E-Book, Englisch, 1528 Seiten, ePub
Reihe: AO-Publishing
Aebi AO Spine Manual, Volume 1: Principles and Techniques; Volume 2: Clinical Applications
1. Auflage 2007
ISBN: 978-3-13-258187-6
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 1528 Seiten, ePub
Reihe: AO-Publishing
ISBN: 978-3-13-258187-6
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Based on the successful format of AO courses, this two-volume reference is a comprehensive manual for the latest AO spine techniques. For each case, the book guides the reader from case presentation, through rationale for surgical treatment, and to non-operative treatment options. The authors describe potential complications in spine surgery and outcomes.
Volume I, , begins with a complete review of basic science concepts, helping the reader understand the biomechanics, biology, and the surgical anatomy of the spine. This volume provides a systematic overview of spinal instrumentation, computer-assisted surgery, and anesthesia considerations.
Volume II,, presents a compilation of clinical cases addressing the most common spinal problems, such as spinal trauma, tumors, infections, inflammatory processes, deformities, degenerative spinal diseases, and metabolic bone disease.
Throughout both volumes, high-quality photographs and drawings illustrate surgical techniques step-by-step and demonstrate key concepts of management. Clear, easy-to-reference bulleted lists and shaded text boxes facilitate rapid review of important learning points. An accompanying DVD-ROM with video clips from live surgery symposia and practical exercises also enhance the reader's learning experience.
Max Aebi, Vincent Arlet, John K. Webb
Zielgruppe
Ärzte
Fachgebiete
Weitere Infos & Material
Volume 1
1 Preface—AO Education and Teaching Concept
2 Introduction—AO Principles Applied to the Spine
3 History of Spine Surgery Within AO
4 Biomechanics of the Spine
5 Biology of the Spine
6 Surgical Anatomy of the Spine
7 Spinal Instrumentation
8 Computer-Assisted Surgery
9 Anesthesia for Spine Surgery
Volume 2
1 Spinal Trauma
2 Spinal Tumors
3 Infections of the Spine
4 Inflammatory Processes
5 Deformities of the Spine
6 Spondylolysis, Spondylolisthesis, and Spondyloptosis
7 Degenerative Spinal Diseases
8 Metabolic Bone Disease of the Spine—Osteoporosis
9 Complications in Spine Surgery
10 Documentation, Evaluation, and Outcome in Spine Surgery
2 INTRODUCTION—AO PRINCIPLES APPLIED TO THE SPINE
Max Aebi
1 AO organization
1 AO ORGANIZATION
The AO organization has attained its reputation as a world leader in musculoskeletal trauma through its innovative and systematic approach to operative fracture treatment which started in the mid 1950s. Over the years, the AO organization has become a foundation with a mission based on four fundamental pillars: development, research, education, and documentation. These four elements are all geared toward a fracture treatment that is based on stable internal fixation to allow faster bone healing and early motion of the injured limb. Thus, early mobilization, active rehabilitation, and early reintegration of the patient into their original social and working environment are made possible.
AO has allocated enormous resources to making fracture treatment better, more standardized, reproducible, and rational; these improvements are based on scientific research throughout the whole continuum from the bench (basic science), to the bed side (clinical application), and beyond (outcome).
These principles were transferred to treating primarily spinal fractures within this environment and context, while the enormous potential of stable internal fixation for the whole spectrum of spinal disorders had not yet been recognized. Compared to long-bone fractures, spinal fractures are almost always “articular” injuries afflicting the motion segment (ie, the functional unit, FU, of the spine), involving the disc, facet joints, ligamentous structures, and at least one of the adjacent vertebrae. Even today, these injuries cannot be “reconstructed” in an anatomical fashion like a long-bone fracture, but they need to be treated with a fusion, a measure that nature would finally have done over a prolonged period of time in many cases by itself. In most of the cases, the spinal fracture treatment ends with an arthrodesis of two or more vertebral bodies, in which all the principles of modern fracture treatment propagated by AO can be applied: optimal mechanical conditions for fitting two or more parts together, anatomical alignment, stable internal fixation, compression between the parts fitted together, and early mobilization and muscular exercise to avoid the fracture “disease”. In the very few cases of spinal trauma where pure fracture principles can be applied, fusion is obviously avoided (odontoid fracture, traumatic spondylolysis of C2 and lumbar vertebrae).
The early spine surgeons within AO developed surgical concepts and implants, which allowed a comprehensive treatment of spinal fractures: anterior and posterior plating of the cervical spine, pedicular fixation, and anterior plating as well as rod systems for thoracolumbar fractures. All of these are concepts, which hold true today, although many implants have been adapted under market pressures into more sophisticated or “modern” implants.
In the late 1960s and 1970s the AO surgeons used the Harrington instrumentation, which was originally developed for deformity surgery. They quickly understood the significance of the pedicle as an anatomical entity for anchoring instrumentation to the spine as introduced by Judet and Roy-Camille. Magerl, and later Dick, however, made it possible to shorten the extent of the fixation on the spine by linking the pedicle screws in an angle-stable fashion to a vertical bar (rod); first with the external fixator, and later on with the internal fixator. For the first time this technology allowed the surgeon to limit the fixation to one or two segments, thereby preserving the mobility of healthy motion segments. The intrinsic stability of these new systems allowed for early mobilization of the patient without a cast or corset, which are detrimental to the stabilizing muscles of the spine and highly uncomfortable for the patient. While AO temporarily borrowed the Harrington instrumentation to deal with fractures, the AO surgeons started to use the original trauma implants and concepts in nontraumatic conditions, foremost for degenerative diseases, pathological fractures (tumors, infections), and finally in deformities. The leading principles were: reconstruction of the anatomy, stable fixation respecting fundamental mechanical principles of the spine, short fixation to maintain a maximum number of mobile motion segments, and early mobilization. In 1981 a patient with an anterior lumbar interbody fusion usually had to stay in bed and in hospital for 4–6 weeks. Today, the patient can leave the hospital 3–4 days after surgery wearing a soft brace for comfort if needed.
In 2003, a spine section was formally created within the AO Foundation with a great amount of autonomy in day-to-day business and ultimately its own legal structure (2006). This organization has finally implemented all four pillars of the AO Foundation:
- Development of implants based on sound scientific principles.
- Education.
- Research network with clear research priorities and strategies.
- Documentation systems with specific registries.
2 DEVELOPMENT
Having been influenced and stimulated by the early success in spinal trauma surgery, in 1987 Aebi and Webb had a vision to design and develop a philosophy of spine surgery. This philosphy included a spinal system, which not only addresses trauma, but the whole spinal pathology from the occiput to the sacrum, and from the front as well as from the back. These spine surgeons utilized what they had learned from the AO founders: to develop precise, simple instrumentation with as few instruments and implants as possible, but of the highest quality, which allowed for a reproducible surgical treatment of the spine. This led to an enormous expansion of the possibilities and indications in spine surgery. Such a large development, at least initially, represented a challenge for the teaching and education of a small spine group at the time. More and more surgeons adhered to the AOSpine cause, forming a group of surgeons who paralleled their trauma colleagues in developing their own less invasive spine surgery concept. This included cages, bone substitutes, and sophisticated retractor systems in combination with optical systems (technology integration in the true sense of word). At this time, the group did not jump on the bandwagon of endoscopic spine surgery. 10 years later, when endoscopic spine surgery was recognized as a fad, nonAO surgeons and producers switched to the AO concepts by imitating, for instance, the retractor system. This is just one example of how AO's first spine surgeons, in the tradition of the AO Foundation, acted as the leaders and initiators of new trends in spine surgery.
3 EDUCATION
Although the AO's spine surgeons adapted very quickly to the concept of trauma courses, very soon they developed new educational pathways by introducing interactive case-based courses and live surgery courses. This leadership, and the success of such educational formats, were soon to be adopted in other subspeciality courses. It also became necessary to compile a manual of AO principles in spine surgery in order to bring all the knowledge of broad variety and high versatility in spine surgery together. This handbook quickly appeared in four languages (English, Spanish, Mandarin, and Japanese) [1]. Due to the very rapid accumulation of new technology and new knowledge the “AOSpine Manual” was to be followed quickly by this more comprehensive book, which you now hold in your hands.
One of the major tasks in education today is to offer teaching and learning modules that benefit not only orthopedic surgeons, but neurosurgeons as well. Spine surgery has become a sub-specialty, which can be reached through different curricula: orthopedic surgery and neurological surgery.
4 RESEARCH
Whereas AO institutions and AO-linked clinical departments have contributed significantly to the assessment of new implants—biomechanically and clinically—the AOSpine group has decided to use its resources in a very focused manner and to explore as a first priority the aging and degenerated disc with the possibility of replacing it with biological and/or mechanical devices, thus, maintaining the function of a motion segment. Today's market is overflowing with new mechanical prostheses with very poorly established background data. To assure a sustained development and growth it is paramount that sound scientific knowledge is established before adding other implants. The AOSpine group has decided to put most of the available resources for research in centers that have already created specific knowledge and expertise, and which can be linked as a spinal reference network for research. The second priority is the aging spine, specifically the bone (osteoporosis) and ways in which it can be repaired.
The challenges of the future are manifold:
- To maintain the integrity of a medical and scientific organization that is driven by real innovative thinking and conceptual approaches.
- To develop a strong presence in the spine world, by maintaining the values and valid principles of the AO Foundation.
- To open the AO's community to an extended spine world by building and maintaining an integrated basic and clinical science and research network. This should cover the real needs of an aging society in spinal care for which new products have to be developed for the benefit of the patients.
- To incorporate...
