Denaro / D'Avella Pitfalls in Cervical Spine Surgery

Avoidance and Management of Complications
1. Auflage 2009
ISBN: 978-3-540-85019-9
Verlag: Springer Berlin Heidelberg
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 303 Seiten

Spinal surgery is a unique area in the process of continuous development. New skills are applied daily in this delicate field by the spinal surgeon: this professional can be either an orthopaedic surgeon or a neurosurgeon dedicated to the treatment of spinal diseases. This book offers a comprehensive approach and reviews all of the possible errors encountered by spinal surgeons in the clinical practice. It is mainly directed towards young surgeons approaching spinal surgery and also to experienced surgeons with regards to complications related to the latest technologies in the spinal field. This approach of treating and understanding problems in cervical spine surgery is unique and will guide the reader towards an improved level of attention regarding pitfalls in cervical spine surgery, therefore fostering the ability of preventing major complications and medicolegal consequences.

Autoren/Hrsg.

Denaro, Luca

D'Avella, Domenico

Denaro, Vincenzo

Inhaltsverzeichnis

1;Copyright Page;4
2;Foreword;5
3;Foreword;7
4;Preface;8
5;Contents;10
6;Contributors;12
7;Part I: General Complications;15
7.1;Chapter 1;16
7.1.1;Complication Related to Medical Conditions;16
7.1.1.1;1.1 Introduction;16
7.1.1.2;1.2 Comorbidities Increasing the Risk of Major Perioperative Complications;16
7.1.1.3;1.3 Comorbidities Specifi cally Increasing the Risk of Perioperative Cardiac Events;17
7.1.1.4;1.4 Comorbidities Increasing the Risk of Postoperative Infections and Their Management;18
7.1.1.5;1.5 Comorbidities Complicating Spinal Fusion;20
7.1.1.6;1.6 Comorbidities Associated with Poor Neurologic Recovery After Surgery;21
7.1.1.7;References;22
7.2;Chapter 2;25
7.2.1;Hematologic Issues in Cervical Spine Surgery;25
7.2.1.1;2.1 Changes in Blood Cell Count Parameters;25
7.2.1.1.1;2.1.1 Anemia;25
7.2.1.1.1.1;2.1.1.1 Approach to the Anemic Patient;25
7.2.1.1.1.2;2.1.1.2 Anemia’s Decalogue for the Surgeon;27
7.2.1.1.2;2.1.2 Polycythemia;27
7.2.1.1.2.1;2.1.2.1 Polycythemia and Cervical Spinal Surgery;28
7.2.1.1.2.2;2.1.2.2 Tips for the Orthopedic Surgeon in the Presence of a PV;28
7.2.1.1.3;2.1.3 Reduction in the White Blood Cell Count;28
7.2.1.1.3.1;2.1.3.1 Absolute Neutropenia;28
7.2.1.1.3.2;2.1.3.2 Absolute Lymphocytopenia;29
7.2.1.1.4;2.1.4 Increase in White Blood Cell Count;29
7.2.1.1.4.1;2.1.4.1 Absolute Neutrophilia;29
7.2.1.1.4.2;2.1.4.2 Absolute Lymphocytosis;29
7.2.1.1.4.3;2.1.4.3 Absolute Eosinophilia and Absolute Monocytosis;29
7.2.1.1.5;2.1.5 Changes in Platelet Count;29
7.2.1.1.5.1;2.1.5.1 Abnormal Increase in Platelet Count;29
7.2.1.1.5.2;2.1.5.2 Abnormal Decrease in Platelet Count;30
7.2.1.1.6;2.1.6 How a Cervical Spine Surgeon should Manage Patients with Changes in Blood Cell Count;30
7.2.1.2;2.2 Patients with Monoclonal Gammopathy;31
7.2.1.2.1;2.2.1 Monoclonal Gammopathy of Undetermined Significance (MGUS);31
7.2.1.2.2;2.2.2 Multiple Myeloma;32
7.2.1.3;2.3 Preoperative Evaluation of the Hemorrhagic Risk;32
7.2.1.3.1;2.3.1 Abnormal Hemostatic and Coagulation Parameters;32
7.2.1.3.1.1;2.3.1.1 Qualitative Platelets Defects (Thrombocytopathies);33
7.2.1.3.1.2;2.3.1.2 Coagulopathies;34
7.2.1.3.1.3;2.3.1.3 The laboratory Interface;35
7.2.1.4;2.4 Preoperative Evaluation of the Thromboembolic Risk;35
7.2.1.5;2.5 Thromboprophylaxis in Cervical Spine Surgery;36
7.2.1.6;References;38
7.3;Chapter 3;40
7.3.1;Complications in Surgical Management of Cervical Spinal Metastases;40
7.3.1.1;3.1 Spinal Metastases: Introduction;40
7.3.1.1.1;3.1.1 Epidemiology;40
7.3.1.1.2;3.1.2 Anatomical Localization and Pathophysiology;40
7.3.1.1.3;3.1.3 Presentation;41
7.3.1.1.4;3.1.4 Management: Past and Present;42
7.3.1.1.5;3.1.5 Surgical Indications and Approaches;43
7.3.1.2;3.2 Surgery-Related Prognosis in Bone Metastatic Patients;43
7.3.1.2.1;3.2.1 Surgery-Related Complications;44
7.3.1.2.1.1;3.2.1.1 Surgical Complications;44
7.3.1.2.1.2;3.2.1.2 Hardware-Related Complications;45
7.3.1.2.1.3;3.2.1.3 Medical Complications;46
7.3.1.2.1.4;3.2.1.4 Complications Rates of Spinal Surgery and Minimally Invasive Spinal Surgery;46
7.3.1.2.2;3.2.2 Presurgical Quantifi cation of Risk and Patient Selection;48
7.3.1.2.3;3.2.2.1 Classifi cations: Prediction of Life Expectancy and Optimal Treatment Selection;49
7.3.1.3;References;53
7.4;Chapter 4;55
7.4.1;Systematic Approach to the Patient to Minimize Errors of Diagnosis and Surgical Indications;55
7.4.1.1;4.1 Introduction;55
7.4.1.2;4.2 Approach to the Patient with NeckPain: History;56
7.4.1.3;4.3 Physical Examination;58
7.4.1.4;4.4 Laboratory Studies;60
7.4.1.5;4.5 Imaging;60
7.4.1.6;4.6 Neurophysiology (Electrodiagnostic Studies);62
7.4.1.6.1;4.6.1 Electromyography;62
7.4.1.6.2;4.6.2 Evoked Potentials;63
7.4.1.6.2.1;4.6.2.1 Somatosensory-Evoked Potentials;63
7.4.1.6.2.2;4.6.2.2 Motor-Evoked Potentials;63
7.4.1.7;4.7 General Considerations and Conclusions;63
7.4.1.8;References;65
8;Part II: Peri-operative complications;67
8.1;Chapter 5;68
8.1.1;Considerations and Anesthesiologic Complications in Spinal Surgery;68
8.1.1.1;5.1 Preoperative Consideration;68
8.1.1.1.1;5.1.1 Age;68
8.1.1.1.2;5.1.2 General Health Conditions;68
8.1.1.1.3;5.1.3 Functional State;68
8.1.1.1.4;5.1.4 Nutrition Conditions;69
8.1.1.1.5;5.1.5 Psychological State;69
8.1.1.1.6;5.1.6 Cardiologic Problems;69
8.1.1.1.7;5.1.7 Lung Disease;70
8.1.1.1.8;5.1.8 Liver Disease;70
8.1.1.1.9;5.1.9 Kidney Disease;70
8.1.1.2;5.2 Perioperative Considerations;70
8.1.1.2.1;5.2.1 Airways Management;70
8.1.1.2.1.1;5.2.1.1 Direct Laryngoscopy;71
8.1.1.2.1.2;5.2.1.2 Trachlight ®;71
8.1.1.2.1.3;5.2.1.3 Airtraq ®;71
8.1.1.2.1.4;5.2.1.4 Glidescope ®;72
8.1.1.2.1.5;5.2.1.5 LMA-Classic™;73
8.1.1.2.1.6;5.2.1.6 LMA-Fastrach™;73
8.1.1.2.1.7;5.2.1.7 LMA-Proseal™;73
8.1.1.2.1.8;5.2.1.9 Cobra PLA;74
8.1.1.2.2;5.2.2 Pulmonary Ventilation in Vertebral Surgery;74
8.1.1.2.3;5.2.3 Mechanic Breathing and Patient’s Positioning Effects;75
8.1.1.2.4;5.2.4 Controlled Hypotension;75
8.1.1.2.5;5.2.5 Perioperative Monitoring;75
8.1.1.2.5.1;5.2.5.1 Breathing Monitoring (Primus/Zeus Drager ® );75
8.1.1.2.5.2;5.2.5.2 Hemodynamic Monitoring;75
8.1.1.2.5.3;5.2.5.3 Fluid Balance;75
8.1.1.2.5.4;5.2.5.4 Body Temperature Monitoring;76
8.1.1.3;References;76
8.2;Chapter 6;78
8.2.1;General Complications Related to Patient Positioning;78
8.2.1.1;6.1 Introduction;78
8.2.1.2;6.2 Posterior Approach: Precautions and Recommendation;78
8.2.1.3;6.3 Anterior Approach: Precautions and Recommendation;81
8.2.1.4;6.4 Circumferential Approach: Precautions and Recommendation;83
8.2.1.5;References;85
9;Part III: Complications of Surgical Approaches;87
9.1;Chapter 7;88
9.1.1;Complications Related to Anterior Approaches;88
9.1.1.1;7.1 Transoral Approach;88
9.1.1.1.1;7.1.1 Surgical Technique;89
9.1.1.1.2;7.1.2 Complications;91
9.1.1.1.2.1;7.1.2.1 Intraoperative Complications;92
9.1.1.1.2.1.1;Soft Tissue Injury;92
9.1.1.1.2.1.2;Neural Injury;93
9.1.1.1.2.1.3;Osseous Injury;93
9.1.1.1.2.2;7.1.2.2 Postoperative Complications;93
9.1.1.1.2.2.1;Soft Tissues Injury;93
9.1.1.1.2.2.2;Neural Injury;94
9.1.1.1.2.2.3;Osseous Injury;94
9.1.1.1.2.2.4;Postoperative Infection;94
9.1.1.2;7.2 Transmandibular Approach;94
9.1.1.2.1;7.2.1 Complications;94
9.1.1.3;7.3 Submandibular Approach;95
9.1.1.3.1;7.3.1 Complications;95
9.1.1.4;References;96
9.2;Chapter 8;98
9.2.1;Complications Related to Anterolateral Approaches;98
9.2.1.1;8.1 High and Low Presternocleidomastoid Approaches (Retropharyngeal and Precarotid);98
9.2.1.1.1;8.1.1 Surgical Technique;98
9.2.1.1.1.1;8.1.1.1 Low Anterolateral Approach;98
9.2.1.1.1.2;8.1.1.2 High Anterolateral Approach;101
9.2.1.1.2;8.1.2 Intraoperative Complications;102
9.2.1.1.2.1;8.1.2.1 Vascular Injuries;102
9.2.1.1.2.1.1;Carotid Artery;102
9.2.1.1.2.1.2;Vertebral Artery;104
9.2.1.1.2.1.3;Jugular Vein;105
9.2.1.1.2.1.4;Thyroid Vessels;105
9.2.1.1.2.2;8.1.2.2 Soft Tissue and Visceral Injury;106
9.2.1.1.2.2.1;Esophagus and Pharynx;106
9.2.1.1.2.2.2;Salivary Duct;106
9.2.1.1.2.2.3;The Thyroid Gland;107
9.2.1.1.2.2.4;The Thoracic Duct;107
9.2.1.1.2.3;8.1.2.3 Neurological Injury;108
9.2.1.1.2.3.1;Facial Nerve (Seventh Cranial Nerve) and Hypoglossal Nerve (Twelfth Cranial Nerve);108
9.2.1.1.2.3.2;Laryngeal Nerves;108
9.2.1.1.2.3.3;Cervical Sympathetic Chain;109
9.2.1.1.2.3.4;Spinal Cord and to the Nerve Roots;109
9.2.1.1.3;8.1.3 Postoperative Complications;109
9.2.1.2;8.2 Presternocleidomastoid Approach (Retropharyngeal and Retrocarotid);109
9.2.1.2.1;8.2.1 Technique;110
9.2.1.2.2;8.2.2 Complications;110
9.2.1.2.2.1;8.2.2.1 Vascular Injury;110
9.2.1.2.2.2;8.2.2.2 Neurological Injury;111
9.2.1.2.2.3;8.2.2.3 Visceral Injury;111
9.2.1.2.3;8.2.3 Advantages;111
9.2.1.3;8.3 Retrosternocleidomastoid Approach;111
9.2.1.4;References;113
9.3;Chapter 9;116
9.3.1;Complications Related to Posterior Approach;116
9.3.1.1;9.1 Introduction;116
9.3.1.2;9.2 Pitfalls;118
9.3.1.2.1;9.2.1 Bad Positioning;118
9.3.1.2.2;9.2.2 Neurological Injury;118
9.3.1.2.3;9.2.3 Cerebrospinal Fluid Leaks;120
9.3.1.2.4;9.2.4 Postoperative C5 Palsy;120
9.3.1.2.5;9.2.5 Vascular Injuries;121
9.3.1.3;References;123
10;Part IV: Complications related to osteo-articular diseases;126
10.1;Chapter 10;127
10.1.1;Degenerative Disk Disease;127
10.1.1.1;10.1 Introduction;127
10.1.1.2;10.2 Anterior Surgical Techiques;127
10.1.1.2.1;10.2.1 Anterior Discectomy/Corpectomy and Fusion;127
10.1.1.2.1.1;10.2.1.1 Vascular Lesions;132
10.1.1.2.1.1.1;Common Carotid Artery Lesions;132
10.1.1.2.1.1.2;Vertebral Artery Lesion;133
10.1.1.2.1.1.3;Jugular Vein Lesion;134
10.1.1.2.1.2;10.2.1.2 Soft Tissue Lesions;134
10.1.1.2.1.3;10.2.1.3 Spinal and Dural Lesions;135
10.1.1.2.2;10.2.2 Anterior Decompression with Multiple Subtotal Corpectomies;136
10.1.1.2.2.1;10.2.2.1 Complications;137
10.1.1.2.3;10.2.3 Anterior Instrumentation;139
10.1.1.2.3.1;10.2.3.1 Plates and Screws;142
10.1.1.2.3.2;10.2.3.2 Anterior Cervical Cages;144
10.1.1.3;10.3 Posterior Surgical Techniques;146
10.1.1.3.1;10.3.1 Laminectomy and Fusion;146
10.1.1.3.1.1;10.3.1.1 Dural Tears and Neural Lesions;148
10.1.1.3.1.2;10.3.1.2 Bleeding from Venous Plexus;148
10.1.1.3.1.3;10.3.1.3 Lateral Mass Removal;148
10.1.1.3.1.4;10.3.1.4 General Complications;149
10.1.1.3.2;10.3.2 Laminoplasty;150
10.1.1.3.2.1;10.3.2.1 Complications Related to the Laminae or Hinge;150
10.1.1.3.2.2;10.3.2.2 Selective Paralysis of the C5 Root;151
10.1.1.3.2.3;10.3.2.3 Wrong Patient Selection;151
10.1.1.3.3;10.3.3 Posterior Instrumentation at the Lower Cervical Spine;151
10.1.1.3.3.1;10.3.3.1 Wiring Techniques and Laminar Hooks;152
10.1.1.3.3.2;10.3.3.2 Screw-Based Systems;153
10.1.1.3.3.2.1;Lateral Mass Screw Fixation;153
10.1.1.3.3.3;10.3.3.3 Pedicle Screw Fixation;155
10.1.1.3.3.4;10.3.3.4 Bone Graft Mobilization;155
10.1.1.4;10.4 Cervical Spine Arthroplasty;155
10.1.1.4.1;10.4.1 Implants;155
10.1.1.4.2;10.4.2 Clinical Results;156
10.1.1.4.2.1;10.4.2.1 Bryan Cervical disk;156
10.1.1.4.2.2;10.4.2.2 Prestige;156
10.1.1.4.2.3;10.4.2.3 Prodisc-C;157
10.1.1.4.3;10.4.3 Complications and Revision Surgery;157
10.1.1.5;10.5 Pitfalls Related to Minimally Invasive Cervical Spine Surgery;160
10.1.1.5.1;10.5.1 Anterior Approaches;161
10.1.1.5.2;10.5.2 Posterior Approaches;162
10.1.1.5.2.1;10.5.2.1 Surgical Technique;162
10.1.1.5.2.2;10.5.2.2 Complications;163
10.1.1.6;References;164
10.2;Chapter 11;170
10.2.1;Cervical Spine Bone Tumor Surgery;170
10.2.1.1;11.1 General Considerations in Cervical Spine Tumor Surgery;170
10.2.1.1.1;11.1.1 Indications;171
10.2.1.2;11.2 Complications;172
10.2.1.2.1;11.2.1 Vascular Complications;173
10.2.1.2.1.1;11.2.1.1 Vertebral Artery Lesions;173
10.2.1.2.2;11.2.2 Lesions of the Deep Structures of the Neck;174
10.2.1.2.3;11.2.3 Neurological Complications;174
10.2.1.2.3.1;11.2.3.1 Myeloradicular Lesions and Liquoral Fistulas;174
10.2.1.2.3.2;11.2.3.2 Intradural and Extradural Hematoma;175
10.2.1.2.4;11.2.4 Extracanalar Neurological Lesions;176
10.2.1.2.5;11.2.5 Reconstruction Failures;176
10.2.1.2.5.1;11.2.5.1 General Complications;177
10.2.1.3;References;178
10.3;Chapter 12;180
10.3.1;Cervical Spine Traumas;180
10.3.1.1;12.1 Introduction;180
10.3.1.2;12.2 Classifi cation and Surgical Indications;184
10.3.1.2.1;12.2.1 Upper Cervical Spine Injuries;184
10.3.1.2.2;12.2.2 Lower Cervical Spine Injuries;190
10.3.1.2.2.1;12.2.2.1 Compression Flexion;191
10.3.1.2.2.2;12.2.2.2 Vertical Compression;191
10.3.1.2.2.3;12.2.2.3 Distractive Flexion Injuries;192
10.3.1.2.2.4;12.2.2.4 Compressive Extensions;192
10.3.1.2.2.5;12.2.2.5 Distractive Extension;192
10.3.1.2.2.6;12.2.2.6 Lateral Compression;192
10.3.1.2.2.7;12.2.2.7 Complications;192
10.3.1.3;References;195
10.4;Chapter 13;197
10.4.1;Infections of the Cervical Spine;197
10.4.1.1;13.1 Introduction;197
10.4.1.2;13.2 Iatrogenic Infections;198
10.4.1.2.1;13.2.1 Intrinsic Risk Factors;198
10.4.1.2.2;13.2.2 Extrinsic Risk Factors;199
10.4.1.2.3;13.2.3 Classifi cation;201
10.4.1.2.4;13.2.4 Diagnosis;201
10.4.1.2.4.1;13.2.4.1 Laboratory Findings;201
10.4.1.2.4.2;13.2.4.2 Imaging;202
10.4.1.2.5;13.2.5 Management;202
10.4.1.2.5.1;13.2.5.1 Wound Infections;202
10.4.1.2.5.2;13.2.5.2 Discitis;203
10.4.1.2.5.3;13.2.5.3 Vertebral Osteomyelitis;203
10.4.1.3;References;205
10.5;Chapter 14;206
10.5.1;Pitfalls Related to Infl ammatory Disorders;206
10.5.1.1;14.1 General Considerations;206
10.5.1.2;14.2 Pitfalls Related to Patients with Rheumatoid Arthritis;206
10.5.1.2.1;14.2.1 Considerations for Fixation and Fusion;208
10.5.1.2.2;14.2.2 Anterior Approaches;208
10.5.1.2.3;14.2.3 Complications of Occipito-Cervical Decompression and Fusion Procedures;210
10.5.1.2.3.1;14.2.3.1 Complications to Meninges, Spinal Cord, and Nerve Roots;212
10.5.1.2.3.2;14.2.3.2 Vascular Lesions;213
10.5.1.2.3.3;14.2.3.3 Mobilization of Instrumentation;213
10.5.1.2.4;14.2.4 Posterior Fixation at C1–C7 in Patients with RA;213
10.5.1.3;14.3 Pitfalls Related to Patients with Ankylosing Spondylitis;214
10.5.1.3.1;14.3.1 Treatment of Cervical Flexion Deformity in AS;214
10.5.1.3.1.1;14.3.1.1 Surgical Technique of Cervical Extension Osteotomy;215
10.5.1.3.1.2;14.3.1.2 Complications of Cervical Extension Osteotomy;216
10.5.1.3.2;14.3.2 Cervical Spine Fractures in AS;217
10.5.1.3.2.1;14.3.2.1 Complications of Surgery for Cervical Spine Fractures in AS;218
10.5.1.4;References;218
11;Part V: Complications related to neural diseases;222
11.1;Chapter 15;223
11.1.1;Spinal Cord Neoplasms;223
11.1.1.1;15.1 Primary and Metastatic Intradural Cervical Spine Tumors;223
11.1.1.2;15.2 Intradural Intramedullary Neoplasms;223
11.1.1.2.1;15.2.1 Astrocytomas;224
11.1.1.2.2;15.2.2 Ependymomas;224
11.1.1.2.3;15.2.3 Hemangioblastomas;225
11.1.1.2.4;15.2.4 Intramedullary Spinal Cord Metastases;225
11.1.1.3;15.3 Intradural Extramedullary Neoplasms;225
11.1.1.3.1;15.3.1 Meningiomas;226
11.1.1.3.2;15.3.2 Nerve Sheath Tumors;226
11.1.1.4;15.4 Surgical Technique and Complication Avoidance;226
11.1.1.5;References;229
11.2;Chapter 16;231
11.2.1;Syringomyelia;231
11.2.1.1;16.1 Syringomyelia and the Chiari Malformations;231
11.2.1.2;16.2 Pathogenesis and Development Theories;231
11.2.1.3;16.3 Symptomatology;232
11.2.1.4;16.4 Diagnosis and Evaluation;232
11.2.1.5;16.5 Surgical Treatment and Complications Avoidance;232
11.2.1.5.1;16.5.1 Primary Syringomyelia: Decompression of Subarachnoid Space;233
11.2.1.5.2;16.5.2 Shunting Procedures for Syringomyelia;233
11.2.1.5.3;16.5.3 Syringomyelia and Chiari Malformation: Posterior Fossa Decompression;234
11.2.1.6;References;237
12;Part VI: Miscellanea;238
12.1;Chapter 17;239
12.1.1;Complications Related to Graft;239
12.1.1.1;17.1 Introduction;240
12.1.1.2;17.2 Autograft;240
12.1.1.3;17.3 Allografts;241
12.1.1.3.1;17.3.1 Studies Comparing Allografts vs. Autografts;241
12.1.1.4;17.4 Bone Graft Substitutes;244
12.1.1.4.1;17.4.1 Ceramics;244
12.1.1.4.2;17.4.2 Demineralized Bone Matrices;244
12.1.1.4.3;17.4.3 Osteoinductive Growth Factors;245
12.1.1.5;17.5 Donor Site Complications;245
12.1.1.5.1;17.5.1 The Iliac Crest;245
12.1.1.5.1.1;17.5.1.1 Donor Site Pain;246
12.1.1.5.1.2;17.5.1.2 Nerve Injury;246
12.1.1.5.1.3;17.5.1.3 Vascular Injury;251
12.1.1.5.1.4;17.5.1.4 Fractures of the Ilium;251
12.1.1.5.1.5;17.5.1.5 Violation of the Sacroiliac Joint;251
12.1.1.5.1.6;17.5.1.6 Hernia;261
12.1.1.5.1.7;17.5.1.7 Hematoma;261
12.1.1.5.1.8;17.5.1.8 Gait Disturbance;266
12.1.1.5.1.9;17.5.1.9 Infections;266
12.1.1.5.1.10;17.5.1.10 Other Complications;266
12.1.1.5.1.11;17.5.1.11 Cosmetic Deformity;266
12.1.1.5.1.12;17.5.1.12 Tumor Transplantation;266
12.1.1.6;17.6 Bicortical Cylindrical Graft as Required by the Cloward Instrumentation;268
12.1.1.6.1;17.6.1 Errors;268
12.1.1.7;17.7 Tricortical Rectangular Graft for Smith–Robinson-Type Vertebral Fusion;268
12.1.1.7.1;17.7.1 Errors;269
12.1.1.8;17.8 Tricortical Graft for Multiple Subtotal Vertebrectomies and Reconstruction;269
12.1.1.8.1;17.8.1 Errors;269
12.1.1.9;17.9 Fibula;270
12.1.1.9.1;17.9.1 Fibular Donor Site Complications;270
12.1.1.10;17.10 Tibia;270
12.1.1.11;17.11 Recipient Site Complications;270
12.1.1.12;17.12 Cervical Nonunion;271
12.1.1.13;17.13 Failure of Long Strut Graft for Multilevel Cervical Corpectomy;273
12.1.1.13.1;17.13.1 Prevention of Failure;275
12.1.1.14;17.14 The Future;276
12.1.1.15;References;277
12.2;Chapter 18;282
12.2.1;Pitfalls Related to Inadequate or Incomplete Surgical Technique and Errors of Level;282
12.2.1.1;18.1 Incomplete or Inadequate Surgical Technique;282
12.2.1.2;18.2 Errors of Level;284
12.2.1.2.1;18.2.1 To Prevent the More Common Errors of Level: Revision of the Literature and General Considerations;285
12.2.1.3;References;289
12.3;Chapter 19;290
12.3.1;Complications Due to Inadequate Cervical Spinal Immobilization;290
12.3.1.1;19.1 Introduction;290
12.3.1.2;19.2 Complications of Cervical Spinal Orthoses;292
12.3.1.3;19.3 Halo Vest Immobilization;293
12.3.1.3.1;19.3.1 Complications of the Halo Immobilization;295
12.3.1.4;References;297
13;Index;299