . . . . 190
19.5.5 Treatment . . . . . . . . . . . . . 191
19.5.6 Prognosis/Complications . . . 191
19.6 Surgical Pearls. . . . . . . . . . 191
Common Clinical
Questions . . . . . . . . . . . . . 192
Answers to Common
Clinical Questions . . . . . . . 192
References . . . . . . . . . . . . 192
20. Primary Bony Spinal Column Tumors . . . . . . . . . . . . . . . . . . . . . . 194
Mark A. Feger, Quante Singleton, John Clayton Clohisy Jr, and Matthew L. Goodwin
20.1 Key Points . . . . . . . . . . . . 194
20.2 Background . . . . . . . . . . . 194
20.3 Signs, Symptoms, and
Physical Examination . . . . 196
20.4 Workup and
Neuroimaging . . . . . . . . . 197
20.5 Treatment . . . . . . . . . . . . 198
20.6 Surgical Pearls. . . . . . . . . . 199
Common Clinical
Question. . . . . . . . . . . . . . 200
Answer to Common Clinical
Question. . . . . . . . . . . . . . 200
References . . . . . . . . . . . . 200
21. Surgical Management of Spinal Metastases . . . . . . . . . . . . . . . . 201
Esteban Quiceno, Amna Hussein, Michael Galgano, and Ali A. Baaj
21.1 Key Points . . . . . . . . . . . . 201
21.2 Background . . . . . . . . . . . 201
21.3 Signs, Symptoms, and
Physical Examination . . . . 202
21.4 Workup and
Neuroimaging . . . . . . . . . 202
21.5 Treatment . . . . . . . . . . . . 204
21.6 Surgical Pearls. . . . . . . . . . 204
Common Clinical
Questions . . . . . . . . . . . . . 205
Answers to Common
Clinical Questions . . . . . . . 205
References . . . . . . . . . . . . 205
Contents xvfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.22. Intradural Extramedullary and Intramedullary Spinal
Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Esteban Quiceno, Amna Hussein, Jose Manuel Orenday-Barraza, and Ali A. Baaj
22.1 Key Points. . . . . . . . . . . . . 207
22.2 Indications . . . . . . . . . . . . 207
22.3 Technique . . . . . . . . . . . . . 208
22.3.1 Surgical Technique for
Intradural Extramedullary
Tumors . . . . . . . . . . . . . . . 208
22.3.2 Surgical Technique for
Intradural Intramedullary
Tumors . . . . . . . . . . . . . . . 211
22.4 Complications . . . . . . . . . . 212
22.5 Postoperative Care . . . . . . 213
22.6 Surgical Pearls . . . . . . . . . 214
22.7 Outcomes . . . . . . . . . . . . 214
Common Clinical
Questions. . . . . . . . . . . . . 214
Answers to Common
Clinical Questions . . . . . . . 214
References . . . . . . . . . . . . 215
23. Cervical and Thoracic Spine Degenerative Disease . . . . . . . . . 216
Jean-Valery Coumans
23.1 Key Points. . . . . . . . . . . . . 216
23.2 Cervical Disk Herniation . . . 216
23.2.1 Background . . . . . . . . . . . 216
23.2.2 Signs, Symptoms, and
Physical Examination . . . . 217
23.2.3 Workup . . . . . . . . . . . . . . 217
23.2.4 Treatment . . . . . . . . . . . . . 218
23.2.5 Surgical Pearls . . . . . . . . . . 218
23.3 Cervical Spondylotic
Myelopathy. . . . . . . . . . . . 219
23.3.1 Background . . . . . . . . . . . 219
23.3.2 Signs, Symptoms, and
Physical Examination . . . . 219
23.3.3 Workup . . . . . . . . . . . . . . 220
23.3.4 Treatment . . . . . . . . . . . . 221
23.3.5 Surgical Pearls . . . . . . . . . 221
Common Clinical
Questions. . . . . . . . . . . . . 221
Answers to Common
Clinical Questions . . . . . . . 222
References . . . . . . . . . . . . 222
24. Degenerative Lumbar Spine Disease . . . . . . . . . . . . . . . . . . . . . . 223
Juan Emmerich
24.1 Key Points. . . . . . . . . . . . . 223
24.2 Background . . . . . . . . . . . 224
24.3 Specific Conditions . . . . . . 224
24.3.1 Radicular Pain . . . . . . . . . 224
24.3.2 Neurogenic
Claudication . . . . . . . . . . . 225
24.3.3 Axial Back Pain from
Intervertebral Disk Disease
(without Deformity) . . . . . 226
xvi Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.24.3.4 Axial Back Pain from Facet
Joint Disease . . . . . . . . . . 227
24.3.5 Spondylolisthesis . . . . . . . 228
24.3.6 Degenerative Scoliosis and
Kyphosis . . . . . . . . . . . . . 230
Common Clinical
Questions . . . . . . . . . . . . . 231
Answers to Common
Clinical Questions . . . . . . . 232
References . . . . . . . . . . . . 232
25. Congenital and Neuromuscular Scoliosis . . . . . . . . . . . . . . . . . . 233
Michael J. Yang, Steven W. Hwang, and Amer F. Samdani
25.1 Key Points . . . . . . . . . . . . 233
25.2 Congenital Scoliosis . . . . . 233
25.3 Neuromuscular
Scoliosis . . . . . . . . . . . . . 237
Common Clinical
Questions . . . . . . . . . . . . . 238
Answers to Common
Clinical Questions . . . . . . . 239
References . . . . . . . . . . . . 239
26. Scheuermann’s Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Venkat Boddapati and Han Jo Kim
26.1 Key Points . . . . . . . . . . . . 241
26.2 Background . . . . . . . . . . . 242
26.3 Signs, Symptoms, and
Physical Examination . . . . 242
26.4 Workup. . . . . . . . . . . . . . 243
26.5 Neuroimaging . . . . . . . . . 244
26.6 Treatment . . . . . . . . . . . . 244
26.6.1 Nonoperative Treatment . . 244
26.6.2 Operative Treatment . . . . . 245
26.7 Surgical Pearls. . . . . . . . . . 247
Common Clinical
Questions . . . . . . . . . . . . . 247
Answers to Common
Clinical Questions . . . . . . . 247
References . . . . . . . . . . . . 248
27. Adolescent Idiopathic Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Kevin Kwan, Josephine Coury, Yong Shen, and Lawrence G. Lenke
27.1 Key Points . . . . . . . . . . . . 249
27.2 Definition . . . . . . . . . . . . 250
27.3 Prevalence. . . . . . . . . . . . 250
27.4 Clinical Evaluation . . . . . . 250
27.5 Radiographic Evaluation . . . 250
27.6 Skeletal Maturity. . . . . . . . 253
27.7 Management Overview . . . 253
27.8 Observation . . . . . . . . . . . 254
Contents xviifrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.27.9 Bracing . . . . . . . . . . . . . . . 254
27.10 Physical Therapy . . . . . . . . 254
27.11 Surgical Intervention . . . . . 255
27.12 Lenke Classification . . . . . . 255
27.13 Instrumented Level
Selection. . . . . . . . . . . . . . 256
Common Clinical
Questions. . . . . . . . . . . . . 258
Answers to Common
Clinical Questions . . . . . . . 259
References . . . . . . . . . . . . 259
28. Adult Degenerative Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Hai Le, Wyatt D. Vander Voort, Joseph Wick, and Eric Klineberg
28.1 Key Points. . . . . . . . . . . . . 261
28.2 Background . . . . . . . . . . . 262
28.3 Signs, Symptoms, and
Physical Examination. . . . . 262
28.4 Evaluation of Adult
Degenerative Deformity . . . 263
28.5 Spinopelvic Parameters . . . 264
28.6 Treatment . . . . . . . . . . . . 264
28.7 Complications . . . . . . . . . 265
Common Clinical
Questions. . . . . . . . . . . . . 265
Answers to Common
Clinical Questions . . . . . . . 265
References . . . . . . . . . . . . 266
29. Radiographic Parameters of Spinal Deformity . . . . . . . . . . . . . 267
Alexander Aabedi, Vijay Letchuman, Andrew K. Chan, and Praveen V. Mummaneni
29.1 Key Points. . . . . . . . . . . . . 267
29.2 Background . . . . . . . . . . . 268
29.3 Signs, Symptoms, and
Physical Examination. . . . . 268
29.3.1 Neuroimaging . . . . . . . . . . 268
29.4 Treatment . . . . . . . . . . . . 270
Common Clinical
Questions. . . . . . . . . . . . . 274
Answers to Common
Clinical Questions . . . . . . . 274
References . . . . . . . . . . . . 274
30. Vascular Pathology of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Michael D. White, Timothy D. Uschold, and Steve W. Chang
30.1 Key Points. . . . . . . . . . . . . 277
30.2 Cavernous
Malformations . . . . . . . . . 278
30.3 Arteriovenous Lesions . . . . 279
Common Clinical
Questions. . . . . . . . . . . . . 284
Answers to Common
Clinical Questions . . . . . . . 285
References . . . . . . . . . . . . 285
xviii Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.31. Spondyloarthropathies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
Joshua Vignolles-Jeong, Alexander Keister, Samuel Ammerman, and
Andrew J. Grossbach
31.1 Key Points . . . . . . . . . . . . 286
31.2 Ankylosing Spondylitis
Seronegative
Arthropathy . . . . . . . . . . 287
31.2.1 Background . . . . . . . . . . . 287
31.2.2 Signs, Symptoms, and
Physical Examination . . . . 287
31.2.3 Workup . . . . . . . . . . . . . . 288
31.2.4 Neuroimaging . . . . . . . . . 289
31.2.5 Treatment . . . . . . . . . . . . 289
31.2.6 Surgical Pearls . . . . . . . . . 289
31.3 Rheumatoid Arthritis . . . . 289
31.3.1 Background . . . . . . . . . . . 289
31.3.2 Signs, Symptoms, and
Physical Examination . . . . 290
31.3.3 Workup . . . . . . . . . . . . . . 290
31.3.4 Neuroimaging . . . . . . . . . 290
31.3.5 Treatment . . . . . . . . . . . . 290
31.3.6 Surgical Pearls . . . . . . . . . 291
31.4 Diffuse Idiopathic Skeletal
Hyperostosis . . . . . . . . . . 291
31.4.1 Background . . . . . . . . . . . 291
31.4.2 Signs, Symptoms, and
Physical Examination . . . . 291
31.4.3 Workup/Neuroimaging . . . . 291
31.4.4 Treatment . . . . . . . . . . . . . 292
31.4.5 Surgical Pearls . . . . . . . . . . 292
31.5 Ossification of the Posterior
Longitudinal Ligament. . . . 293
31.5.1 Background . . . . . . . . . . . 293
31.5.2 Signs, Symptoms, and
Physical Examination . . . . 294
31.5.3 Workup/Neuroimaging . . . 294
31.5.4 Treatment . . . . . . . . . . . . . 294
31.5.5 Surgical Pearls . . . . . . . . . . 294
Common Clinical
Questions . . . . . . . . . . . . . 294
Answers to Common
Clinical Questions . . . . . . . 296
References . . . . . . . . . . . . 296
32. Spinal Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Mohammad Hassan A. Noureldine and Puya Alikhani
32.1 Key Points . . . . . . . . . . . . 299
32.2 Spinal Hematomas . . . . . . 300
32.3 Cauda Equina and Conus
Medullaris Syndromes . . . 303
32.4 Spinal Epidural
Abscess . . . . . . . . . . . . . . 305
Common Clinical
Questions . . . . . . . . . . . . . 308
Answers to Common
Clinical Questions . . . . . . . 308
References . . . . . . . . . . . . 308
Contents xixfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.IV: Surgical Techniques
33. Occipitocervical Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Amna Hussein, Esteban Quiceno, and Ali A. Baaj
33.1 Key Points. . . . . . . . . . . . . 315
33.2 Indications . . . . . . . . . . . . 315
33.3 Technique . . . . . . . . . . . . . 316
33.4 Complications . . . . . . . . . . 317
33.5 Postoperative Care . . . . . . 318
33.6 Outcomes . . . . . . . . . . . . . 318
33.7 Surgical Pearls . . . . . . . . . 318
Common Clinical
Questions. . . . . . . . . . . . . 318
Answers to Common
Clinical Questions . . . . . . . 319
References . . . . . . . . . . . . 319
34. Transoral Odontoidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Karan S. Patel, Cameron Kia, Colin B. Harris, and Frank Μ. Phillips
34.1 Key Points. . . . . . . . . . . . . 320
34.2 Indications . . . . . . . . . . . . 321
34.3 Technique . . . . . . . . . . . . . 321
34.4 Complications . . . . . . . . . . 323
34.5 Postoperative Care . . . . . . 324
34.6 Outcomes . . . . . . . . . . . . . 325
34.7 Surgical Pearls . . . . . . . . . 325
Common Clinical
Questions. . . . . . . . . . . . . 325
Answers to Common
Clinical Questions . . . . . . . 327
References . . . . . . . . . . . . 327
35. Endoscopic Endonasal Odontoidectomy. . . . . . . . . . . . . . . . . . . 328
Umberto Tosi, Jeffrey P. Greenfield, and Theodore H. Schwartz
35.1 Key Points. . . . . . . . . . . . . 328
35.2 Indications . . . . . . . . . . . . 329
35.3 Technique . . . . . . . . . . . . . 329
35.4 Complications . . . . . . . . . . 332
35.5 Postoperative Care . . . . . . 334
35.6 Outcomes . . . . . . . . . . . . . 334
35.7 Surgical Pearls . . . . . . . . . 335
Common Clinical
Questions. . . . . . . . . . . . . 335
Answers to Common
Clinical Questions . . . . . . . 335
References . . . . . . . . . . . . 335
xx Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.36. C1–C2 Fixation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Timothy Chryssikos, Nitin Agarwal, Alysha Jamieson, and Praveen V. Mummaneni
36.1 Key Points . . . . . . . . . . . . 337
36.2 Indications of C1–C2
Fixation . . . . . . . . . . . . . . 338
36.3 Preparation for C1–C2
Fixation . . . . . . . . . . . . . . 339
36.3.1 C1–C2 Fixation Constructs
Using C1 Lateral Mass
Screws with C2 Pars,
Pedicle, or Translaminar
Screws . . . . . . . . . . . . . . 339
36.3.2 C1–C2 Transarticular
Screws . . . . . . . . . . . . . . 343
36.3.3 C1–C2 Wiring Methods . . . 343
36.4 Complications . . . . . . . . . . 344
36.5 Postoperative Care . . . . . . 344
36.6 Surgical Pearls. . . . . . . . . . 344
Common Clinical
Questions . . . . . . . . . . . . . 345
Answers to Common
Clinical Questions . . . . . . . 345
References . . . . . . . . . . . . 345
37. Odontoid Screw Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Rajiv Saigal and Dean Chou
37.1 Key Points . . . . . . . . . . . . 347
37.2 Indications and
Contraindications . . . . . . 347
37.3 Technique . . . . . . . . . . . . 348
37.4 Complications . . . . . . . . . 350
37.5 Postoperative Care. . . . . . 350
37.6 Outcomes . . . . . . . . . . . . 351
37.7 Surgical Pearls. . . . . . . . . . 351
Common Clinical
Questions . . . . . . . . . . . . . 352
Answers to Common
Clinical Questions . . . . . . . 352
References . . . . . . . . . . . . 352
38. Cervical Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Yazid Maghrabi and Saleh Baeesa
38.1 Key Points . . . . . . . . . . . . 353
38.2 Indications. . . . . . . . . . . . 354
38.3 Technique . . . . . . . . . . . . 354
38.4 Complications . . . . . . . . . 355
38.5 Postoperative Care. . . . . . 356
38.6 Outcomes . . . . . . . . . . . . 357
38.7 Surgical Pearls. . . . . . . . . . 358
Common Clinical
Questions . . . . . . . . . . . . . 358
Answers to Common
Clinical Questions . . . . . . . 359
References . . . . . . . . . . . . 359

39. Anterior Cervical Diskectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
TJ Florence, Ansley Unterberger, and Andrew C. Vivas
39.1 Key Points. . . . . . . . . . . . . 361
39.2 Indications . . . . . . . . . . . . 361
39.3 Technique . . . . . . . . . . . . . 361
39.4 Complications . . . . . . . . . . 366
39.5 Postoperative Care . . . . . . 367
39.6 Outcomes . . . . . . . . . . . . . 367
39.7 Surgical Pearls . . . . . . . . . 367
Common Clinical
Questions. . . . . . . . . . . . . 368
Answers to Common
Clinical Questions . . . . . . . 369
References . . . . . . . . . . . . 369
40. Anterior Cervical Corpectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Joshua Chalif, Anran Li, Eric Chalif, and Hasan Zaidi
40.1 Key Points. . . . . . . . . . . . . 371
40.2 Indications . . . . . . . . . . . . 372
40.3 Technique . . . . . . . . . . . . . 373
40.4 Complications . . . . . . . . . . 376
40.5 Postoperative Care . . . . . . 379
40.6 Outcomes . . . . . . . . . . . . . 379
40.7 Surgical Pearls . . . . . . . . . 380
Common Clinical
Questions. . . . . . . . . . . . . 380
Answers to Common
Clinical Questions . . . . . . . 381
References . . . . . . . . . . . . 381
41. Cervical Laminectomy with and without Fusion . . . . . . . . . . . 383
Ian David Connolly, Muhamed Hadzipasic, and Ganesh M. Shankar
41.1 Key Points. . . . . . . . . . . . . 383
41.2 Indications . . . . . . . . . . . . 384
41.3 Contraindications . . . . . . . 384
41.4 Technique . . . . . . . . . . . . . 384
41.5 Complications . . . . . . . . . . 388
41.6 Postoperative Care . . . . . . 389
41.7 Outcomes . . . . . . . . . . . . 389
41.8 Surgical Pearls . . . . . . . . . 389
Common Clinical
Questions. . . . . . . . . . . . . 390
Answers to Common
Clinical Questions . . . . . . . 390
References . . . . . . . . . . . . 390
xxii Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.42. Cervical Laminoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
Aria Jamshidi, Glen R. Manzano, and Allan D. Levi
42.1 Key Points . . . . . . . . . . . . 392
42.2 Indications. . . . . . . . . . . . 392
42.3 Contraindications . . . . . . 393
42.4 Technique . . . . . . . . . . . . 393
42.5 Complications . . . . . . . . . 397
42.6 Postoperative Care. . . . . . 398
42.7 Outcomes . . . . . . . . . . . . 398
42.8 Surgical Pearls. . . . . . . . . . 399
Common Clinical
Questions . . . . . . . . . . . . . 399
Answers to Common
Clinical Questions . . . . . . . 399
References . . . . . . . . . . . . 399
43. Posterior Cervical Foraminotomy . . . . . . . . . . . . . . . . . . . . . . . . . 401
Rajakumar V. Deshpande, Murali Krishna P., Chaitanya Prabhu K., and
Dhiraj Kumar Poonia
43.1 Key Points . . . . . . . . . . . . 401
43.2 Indications and
Contraindications . . . . . . 402
43.2.1 Indications . . . . . . . . . . . 402
43.2.2 Contraindications . . . . . . 402
43.3 Technique . . . . . . . . . . . . 402
43.3.1 Patient Positioning . . . . . . 402
43.3.2 Preparation and
Draping . . . . . . . . . . . . . . 403
43.3.3 Surgical Techniques . . . . . 403
43.4 Microsurgical
Techniques . . . . . . . . . . . 403
43.4.1 Open Microscopic
Procedure . . . . . . . . . . . . 403
43.4.2 Tubular Retractor
Procedure . . . . . . . . . . . . 403
43.5 Foraminotomy Under
Microscope . . . . . . . . . . . 404
43.6 Endoscopic Techniques. . . 406
43.6.1 Full Endoscopic Posterior
Cervical Foraminotomy . . . 406
43.7 Biportal Endoscopic
Posterior Cervical
Foraminotomy . . . . . . . . . 407
43.8 Endoscopic Posterior
Cervical Foraminotomy—
Destandau’s Technique . . . 408
43.9 Complications of Posterior
Cervical Foraminotomy . . . 409
43.10 Postoperative Care . . . . . . 409
43.11 Outcomes . . . . . . . . . . . . . 410
43.12 Surgical Pearls. . . . . . . . . . 410
Common Clinical
Questions . . . . . . . . . . . . . 410
Answers to Common
Clinical Questions . . . . . . . 411
References . . . . . . . . . . . . 411
Contents xxiiifrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.44. Cervical Open Reduction Techniques: Anterior and
Posterior Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Glenn A. Gonzalez, Ahilan Sivaganesan, George M. Ghobrial, and James S. Harrop
44.1 Key Points. . . . . . . . . . . . . 413
44.2 Indications . . . . . . . . . . . . 414
44.3 Technique . . . . . . . . . . . . . 414
44.3.1 Anterior Approach . . . . . . 414
44.3.2 Posterior Approach . . . . . . 417
44.4 Complications . . . . . . . . . . 417
44.5 Postoperative Care . . . . . . 419
44.6 Outcomes . . . . . . . . . . . . 419
44.7 Surgical Pearls . . . . . . . . . 420
Common Clinical
Questions. . . . . . . . . . . . . 420
Answers to Common
Clinical Questions . . . . . . . 421
References . . . . . . . . . . . . 421
45. Surgical Resection of Spinal Vascular Lesions . . . . . . . . . . . . . . 422
James J. Zhou, Arnau Benet, Timothy D. Uschold, Alim P. Mitha, and Steve W. Chang
45.1 Key Points. . . . . . . . . . . . . 422
45.2 Indications . . . . . . . . . . . . 423
45.3 Technique . . . . . . . . . . . . . 423
45.4 Complications . . . . . . . . . . 425
45.5 Postoperative Care . . . . . . 426
45.6 Outcomes . . . . . . . . . . . . . 426
45.7 Surgical Pearls . . . . . . . . . 427
Common Clinical
Questions. . . . . . . . . . . . . 428
Answers to Common
Clinical Questions . . . . . . . 428
References . . . . . . . . . . . . 428
46. Freehand Thoracic Pedicle Screw Insertion . . . . . . . . . . . . . . . . 430
Kelly Chamberlin, Martin G. Piazza, and Michael Galgano
46.1 Key Points. . . . . . . . . . . . . 430
46.2 Indications . . . . . . . . . . . . 430
46.3 Technique . . . . . . . . . . . . . 431
46.4 Freehand Screws for
Deformity: Special
Considerations . . . . . . . . . 433
46.5 Complications . . . . . . . . . . 435
46.6 Postoperative Care . . . . . . 435
46.7 Outcomes . . . . . . . . . . . . 436
46.8 Surgical Pearls . . . . . . . . . 436
Common Clinical
Questions. . . . . . . . . . . . . 436
Answers to Common
Clinical Questions . . . . . . . 437
References . . . . . . . . . . . . 437
xxiv Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.47. Navigation in Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Salah A. Alakkad and Esteban Quiceno
47.1 Key Points . . . . . . . . . . . . 439
47.2 Description . . . . . . . . . . . 439
47.3 Indications and
Advantages . . . . . . . . . . . 440
47.4 Future of Spinal
Navigation. . . . . . . . . . . . 441
47.5 Surgical Pearls. . . . . . . . . . 441
Common Clinical
Questions . . . . . . . . . . . . . 442
Answers to Common
Clinical Questions . . . . . . . 443
References . . . . . . . . . . . . 443
48. Robotics in Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444
Brendan F. Judy, Andrew M. Hersh, and Nicholas Theodore
48.1 Key Points . . . . . . . . . . . . 444
48.2 Indications. . . . . . . . . . . . 445
48.3 Technique . . . . . . . . . . . . 445
48.4 Complications . . . . . . . . . 445
48.5 Postoperative Care. . . . . . 448
48.6 Outcomes . . . . . . . . . . . . 448
48.7 Surgical Pearls. . . . . . . . . . 449
Common Clinical
Questions . . . . . . . . . . . . . 449
Answers to Common
Clinical Questions . . . . . . . 450
References . . . . . . . . . . . . 450
49. Posterolateral Thoracic Approaches . . . . . . . . . . . . . . . . . . . . . . . 452
Grace X. Xiong and Christopher M. Bono
49.1 Key Points . . . . . . . . . . . . 452
49.2 Indications. . . . . . . . . . . . 453
49.3 Technique . . . . . . . . . . . . 454
49.3.1 Transpedicular
Approach . . . . . . . . . . . . 455
49.3.2 Costotransversectomy . . . 455
49.3.3 Lateral Extracavitary
Approach . . . . . . . . . . . . 456
49.4 Complications . . . . . . . . . 456
49.5 Postoperative Care . . . . . . 457
49.6 Outcomes . . . . . . . . . . . . . 457
49.7 Surgical Pearls. . . . . . . . . . 457
Common Clinical
Questions . . . . . . . . . . . . . 458
Answers to Common
Clinical Questions . . . . . . . 458
References . . . . . . . . . . . . 458
Contents xxvfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.50. Minimally Invasive Lateral Retropleural Approach for
Thoracic Diskectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460
S. Harrison Farber, James J. Zhou, Nima Alan, and Juan S. Uribe
50.1 Key Points. . . . . . . . . . . . . 460
50.2 Indications . . . . . . . . . . . . 461
50.3 Technique . . . . . . . . . . . . . 461
50.4 Complications . . . . . . . . . . 463
50.5 Postoperative Care . . . . . . 464
50.6 Outcomes . . . . . . . . . . . . . 464
50.7 Surgical Pearls . . . . . . . . . 464
Common Clinical
Questions. . . . . . . . . . . . . 465
Answers to Common
Clinical Questions . . . . . . . 466
References . . . . . . . . . . . . 466
51. Lateral Approaches to the Thoracolumbar Spine . . . . . . . . . . . 467
C. Rory Goodwin and Jean-Paul Wolinsky
51.1 Key Points. . . . . . . . . . . . . 467
51.2 Indications . . . . . . . . . . . . 467
51.3 Technique . . . . . . . . . . . . . 468
51.4 Complications . . . . . . . . . . 471
51.5 Postoperative Care . . . . . . 471
51.6 Outcomes . . . . . . . . . . . . . 472
51.7 Surgical Pearls . . . . . . . . . 472
Common Clinical
Questions. . . . . . . . . . . . . 473
Answers to Common
Clinical Questions . . . . . . . 473
References . . . . . . . . . . . . 473
52. Open and Minimally Invasive Spinal Lumbar
Microdiskectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474
Sabastian Hajtovic, Alexandra J. White, Brian Fiani, and Jonathan J. Rasouli
52.1 Key Points. . . . . . . . . . . . . 474
52.2 Indications . . . . . . . . . . . . 475
52.3 Technique . . . . . . . . . . . . . 476
52.3.1 Open . . . . . . . . . . . . . . . . 476
52.3.2 Minimally Invasive
Technique . . . . . . . . . . . . . 477
52.4 Complications . . . . . . . . . . 478
52.5 Postoperative Care . . . . . . 479
52.6 Outcomes . . . . . . . . . . . . 480
52.7 Surgical Pearls . . . . . . . . . 480
Common Clinical
Questions. . . . . . . . . . . . . 480
Answers to Common
Clinical Questions . . . . . . . 480
References . . . . . . . . . . . . 481
xxvi Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.53. Lumbar Laminectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482
Matthew T. Carr, Frank J. Yuk, and Jeremy Steinberger
53.1 Key Points . . . . . . . . . . . . 482
53.2 Indications. . . . . . . . . . . . 482
53.3 Technique . . . . . . . . . . . . 483
53.4 Complications . . . . . . . . . 486
53.5 Postoperative Care. . . . . . 486
53.6 Outcomes . . . . . . . . . . . . 487
53.7 Surgical Pearls. . . . . . . . . . 487
Common Clinical
Questions . . . . . . . . . . . . . 488
Answers to Common
Clinical Questions . . . . . . . 488
References . . . . . . . . . . . . 489
54. Endoscopic Lumbar Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
Sananthan Sivakanthan and Christoph Hofstetter
54.1 Key Points . . . . . . . . . . . . 490
54.2 Indications. . . . . . . . . . . . 490
54.3 Surgical Technique. . . . . . 491
54.4 Complications . . . . . . . . . 494
54.5 Postoperative Care. . . . . . 494
54.6 Outcomes . . . . . . . . . . . . 494
54.7 Surgical Pearls. . . . . . . . . . 494
Common Clinical
Questions . . . . . . . . . . . . . 494
Answers to Common
Clinical Questions . . . . . . . 495
55. Open Transforaminal Lumbar Interbody Fusion . . . . . . . . . . . . 496
Jose A. Canseco, Yunsoo Lee, Jeremy C. Heard, and Christopher K. Kepler
55.1 Key Points . . . . . . . . . . . . 496
55.2 Indications. . . . . . . . . . . . 496
55.3 Technique . . . . . . . . . . . . 497
55.3.1 Open Transforaminal
Lumbar Interbody Fusion . 497
55.4 Complications . . . . . . . . . 499
55.5 Postoperative Care. . . . . . 500
55.6 Outcomes . . . . . . . . . . . . . 500
55.7 Surgical Pearls. . . . . . . . . . 500
Common Clinical
Questions . . . . . . . . . . . . . 500
Answers to Common
Clinical Questions . . . . . . . 501
References . . . . . . . . . . . . 501
Contents xxviifrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.56. Minimally Invasive Transforaminal Lumbar Interbody
Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Marisa Gandía and Jose Manuel Viñuela-Prieto
56.1 Key Points. . . . . . . . . . . . . 504
56.2 Indications . . . . . . . . . . . . 504
56.3 Technique . . . . . . . . . . . . . 505
56.4 Complications . . . . . . . . . . 507
56.5 Postoperative Care . . . . . . 508
56.6 Outcomes . . . . . . . . . . . . . 508
56.7 Surgical Pearls . . . . . . . . . 508
Common Clinical
Questions. . . . . . . . . . . . . 509
Answers to Common
Clinical Questions . . . . . . . 509
References . . . . . . . . . . . . 510
57. Lateral Lumbar Interbody Fusion . . . . . . . . . . . . . . . . . . . . . . . . . 512
Mohamed A.R. Soliman, Asham Khan, and John Pollina
57.1 Key Points. . . . . . . . . . . . . 512
57.2 Indications . . . . . . . . . . . . 512
57.3 Contraindications . . . . . . . 513
57.4 Preoperative Planning . . . . 513
57.5 Patient Positioning . . . . . . 514
57.5.1 Standard LLIF . . . . . . . . . . 514
57.5.2 Prone Lateral (PL) LLIF . . . . 514
57.5.3 Prone Transpsoas (PTP)
LLIF . . . . . . . . . . . . . . . . . 515
57.6 Technique . . . . . . . . . . . . . 516
57.7 Complications . . . . . . . . . 520
57.8 Postoperative Care . . . . . . 521
57.9 Outcomes . . . . . . . . . . . . 521
57.10 Surgical Pearls . . . . . . . . . 521
Common Clinical
Questions. . . . . . . . . . . . . 522
Answers to Common
Clinical Questions . . . . . . . 522
References . . . . . . . . . . . . 522
58. Single-Position Lateral Lumbar Interbody Fusion. . . . . . . . . . . 524
James J. Zhou, S. Harrison Farber, Nima Alan, and Juan S. Uribe
58.1 Key points. . . . . . . . . . . . . 524
58.2 Indications . . . . . . . . . . . . 524
58.3 Technique . . . . . . . . . . . . . 525
58.4 Complications . . . . . . . . . . 527
58.5 Postoperative Care . . . . . . 528
58.6 Outcomes . . . . . . . . . . . . . 528
58.7 Surgical Pearls . . . . . . . . . 529
Common Clinical
Questions. . . . . . . . . . . . . 529
Answers to Common
Clinical Questions . . . . . . . 529
References . . . . . . . . . . . . 530
xxviii Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.59. Pedicle Subtraction Osteotomy/Smith-Petersen Osteotomy 531
Stephen M. Bergin, Khoi D. Than, Frank La Marca, Paul Park, and Juan M. Valdivia
59.1 Key Points . . . . . . . . . . . . 531
59.2 Indications. . . . . . . . . . . . 531
59.3 Technique . . . . . . . . . . . . 532
59.3.1 Pedicle Subtraction
Osteotomy . . . . . . . . . . . . 532
59.3.2 Smith-Petersen
Osteotomy . . . . . . . . . . . . 532
59.4 Complications . . . . . . . . . 533
59.5 Postoperative Care. . . . . . 534
59.6 Outcomes . . . . . . . . . . . . . 535
59.7 Surgical Pearls. . . . . . . . . . 535
Common Clinical
Questions . . . . . . . . . . . . . 535
Answers to Common
Clinical Questions . . . . . . . 535
References . . . . . . . . . . . . 536
60. Vertebral Body Tethering for Scoliosis. . . . . . . . . . . . . . . . . . . . . 537
Nuri Demirci, Altug Yucekul, Caglar Yilgor, and Ahmet Alanay
60.1 Key Points . . . . . . . . . . . . 537
60.2 Indications. . . . . . . . . . . . 538
60.3 Surgical Technique. . . . . . 539
60.4 Complications . . . . . . . . . 539
60.5 Postoperative Care. . . . . . 540
60.6 Outcomes . . . . . . . . . . . . 540
60.7 Surgical Pearls. . . . . . . . . . 540
Common Clinical
Questions . . . . . . . . . . . . . 542
Answers to Common
Clinical Questions . . . . . . . 542
References . . . . . . . . . . . . 542
61. Percutaneous Pedicle Screw Placement . . . . . . . . . . . . . . . . . . . 544
Michael Y. Wang
61.1 Key Points . . . . . . . . . . . . 544
61.2 Indications. . . . . . . . . . . . 544
61.3 Technique . . . . . . . . . . . . 545
61.4 Complications . . . . . . . . . 547
61.5 Postoperative Care. . . . . . 548
61.6 Surgical Pearls. . . . . . . . . . 548
Common Clinical
Questions . . . . . . . . . . . . . 549
Answers to Common
Clinical Questions . . . . . . . 549
References . . . . . . . . . . . . 550
Contents xxixfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.62. Awake Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
David A.W. Sykes, Jeff Gadsden, Dhanesh K. Gupta, and Muhammad M. Abd-El-Barr
62.1 Key Points. . . . . . . . . . . . . 551
62.2 Indications . . . . . . . . . . . . 551
62.3 Technique . . . . . . . . . . . . . 552
62.4 Complications . . . . . . . . . . 553
62.5 Postoperative Care . . . . . . 553
62.6 Outcomes . . . . . . . . . . . . . 553
62.7 Surgical Pearls . . . . . . . . . 554
Common Clinical
Questions. . . . . . . . . . . . . 554
Answers to Common
Clinical Questions . . . . . . . 554
References . . . . . . . . . . . . 555
63. Anterior Lumbar Interbody Fusion . . . . . . . . . . . . . . . . . . . . . . . . 556
Cristiano Magalhães Menezes and Marlus Sérgio Borges Salomão Junior
63.1 Advantages. . . . . . . . . . . . 556
63.2 Indications . . . . . . . . . . . . 557
63.3 Preoperative Imaging
Considerations . . . . . . . . . 557
63.4 Technique . . . . . . . . . . . . . 557
63.5 Complications . . . . . . . . . . 558
63.6 Patient-Specific
Considerations . . . . . . . . . 559
63.7 Outcomes . . . . . . . . . . . . 560
63.8 Surgical Pearls . . . . . . . . . 560
Common Clinical
Questions. . . . . . . . . . . . . 561
Answers to Common
Clinical Questions . . . . . . . 561
References . . . . . . . . . . . . 562
64. Sacroiliac Joint Fusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
Kalaventhan Pathinathan, Ashish D. Diwan, Joseph Maalouly, and Prashanth J. Rao
64.1 Key Points. . . . . . . . . . . . . 563
64.2 Indications . . . . . . . . . . . . 564
64.3 Techniques . . . . . . . . . . . . 564
64.4 Complications . . . . . . . . . . 570
64.5 Postoperative Care . . . . . . 571
64.5.1 Open Technique . . . . . . . . 571
64.5.2 Minimally Invasive
Technique . . . . . . . . . . . . . 572
64.6 Outcomes . . . . . . . . . . . . 573
64.7 Surgical Pearls . . . . . . . . . 573
Common Clinical
Questions. . . . . . . . . . . . . 576
Answers to Common
Clinical Questions . . . . . . . 576
References . . . . . . . . . . . . 577
xxx Contentsfrom: Baaj et al, Handbook of Spine Surgery (9781684205547)
© 2025. Thieme. All rights reserved.65. Sacrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579
Jean-Paul Wolinsky and Ziya Gokaslan
65.1 Key Points . . . . . . . . . . . . 579
65.2 Indications. . . . . . . . . . . . 580
65.3 Preoperative
Considerations/
Management . . . . . . . . . . 580
65.4 Anatomic
Considerations. . . . . . . . . 580
65.5 Technique . . . . . . . . . . . . 581
65.5.1 Combined Anterior–
Posterior Approach . . . . . 584
65.5.2 Reconstruction . . . . . . . . 585
65.6 Complications . . . . . . . . . . 586
65.7 Postoperative Care . . . . . . 587
65.8 Outcomes . . . . . . . . . . . . . 587
65.9 Surgical Pearls. . . . . . . . . . 587
Common Clinical
Questions . . . . . . . . . . . . . 587
Answers to Common
Clinical Questions . . . . . . . 588
References . . . . . . . . . . . . 588
66. Vertebral Body Augmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 590
Tarek P. Sunna’, Charbel Moussalem, Mohamad Nabih El Houshiemy, and
Sarah Kawtharani
66.1 Key Points . . . . . . . . . . . . 590
66.2 Indications. . . . . . . . . . . . 591
66.3 Diagnosis . . . . . . . . . . . . 591
66.4 Technique . . . . . . . . . . . . 592
66.4.1 Vertebroplasty . . . . . . . . . 593
66.4.2 Kyphoplasty . . . . . . . . . . 593
66.5 Complications . . . . . . . . . 593
66.6 Postoperative Care. . . . . . 593
66.7 Outcomes . . . . . . . . . . . . . 594
66.8 Surgical Pearls. . . . . . . . . . 594
Common Clinical
Questions . . . . . . . . . . . . . 595
Answers to Common
Clinical Questions . . . . . . . 595
References . . . . . . . . . . . . 595
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597