Daftar Isi Bridwell Spine

The Textbook of
Spinal Surgery
Third Edition Volume 1
The Textbook of
Spinal Surgery
Third Edition Volume 1
Editors in Chief
KEITH H. BRIDWELL
J. Albert Key Distinguished Professor of Orthopaedic Surgery and
Professor of Neurological Surgery
Chief, Pediatric/Adult Spinal Deformity Service
Director, Washington University Spine Fellowship
Washington University Orthopaedics
Washington University School of Medicine
Saint Louis, Missouri
RONALD L. DEWALD
Professor Emeritus
Department of Orthopedic Surgery
Rush Medical College
Chicago, Illinois
Associate Editors
Peter D. Angevine
Jacob M. Buchowski
Charles C. Edwards II
Christopher L. Hamill
Timothy R. Kuklo
Ronald A. Lehman, Jr.
Scott J. Luhmann
Lawrence G. Lenke
John M. Rhee
K. Daniel Riew
Managing Editor for Dr. Bridwell
Theresa M. Iffrig
Acquisitions Editor: Robert Hurley

Product Manager: Elise M. Paxson
Production Manager: Alicia Jackson
Senior Manufacturing Manager: Benjamin Rivera
Marketing Manager: Lisa Lawrence
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Library of Congress Cataloging-in-Publication Data
The textbook of spinal surgery / editors in chief, Keith H. Bridwell,
Ronald L. DeWald ; associate editors, Peter Angevine . . . [et al.];
administrative assistant to Dr. Bridwell, Theresa M. Iffrig.3rd ed.
p. ; cm.
Spinal surgery
Includes bibliographical references and index.
ISBN 978-0-7817-8620-1 (alk. paper)
1. SpineSurgery. I. Bridwell, Keith H. II. Dewald, Ronald L., 1934III. Title: Spinal surgery.
[DNLM: 1. Spinal Diseasessurgery. 2. Biomechanics.
3. Spinesurgery. WE 725]
RD768.T448 2011
617.56059dc23
2011024927
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However,
the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the
information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of
the contents of the publication. Application of the information in a particular situation remains the professional responsibility of
the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in
accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes
in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged
to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This
is particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use
in restricted research settings. It is the responsibility of the health care providers to ascertain the FDA status of each drug or device
planned for use in their clinical practice.
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10 9 8 7 6 5 4 3 2 1
To the patients who will benefit from our evolving

understanding of surgical indications, techniques, and
complications.
Foreword
I first met Dr. Bridwell in the early 1980s at a spine meeting in

Minneapolis, where we were introduced by our good friend
and host, Dr. Robert Winter. I was a newcomer to St. Louis and
Dr. Bridwell was thinking about moving to the area from
Cincinnati. We had a conversation at that meeting, which led
to more exchanges afterwards and planted the seeds for a lifelong friendship.
Eventually, Dr. Bridwell moved to St. Louis where I had the
pleasure of closely following his career. I learned that his
dream was to establish a superb academic center for the treatment of spinal deformities and to provide education at a
global level. During the quarter of a century that I have
known him, I have seen Dr. Bridwell realize this dream with
great success and benefitted from his contributions both as a
colleague and as a friend. In that time, Dr. Bridwell has not
only created a world class institution for the treatment of spinal disorders, he has done an extraordinary job of providing
ongoing research activities and creating an educational environment from which everyone can benefit. This textbook
stands as a testament to his commendable efforts to achieve
these goals.
The first edition of this book quickly became a classic, filling
the gap of resources needed for the education of spine surgeons. Prior to this publication, not a single book existed to
address all aspects of spine surgery. Within this rapidly expanding field, the need for a standard and reliable resource became
even greater. This book thus covers a spectrum of topics from
the simple to the most complex, dealing with all regions of the
spine from occiput to pelvis, offering diagnoses for all ages

from very young children to adults, and sharing all current and
up-to-date surgical approaches and techniques.
Dr. Bridwell and his respected associate editors and authors
have taken every measure to produce an outstanding work
addressing all basic principles and techniques of modern spine
surgery. The chapters are detailed yet simultaneously to the
point. They are also well illustrated and supplemented by useful references for those seeking additional information.
The third edition of The Textbook of Spinal Surgery represents
significant revisions to accommodate fresh and relevant information on new outcomes, technology, and clinical research.
The material covers knowledge needed for a readership comprising medical students, allied health professionals, residents
and fellows to pediatric orthopaedic surgeons and spine care
specialists.
The editors and authors of this publication stand at the forefront of the field. They are to be congratulated for consolidating the topic of spine surgery into one readily accessible textbook, a reference source that should appear in all libraries and
on the shelves of those who provide care for patients with
spinal disorders.
Behrooz A. Akbarnia, MD
Clinical Professor, Department of Orthopaedics
University of California, San Diego
Medical Director, San Diego Center for Spinal Disorders
Past President, Scoliosis Research Society
vii
Contributing Authors
Kuniyoshi Abumi, MD
Professor
Department of Spinal Reconstruction
Hokkaido University Graduate School of Medicine
Kita-Ku, Sapporo, Japan
Neel Anand, MD
Director, Orthopaedic Spine Surgery, Minimally
Invasive Spine Surgery
Spine Center
Cedars Sinai Medical Center
Los Angeles, California
Frank L. Acosta, Jr., MD

Assistant Professor
Department of Neurological Surgery
Cedars-Sinai Medical Center
Paul A. Anderson, MD
Professor
Department of Orthopedic Surgery and Rehabilitation
University of Wisconsin
Madison, Wisconsin
Steven S. Agabegi, MD
Assistant Professor
Department of Orthopaedic Surgery
University of Cincinnati College of Medicine
Cincinnati, Ohio
Peter D. Angevine, MD, MPH

Assistant Professor
Neurological Surgery
Columbia University College of Physicians and Surgeons
New York, New York
Raheel Ahmed, MD, PhD

Department of Neurosurgery
University of Iowa Hospitals and Clinics
Iowa City, Iowa
Toomas Anton, MD
Willoughby Hills Medical Center
Willoughby Hills, Ohio
Michael C. Ain, MD
Associate Professor
Department of Orthopaedics and Neurosurgery
Johns Hopkins University
Baltimore, Maryland
Joshua D. Auerbach, MD
Orthopaedic Surgeon
Bronx-Lebanon Hospital Center
Bronx, New York
Behrooz A. Akbarnia, MD
Clinical Professor
Department of Orthopaedics
San Diego, California
Medical Director
San Diego Center for Spinal Disorders
La Jolla, California
Todd J. Albert, MD
Richard H. Rothman Professor and Chairman
Professor of Neurosurgery
Thomas Jefferson University and Hospitals
Philadelphia, Pennsylvania
Howard S. An, MD
Professor of Orthopaedic Surgery
Rush University Medical Center
Chicago, Illinois
Kelley Banagan, MD
University of Maryland Orthopaedics
Baltimore, Maryland
Eli M. Baron, MD
Neurosurgeon and Spine Surgeon
Cedars Sinai Spine Center
Sushil K. Basra, MD
Clinical Instructor
Orthopaedic Spine Surgery
Emory University School of Medicine
The Emory Spine Center
Atlanta, Georgia
Carlo Bellabarba, MD
Department of Orthopaedics and Sports Medicine
Harborview Medical Center
University of Washington
Seattle, Washington
ix
Edward C. Benzel, MD
Chairman
Cleveland Clinic
Cleveland, Ohio
Mark Bernhardt, MD
Clinical Professor
University of Missouri Kansas City School of Medicine
Kansas City Orthopaedic Institute
Dickson-Diveley Midwest Orthopaedic Clinic
Leawood, Kansas
David S. Bradford, MD
Professor and Chair Emeritus
University of California, San Francisco
San Francisco, California
Keith H. Bridwell, MD
J. Albert Key Distinguished Professor of Orthopaedic Surgery and
Chief, Pediatric/Adult Spinal Deformity Service
Director, Washington University Spine Fellowship
Washington University Orthopaedics
Rudolf Bertagnoli, MD
Pro Spine
Straubing, Germany
Sigurd H. Berven, MD
Associate Professor in Residence
University of California San Francisco
Robert Shay Bess, MD

Orthopaedic Surgery
Rocky Mountain Hospital for Children
Denver, Colorado
Jason T. Bessey, MD
The Rothman Institute
Thomas Jefferson University
Randal R. Betz, MD
Chief of Staff
Shriners Hospitals for Children, Philadelphia
Mark H. Bilsky, MD
Professor
Neurosurgery
Weill Cornell Medical College;
Attending
Neurosurgery
Memorial Sloan-Kettering Cancer Center
New York, New York
Oheneba Boachie-Adjei, MD
The Scoliosis Service
Hospital for Special Surgery
New York, New York
Scott D. Boden, MD
Professor
Orthopaedic Surgery
Emory University School of Medicine;
Director
The Emory Orthopaedics & Spine Center
Atlanta, Georgia
Shelly M. Bolon, BS, CNIM

Department of Perioperative Services
BJC Healthcare
Darrel S. Brodke, MD
Professor and Vice Chairman
Department of Orthopedics
University of Utah
Salt Lake City, Utah
Jacob M. Buchowski, MD, MS

Assistant Professor of Orthopaedic and Neurological Surgery
Director
Center for Spinal Tumors
Douglas C. Burton, MD
Marc and Elinor Asher Spine Professor
University of Kansas School of Medicine
Kansas City, Kansas
Danielle B. Cameron, BA
Clinical Research Coordinator
Orthopaedic Surgery
Childrens Hospital of Philadelphia
Robert M. Campbell, Jr., MD

Director
The Center for Thoracic Insufficiency Syndrome
Childrens Hospital of Philadelphia;
Attending Physician
Division of Orthopaedics
Victoria A. Campbell, ENS, MC, USN

Walter Reed Army Medical Center
Washington, DC
Mauricio A. Campos Daziano, MD

Associate Instructor
Pontificia Universidad Catlica de Chile
Santiago, Chile
Eugene J. Carragee, MD
Stanford University School of Medicine
Stanford, California;
Division Chief, Spinal Surgery
Stanford Medicine Outpatient Center
Redwood City, California
Charles H. Crawford III, MD

Assistant Professor
University of Louisville
Louisville, Kentucky
Geoffrey A. Cronen, MD
Orthopaedic Spine Surgeon
Florida Medical Clinic
Tampa, Florida
Gilbert Chan, MD
Research Fellow
Jens R. Chapman, MD
Professor and Acting Chairman, HansJoerg Wyss Endowed Chair
Department of Orthopaedic Surgery and Sports Medicine
University of Washington;
Joint Professor of Neurological Surgery
Seattle, Washington
Michelle J. Clarke, MD
Senior Associate Consultant
Neurologic Surgery
Mayo Clinic
Rochester, Minnesota
David H. Clements III, MD

Associate Professor, Attending Physician
Shriners Hospital for Children
Brendan J. Collins, MD
Instructor in Surgery
Division of Plastic and Reconstructive Surgery
Johns Hopkins Hospital
Attending Plastic and Reconstructive Surgeon
Division of Plastic and Reconstructive Surgery
Mercy Medical Center
Baltimore, Maryland
Paul Richard Cooper, MD

Ricciardi Professor Emeritus of Neurosurgery
New York University School of Medicine
New York, New York
Paul A. Craig, RN, JD

Chief Risk & Human Resources Officer
University of California San Diego Health Sciences
Alvin H. Crawford, MD, FACS

Professor of Orthopaedic Surgery
Pediatrics and Orthopaedic Surgery
Director of Spine Fellowship
Director of Pediatric Orthopaedic Fellowship
Cincinnati Childrens Hospital
Cincinnati, Ohio
Matthew E. Cunningham, MD, PhD

Assistant Professor
Orthopaedic Surgery
Weill-Cornell Medical College, Cornell University;
Assistant Attending
Orthopaedic Surgery
Hospital for Special Surgery
New York, New York
Linda Park DAndrea, MD

Division of Spinal Disorders and Surgery
Brandywine Institute of Orthopaedics
Phoenixville, Pennsylvania
Alexis B.C. Dang, MD

Division of Sports Medicine
University of Rochester
Rochester, New York
Michael D. Daubs, MD
Assistant Professor
University of Utah
John G. DeVine, MD
Assistant Professor
Department of Surgery
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Ronald L. DeWald, MD
Professor Emeritus
Rush Medical College
Chicago, Illinois
John R. Dimar II, MD

Clinical Professor
University of Louisville
Chief
Pediatric Orthopedics
Kosairs Childrens Hospital
Staff Physician
Leatherman Spine Center
Louisville, Kentucky
Anton E. Dmitriev, PhD, MSc

Director
Spine Research Center
Integrated Department of Orthopaedics and Rehabilitation
Washington, DC
xi
xii
Angus S. Don, MD, FRACS

Visiting Assistant Professor
Stanford University Medical Center
Stanford, California
Orthopaedic and Spinal Surgeon
Auckland City Hospital
Auckland, New Zealand
John P. Dormans, MD
Professor
University of Pennsylvania School of Medicine;
Chief
The Childrens Hospital of Philadelphia
Denis S. Drummond, MD
Professor Emeritus
Orthopaedic Surgery
University of Pennsylvania School of Medicine;
Chief Emeritus
Orthopaedic Surgery
The Childrens Hospital of Philadelphia
Atiq Durrani, MD
Orthopaedic Surgery Spine Specialist
Center for Advanced Spine Technologies (CAST)
Cincinatti, Ohio
Tobin Eckel, MD
Private Practice
Washington, DC
Charles C. Edwards, MD
The Maryland Spine Center
Baltimore, Maryland
John B. Emans, MD
Professor
Orthopedic Surgery
Harvard Medical School
Director
Division of Spine Surgery
Childrens Hospital
Boston, Massachusetts
Sanford E. Emery, MD, MBA

Professor and Chair
West Virginia University
Morgantown, West Virginia
Jack R. Engsberg, PhD

Associate Professor
Occupational Therapy
Jean-Pierre Farcy, MD
Clinical Professor
Orthopaedics
New York University Hospital for Joint Diseases
New York, New York
David S. Feldman, MD
Associate Professor
Orthopedic Surgery
New York University Hospital for Joint Diseases;
Chief
Division of Pediatric Orthopedic Surgery
New York, New York
Richard G. Fessler, MD, PhD

Professor
Neurosurgery
Northwestern University
Chicago, Illinois
Charles C. Edwards II, MD

The Maryland Spine Center
Baltimore, Maryland
Brett Freedman, MD
U.S. Army
Landstuhl Regional Medical Center
Landstuhl, Germany
Frank J. Eismont, MD
University of Miami
Jackson Memorial Hospital
University of Miami Miller School of Medicine Spine Center
Rehabilitation Center
Miami, Florida
Michael B. Ellman, MD
Resident
Chicago, Illinois
Christopher G. Furey, MD
Associate Professor
Case Western Reserve University
Case Medical Center
Cleveland, Ohio
Keith R. Gabriel, MD
Associate Professor of Surgery
Division of Orthopaedics and Rehabilitation
Southern Illinois University School of Medicine
Springfield, Illinois
Robert W. Gaines, Jr., MD

Senior Spine Surgeon
Columbia Orthopaedic Group
Columbia, Missouri
Steven R. Garfin, MD
Professor and Chair
Sumeet Garg, MD
Assistant Professor
Orthopaedic Surgery
University of Colorado Denver School of Medicine
Surgeon
Pediatric Orthopaedic Surgery
The Childrens Hospital
Aurora, Colorado
Gregory P. Gebauer, MD, MS

Spine Fellow
Daniel E. Gelb, MD
Associate Professor and Vice Chairman
University of Maryland School of Medicine
Baltimore, Maryland
Sergio A. Glait, MD
Orthopaedic Surgery Resident
New York University
Hospital for Joint Diseases
New York, New York
R. Christopher Glattes, MD
Elite Orthopaedic Center
Nashville, Tennessee
Ryan T. Gocke, MD
West Virginia University
Morgantown, West Virgina
Ziya L. Gokaslan, MD, FACS

Donlin M. Long Professor
Neurosurgery, Oncology and Orthopaedic Surgery
Johns Hopkins University;
Vice-Chairman
Director of Spine Program
Johns Hopkins University School of Medicine
Baltimore, Maryland
Joseph Gondusky, MD
Naval Medical Center San Diego
Christopher R. Good, MD
Director
Scoliosis and Spinal Deformity Surgery
Virginia Spine Institute
Reston, Virginia
Matthew F. Gornet, MD
Staff Physician
Spine Research Center
The Orthopedic Center of Saint Louis
Oren N. Gottfried, MD
Acting Instructor
University of Utah
Munish C. Gupta, MD
Professor
Co-Director of Spine Center
Chief of Orthopaedic Spinal Disorders Service
Vice Chair of Academics
University of California, Davis Health System
Sacramento, California
Purnendu Gupta, MD
Associate Professor of Surgery
Section of Orthopaedic Surgery and Rehabilitation Medicine
University of Chicago, Pritzker School of Medicine
University of Chicago Medical Center
Chicago, Illinois
Hartmann Habbicht, PhD

Pro Spine
Straubing, Germany
Christopher L. Hamill, MD
Associate Clinical Professor
State University of New York at Buffalo
Buffalo, New York
D. Kojo Hamilton, MD
Assistant Professor
University of Maryland Medical Center
Baltimore, Maryland
Kim W. Hammerberg, MD
Assistant Professor
Orthopaedics
Consultant
Orthopedics
Chicago, Illinois
Heather Hansen, Esq.

Partner
OBrien & Ryan, LLC
Plymouth Meeting, Pennsylvania
Jrgen Harms, MD
Professor
Spine Surgery Center
SRH Klinikum Karlsbad-Langensteinbach
Karlsbad, Germany
xiii
xiv
Eric Harris, MD
Naval Medical Center San Diego
Daniel J. Hedequist, MD
Assistant Professor of Orthopedic Surgery
Childrens Hospital Boston
Boston, Massachusetts
Melvin D. Helgeson, MD
Department of Orthopaedics and Rehabilitation
Washington, DC
Harry N. Herkowitz, MD
Chairman
William Beaumont Hospital
Royal Oak, Michigan
Kazutoshi Hida, MD, PhD

Clinical Professor
Graduate School of Medicine, Hokkaido University
Sapporo City, Japan
Alan S. Hilibrand, MD
Professor of Orthopaedic Surgery and Neurosurgery
Director of Medical Education
Jefferson Medical College
Jessica Hillyer, PhD

Post-Doctoral Fellow
International Collaboration on Repair Discoveries
University of British Columbia
Vancouver, British Columbia, Canada
Harish S. Hosalkar, MD
Attending Orthopedic Surgeon
M. Timothy Hresko, MD
Associate Professor
Orthopaedic Surgery
Childrens Hospital Boston
Boston, Massachussetts
Brian C. Hsu, MBBS, FRACS

Orthopaedic Spinal Surgeon
Visiting Medical Officer
Childrens Hospital at Westmead
Sydney, Australia
Orthopaedic Spinal Surgeon
Orthopaedic & Arthritis Specialist Centre
Chatswood, Sydney, Australia
Wellington K. Hsu, MD
Assistant Professor
Departments of Orthopaedic Surgery and Neurological Surgery
Chicago, Illinois
Serena S. Hu, MD
Professor and Vice Chair
University of California, San Francisco
Manabu Ito, MD
Professor
Deparment of Advanced Medicine for Spine and Spinal Cord
Disorders
Hokkaido University Graduate School of Medicine
Sapporo, Japan
Christine Jacob, MD
Private Practice
SLUCare Physicians
Saint Louis, Missiouri
Charles E. Johnston II, MD

Professor
Orthopedic Surgery
University of Texas Southwestern Medical School;
Assistant Chief of Staff
Texas Scottish Rite Hospital
Dallas, Texas
James D. Kang, MD
Professor
Orthopaedic and Neurological Surgery
Vice Chair
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Bruce A. Kaufman, MD
Professor
Neurosurgery
Medical College of Wisconsin
Chief
Pediatric Neurosurgery
Childrens Hospital of Wisconsin
Milwaukee, Wisconsin
Kathryn A. Keeler, MD
Assistant Professor
Saint Louis Childrens Hospital
Shriners Hospital for Children, Saint Louis
Mustafa H. Khan, MD
Chicago, Illinois
A. Jay Khanna, MD
Associate Professor
Orthopaedic Surgery and Biomedical Engineering
Johns Hopkins Center for Bioengineering Innovation and Design
Baltimore, Maryland
Lawrence T. Khoo, MD
Director
Spinal Neurosurgery
Los Angeles Spine Clinic
Good Samaritan Hospital and Clinics
David H. Kim, MD
Assistant Clinical Professor
Orthopaedic Surgery
Tufts University School of Medicine;
Director of Medical Education
New England Baptist Hospital
Boston, Massachussetts
Hubert Labelle, MD
Professor
Surgery
University of Montreal
Chief
Orthopaedics
Sainte-Justine University Center Hospital
Montreal, Canada
Sue Min Lai, PhD, MS, MBA

Professor and Director of Kansas Cancer Registry
Department of Preventive Medicine and Public Health
University of Kansas Medical Center
Kansas City, Kansas
Manish P. Lambat, MS DNB

Sung-Soo Kim, MD
Assistant Professor
Seoul Spine Institute
Inje University Sanggye Paik Hospital
Seoul, Korea
Fellow
Pediatric Orthopaedics
Louisiana State University Health Sciences Center
Childrens Hospital
New Orleans, Louisiana
Yongjung J. Kim, MD
Assistant Professor
Orthopedic Surgery
Columbia University
New York, New York
Andrew G.S. King, MB, ChB, FRACS, FACS

Robert DAmbrosia Professor of Orthopedic Surgery
Louisiana State University Health Sciences Center
New Orleans, Louisiana
Tyler R. Koski, MD
Assistant Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois
Yoshihisa Kotani, MD
Assistant Professor
Hokkaido University Hospital
Sapporo, Japan
William E. Krauss, MD
Associate Professor
Mayo Medical School
Timothy R. Kuklo, MD, JD

Orthopaedic Surgeon
Colorado Comprehensive Spine Institute
Englewood, Colorado
James E. Lashley, MD
Orthopaedic & Spine Surgeon
Hamilton Medical Center
Dalton, Georgia
William C. Lauerman, MD
Professor and Chief
Georgetown University Hospital
Washington, DC
Ilya Laufer, MD
Weill Cornell Medical College
New York Presbyterian Hospital
New York, New York
Brandon Lawrence, MD
Assistant Professor
University of Utah
James Lawrence, MD
Thomas Jefferson University Medical College
Mark C. Lee, MD
Assistant Professor
Orthopaedics
Connecticut Childrens Medical Center
Hartford, Connecticut
Brian K. Kwon, MD, PhD, FRCSC

Associate Professor
Ronald A. Lehman, Jr., MD

Director
Pediatric and Adult Spine Surgery
Washington, DC
xv
xvi
Lawrence G. Lenke, MD
The Jerome J. Gilden Professor of Orthopedic Surgery
Co-Director of Adult/Pediatric Scoliosis and Reconstructive
Spinal Surgery
Chief of Spinal Surgery Shriners Hospital for Children, Saint Louis
Jeffrey R. Leonard, MD
Assistant Professor
Neurological Surgery and Pedaitrics
John C. Liu, MD
Associate Professor
Chicago, Illinois
John Louis-Ugbo, MD
Emory University
Atlanta, Georgia
John P. Lubicky, MD, FAAOS, FAAP

Professor of Orthopaedic Surgery & Pediatrics
West Virginia University School of Medicine
Morgantown, West Virginia
Kamran Majid, MD
Fellow, Orthopaedic Spine Surgery
Royal Oak, Michigan
Steven M. Mardjetko, MD, FAAP

Associate Professor
Orthopedic Surgery
Rush University
Chicago, Illinois;
Illinois Bone & Joint Institute
Morton Grove, Illinois
Richard E. McCarthy, MD
Professor
Chief of Spinal Deformities
University of Arkansas for Medical Sciences;
Professor
Chief of Spinal Deformities
Arkansas Childrens Hospital
Little Rock, Arkansas
Paul C. McCormick, MD, MPH

The Neurological Institute
Columbia University
New York, New York
Gegory S. McLoughlin, MD, FRCSC

Steven C. Ludwig, MD
Associate Professor and Chief
Spine Surgery
Baltimore, Maryland
Scott J. Luhmann, MD
Associate Professor
Attending Orthopaedic Surgeon
Shriners Hospital for Children, Saint Louis
Angel E. Macagno, MD
Resident
SUNY Downstate Medical Center
Brooklyn, New York
Neurosurgery
University of Saskatchewan
Saskatoon, Saskatchewan, Canada
Michael John McMaster, MD, FRCS

Clinical Director
Scottish National Paediatric Spine Deformity Centre
Royal Hospital for Sick Children;
Consultant Orthopaedic Spine Surgeon
Royal Infirmary of Edinburgh
Edinburgh, Scotland, United Kingdom
Thomas G. McPartland, MD
Clinical Instructor
University of Medicine and Dentistry of New Jersey, Robert Wood
Johnson Medical School
New Brunswick, New Jersey
Jwalant S. Mehta, MS, MCh, FRCS

Andrew W. Mack, MD
Washington, DC
Consultant Spine Surgeon

Centre for Spinal Studies and Surgery
Queens Medical Centre, Nottingham University Hospitals
Nottingham, United Kingdom
Arnold H. Menezes, MD, FACS, FAAP

Jean-Marc Mac-Thiong, MD, PhD
Assistant Professor
Surgery
Sainte-Justine University Center Hospital
University of Montreal
Montreal, Canada

Iowa City, Iowa
Richard B. Meyrat, MD
Methodist Dallas Medical Center
Dallas, Texas
Fred Mo, MD
Orthopaedic Surgery
Yale New Haven Hospital
New Haven, Connecticut
Alfred T. Ogden, MD
The Neurological Institute
Columbia University
New York, New York
David J. Moller, MD
Assistant Professor
University California Davis, Medical Center
Sacramento, California
Elena B. Okon, PhD

Research Associate
International Collaboration on Repair Discoveries
David M. Montgomery, MD
Royal Oak, Michigan
Janice F. Mulligan, Esq.

Law Offices of Mulligan & Banham
Gbolahan O. Okubadejo, MD
Active Joints Orthopedics
Staff Physician
Englewood Hospital
Englewood, New Jersey
Stephen L. Ondra, MD
Gregory M. Mundis, Jr., MD
Pediatric and Adult Deformity Surgery
Cervical Spine Surgery
Spine Surgery
San Diego Center for Spinal Disorders
La Jolla, California
Fadi Nasr, MD
Chicago, Illinois

Northwestern University Feinberg School of Medicine
Chicago, Illinois
LTC Joseph R. Orchowski, MD

Chief
Orthopaedic Spine Section
Tripler Army Medical Center
Honolulu, Hawaii
Brian A. OShaughnessy, MD
Ahmad N. Nassr, MD
Assistant Professor of Orthopaedic Surgery
Mayo Clinic
Chris J. Neal, MD
Chicago, Illinois
Clarke Nelson, MD
Baltimore, Maryland
Peter O. Newton, MD
Associate Clinical Professor
Universtiy of California, San Diego
Rady Childrens Hospital
Neurosurgeon
Howell Allen Clinic
Nashville, Tennessee
Timothy S. Oswald, MD
Assistant Clinical Professor
Emory University;
Pediatric Orthopaedic Associates
Atlanta, Georgia
Anne M. Padberg, MS, CCC-A

Director of Intraoperative Monitoring
BJC Healthcare
St. Louis, Missouri
Daniel K. Park, MD
Spinal Surgery Fellow
Emory University
Atlanta, Georgia
Alpesh A. Patel, MD
Douglas D. Nowak, MD
Columbia University Medical Center
New York, New York
Michael F. OBrien, MD
Southwest Scoliosis Institute
Baylor Scoliosis Center
Plano, Texas
Assistant Professor
University of Utah School of Medicine
Ashish Patel, MD
New York, New York
xvii
xviii
Joseph H. Perra, MD
Staff Surgeon
Twin Cities Spine Center
Minneapolis, Minnesota
Mark A. Pichelmann, MD
Mayo Clinic
John J. Regan, MD
Fellowship-Trained Spine Surgeon
Private Practice
Beverly Hills, California
Daniel K. Resnick, MD, MS

Associate Professor and Vice Chairman
Neurosurgery
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin
Kornelis A. Poelstra, MD
Assistant Professor of Orthopaedics
Baltimore, Maryland
David W. Polly, Jr., MD

Professor and Chief of Spine Surgery
Orthopaedic Surgery
University of Minnesota
Minneapolis, Minnesota;
Professor of Surgery
Uniformed Services University of the Health Sciences
Bethesda, Maryland
John M. Rhee, MD
Associate Professor
Emory University
Emory Spine Center
Atlanta, Georgia
B. Stephens Richards III, MD

Professor
University of Texas Southwestern Medical Center at Dallas
Assistant Chief of Staff
Texas Scottish Rite Hospital for Children
Dallas, Texas
Ravi K. Ponnappan, MD
Assistant Professor
Orthopaedic Surgery
RaKerry K. Rahman, MD
Orthopaedic Surgeon
Southern Illinois University Medical Center
Springfield, Illinois
Sharad Rajpal, MD
University of Wisconsin Medical School
Madison, Wisconsin
Alexander Rasouli, MD
University of Miami/Jackson Memorial Hospital
University of Miami Miller School of Medicine Spine Center
Rehabilitation Center
Miami, Florida
K. Daniel Riew, MD
Mildred B. Simon Distinguished Professor of Orthopedic Surgery
Chief, Cervical Spine Surgery & Director, Orthopedic & Rehab
Institute for Cervical Spine Surgery
Jeffrey A. Rihn, MD
Media, Pennsylvania
Joseph Riina, MD
Spine Surgeon
Indiana Orthopaedic Hospital
Indianapolis, Indiana
Anthony S. Rinella, MD
Spine and Scoliosis Surgeon
Founder
Illinois Spine and Scoliosis Center
Homer Glen, Illinois
Barry L. Raynor, BA, CNIM

BJC Healthcare
Keith M. Rinkus, MD, MS

Surgeon
Orthopaedic Sports Medicine and Rehabilitation
Red Bank, New Jersey
David L. Reames, MD
University of Virginia School of Medicine
Charlottesville, Virginia
Brandon G. Rocque, MD
University of Wisconsin Medical School
Madison, Wisconsin
Richard Redett, MD
Associate Professor and Director
Pediatric Plastic Surgery
Plastic and Reconstructive Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland
Julian A. Romagnoli, MD
Spine Fellow
Spine Surgery
Columbia Orthopaedic Group
Columbia, Missouri
Peter S. Rose, MD
Senior Associate Consultant
Mayo Clinic
Rebecca Rosemann, MS, PA-C

Physician Assistant
Spine Center
Michael K. Rosner, MD
Associate Professor in Surgery
Surgery Department
Uniformed University of the Health Sciences
Bethesda, Maryland
Director of Neurosurgery, Complex Spine
Neurosurgery Service
Washington, DC
Steven Scherping, MD
Associate Professor
Orthopaedic Surgery
Georgetown University Hospital
Washington, DC
Thomas A. Schildhauer, MD
Surgical Clinic and Polyclinic
Bergmannsheil University Hospital
Ruhr-Universitt Bochum
Bochum, Germany
Frank J. Schwab, MD
Chief of Spinal Deformity Service
Orthopaedics
New York, New York
David G. Schwartz, MD
Spine Surgeon
Pierre Roussouly, MD
Chief
Department of Orthopedic and Spine Surgery
Centre Medico-Chirurgical De Readaptation des Massues
Lyon, France
ML Chip Routt, MD
Department of Orthopaedics and Sports Medicine
Harborview Medical Center
Seattle, Washington
Michael Ruf, MD
Orthopedics and Traumatology
SRH-Zentralklinikum Suhl
Suhl, Germany
Debra A. Sala
Research Coordinator
Center for Children
New York, New York
Amer F. Samdani, MD
James O. Sanders, MD
Professor of Orthopaedics and Pediatrics
Department of Orthpaedics and Rehabilitation
University of Rochester
Rochester, New York
Edward R.G. Santos, MD

Assistant Professor
Orthopaedic Surgery
University of Minnesota
James D. Schwender, MD
Twin Cities Spine Center
Daniel M. Sciubba, MD
Assistant Professor
Neurosurgery, Oncology, and Orthopaedic Surgery
Director
Minimally Invasive Spine Surgery
Director
Spine Research
Baltimore, Maryland
Christopher I. Shaffrey, MD, FACS

Harrison Distinquished Teaching Professor
University of Virginia
Charlottesville, Virginia
M. Mohsin Shah, MD
Neurosurgical Fellow
Seattle Neuroscience Institute
Swedish Medical Center
Seattle, Washington
Eric D. Shirley, MD, LCDR, MC, USN

Attending Physician
Department of Pediatric Orthopaedic Surgery
Nemours Childrens Clinic
Jacksonville, Florida
Harry L. Shufflebarger, MD
Chief
Division of Spinal Surgery
Miami Childrens Hospital
Miami, Florida
Rick C. Sasso, MD, FACS

Associate Professor
Chief of Spine Surgery
Clinical Orthopaedic Surgery
Indiana University School of Medicine
Kern Singh, MD
Assistant Professor
Orthopaedic Surgery
Chicago, Illinois
xix
xx
David L. Skaggs, MD
Associate Professor
Orthopaedic Surgery
University of Southern California School of Medicine
Endowed Chair
Pediatric Spinal Disorders
Associate Director
Childrens Orthopaedic Center
Childrens Hospital Los Angeles
Ufuk Talu, MD
Professor
Istanbul University
Istanbul, Turkey
H. Thomas Temple, MD
University of Miami Miller School of Medicine
Miami, Florida
Jason E. Smith, MD
Spine Surgery Fellow
Andelle L. Teng, MD, MS

Cascade Orthopaedics
Auburn, Washington
Zachary A. Smith, MD
Fellow in Spinal Surgery
Northwestern Memorial Hospital
Chicago, Illinois
David L. Spencer, MD
Clinical Associate Professor
Orthopedic Surgery
University of Illinois College of Medicine
Chicago, Illinois
George H. Thompson, MD
Professor
Orthopaedic Surgery and Pediatrics
Case Western Reserve University;
Director
Pediatric Orthopaedics
Rainbow Babies and Childrens Hospital
Cleveland, Ohio
Earl D. Thuet, BS, CNIM

David A. Spiegel, MD
Assistant Professor
Orthopaedic Surgery
The University of Pennsylvania School of Medicine
Division of Orthopaedic Surgery
Paul D. Sponseller, MD
Professor
Chief Pediatric Orthopaedics
Childrens Orthopaedics and Spine Surgery
Johns Hopkins Medicine
Baltimore, Maryland
Daniel J. Sucato, MD, MS

Associate Professor
University of Texas at Southwestern Medical Center
Director
Orthopaedic Surgery
Center for Excellence in Spine Research
Texas Scottish Rite Hospital
Dallas, Texas
Se-Il Suk, MD, PhD

Professor and Director
Seoul Spine Institute
Inje University Sanggye Paik Hospital
Seoul, Korea
Ganesh Swamy, MD
Clinical Lecturer
University of Calgary
Calgary, Alberta, Canada

BJC Healthcare
John E. Tis, MD
Assistant Professor
Baltimore, Maryland
Vincent C. Traynelis, MD
Iowa City, Iowa
Kene T. Ugokwe, MD
Clinical Instructor and Spine Fellow
University of Wisconsin
Madison, Wisconsin
Jessica J. Uitto, Esq.

OBrien & Ryan, LLP
Plymouth Meeting, Pennsylvania
Vidyadhar V. Upasani, MD
Resident
Orthopedic Surgery
University of California San Diego
Fulya stnkan, MD
Department of Pediatric Orthopaedic Surgery
New York, New York
Alexander R. Vaccaro, MD
Thomas Jefferson University Hospital
Jason P. Young, MD
Resident
Loyola University Medical Center
Maywood, Illinois
Corey J. Wallach, MD
The Anderson Clinic
Arlington, Virginia
Jeffrey C. Wang, MD
Associate Professor
Orthopaedics and Neurosurgery
Chief of Spine Surgery
University of California Los Angeles Comprehensive Spine Center
Santa Monica, California
Mark Weidenbaum, MD
Columbia University
New York, New York
Stuart L. Weinstein, MD
Ignacio V. Ponseti Chair and Professor of Orthopaedic Surgery
Iowa City, Iowa
Jean-Paul Wolinsky, MD
Assistant Professor
Neurosurgery and Oncology
Clinical Director
Johns Hopkins Spine Program
Baltimore, Maryland
Adam L. Wollowick, MD
Assistant Professor
Albert Einstein College of Medicine
Attending Surgeon
Montefiore Medical Center
Bronx, New York
Yoshiya Yamada, MD
Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
New York, New York
Paul H. Young, MD
Clinical Professor
Section of Neurosurgery
Department of Surgery
Center for Anatomical Science and Education
Saint Louis University School of Medicine
James J. Yue, MD
Associate Professor
Yale School of Medicine
New Haven, Connecticut
Lukas P. Zebala, MD
Assistant Professor
Reinhard D. Zeller, MD, ScD, FRCSC

Associate Professor
University of Toronto
Head, Spine Program
The Hospital for Sick Children
Toronto, Ontario, Canada
Amer Zeni, MD
Indiana University School of Medicine
Riley Hospital for Children
Hong Zhang, MD
Associate Professor
The University of Texas Southwestern Medical Center
Texas Scottish Rite Hospital for Children
Dallas, Texas
xxi
Preface
In this, the third edition of The Textbook of Spinal Surgery, we

attempt to cover all important etiologies (deformity, degenerative, traumatic and neoplastic) of pediatric and adult spinal
surgery, as well as all pathologies from the skull to the sacrum.
It has now been 13 years since we published the second edition.
In the first edition we had 45 chapters and 60 contributors. In
the second edition we had 130 chapters and 182 contributors.
In this edition we have 156 chapters and 60 contributors.
As in the first two editions, we have a blend of orthopaedic
and neurosurgical colleagues from all over the world contributing chapters.
With this edition, we have more heavily peer-reviewed the
chapters. Each chapter was reviewed by an associate and a
senior editor before publication. Most chapters were returned
to the author for revision before submitting to the publisher.
Therein, we believe these chapters will impress you with their
quality and excellence.
Rather than bombard the reader with a 200-list bibliography, we decided to condense the reference list to a more manageable size. Therein, with each chapter we attempted to reference a small number of classic articles and otherwise the most
current and pertinent ones.
Since the second edition, spinal surgery has grown tremendously. More surgeons are specializing in spinal surgery and
training with fellowships than was the case when the second
edition was published. Neurosurgeons are also far more contributory to the field than was the case many years ago. We feel
this will be reflected in the current edition.
We are also in the process of producing several techniques
videos which we feel will be helpful to the readers. The topics
include adult thoracic vertebral column resection for scoliosis
deformity, posterior vertebral column resection, cervical
corpectomy and reconstruction, disc arthroplasty in the
cervical spine, and extracavitary metastatic tumor resection and
reconstruction.
As with the past editions, this textbook will be of great value
to medical students, select physical therapists and physiatrists
who are particularly interested in the study of spinal pathology
and surgical treatment, orthopaedic and neurosurgery residents and fellows and practicing orthopaedic surgeons and
neurosurgeons.
Ronald L. DeWald, MD
xxiii
Acknowledgments
As stated in the preface, our associate editors have done a tremendous amount of work, peer-reviewing all chapters before
they were submitted to the publisher. I would like to particularly thank those associate editors, Peter D. Angevine, Jacob M.
Buchowski, Charles C. Edwards II, Christopher L. Hamill,
Timothy R. Kuklo, Ronald A. Lehman Jr., Lawrence G. Lenke,
Scott J. Luhmann, John M. Rhee, and K. Daniel Riew; their
wives, Anne Angevine, Katherine Buchowski, Ann Edwards,
Vikki Hamill, Linda Kuklo, Marina Lehman, Beth Lenke, Jan
Luhmann, Marcia Ko, and Mary Riew; and their families for
allowing them to devote extra time to advancing the knowledge
of spinal surgery for all students of the field.
We would very much like to thank Terri Iffrig. She was the
managing editor for the second edition for which her job was
twice as big as it was for the first edition and for this edition it
was twice as big again. Without her hard work and organization, the textbook would never have come to fruition.
Also, we would like to thank the Lippincott Williams &
Wilkins staff, including Robert Hurley, David Murphy, Elise
Paxson, Eileen Wolfberg, and Sarah Granlund, for working so
hard with us on this project.
As with the other two editions, Dr. Bridwell thanks and
acknowledges Dr. Ronald L. DeWald for his guidance and
teachings over the years. Most of the associate editors and a
very high percentage of the contributing authors were either
trained by Dr. DeWald or by the people he trained. We thank
him for his guidance and inspiration.
xxv
Contents
Foreword vii
Contributing Authors ix
Preface xxiii
Acknowledgments xxv
SECTION I: General Considerations

SECTION EDITOR: JOHN M. RHEE
1.
The Evolution of Spine Surgery since the Second Edition of The Textbook
of Spinal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
RONALD L. DEWALD
2.
Spinal Cord and Nerve Root Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANNE M. PADBERG, BARRY L. RAYNOR, EARL D. THUET, AND SHELLY M. BOLON
3.
Bone Grafting and Spine Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

JOHN LOUIS-UGBO AND SCOTT D. BODEN
4.
Medical Complications in the Adult Spinal Patient . . . . . . . . . . . . . . . . . . . . . . . 49

ALEXIS B.C. DANG AND SERENA S. HU
5.
Trunk Range of Motion and Gait Considerations in Patients

with Spinal Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
JACK R. ENGSBERG, LAWRENCE G. LENKE, AND KEITH H. BRIDWELL
SECTION II: Biomechanics

SECTION EDITOR: TIMOTHY R. KUKLO
6.
General Considerations of Biomechanical Testing . . . . . . . . . . . . . . . . . . . . . . . . 65

ANTON E. DMITRIEV
7.
Basic Pedicle Screw and Construct Biomechanics . . . . . . . . . . . . . . . . . . . . . . . . . 74

C.H. CRAWFORD III, B.A. OSHAUGHNESSY, AND T.R. KUKLO
8.
Biomechanics of Three-Dimensional Scoliosis Correction . . . . . . . . . . . . . . . . . . 79

ANDREW G. S. KING AND MANISH P. LAMBAT
9.
Treatment Considerations and Biomechanics of the Lumbosacral Spine . . . . . . . . 86

GEOFFREY CRONEN AND TIMOTHY R. KUKLO
10.
Normal Spinal Anatomy: Normal Sagittal Plane Alignment . . . . . . . . . . . . . . . . . 93

MARK BERNHARDT
xxvii
xxviii
Contents
SECTION III: Anatomic Approaches

SECTION EDITOR: RONALD A. LEHMAN, JR.
11.
Microscopic Approach to the Posterior Lumbar Spine for Decompression . . . 101

JASON P. YOUNG AND PAUL H. YOUNG
12.
Minimal Access Techniques Using Tubular Retractors for Disc Herniations

and Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
NEEL ANAND AND ELI M. BARON
13.
Anterior Cervical Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

RONALD A. LEHMAN JR AND K. DANIEL K. RIEW
14.
Jaw-Splitting Approaches to the Upper Cervical Spine . . . . . . . . . . . . . . . . . . . 127

DANIEL M. SCIUBBA, GREGORY S. MCLOUGHLIN, ZIYA L. GOKASLAN,
AND JEAN-PAUL WOLINSKY
15.
The Modified Anterior Approach to the Cervicothoracic Junction . . . . . . . . . . . 140

KAMRAN MAJID AND HARRY N. HERKOWITZ
16.
Transsternal Approaches to the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

DANIEL M. SCIUBBA, CLARKE NELSON, JEAN-PAUL WOLINSKY, AND ZIYA L. GOKASLAN
17.
Anterior Exposure of the Thoracic and Lumbar Spine Down to L4 . . . . . . . . . . 158

MELVIN D. HELGESON AND RONALD A. LEHMAN JR
18.
Anterior Approaches to the Distal Lumbar Spine and Sacrum . . . . . . . . . . . . . . 165

JOHN E. TIS AND RONALD A. LEHMAN JR
19.
Direct Lateral Approach to the Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . 175

NEEL ANAND AND ELI M. BARON
SECTION IV: The Cervical Degenerative Spine

SECTION EDITOR: JOHN M. RHEE
20.
Cervical State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

JOHN M. RHEE
21.
Evaluation of Axial Neck Pain. Who is a Surgical Candidate and Who Isnt:
How to Manage the Nonoperative Treatment, How to Work Up the Pathology . . . 185
KEITH RINKUS AND JOHN M. RHEE
22.
Cervical Radiculopathy: Clinical Evaluation and Nonoperative Treatment . . . . . 196

PETER S. ROSE, JOHN M. RHEE, AND K. DANIEL RIEW
23.
Cervical Spondylosis and Radiculopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

ANDELLE L. TENG, COREY WALLACH, AND JEFFREY C. WANG
24.
Cervical Myelopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

JOHN M. RHEE, SUSHIL K. BASRA, AND K. DANIEL RIEW
Contents
25.
xxix
Occipitocervical and Atlantoaxial Methods of Fusion: C1-2 Fixation,

Harms Screw, Magerl Screw, Wiring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
RAHEEL AHMED, VINCENT C. TRAYNELIS, AND ALEXANDER R. VACCARO
26.
Anterior Decompression, Instrumentation, Fusion Techniques:

Corpectomy, Strut Grafting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
AHMAD NASSR, RAVI K. PONNAPPAN, AND JAMES D. KANG
27.
Anterior Decompression, Instrumentation, Fusion Techniques: Discectomy,

Foraminotomy, Disc Space Carpentry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
RAVI K. PONNAPPAN, AHMAD NASSR, AND JAMES D. KANG
28.
Anterior Cervical Plating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268

ANDREW W. MACK, RONALD A. LEHMAN III, AND TIMOTHY R. KUKLO
29.
Indications and Techniques for Transoral and Foramen

Magnum Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
ARNOLD H. MENEZES
30.
Subaxial Posterior Decompression and Fusion Techniques . . . . . . . . . . . . . . . . . 293

DOUGLAS D. NOWAK, KORNELIS A. POELSTRA, AND STEVEN C. LUDWIG
31.
Subaxial Posterior Foraminotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

DOUGLAS D. NOWAK, RAKERRY K. RAHMAN, KORNELIS A. POELSTRA,
AND STEVEN C. LUDWIG
32.
Subaxial Posterior Laminoplasty and Laminectomy . . . . . . . . . . . . . . . . . . . . . . 307

DOUGLAS D. NOWAK, KORNELIS A. POELSTRA, AND STEVEN C. LUDWIG
33.
Subaxial Posterior Lateral Mass Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313

MELVIN D. HELGESON AND RONALD A. LEHMAN JR.
34.
Subaxial Cervical Pedicle Screw Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

KUNIYOSHI ABUMI, MANABU ITO, AND HIDEKI SUDO
35.
Revision Cervical Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

BRIAN A. OSHAUGHNESSY, CHARLES H. CRAWFORD III, RONALD L. LEHMAN,
AND TIMOTHY R. KUKLO
36.
Cervical Disc Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344

WELLINGTON K. HSU AND PAUL A. ANDERSON
SECTION V: The Thoracic and Lumbar Degenerative Spine

SECTION EDITOR: TIMOTHY R. KUKLOW
37.
Thoracic and Lumbar Degenerative Disorders: State of the Art . . . . . . . . . . . . . 353

JACOB M. BUCHOWSKI
38.
Evaluation of Thoracic and Lumbar Axial Back Pain . . . . . . . . . . . . . . . . . . . . . 355

KATHRYN KEELER AND JACOB M. BUCHOWSKI
xxx
Contents
39.
Evaluation of Thoracic and Lumbar Radicular Pathology. Who Is a Surgical

Candidate and Who Isnt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
KATHRYN A. KEELER AND JACOB M. BUCHOWSKI
40.
Use of Discography to Evaluate Lumbar Back Pain with

an Eye Toward Surgical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
EUGENE J. CARRAGEE AND ANGUS S. DON
41.
Surgical Treatment of Lumbar Disc Herniation . . . . . . . . . . . . . . . . . . . . . . . . . 387

DAVID LEE SPENCER
42.
Surgical Treatment of Lumbar Spinal Stenosis. . . . . . . . . . . . . . . . . . . . . . . . . . 394

GBOLAHAN O. OKUBADEJO AND JACOB M. BUCHOWSKI
43.
Revision Laminectomy: Indications and Techniques . . . . . . . . . . . . . . . . . . . . . 402

PETER D. ANGEVINE
44.
Strategies and Techniques for Dural Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

CHRIS J. NEAL, TYLER KOSKI, AND STEPHEN L. ONDRA
45.
When to Consider ALIF, TLIF, PLIF, PSF, or

Motion-Preserving Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
DAVID W. POLLY AND EDWARD RAINIER G. SANTOS
46.
Motion-Preservation Techniques (Other Than Disc Arthroplasty) . . . . . . . . . . . 428

JOHN G. DEVINE
47.
Transforaminal Lumbar Interbody Fusion/Posterior Lumbar

Interbody Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436
CHRISTOPHER R. GOOD AND TIMOTHY R. KUKLO
48.
Anterior Lumbar Interbody Fusion Techniques . . . . . . . . . . . . . . . . . . . . . . . . . 445

MICHAEL K. ROSNER AND VICTORIA A. CAMPBELL
49.
Minimally Invasive Posterior Surgery for the Lumbar Spine . . . . . . . . . . . . . . . 452

JAMES D. SCHWENDER AND BRIAN C. HSU
50.1.
Total Disc Replacement: Concepts/Design Strategy/Indications/

Contraindications/Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
JAMES J. YUE, BRANDON LAWRENCE, AND FRED MO
50.2.
Total Disc ReplacementMaverick . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471

MATTHEW F. GORNET
50.3.
Lumbar Total Disc Replacement: CHARITE Artificial Disc . . . . . . . . . . . . . . . . 483

OREN N. GOTTFRIED AND DARREL S. BRODKE
50.4.
Total Disc Replacement: ProDisc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493

UFUK TALU, RUDOLF BERTAGNOLI, HARTMANN HABBICHT,
GANESH SWAMY, AND SERENA S. HU
51.
Revision Lumbar Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503

JOSHUA D. AUERBACH AND TIMOTHY R. KUKLO
52.
Complications of Lumbosacral Spine Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 513

JOHN R. DIMAR II
Contents
53.
xxxi
The Future: Disc Regeneration and Other Technologies . . . . . . . . . . . . . . . . . . 525

DANIEL K. PARK, MICHAEL B. ELLMAN, KERN SINGH, AND HOWARD S. AN
54.
Posterior Dynamic Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 534

ZACHARY A. SMITH AND LARRY T. KHOO
55.
Thoracic Discectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539

DAVID J. MOLLER AND JOHN C. LIU
56.
Thoracic Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546

TYLER KOSKI AND FADI NASR
SECTION VI: Spondylolisthesis

SECTION EDITOR: CHARLES C. EDWARDS II
57.
Spondylolisthesis: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553

CHARLES EDWARDS II AND MARK WEIDENBAUM
58.
Wiltse and Marchetti/Bartolozzi Classifications of

SpondylolisthesisGuidelines for Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 556
RAKERRY K. RAHMAN, JOSEPH PERRA, AND MARK WEIDENBAUM
59.
Sacro-Pelvic Morphology, Spino-Pelvic Alignment, and

the Spinal Deformity Study Group Classification . . . . . . . . . . . . . . . . . . . . . . . . 563
HUBERT LABELLE AND JEAN-MARC MAC-THIONG
60.
The Natural History of Spondylolisthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576

KIM HAMMERBERG AND MUSTAFA KHAN
61.
Pars Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581

PURNENDU GUPTA AND MUNISH C. GUPTA
62.1.
Low-Grade Spondylolisthesis in Children and Adolescents . . . . . . . . . . . . . . . . 590

M. TIMOTHY HRESKO
62.2.
Low-Grade Spondylolisthesis in Adults: Surgical Management . . . . . . . . . . . . . 596

STEVEN MARDJETKO
63.
Adult Degenerative Spondylolisthesis Without Lysis . . . . . . . . . . . . . . . . . . . . . 617

STEVEN S. AGABEGI, DAVID M. MONTGOMERY, AND HARRY N. HERKOWITZ
64.
High-Grade Spondylolisthesis: Fusion In Situ . . . . . . . . . . . . . . . . . . . . . . . . . . 633

MAURICIO CAMPOS AND STUART WEINSTEIN
65.
High-Grade Spondylolisthesis: Partial Reduction . . . . . . . . . . . . . . . . . . . . . . . 638

PIERRE ROUSSOULY AND RICHARD B. MEYRAT
66.
High-Grade Spondylolisthesis: Posterior Decompression and

Spanning/Dowel Fibula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 646
RICK C. SASSO AND JAMES E. LASHLEY
67.
High Dysplastic Spondylolisthesis: Anatomic Reduction.

The Harms/Shufflebarger Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 660
HARRY L. SHUFFLEBARGER
xxxii
Contents
68.
Reduction of High-Grade Spondylolisthesis: The Edwards Technique . . . . . . . . 668

CHARLES C. EDWARDS AND CHARLES C. EDWARDS II
69.
The L5 Vertebrectomy Approach for the Treatment of Spondyloptosis with

Reduction of L4 onto S1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686
JULIAN A. ROMAGNOLI, JWALANT S. MEHTA, AND ROBERT W. GAINES
70.
Complications of Spondylolysis/Spondylolisthesis Surgery . . . . . . . . . . . . . . . . 701

JOHN P. LUBICKY AND AMER ZENI
SECTION VII: Idiopathic Scoliosis

SECTION EDITOR: CHARLES C. EDWARDS II
71.
Introduction to Adolescent Idiopathic Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . 709

CHARLES C. EDWARDS II AND KEITH H. BRIDWELL
72.
Natural History Including Measures of Maturity. . . . . . . . . . . . . . . . . . . . . . . . 711

JAMES O. SANDERS
73.
Clinical Assessment and ParentPatient Expectations. . . . . . . . . . . . . . . . . . . . . 721

ANTHONY RINELLA
74.
Spinal Deformity Outcomes Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 728

RUDOLPH CHRISTOPHER GLATTES, DOUGLAS C. BURTON, AND SUE MIN LAI
75.
Radiographic Classification Scheme: Lenke Classification . . . . . . . . . . . . . . . . . . 738

LAWRENCE G. LENKE
76.
Fusionless Surgery and Growing Rod Techniques for Infantile and

Juvenile Idiopathic Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 754
BEHROOZ A. AKBARNIA, GEORGE H. THOMPSON, AND GREGORY M. MUNDIS JR
77.
Stapling Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 766

TIMOTHY S. OSWALD, PATRICK J. CAHILL, AMER F. SAMDANI, AND RANDAL R. BETZ
78.
Open and Thoracoscopic Anterior Thoracic Surgery . . . . . . . . . . . . . . . . . . . . . 778

PETER O. NEWTON AND VIDYADHAR V. UPASANI
79.
Thoracoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 792
DAVID H. CLEMENTS, AMER F. SAMDANI, AND RANDAL R. BETZ
80.
Evolution of Instrumentation for Adolescent Idiopathic Scoliosis . . . . . . . . . . . 800

GBOLAHAN O. OKUBADEJO AND KEITH H. BRIDWELL
81.
Short Segment Bone-on-Bone Fusion for Adolescent Idiopathic Scoliosis . . . 808

JULIAN A. ROMAGNOLI AND ROBERT W. GAINES
82.
Posterior Spinal Deformity Correction Techniques . . . . . . . . . . . . . . . . . . . . . . 823

BRIAN A. OSHAUGHNESSY AND LAWRENCE G. LENKE
83.
Anterior Lumbar and Thoracolumbar Correction and Fusion for AIS . . . . . . . . 848
DANIEL J. SUCATO, HONG ZHANG, AND CHARLES E. JOHNSTON
84.
Treatment of Thoracic Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866

KEITH H. BRIDWELL
Contents
85.
xxxiii
Selective Thoracic Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 889

BRETT FREEDMAN, CHARLES EDWARDS II, AND KEITH H. BRIDWELL
86.
Complications Associated with Adolescent Idiopathic Scoliosis Surgery . . . . . . . 905

MARK C. LEE, B. STEPHENS RICHARDS, AND CHARLES E. JOHNSTON
SECTION VIII: Adult Spinal Deformity

SECTION EDITOR: CHRISTOPHER L. HAMILL
87.
Adult Spinal DeformityIntroduction/State of the Art . . . . . . . . . . . . . . . . . . 919

CHRISTOPHER L. HAMILL
88.
Adult Spinal Deformity Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 921

FRANK SCHWAB, SIGURD BERVEN, AND KEITH H. BRIDWELL
89.
De Novo Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 929

ASHISH PATEL, FRANK SCHWAB, AND JEAN-PIERRE FARCY
90.
Sagittal Imbalance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 938

CHRISTOPHER L. HAMILL, PETER D. ANGEVINE, AND KEITH H. BRIDWELL
91.
Fixed Coronal Imbalance of the Spine: Clinical Significance and

Operative Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 948
BRIAN HSU AND SIGURD BERVEN
92.
Spinal Deformity in the Older Patient With Kyphosis . . . . . . . . . . . . . . . . . . . . 962

FRANK L. ACOSTA JR, TYLER KOSKI, AND STEPHEN L. ONDRA
93.
Revision Surgeries for Adult Spinal Deformity . . . . . . . . . . . . . . . . . . . . . . . . . 970

MATTHEW E. CUNNINGHAM AND OHENEBA BOACHIE-ADJEI
94.
Smith-Petersen Osteotomy of the Spine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 982

DOUGLAS C. BURTON
95.
Pedicle Subtraction Procedures for Complex Spinal Deformity . . . . . . . . . . . . . 987

BRIAN A. OSHAUGHNESSY, JACOB M. BUCHOWSKI, AND KEITH H. BRIDWELL
96.
Vertebral Column Resection for Complex Spinal Deformity:

Posterior Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999
SE-IL SUK
97.
Vertebral Column Resection for Complex Spinal Deformity:

Anterior and Posterior Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1015
SIGURD BERVEN AND DAVID S. BRADFORD
98.
Minimally Invasive Deformity Surgery: Future Directions . . . . . . . . . . . . . . . . 1021

FADI NASR, TYLER KOSKI, JOHN LIU, STEPHEN ONDRA, AND RICHARD FESSLER
99.
Fusion to the Sacrum and Fixation Techniques of the Sacropelvic Junction . . . 1031
ANGEL E. MACAGNO AND MICHAEL F. OBRIEN
100.
Structural Grafting for Adult Spinal Deformity. . . . . . . . . . . . . . . . . . . . . . . . 1052

PETER D. ANGEVINE AND KEITH H. BRIDWELL
xxxiv
Contents
SECTION IX: Dysplastic and Congenital Deformities

SECTION EDITOR: SCOTT J. LUHMANN
101.
Introduction/State of the Art in the Care of Dysplastic and

Congenital Spine Deformities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1059
SCOTT J. LUHMANN
102.
Dysplastic Scoliosis: Neurofibromatosis Spinal Pathology . . . . . . . . . . . . . . . . 1062

ALVIN H. CRAWFORD, AND KEITH R. GABRIEL
103.
Spinal Deformities in Marfan Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1078

PAUL D. SPONSELLER
104.
Spinal Deformity in Skeletal Dysplasia Conditions . . . . . . . . . . . . . . . . . . . . . 1084

ERIC D. SHIRLEY AND MICHAEL C. AIN
105.
The Spine in Osteogenesis Imperfecta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1099

PAUL D. SPONSELLER AND SERGIO A. GLAIT
106.
Spinal Deformity in Familial Dysautonomia . . . . . . . . . . . . . . . . . . . . . . . . . . 1107

DAVID S. FELDMAN, FULYA STNKAN, AND DEBRA A. SALA
107.
Congenital Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1118

MICHAEL J. MCMASTER
108.
Hemivertebra Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1139

MICHAEL RUF AND JRGEN HARMS
109.
Congenital Intraspinal Anomalies: Spinal

DysraphismEmbryology, Pathology, and Treatment . . . . . . . . . . . . . . . . . . . 1149
JEFFREY LEONARD, M. MOHSIN SHAH, AND BRUCE KAUFMAN
110.
Thoracic Insufficiency Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1179

ROBERT M. CAMPBELL JR.
111.
Congenital Anomalies of the Cervical Spine in Children:

Management of Segmental Instability and Spinal Canal Encroachment . . . . . . 1194
HARISH S. HOSALKAR, DANIELLE B. CAMERON, AND DENIS S. DRUMMOND
SECTION X: Paralytic Deformity

SECTION EDITOR: SCOTT J. LUHMANN
112.
Introduction/State of the Art in the Care of the Paralytic

and Neuromuscular Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1209
SCOTT J. LUHMANN
113.
Paralytic Scoliosis and the Spastic Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1214

THOMAS G. MCPARTLAND AND JOHN B. EMANS
114.
Surgical Treatment of Flaccid Neuromuscular Scoliosis . . . . . . . . . . . . . . . . . . 1229

GILBERT CHAN, DAVID A. SPIEGEL, AND DENIS S. DRUMMOND
115.
Surgical Treatment of Myelomeningocele Deformities . . . . . . . . . . . . . . . . . . . 1244

RICHARD E. MCCARTHY
Contents
116.
xxxv
Management of Paralytic Neuromuscular Disorders with an

Emphasis on Pelvic Obliquity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1252
DANIEL J. HEDEQUIST
117.
Role of Halo Traction and Halo-Femoral Traction in

Paralytic/Neuromuscular Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1265
SCOTT J. LUHMANN AND DAVID L. SKAGGS
SECTION XI: Kyphosis and Postlaminectomy Deformities

SECTION EDITOR: PETER D. ANGEVINE
118.
Introduction and Current State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . 1279

PETER ANGEVINE
119.
Cervical Instability and Kyphosis (Rheumatoid,

Dwarfism, Degenerative, Others) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1281
ERIC HARRIS, JAMES LAWRENCE, JEFFREY RIHN, JOSEPH GONDUSKY, AND
ALAN HILIBRAND
120.
Surgical Treatment of Scheuermanns Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . 1295

ANGEL E. MACAGNO, MICHAEL F. OBRIEN, AND HARRY L. SHUFFLEBARGER
121.
Short-Segment Anterior Fusion of Symptomatic Scheuermanns Disease . . . . . 1312

JWALANT S. MEHTA AND ROBERT W. GAINES
122.
Postlaminectomy Deformities in the Thoracic and Lumbar Spine . . . . . . . . . . 1326

BRANDON G. ROCQUE, SHARAD RAJPAL, AND DANIEL K. RESNICK
123.
Posttraumatic Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1332

JACOB M. BUCHOWSKI
124.
Ankylosing Spondylitis/Thoracolumbar Deformities . . . . . . . . . . . . . . . . . . . . 1340

CHRISTOPHER L. HAMILL
125.
Cervicothoracic Extension Osteotomy for Chin-On-Chest Deformity . . . . . . . 1345

CHRISTOPHER G. FUREY
126.
The Role of Osteotomies in the Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . 1355

K. DANIEL RIEW AND ADAM L. WOLLOWICK
SECTION XII: Trauma

SECTION EDITOR: RONALD A. LEHMAN, JR.
127.
Trauma State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1377

RONALD A. LEHMAN, JR. AND TOBIN ECKEL
128.
Classification of Cervical Spine Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1381

ALPESH A. PATEL, ALEXANDER R. VACCARO, AND PAUL A. ANDERSON
129.
Classification of Thoracic and Lumbar Fractures . . . . . . . . . . . . . . . . . . . . . . . 1390

RONALD A. LEHMAN, JR., JASON T. BESSEY, AND ALEXANDER R. VACCARO
xxxvi
Contents
130.
Surgical Management of Cervical Spine Fractures . . . . . . . . . . . . . . . . . . . . . . 1399

KELLEY BANAGAN AND DANIEL GELB
131.
Anterior and Posterior Instrumentation Techniques Used in the

Thoracic Spine for Treatment of Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . 1411
DAVID H. KIM, JEFFREY A. RIHN, AND TODD J. ALBERT
132.
Surgical Treatment of Thoracolumbar and Lumbar Fractures . . . . . . . . . . . . . 1424

MICHAEL D. DAUBS AND SHAY BESS
133.
Anterior Decompression Techniques for Thoracic and Lumbar Fractures. . . . . 1439

DAVIS L. REAMES, D. KOJO HAMILTON, ANTON TOOMAS, AND
CHRISTOPHER I. SHAFFREY
134.
Minimal Access Techniques for Spine Trauma . . . . . . . . . . . . . . . . . . . . . . . . . 1449

JOSEPH RIINA, DAVID G. SCHWARTZ, JASON E. SMITH, AND KATHY J. FLINT
135.
Management and Surgical Treatment of Fractures of

the Lumbosacral Region and the Sacrum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1460
CARLO BELLABARBA, THOMAS A. SCHILDHAUER, M.L. CHIP ROUTT, AND
JENS R. CHAPMAN
136.
Novel Approaches to Neural Repair and Regeneration

After Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1474
ELENA OKON, JESSICA HILLYER, AND BRIAN K. KWON
SECTION XIII: Tumor and Osteomyelitis

SECTION EDITOR: PETER D. ANGEVINE
137.
Introduction and State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1485

PETER D. ANGEVINE
138.
Benign Tumors of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1487

SUMEET GARG AND JOHN P. DORMANS
139.
Primary Malignant Tumors of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1499

GREGORY S. MCLOUGHLIN, DANIEL M. SCIUBBA, AND JEAN-PAUL WOLINSKY
140.
The Surgical Treatment of Metastatic Spine Disease . . . . . . . . . . . . . . . . . . . . 1511

ILYA LAUFER, PETER S. ROSE, AND MARK H. BILSKY
141.
Intramedullary Spinal Cord Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1520

KAZUTOSHI HIDA
142.
Intradural, Extramedullary Spinal Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . 1535

ALFRED T. OGDEN AND PAUL C. MCCORMICK
143.
Spinal Vascular Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1544

MICHELLE J. CLARKE, WILLIAM E. KRAUSS, AND MARK A. PICHELMANN
14 4.
Spinal Infection/Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1553

SANFORD E. EMERY AND RYAN T. GOCKE
Contents
145.
xxxvii
Tumors of the Sacrum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1560

ALEXANDRE RASOULI, H. THOMAS TEMPLE, AND FRANK J. EISMONT
146.
Adjuvant Therapy of Spinal Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1575

ILYA LAUFER, YOSHIYA YAMADA, AND MARK H. BILSKY
SECTION XIV: Complications

SECTION EDITOR: JACOB M. BUCHOWSKI
147.
Introduction/State-of-the-Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1581
JACOB M. BUCHOWSKI
148.
Neurological Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1584

LUKAS P. ZEBALA AND JACOB M. BUCHOWSKI
149.
Reconstruction of Complex Spinal Wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . 1591

BRENDAN COLLINS AND RICHARD J. REDETT
150.
Vascular Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1598

GREGORY GEBAUER AND A. JAY KHANNA
151.
Postoperative Early and Late Wound/Implant Infections . . . . . . . . . . . . . . . . 1608

SUMEET GARG AND JACOB M. BUCHOWSKI
152.
Cerebrospinal Fluid Fistula and Pseudomeningocele . . . . . . . . . . . . . . . . . . . . 1617

KENE UGOKWE AND EDWARD C. BENZEL
153.
Pseudarthrosis in Spinal Deformity Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 1622

YONGJUNG J. KIM AND PETER D. ANGEVINE
154.
Legal Implications and Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1633

JANICE F. MULLIGAN, HEATHER HANSEN, JESSICA UITTO,
PAUL CRAIG, AND STEVEN R. GARFIN
155.
Unresolved Postoperative Spine Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1649

WILLIAM C. LAUERMAN AND STEVEN C. SCHERPING
156.
Medical Complications Associated with Spinal Surgery . . . . . . . . . . . . . . . . . . 1665

ELI M. BARON AND TODD J. ALBERT
Index 1675

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The Textbook of

Acquisitions Editor: Robert Hurley

To the patients who will benefit from our evolving

I first met Dr. Bridwell in the early 1980s at a spine meeting in

spine from occiput to pelvis, offering diagnoses for all ages

Frank L. Acosta, Jr., MD

Peter D. Angevine, MD, MPH

Raheel Ahmed, MD, PhD

Robert Shay Bess, MD

Shelly M. Bolon, BS, CNIM

Jacob M. Buchowski, MD, MS

Robert M. Campbell, Jr., MD

Victoria A. Campbell, ENS, MC, USN

Mauricio A. Campos Daziano, MD

Charles H. Crawford III, MD

David H. Clements III, MD

Paul Richard Cooper, MD

Paul A. Craig, RN, JD

Alvin H. Crawford, MD, FACS

Matthew E. Cunningham, MD, PhD

Linda Park DAndrea, MD

Alexis B.C. Dang, MD

John R. Dimar II, MD

Anton E. Dmitriev, PhD, MSc

Angus S. Don, MD, FRACS

Sanford E. Emery, MD, MBA

Jack R. Engsberg, PhD

Richard G. Fessler, MD, PhD

Charles C. Edwards II, MD

Robert W. Gaines, Jr., MD

Gregory P. Gebauer, MD, MS

Ziya L. Gokaslan, MD, FACS

Hartmann Habbicht, PhD

Heather Hansen, Esq.

Kazutoshi Hida, MD, PhD

Jessica Hillyer, PhD

Brian C. Hsu, MBBS, FRACS

Charles E. Johnston II, MD

Sue Min Lai, PhD, MS, MBA

Manish P. Lambat, MS DNB

Andrew G.S. King, MB, ChB, FRACS, FACS

Timothy R. Kuklo, MD, JD

Brian K. Kwon, MD, PhD, FRCSC

Ronald A. Lehman, Jr., MD

John P. Lubicky, MD, FAAOS, FAAP

Steven M. Mardjetko, MD, FAAP

Paul C. McCormick, MD, MPH

Gegory S. McLoughlin, MD, FRCSC

Michael John McMaster, MD, FRCS

Jwalant S. Mehta, MS, MCh, FRCS

Consultant Spine Surgeon

Arnold H. Menezes, MD, FACS, FAAP

Professor and Vice Chairman

Elena B. Okon, PhD

Janice F. Mulligan, Esq.

Professor of Neurological Surgery

LTC Joseph R. Orchowski, MD

Anne M. Padberg, MS, CCC-A

Daniel K. Resnick, MD, MS

David W. Polly, Jr., MD