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`LIBRARY OF CONGRESS CATALOGING -IN -PUBLICATION DATA
`
`Atlas of minimal access spine surgery I edited by John J. Regan, Isador Lieberman.-2nd ed.
`p.
`; cm.
`Rev. ed. of: Atlas of endoscopic spine surgery I edited by John J. Regan,
`Paul C. McAfee, Michael J. Mack. 1995.
`Includes bibliographical references and index.
`ISBN 1-57626- 100-X (hardcover)
`1. Spine-Endoscopic surgery. 2. Spine-Endoscopic surgery-Atlases.
`[DNLM: l. Spine-surgery-Atlases. 2. Endoscopy-methods-Atlases. 3. Spinal Diseases(cid:173)
`surgery-Atlases. 4. Surgical Procedures, Minimally Invasive-methods-Atlases. WE 17
`I. Regan, John)., 1952-
`M6648 2001]
`II. Lieberman, I.H. (Isador H. )
`III. Regan, John J., 1952-
`Atlas of endoscopic spine surgery.
`RD533 .R44 2002
`617.5'6059-dc21
`20020 10305
`
`QM/EB/EB
`5 4 3 2
`
`

`

`

`

`xvi
`
`Contents
`
`13 Laparoscopic Lateral L4-5 Disc Exposure 183
`Fred Brody, M.D., and Isador H. Lieberman, B.Sc., M.D., M.B.A.,
`F.R.C.S.(C)
`
`14 Lateral Retroperitone~ Approach to the
`Lumbar Spine: The Lateral Bagby and Kuslich
`Procedure (Tl2-L5) 189
`Paul C. McAfee, M.D.
`
`15 Gasless Endoscopic Lumbar Surgery:
`Balloon-Assisted Retroperitoneal Approach to the
`Anterior Lumbar Spine 205
`John S. Thalgott, M.D., and James M. Giuffre, B.A.
`
`16 Microsurgical Techniques in Lumbar Spinal
`Stenosis 221
`K. Daniel Riew, M.D. , and John M. Rhee, M.D.
`
`Thoracic Spine
`
`17 Treatment of Thoracic Disc Disease 235
`Curtis A. Dickman, M.D.
`
`18 Endoscopic Anterior Repair in Spinal Trauma 285
`Rudolf Beisse, M.D.
`
`Section on Surgical Technique for Reconstruction of
`Spinal Tumors 310
`Michael Potulski, M.D., Daniel H. Kim, M.D., and
`Tae-Ahn Jahng, M.D., Ph.D.
`
`19 Thoracoscopic Sympathectomy 321
`Curtis A. Dickman, M.D.
`
`Spinal Deformity
`
`20 Pediatric Spinal Deformities 341
`Alvin H. Crawford, M.D. , and Atiq Durrani, M.D.
`
`21 Alternative Approaches to Thoracoscopic
`Anterior Spinal Release and Fusion for Spinal
`Deformity 385
`Peter 0. Newton, M.D.
`
`22 Prone-Position Endoscopic Approach for Deformity
`Surgery 399
`Isador H. Lieberman, B.Sc., M.D., M.B.A ., F.R.C.S. (C)
`
`23 Anterior Spinal Instrumentation in Spinal
`Deformity 409
`
`Thoracoscopic Anterior Release and Fusion Using
`MOSS-Miami Instrumentation 409
`Randal R. Betz, M.D., Peter 0. Newton, M.D., David H.
`Clements III, M.D., and Rohinton K. Balsara, M.D., F.A.C.C.P.
`
`Endoscopic Techniques for Treatment of Thoracic and
`Thoracolumbar Scoliosis 423
`George D. Picetti III, M.D., Janos P. Ertl, M.D. , and
`H. Ulrich Bueff, M.D.
`
`Part IV. NEW TECHNOLOGY
`
`24 Minimally Invasive Vertebral Body Augmentation
`and Reconstruction for Osteoporotic and Osteolytic
`Wedge Compression Fractures 441
`Isador H. Lieberman, B.Sc., M.D., M.B.A., F.R. C.S.(C), and
`Mark A. Reiley, M.D.
`
`25
`
`Intradiscal Electrothermal Therapy 451
`Jeffrey A. Saal, M.D., and Joel S. Saal, M.D.
`
`26 Microendoscopic Discectomy 465
`Robert E. Isaacs, M.D., Faheem A. Sandhu, M.D., Ph.D.,
`and Richard G. Fessler, M.D., Ph.D.
`
`27 Percutaneous Discectomy 487
`Anthony T. Yeung, M.D.
`
`28 Nucleus Pulposus Replacement 517
`Qi-Bin Bao, Ph.D., and Hansen A. Yuan, M.D.
`
`29 Link SB Charite Total Disc Replacement 525
`Paul C. McAfee, M.D.
`
`30 Extreme Lateral Interbody Fusion (XLIF) 539
`Marc I. Ma/berg, M.D.
`
`Index 555
`
`

`

`

`

`540
`
`NEW TECHNOLOGY
`
`crease the exposure to injury to the neural elements. Kam(cid:173)
`bin's triangle is not an adequately sized space within which
`to accomplish an interbody fusion. There is adequate space,
`however, anterior to the nerve root but posterior to the
`-23 Disc procedures here at the lateral
`sympathetic chain. 22
`aspect of the spine access the'<!isc space through the psoas
`muscle. 1s-is,z4,25 This is an attractive approach but limited by
`the potential risk to the exiting nerve roots and lumbar
`plexus, which lie within the muscle itself.
`An extreme lateral interbody fusion (XLIF) through a
`minimally invasive incision and psoas muscle-splitting ap(cid:173)
`proach has the potential to significantly reduce the morbid(cid:173)
`ity currently associated with an interbody fusion of lumbar
`vertebrae. Performed with the patient in the prone position,
`the procedure can easily be supplemented with percuta(cid:173)
`neous insertion of transfacet screws, achieving the stable
`construct of interbody fusion with a posterior tension
`band.12-14,26-30
`The extreme lateral approach to the disc and the trans(cid:173)
`facet screw placement are achieved using a novel guide(cid:173)
`frame that allows reliable access to and maintenance of the
`target area. Seminal to this trans-psoas approach is a neuro(cid:173)
`monitoring system that is surgeon controlled and provides
`information about both direction and proximity of nerves
`at risk.
`Clinical experience with this minimally invasive fusion
`technique is limited. However, the early experience is en(cid:173)
`couraging. The quantitative abilities of the neuro-monitor(cid:173)
`ing system have been confirmed both clinically31 -32 and with
`intraoperative correlation with somatosensory-evoked po(cid:173)
`tentials. The guideframe is radiolucent with the exception
`of radiodense targeting elements and has been able to
`maintain access throughout the procedure with only slight
`readjustments.
`
`INDICATIONS AND CONTRAINDICATIONS
`The indications for this approach are the same as those al(cid:173)
`ready commonly used for a primary interbody fusion.
`These include discogenic pain, degenerative disc disease, de(cid:173)
`generative listhesis, and facet degeneration unresponsive to
`nonoperative management for a minimum of 3 months.
`Instability on flexion/extension radiographs without a pars
`defect should also be considered an indication. Upper lum(cid:173)
`bar segments can be accessed if the ribs do not interfere lat(cid:173)
`erally; the L2-3 disc has been successfully fused using this
`technique.
`Patients with a history of infection or suspicion of ma(cid:173)
`lignancy are not candidates for this procedure. Endplate
`erosion precludes adequate support for the interbody allo-
`
`graft. A bulging annulus is the natural consequence of de(cid:173)
`generation of the nucleus pulposus and does not represent
`a contraindication; however, an extruded or sequestered
`disc cannot be adequately treated by fusion alone. And pos(cid:173)
`terior access for direct decompression or disc fragment re(cid:173)
`moval, for example, is unattainable from this extreme later(cid:173)
`al approach.
`
`PREOPERATIVE PLANNING
`As with any major procedure, adequate medical evaluation
`is mandatory. Patients being considered for this approach
`should have a complete evaluation of the lumbar spine.
`Plain x-ray films should include lateral flexion/extension
`views. A fully exposed anteroposterior and lateral lumbar x(cid:173)
`ray film is necessary to evaluate the proximity of the ribs
`when considering fusion of the upper lumbar levels. An up(cid:173)
`to-date MRI and electrodiagnostic analysis complete the
`spinal studies. The history and physical examination must
`correlate with the studies and indicate that the disc(s) in
`question is indeed the pain generator.
`The plain x-ray films are evaluated to ensure that access
`is adequate. The entry point is approximately 14 cm lateral
`to the midline. The crest of the iliac wing may have to be
`drilled or osteotomized for the lower two segments. A tra(cid:173)
`versing rib can be gently retracted by the dilating cannulas
`if it is not completely overlying the interspace.
`Blood loss is minimal and transfusion has not been nec(cid:173)
`essary for this procedure. Conversion to an open procedure
`has not occurred to date. However, the preoperative discus(cid:173)
`sion with the patient should include consideration that the
`approach may not be feasible for technical reasons and that
`a decision may be made whether to convert to an open pro(cid:173)
`cedure or to abort the surgery.
`The operating room must be equipped with a canti(cid:173)
`levered, radiolucent table and radiolucent spinal frame.
`An image intensifier is required throughout the procedure.
`The neuro-monitoring system is placed on a mobile stand
`within the line of sight of the surgeon (Fig. 30-1 ). The sum
`of this equipment occupies considerable space, and there(cid:173)
`fore an adequately sized operating room should be sched(cid:173)
`uled in advance. The scrub team should have sufficient
`training in the use of the targeting device as well as the in(cid:173)
`struments.
`
`TECHNIQUE
`Patient Positioning
`After induction of general endotracheal tube anesthesia,
`surface EMG electrodes are placed on the myotomes corre(cid:173)
`sponding to the operative level(s). The electrodes are con-
`
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`552
`
`NEW TECHNOLOGY
`
`POSTOPERATIVE CARE
`The patient is allowed out of bed as soon as comfort allows.
`Lumbar support is not necessary but can be used to speed
`mobilization. Oral analgesics generally suffice. Patients are
`discharged the following morning. They are instructed to
`resume activities of daily living. Physical therapy is not re(cid:173)
`quired, but the patient is instructed to avoid any strenuous
`activity. The initial follow-up visit is at 10 days to 2 weeks
`and then at intervals routinely used to follow an interbody
`fusion.
`
`COMPLICATIONS
`Experience with this procedure is limited and short term to
`date. Long-term complications, therefore, cannot be as(cid:173)
`sessed. The first two patients experienced sensory changes
`on the ipsilateral side during the lateral approach, which re(cid:173)
`solved spontaneously. In both cases the symptoms were not
`immediate, occurring 12 and 6 hours postoperatively. On
`careful examination of the distribution of the numbness, it
`was thought that the source was irritation of the genito(cid:173)
`femoral or ilioinguinal nerve rather than the nerve root,
`possibly from hematoma in the psoas muscle. This compli(cid:173)
`cation has not been noted in subsequent patients.
`One patient developed sudden onset of radicular pain 6
`weeks postoperatively. X-ray films revealed that the facet
`screw on that side had migrated. It was removed percuta(cid:173)
`neously and the symptoms resolved.
`There have been no respiratory, cardiovascular, urinary,
`or wound complications.
`
`TECHNICAL TIPS
`As with any new procedure, operative time becomes short(cid:173)
`er as experience is gained. The original 4 1/2-hour operation
`now averages 21/2 hours. Lubricating the dilating cannulas
`with saline solution makes them easier to advance. The first
`view through the working cannula is always disconcerting
`because the annulus still has an overlying thin layer of mus(cid:173)
`cle fibers. Testing this layer with the neuro-monitoring ball
`probe can determine if a nerve is camouflaged within it.
`Nerves have been found at the superior margin of the can(cid:173)
`nula and can be retracted with a Love or similar retractor.
`Adequate visualization can be achieved by looking directly
`down the cannula; however, an arthroscope placed in the
`working cannula provides better light and excellent visual(cid:173)
`ization. A nerve at the margin of the cannula can be care(cid:173)
`fully retracted and is not a contraindication to proceeding.
`It should, however, be periodically released as one would do
`during a PLIF.
`Finally, carefu l patient selection and preoperative plan(cid:173)
`ning cannot be overemphas ized.
`
`OUTCOMES
`Experience with this approach to a lumbar interbody fusion
`is limited and short term. The numbe.r of cases and length
`of follow-up are not sufficient for more than anecdotal
`comments. However, interbody fusion supplemented with
`posterior screws across the facets is an established proce(cid:173)
`dure currently in use. 29 This chapter deals with a new surgi(cid:173)
`cal approach rather than a new procedure or implant. The
`outcome of this approach can therefore be judged without
`long-term patient follow-up. The goals in developing this
`surgical technique were to approach the lumbar spine in a
`minimally invasive manner, to be able to perform a stan(cid:173)
`dard operation through this approach, to be able to accu(cid:173)
`rately monitor the neural structures at risk, and to establish
`a technique that is reproducible.
`With these goals in mind, the outcome of this approach
`has been successful albeit limited in overall number of cas(cid:173)
`es. The initial single surgeon series has been extended to
`several other centers. Greater application of this approach
`is needed to demonstrate its reproducibility, but the experi(cid:173)
`ence to date is encouraging.
`
`KEY ANNOTATED REFERENCES
`Boucher HH. A method of spinal fusion.) Bone Joint Surg Br 41:248-
`259, 1959.
`This article is a historical description of a modification to the King
`transfacet fixation technique. In this technique, which has become
`known as the Boucher or King-Boucher technique, a longer screw is
`placed across the facet joint from superior to inferior but in the di(cid:173)
`rection of and taking purchase in the pedicle, increasing the potential
`stability of the construct. The author reports no known failures in
`160 single-level fusions and two failures in 15 multilevel fusions.
`Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitehill R.
`Complications of posterior lumbar interbody fu sion when using
`a titanium threaded cage device. J Neurosurg 93(Suppl):45-52,
`2000.
`The authors present their PLIF experience with respect to incidence
`of complications. Neural complications were most significant, with a
`15% incidence of dural laceration and 9% incidence of postoperative
`radiculopathy revealed to be due to epidural fibrosis.
`Gu Y, Ebraheim NA, Xu R, Rezcallah AT, Yeasting RA. Anatomic con(cid:173)
`siderations of the posterolateral lumbar disk region. Orthopedics
`24:56-58, 2001.
`The authors present their anatomic findings of a surgical safe zone
`on the posterolateral lumbar disc between the anterior limit of the
`lumbar nerve and the posterior limit of the sympathetic tnmk. The
`safe zone was found to have a transverse dimension from 22 to 25
`mrn from the T12-Ll disc to the L4-L5 disc.
`Karnbin P. Arthroscopic microdiscectomy. Scrnin Orthop 6:97-108,
`1991.
`
`

`

`This is a historical description of an arthroscopic discectomy tech(cid:173)
`nique. The arthroscopic discectomy procedure described is performed
`through the triangular working zone at the posterolateral corner of
`the intervertebral disc bounded by the exiting root anterolaterally
`and the traversing root and dural sac medially. This working zone
`has come to be known as Kambin's triangle.
`Mayer HM. A new microsurgical technique for minimally invasive
`anterior lumbar inter body fusion. Spine 22:69 1-700, 1997.
`A series of patients who have undergone a minimally invasive ante(cid:173)
`rior lumbar interbody fusion via a microsurgical retroperitoneal lat(cid:173)
`eral approach to the spine for levels L2-L5 is reported. The retroperi(cid:173)
`toneal space is reached by a blunt, muscle-splitting approach and
`dissection of the psoas muscle attachments from the lateral border of
`the disc.
`Peloza J. Validation of n europhysiologic m onitorin g of posterolat(cid:173)
`eral approach to the sp ine via discogram procedure. Presented at
`the Ninth Internati onal Meeting on Advanced Spine Techniques,
`Montreux, Switzerland, May 2002.
`The Neuro Vision f]B system was used in this study to validate the
`neurophysiologic measu rement of relative nerve root-instrument
`distance during routine lumbar discogram procedures. In JO patients
`(38 levels) the neurophysiologic monitoring parameters changed pre(cid:173)
`dictably as the stimulating discography needle was advanced toward
`the disc, providing a relative measure of nerve root proximity.
`Rajaraman V, Vingan R, Roth P, Hea ry RF, Conklin L, Jacobs GB.
`Visceral and vascular complications resulting from anterior lum (cid:173)
`bar interbody fusion. J Neurosurg 91 (Suppl):60-64, 1999.
`The authors report the results of ALIF procedures in 60 patients, in
`which 24 general surgery-related complications occurred in 23 pa(cid:173)
`tients (38.3%), including sympathetic dysfunction, vascular injury,
`somatic neural injury, sexual dysfunction, prolonged ileus, wound
`incompetence, deep venous thrombosis, acute pancreatitis, and bow(cid:173)
`el injury.
`Stonecipher T, Wright S. Posterior lumbar interbody fusion with
`facet-screw fixation. Spine 14:468-471, 1989.
`The King-Boucher transfacet screw fixation technique is described in
`35 patients undergoing PLIF. Results were good or excellent in 34
`(97%) cases with interbody graft incorporation and no loss of fixa(cid:173)
`tion. There was one case of lamina fracture. The authors attribute
`the high fusion rate to the addition of rigid fixation and describe the
`fixation technique as simple, universally available, and inexpensive.
`Tsantrizos A, Andreou A, Aebi M, Steffen T. Biomechanical stability
`of five sta nd-alone anterior lumbar interbody fusion constructs.
`Eur Spi ne J 9: 14-22, 2000.
`A biomechanical comparison of different stand-alone ALIF cage con(cid:173)
`strncts and cage-related features on initial segment stability is pre(cid:173)
`sented. The authors found that stand-alone cages generally increased
`the nei1tral zone in all directions, suggesting potential initial segrnent
`instability or micromotion at the cage-endplate interface. Supple(cid:173)
`mentary posterior stabilization is rnggested, using pedicular, or
`translaminar or transarticular screws, the latter of which are referred
`to as possible minimally invasive or perwtaneous adiuncts to an
`ALIF proced11re.
`
`Extreme Lateral Interbody Fusion (XLIF)
`
`553
`
`REFERENCES
`I. Abraham DJ, Berkowitz HN, Katz JN . Indications for thoracic
`and lumbar spine fusion and trends in use. Orthop Clin North
`Am 29:803-811, 1998.
`2. Fritze]] P, Hagg 0, Wessberg P, Nordwall A. Swedish Lumbar
`Spine Study Group: 2001 Volvo Award Winner in Clinical Stud(cid:173)
`ies. Lumbar fusion versus nonsurgical treatment for chronic low
`back pain: A multicenter randomized controlled trial from the
`Swedish Lumbar Spine Study Group. Spine 26:2521-2532; dis(cid:173)
`cussion 2532-2534, 2001.
`3. Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitehill R.
`Complications of posterior lumbar interbody fusion when using
`a titanium threaded cage device. J Neurosurg 93(1 Suppl):45-52,
`2000.
`4. Fraser RD. Interbody, posterior, and combined lumbar fusions.
`Spine 20(24Suppl):Sl67-S177, 1995.
`5. Wetzel FT, LaRocca H . The fa iled posterior lumbar interbody fu(cid:173)
`sion. Spine 16:839-845, 1991.
`6. Heniford BT, Matthews BD, Lieberman IH . Laparoscopic lumbar
`interbody spinal fusion. Surg Cl in North Am 80: 1487-1500, 2000.
`7. Mulho lland RC. Cages: Outcomes and complications. Eur Spine
`J 9(Suppl l ):S ll0-S ll 3, 2000.
`8. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB.
`Visceral and vascular complications resulting from anterior lum(cid:173)
`bar interbody fusion. J Neurosurg 91(1 Suppl):60-64, 1999.
`9. Regan JJ, Yuan H, McAfee PC. Laparoscopic fusion of the lumbar
`spine: Minimally invasive spine surgery. A prospective multicen(cid:173)
`ter study evaluating open and laparosco pic lumbar fusion. Spine
`24:402-4 11, 1999.
`10. Zdeblick TA, David, SM. A prospective comparison of surgical
`ap proach for anterior L4-L5 fusion: Laparoscopic versus mini an(cid:173)
`terior lumbar interbody fusion. Spine 25:2682-2687, 2000.
`11. O'Dowd JK, Lam K, Mulholland RC, Harris M. BAK cage: Not(cid:173)
`tingham results. Presented at the Meeting of the North American
`Sp ine Society, October 1998, Sa n Francisco, p 16.
`12. Oxland TR, Lund T. Biomechanics of stand-aloi;e cages and cages
`in co mbination with posterior fixation: A literature review. Eur
`Spine J 9(Suppl l ):S95-Sl0 l, 2000.
`13. Rathonyi GC, Oxland TR, Gerich U, Grassmann S, Nolte LP. The
`role of supplemental translaminar screws in anterior lumbar in(cid:173)
`terbody fixation: A biomechanical study. Eur Spine J 7:400-407,
`1998.
`14. Tsantrizos A, Andreou A, Aeb i M, Steffen T. Biomechanical sta(cid:173)
`bility of five stand-alone anterior lumbar interbody fusion con(cid:173)
`structs. Eur Spine J 9:14-22, 2000.
`15. Hovorka I, de Peretti F, Damon F, Arcamone H, Argenson C. Five
`yea rs' experience of retroperitoneal lumbar and thoracolumbar
`surgery. Eur Spine J 9(Suppl l ):S3 0-S34 , 2000.
`16. Mayer HM. A new microsurgical technique for minimall y inva(cid:173)
`sive anterior lumbar interbody fusion. Spine 22:691-700, 1997.
`17. McAfee PC, Regan JJ, Geis WP, Fedder IL. Minimally invasive an(cid:173)
`terior retroperitoneal approach to the lumbar spine: Emphasis on
`the latera l BAK. Sp ine 23: 1476- 1484, 1998.
`
`

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`554
`
`NEW TECHNOLOGY
`
`18. Wolfla CE, Ma ima n DJ, Co ufa l FJ, Wa llace JR. Re tro pe rito nea l
`latera l lumbar interbod y fu sio n with tita nium threaded cages. J
`Neurosurg 96( l Suppl): 50-55, 2002.
`19. Ka mbin P. Arthroscopic microdi scectom y. Se min Orth o p 6:97-
`108, 1991.
`20. Kambin P, Gennarell i T, Hermantin F. Minimally invasive tech(cid:173)
`niques in spin al surgery: C urrent practice. Neuros urg Focus 4(2) :
`1- 10, 1998.
`21. O 'Brien MF, Peterson D, Crockard HA. A posterolateral micro(cid:173)
`surgica l approach to extrem e lateral lumbar disc herniatio ns. J
`Neurosurg 83 :636-640, 1995.
`22. Ebraheim NA, Xu R, Huntoo n M , Yeasting RA. Loca tio n of ex(cid:173)
`tra fo ra minal lumbar nerve roo ts: An an ato mic stud y. Cl in O r(cid:173)
`th o p 340:23 0-235, l 997.
`23. Gu Y, Ebraheim NA, Xu R, Rezca lla h AT, Yeasting RA . Anato mi c
`consideratio ns o f the postero la teral lumba r di sk regio n. O rth o(cid:173)
`pedics 24:56-58, 200 I.
`24. Dezawa A, Ya m ane T, M ika mi H , M iki H. Re t ro per ito nea l lapa(cid:173)
`rosco pic latera l approach to the lumba r spin e: A new ap proach ,
`technique, a nd clinica l trial. J Spin al D iso rd 13: 138- 143, 2000.
`25. Gio ia G, Ma ndelli D, Capaccio ni B, Ra ndelli F, Tessa ri L. Surgical
`trea tm ent o f fa r lateral lumba r di sc herni atio n. Sp ine 24:1 952-
`1957, 1999.
`
`26. Boucher HH . A m ethod o f spinal fu sio n . J Bo ne Joint Surg Br
`41:248-259, 1959.
`27. King D. Inte rnal fixa tio n for lumbosacral fusion . ] Bone Joint
`Surg Am 30: 560-565, l 948.
`28. Panjabi MM , Yamamoto l , Oxla nd TR, Crisco J], Freedman D.
`Biomechan ica l stability of five ped icle screw fixation systems in a
`human lumba r spine instability model. Cl in Biomech 6: 197-205,
`l 991.
`29. Sto necipher T, Wright S. Posterior lumbar interbody fusion with
`fa cet-screw fixation. Spine 14:468-47 1, 1989.
`30. Volkma n T, H o rto n WC, Hutton WC. Transfacet screw with lum(cid:173)
`ba r interbod y reco nstructio n: A bio mechanical study of m otio n
`segment stiffn ess . J Spinal Disord 9:425-432, 1996.
`3 1. Bea tt y RM, McG uire P, Mo roney JM , H o lladay FP. Continuo us
`int rao pera ti ve electrom yog raphic reco rdin g during spinal sur(cid:173)
`gery. J Neurosurg 82:401 -405, 1995.
`32 . Peloza J. Validation of neuro physio logic mo nitoring o f postero(cid:173)
`lateral approach to the spine via discogra m procedure. Presented
`at the Ninth Internatio nal Meeting o n Ad va nced Spin e Tech(cid:173)
`niqu es, Mo ntreux, Switze rland , May 2002.
`
`