Generate the enolate of the ketone using a strong base such as LDA (lithium diisopropylamide) or KOH in the presence of a suitable amine. This enolate can then be alkylated using an electrophile. The steric hindrance can be controlled by the choice of base, solvent, and reaction temperature.
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tert-butyl 6'-benzyl-N-tert-butyl-7'-oxo-6',7'-dihydro-2'H-spiro[piperidine-4,5'-pyrano[3,2-c]pyrazole]-1-carboxylate
trans-(3R,4S)-1(R)-(α-methylbenzyl)-3-(2,2,5,5-tetramethyl-1-aza-2,5-disilacyclopentyl)-4-(2-pyridyl)-2-azetidinone
