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Surgery of the Spine: Surgical Anatomy and Operative Approaches

Surgery of the Spine: Surgical Anatomy and Operative Approaches

          
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About the Book

In this comprehensive and original monograph, Professor Rene Louis presents in minute detail in one volume the gross anatomy, nerve supply, biomechanics, and microcirculation of the spine. He also presents the surgical approaches to the vertebral bodies and their contents. Professor Louis is a great anatomist and this book has been prepared from his personal observations, both anatomical and surgical. His studies have been meticulously conducted and contain much original research, for instance his work on the motion of the neural elements within the lumbar vertebral canal. The illustrations are neady all original and very often a photograph of the neural or vascular elements is presented alongside a drawing of a given important anatomical area. For all these reasons, this inspiring treatise makes a valuable contri- bution to our knowledge of the spine and forms a basis for an under- standing of the intricacies of surgical anatomy and approaches. It will be especially valuable to the spinal surgeon, but the medical student, the orthopedic resident (or registrar), and the anatomist will also find it extremely useful. Leon L. Wiltse, M.D.

Table of Contents:
1. Descriptive and Functional Anatomy.- 1. Normal and Pathological Development of the Spine.- I. Introduction.- II. Prenatal Development.- A. Formation of the Primitive Streak.- B. Formation of the Notochord.- C. Formation of the Neuraxis.- D. Formation of the Sclerotome.- III. Postnatal Development.- A. Maturation and Growth of the Vertebrae.- B. Adaptation to the Erect Position.- IV. Malformations of the Vertebrae.- A. Dysraphia of the Notochord.- B. Abnormal Segmentation of the Sclerotomes.- C. Vertebral Hypoplasia and Agenesis.- D. Abnormal Ossification.- E. Abnormal Caliber of the Vertebral Canal.- F. Congenital Spondylolysis and Spondylolisthesis.- 2. Morphology of the Spine.- I. Cervical Spine.- A. Posterior Aspect.- B. Anterior Aspect.- C. Craniovertebral Articulations.- D. Lateral Aspect.- E. Sagittal Section.- F. Articulations of the Inferior Cervical Vertebrae.- G. Radiology.- II. Thoracic Spine.- A. Posterior Aspect.- B. Anterior Aspect.- C. Lateral Aspect.- D. Sagittal Section.- E. Intervertebral Articulations.- F. Costovertebral Articulations.- G. Radiology.- 1. Anteroposterior View.- 2. Lateral View.- III. Lumbosacral Spine.- A. Posterior Aspect.- B. Anterior Aspect.- C. Lateral Aspect.- D. Sagittal Section.- E. Lumbosacral Articulations.- F. Radiology.- 1. Anteroposterior View.- 2. Lateral View.- 3. Lumbar Discography.- 4. Oblique View.- 5. Axial View.- 6. Structure of the Vertebrae.- IV. Spinal Myology.- A. Posterior Muscles.- 1. Nuchal Muscles.- 2. Muscles of the Trunk.- 3. Extensor Muscles of the Pelvic Region.- B. Anterolateral Muscles.- 1. Muscles of the Neck.- 2. Muscles of the Thorax.- 3. Muscles of the Abdomen.- 3. Spinal Static Function.- I. Normal Spinal Curvatures.- A. Theories on the Formation of Spinal Curvatures.- B. Features of the Curvatures.- C. Influence of the Pelvis.- II. Variations of the Spinal Curvatures.- A. Sagittal Variations.- B. Coronal Variations.- 4. Spinal Stability.- I. Vertical Stability.- A. Elementary Structure of the Vertebrae.- B. Overall Stability of the Spine.- II. Horizontal Stability.- A. Craniovertebral Articulations.- B. Other Vertebral Articulations.- 5. Spinal Dynamic Function.- I. Articular Mechanics.- A. Craniovertebral Junction.- B. Intervertebral Discs.- C. Flexion-Extension.- D. Inclination-Rotation.- E. Orientation of the Articular Facets.- II. Regional Amplitude.- A. Flexion-Extension.- B. Axial Rotation.- C. Lateral Flexion.- III. Adaptation of the Spine to Effort.- A. Theoretical Aspects.- 1. The "Spinal Lever".- 2. Theory of Articular Triangulation.- B. Experimental Data.- 1. Resistance of the Spinal Structures.- 2. Intradiscal Pressures.- C. Anatomoclinical Observations.- 1. Hyperflexion and Hyperkyphosis.- 2. Hyperextension and Hyperlordosis.- 3. Rotation, Lateral Flexion, and Scoliosis.- 6. Spinal Function: Neural Protection.- I. Vertebral Canal.- A. Walls.- B. Lumen.- II. Intervertebral Foramina.- A. Upper Cervical Region (Occipital Bone to C2).- B. Lower Cervical Region (C2 to C7).- C. Thoracic Region (C7 to T12).- D. Lumbar Region (T12 to S1).- E. Sacral Region.- III. Vertebral Pedicles.- A. Pedicles of the Axis (C2).- B. Lower Cervical Pedicles (C3 to C7).- C. Upper Thoracic Pedicles (T1 to T3).- D. Middle Thoracic Pedicles (T4 to T10).- E. Thoracolumbar Pedicles (T11 to L2).- F. Lower Lumbar Pedicles (L3 to L5).- G. Sacral Pedicles.- 7. Radiculomedullary Axis.- I. Radiculomedullary Morphology.- II. Morphology and Topography of the Spinal Meninges.- III. Vertebromedullary Topography.- A. Spinal Cord Termination.- B. Myelomeres.- C. Topographical Types.- IV. Vertebroradicular Topography.- A. Dural Emergence of the Nerve Roots.- B. Nerve Roots in the Intervertebral Foramina.- V. Neuromeningeal Roentgenography.- A. Cervical Myelography.- B. Thoracic and Lumbosacral Myelography.- C. Axial Tomography of Dural Envelope and Spinal Nerve Roots.- VI. Systematization of the Spinal Cord.- A. Gray Matter.- 1. Dorsal Horn or Somatosensory Zone.- 2. Intermediate or Visceral Zone.- 3. Ventral or Somatomotor Horn.- 4. Reflex Somatic Centers.- 5. Vegetative Spinal Centers.- B. White Matter.- 1. Radicular Fibers and the Reflex Spinal Cord.- 2. Associative Fibers and the Spinal Cord as an Anatomical Unit.- 3. Fibers of Projection: Spinal Cord Subordinate to the Brain.- a) Ascending.- b) Descending.- C. Applied Pathology.- VII. Sensorimotor Areas of the Spinal Cord.- A. Dermatomes.- B. Myotomes.- VIII. Intrinsic Innervation of the Spine.- A. General Layout.- B. Regional Variations.- 1. Cervical.- 2. Thoracic and Lumbar.- IX. Osteoneuromeningeal Spinal Dynamics.- A. Classical Concepts of Neuromeningeal Dynamics.- B. Personal Studies (1964 and 1966).- C. Dynamics of the Vertebral Canal.- D. Meningeal Dynamics.- E. Radicular Dynamics.- 1. Lumbosacral Nerve Roots.- 2. Cervical Nerve Roots.- 3. Thoracic Nerve Roots.- F. Medullary Dynamics.- 8. Spinal Vasculature.- I. Major Prevertebral Vessels.- A. Superior Vascular Sector (C1 to T3).- B. Middle Vascular Sector (T4 to L4).- C. Inferior Vascular Sector (L5 to Coccyx).- II. Extraspinal Collateral Vessels.- A. Superior Vascular Sector (C1 to T3).- B. Middle Vascular Sector (T4 to L4).- C. Inferior Vascular Sector (L5 to Coccyx).- III. Intraspinal Vessels.- A. Osteoarticular Vasculature.- 1. Arterial.- 2. Venous.- B. Neuromeningeal Vasculature.- 1. Arterial.- 2. Venous.- IV. Venous Circulation of the Spine.- V. Spinal Phlebography.- A. Lumbosacral Plexuses.- B. Cervical Plexuses.- 2. Topographical Anatomy and Operative Approaches.- 1. Cervical Spine.- I. Posterior Region.- A. Topography.- 1. Extraspinal Relations.- 2. Intraspinal Relations.- B. Operative Approaches.- 1. Preparation of the Patient.- 2. Anesthesia and Operative Position.- 3. Initial Exposure.- 4. Exposure of the Craniovertebral Junction.- 5. Exposure of the Lower Cervical Spine.- 6. Interlaminar Cervical Approach.- 7. Cervical Laminectomy.- 8. Closure.- 9. Postoperative Care.- 10. Possible Complications.- II. Anterior Cervical Region.- A. Craniovertebral Junction.- 1. Topography.- a) The Anterior Osteoarticular Zone of the Craniovertebral Junction.- b) Anterior Relations: Buccal Cavity.- c) Posterior Relations: Vertebral Canal.- d) Lateral Relations: Posterior Subparotid Space.- 2. Operative Approaches.- a) Transoral.- (1) Preparation of the Patient.- (2) Anesthesia.- (3) Operative Position.- (4) Exposure of the Osteoarticular Structures.- (5) Closure.- (6) Postoperative Care.- (7) Possible Per-and Postoperative Complications.- b) Extrabuccal.- (1) Lateral.- (2) Submaxillary.- B. Lower Cervical Spine.- 1. Topography.- a) Landmarks and Layers of the Neck.- (1) Landmarks.- (2) Layers.- b) Neurovascular Bundle of the Neck.- c) Spinal Axis.- (1) Anterior Discocorporeal Region.- (2) Intervertebral and Transverse Foramina.- (3) Vertebral Canal.- d) Variations of the Vertebral Arteries.- 2. Anterior Approach.- a) Preparation and Anesthesia.- b) Operative Position.- c) Identification of the Site of Incision.- d) Preparation of the Operative Fields.- e) Possible Complications.- f) Initial Exposure.- g) Identification of the Vasculovisceral Axis.- h) Vascular Ligation.- i) Nerves to be Conserved.- j) Exposure of the Cervical Vertebrae.- k) Closure.- 1) Postoperative Care.- m) Possible Complications.- 2. Thoracic Spine.- I. Thoracic Regions.- A. Posterior Region.- B. Anterior Region.- 1. Superior Sector (T2 to T4).- 2. Middle Sector (T4 to T10).- 3. Inferior Sector (T10 to L2).- II. Posterior Region.- A. Topography.- 1. Superficial Landmarks and Skin of the Back.- 2. Musculofascial Layers.- 3. Region of the Vertebral Grooves.- 4. Vertebral Canal.- 5. Intervertebral Foramina.- B. Posterior Approach.- 1. Preparation and Anesthesia.- 2. Operative Position and Field.- 3. Skin Incisions.- a) Vertebral.- b) Iliac.- 4. Possible Complications.- 5. Initial Exposure.- 6. Fibromuscular Disinsertion.- 7. Exposure of the Vertebral Arches.- 8. Possible Complications.- 9 Laminectomy.- 10. Exploration of the Epidural Space.- 11. Intradural Exploration.- 12. Possible Complications.- 13. Meningeal Closure.- 14. Musculofascial Closure.- 15. Skin Closure.- 16. Postoperative Care and Possible Complications.- III. Anterior Region.- A. Cervicothoracic Junction (T2 to T4).- 1. Topography.- a) Sternocostal Wall.- b) Retrosternal Fibroserous Layer.- c) Pretracheal Neurovascular Structures.- d) Visceral Structures.- e) Prevertebral Neurovascular Structures.- f) Vertebrae.- 2. Cardiovascular Variations.- 3. Transsternal Approach: Cervicosternotomy.- B. Middle Thoracic Spine (T4 to T10).- 1. Topography.- a) Anterolateral Thoracic Wall.- (1) Cutaneous and Mammary Layer.- (2) Superficial Muscle Layer.- (3) Intercostal Region.- b) Lateral Thoracic Wall.- (1) Superficial Cutaneoadipose Layer.- (2) Muscular and Neurovascular Layer.- (3) Deep Costal and Intercostal Layer.- (4) Lateral Aspect of the Thoracic Cavity.- c) Posterior Thoracic Wall.- (1) Superficial Cutaneoadipose Layer.- (2) Middle Muscular and Neurovascular Layer.- (3) Deep Costal and Intercostal Region.- (4) Thoracic Cavity.- d) Mediastinum.- (1) Approach Via the Right Pleural Cavity.- (2) Approach by the Left Pleural Cavity.- e) Thoracic Spine.- f) Variations of the Azygos Venous System.- g) Other Venous and Arterial Variations.- (1) Lumbar Veins.- (2) Parietal Thoracic and Lumbar Arteries.- h) Variations of the Parietal Aortic Collaterals.- (1) Frequency of the Topographical Variations.- (2) Number and Dimensions of the Parietal Aortic Arteries.- (3) Venous Relations of the Parietal Aortic Arteries.- 2. Anterior Transpleural Approach.- a) Preparation and Anesthesia.- b) Operative Position.- c) Incision.- d) Parietal Exposure.- e) Exposure of the Anterior Surface of the Thoracic Spine.- f) Special Cases.- g) Parietal Closure.- h) Postoperative Care.- i) Possible Complications.- 3. Anterolateral Transpleural Approach.- a) Operative Position.- b) Parietal Exposure.- c) Exposure of the Spine.- d) Parietal Closure.- 4. Posterolateral Transpleural Approach.- a) Operative Position and Anesthesia.- b) Landmarks and Incision.- c) Dissection of the Superficial Layers.- d) Resection of the Fifth Rib.- e) Exposure of the Spine.- f) Parietal Closure.- g) Postoperative Care.- h) Possible Complications.- 5. Posterolateral Retropleural Approach.- a) Anesthesia and Operative Position.- b) Landmarks and Skin Incision.- c) Transection of the Superficial Layers.- d) Costal Resection.- e) Exposure of the Spine.- f) Closure.- g) Postoperative Care and Possible Complications.- C. Thoracolumbar Junction (T10 to L2).- 1. Topography.- a) Posterior Relations.- b) Anterior Relations.- c) Right Lateral Relations.- d) Left Lateral Relations.- e) Anterolateral Abdominal Wall.- (1) Rectus Abdominis Muscle.- (2) Obliquus Externus Muscle.- (3) Obliquus Internus Muscle.- (4) Transversus Abdominis Muscle.- (5) Neurovascular Bundles.- (6) Fascia Transversalis and Peritoneum.- (7) Diaphragm.- f) Left Thoracolumbar Region.- g) Right Thoracolumbar Region.- h) Immediate Relations of the Thoracolumbar Spine.- i) Horizontal Section Through T12.- 2. Operative Approach.- a) Left Thoracophrenolumbotomy.- (1) Operative Position.- (2) Skin Incisions.- (3) Anterior Parietal Dissection.- (4) Transection of the Diaphragm.- (5) Vascular Sections.- (6) Exposure of the Vertebral Bodies.- (7) Closure.- (8) Possible Complications.- b) Left Lateral Thoracolumbotomy.- (1) Operative Position.- (2) Skin Incision.- (3) Parietal Dissection.- (4) Disinsertion of the Diaphragm.- (5) Vascular Ligation.- (6) Exposure of the Spine.- (7) Closure.- 3. Lumbosacral Spine.- I. Posterior Region.- A. Topography.- 1. Cutaneous and Subcutaneous Layers.- 2. Fasciai Layer.- 3. Erector Spinae Muscles.- 4. Vertebral Arches and Interlaminar Spaces.- 5. Vertebral Canal and Intervertebral Foramina.- 6. Vertebroradicular and Vertebromedullary Topography.- B. Posterior Operative Approach.- 1. Operative Positions.- a) Standard Prone.- b) Flexed Prone.- c) Genupectoral.- d) Lateral.- 2. Median Posterior Approach.- a) Identification of Lesions.- b) Preparation of the Operative Field.- c) Superficial Dissection.- d) Muscle Disinsertion.- e) Exposure of the Vertebral Arches.- f) The Interlaminar Approach.- g) Lumbosacral Laminectomy.- h) Transdural Exploration.- i) Dural Closure.- j) Partietal, Subcutaneous, and Skin Closure.- k) Postoperative Care and Possible Complications.- II. Anterolateral Region.- A. Topography.- 1. Vessels of the Abdominal Wall.- 2. Nerves of the Abdominal Wall.- 3. Musculofascial Layers.- 4. Peritoneum.- 5. Anterolateral Relations of the Lumbar Spine.- a) Serous and Visceral.- b) Muscular.- c) Neural.- d) Vascular.- e) Discocorporeal Layer.- 6. Arterial Angiography.- a) Great Vessels.- b) Metameric Collaterals.- c) Spinal Arteries and Radiculomedullary Circulation.- 7. Venous Angiography.- a) Inferior Vena Cava.- b) Metameric Tributaries.- c) Spinal Venous Plexuses.- 8. Lumbar Arteriography: Horizontal Section Through L2.- 9. Transverse Section of the Abdomen Through L2.- 10. Prevertebral Vascular and Ureteral Anomalies.- B. Operative Approach: Left Lumbotomy.- 1. Operative Position.- 2. Skin Incision.- 3. Parietal Dissection.- 4. Retroperitoneal Decollement.- 5. Hemostasis of the Lumbar Vessels.- 6. Exposure of the Lumbar Spine.- 7. Closure.- 8. Possible Complications.- III. Anterior Region.- A. Topography.- 1. Anterior Parietal Structures.- 2. Peritoneal Structures.- 3. Prevertebral Vascular Structures.- 4. Prevertebral Neural Structures.- 5. Maneuvers to Mobilize the Prevertebral Neurovascular Structures.- 6. Horizontal Section of the Trunk Through L5.- 7. Ectopic Iliac Kidney.- B. Anterior Transperitoneal Approach.- 1. Preparation and Anesthesia.- 2. Operative Position.- 3. Incisions.- 4. Transection of the Abdominal Wall.- 5. Exposure of the Posterior Parietal Peritoneum.- 6. Presentation of the Prevertebral Neurovascular Structures.- 7. Mobilization of the Prevertebral Neurovascular Structures.- 8. Closure.- 9. Postoperative Care.- 10. Possible Complications.- IV. Lumbosacral Region: Special Operative Approaches.- A. Subperitoneal Iliolumbar Approach.- B. Posterolateral Transiliotransverse Approach.- C. Paraspinal Approach.- D. Transiliac Approach (According to Judet).- References.


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Product Details
  • ISBN-13: 9783540114123
  • Publisher: Springer-Verlag Berlin and Heidelberg GmbH & Co. KG
  • Publisher Imprint: Springer-Verlag Berlin and Heidelberg GmbH & Co. K
  • Language: English
  • Returnable: N
  • Sub Title: Surgical Anatomy and Operative Approaches
  • ISBN-10: 3540114122
  • Publisher Date: 01 Dec 1982
  • Binding: Hardback
  • No of Pages: 347
  • Series Title: English
  • Weight: 2045 gr


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