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Book Details
Abstract
In the latest edition of Benzel’s Spine Surgery, renowned neurosurgery authority Dr. Edward C. Benzel, along with new editor Dr. Michael P. Steinmetz, deliver the most up-to-date information available on every aspect of spine surgery. Improved visuals and over 100 brand-new illustrations enhance your understanding of the text, while 26 new chapters cover today's hot topics in the field. A must-have resource for every neurosurgeon and orthopedic spine surgeon, Benzel's Spine Surgery provides the expert, step-by-step guidance required for successful surgical outcomes.
Glean essential, up-to-date information in one comprehensive reference that explores the full spectrum of techniques used in spine surgery.- Covers today's hot topics in spine surgery, such as pelvic parameters in planning for lumbar fusion; minimally invasive strategies for the treatment of tumors and trauma of the spine; and biologics and stem cells.
- A total of 18 intraoperative videos allow you to hone your skills and techniques.
- New editor Michael P. Steinmetz brings fresh insights and improvements to the text.
- Features the addition of 26 chapters, including:
-Biologics in Spine Fusion Surgery
-Endoscopic and Transnasal Approaches to the Craniocervical Junction
-Cellular Injection Techniques for Discogenic Pain
-Minimally Invasive Techniques for Thoracolumbar Deformity
-Spinal Cord Herniation and Spontaneous Cerebrospinal Fluid Leak
-MIS Versus Open Spine Surgery
- Extensive revisions to many of the existing chapters present all of the most up-to-date information available on every aspect of spine surgery.
- Improved visuals and over 100 brand-new illustrations enhance learning and retention.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| 9780323415217v1_WEB.pdf | 1 | ||
| Front Cover | 1 | ||
| Inside Front Cover | 2 | ||
| Benzel's Spine Surgery, 2-Volume Set | 3 | ||
| Copyright Page | 6 | ||
| Dedication | 7 | ||
| Contributors | 8 | ||
| Preface | 21 | ||
| Risk Taking | 21 | ||
| Repetition | 21 | ||
| What Is a Complication? | 21 | ||
| Bias and Conflict of Interest | 23 | ||
| In Memoriam | 24 | ||
| Table Of Contents | 25 | ||
| Video Contents | 32 | ||
| 1 History | 33 | ||
| 1 History of Spine Surgery | 33 | ||
| Summary of Key Points | 33 | ||
| Antique Period and Spine Surgery | 33 | ||
| Medieval Period and Spine Surgery | 34 | ||
| Renaissance and Spine Surgery | 34 | ||
| Early Modern Period and Spine Surgery | 34 | ||
| Spinal Decompression and the Early Modern Period | 35 | ||
| Birth and Development of the Laminectomy | 35 | ||
| H. J. Cline, Jr., and the Argument against Spine Surgery | 35 | ||
| A. G. Smith and the First Successful Laminectomy | 36 | ||
| Laminectomy for Extramedullary Spinal Tumor | 36 | ||
| Laminectomy for Intramedullary Spinal Tumor | 36 | ||
| Variations in Laminectomy Technique | 37 | ||
| Charles A. Elsberg: The Laminectomy in Stride | 38 | ||
| Laminectomy for Intervertebral Disc Herniation. | 39 | ||
| Laminectomy for Cervical Disc Herniation. | 40 | ||
| Laminectomy for Spinal Stenosis. | 40 | ||
| Approaches to the Spine | 40 | ||
| Dorsolateral Approaches to the Spine | 40 | ||
| Ménard’s Costotransversectomy | 40 | ||
| Capener’s Lateral Rhachotomy | 41 | ||
| Larson’s Lateral Extracavitary Approach | 41 | ||
| Spinal Stabilization and Deformity Correction | 42 | ||
| Birth and Development of Spinal Fusion and Spinal Instrumentation | 42 | ||
| Spinal Fusion | 42 | ||
| Spinal Instrumentation and Clinical Biomechanics | 42 | ||
| F. W. Holdsworth | 42 | ||
| Paul Harrington and the Birth of Modern Surgical Stabilization | 43 | ||
| Ventral Approaches to the Spine | 45 | ||
| Ventral Decompression and Stabilization | 45 | ||
| W. Müller | 46 | ||
| B. H. Burns | 46 | ||
| Ito and Others | 47 | ||
| Hodgson and Stock | 47 | ||
| Ventral Deformity Reduction and the Development of Ventral Instrumentation | 48 | ||
| A. F. Dwyer | 48 | ||
| Spine Imaging | 49 | ||
| Summary | 49 | ||
| Key References | 49 | ||
| References | 50 | ||
| 2 History of Spine Biomechanics | 53 | ||
| Summary of Key Points | 53 | ||
| Preclassical Antiquity | 53 | ||
| Classical Antiquity | 53 | ||
| Mythologic Period | 53 | ||
| Scientific Period | 53 | ||
| Pythagoras (580–500 bce) | 53 | ||
| Hippocrates (460–377 bce) | 54 | ||
| Plato (427–347 bce) | 55 | ||
| Aristotle (384–322 bce) | 55 | ||
| Herophilus of Chalcedon (335–280 bce) | 55 | ||
| Archimedes (287–212 bce) | 55 | ||
| Galen of Pergamon (130–200 ce) | 55 | ||
| Middle Ages (330–1453 ce) | 56 | ||
| Paulus of Aegina (625–690 ce) | 56 | ||
| Haly Abbas (930–994 ce) | 56 | ||
| Avicenna (981–1037 ce) | 56 | ||
| Albucasis (936–1013 ce) | 56 | ||
| Renaissance and Premodern Era | 56 | ||
| Leonardo da Vinci (1452–1519) | 57 | ||
| Andreas Vesalius (1514–1564) | 57 | ||
| Galileo Galilei (1564–1642) | 58 | ||
| René Descartes (1596–1650) | 58 | ||
| Giovanni Alfonso Borelli (1608–1679) | 58 | ||
| Robert Hooke (1635–1703) | 59 | ||
| Isaac Newton (1642–1727) | 59 | ||
| Leonard Euler (1707–1783) | 60 | ||
| Thomas Young (1773–1829) | 60 | ||
| Weber Brothers (1795–1891) | 60 | ||
| Etienne–Jules Marey (1838–1904) | 60 | ||
| Christian Wilhelm Braune (1831–1892) and Otto Fischer (1861–1917) | 60 | ||
| Karl Culmann and Herman von Meyer | 60 | ||
| Julius Wolff (1836–1902) | 60 | ||
| Emergence of Modern Biomechanics in the 20th Century | 60 | ||
| Finite Element Analysis | 61 | ||
| Clinical Studies | 61 | ||
| Organizations and Publications | 62 | ||
| Key References | 62 | ||
| References | 63 | ||
| 3 History of Spinal Instrumentation | 65 | ||
| Summary of Key Points | 65 | ||
| Dorsal Thoracolumbar Instrumentation | 65 | ||
| Ventral Thoracolumbar Instrumentation | 68 | ||
| Dorsal Cervical Instrumentation | 68 | ||
| Ventral Cervical Instrumentation | 69 | ||
| Total Disc Arthroplasty: Cervical and Lumbar | 70 | ||
| Cage Technology: Horizontal and Vertical | 71 | ||
| Minimally Invasive Approaches Utilizing Instrumentation | 72 | ||
| Summary | 72 | ||
| Key References | 72 | ||
| References | 74 | ||
| 2 The Fundamentals | 76 | ||
| 4 Evaluation of Spinal Alignment | 76 | ||
| Summary of Key Points | 76 | ||
| Clinical and Radiographic Evaluation of Spinal Alignment | 76 | ||
| Coronal Alignment Angles and Displacements | 78 | ||
| Regional Spinal Alignment | 78 | ||
| Pelvic Alignment | 80 | ||
| Global Spinal Alignment | 80 | ||
| Sagittal Alignment Angles and Displacements. | 80 | ||
| Regional Spinal Alignment | 80 | ||
| Pelvic Alignment | 81 | ||
| Global Spinal Alignment | 81 | ||
| Summary | 81 | ||
| References | 81 | ||
| 5 Functional Anatomy of the Spine | 82 | ||
| Summary of Key Points | 82 | ||
| Overview of the Vertebral Column and Spinal Cord | 82 | ||
| Vertebra | 84 | ||
| Atlas (C1) and Axis (C2) | 84 | ||
| Subaxial Cervical Vertebrae (C3-7) | 85 | ||
| Thoracic Vertebrae | 86 | ||
| Lumbar Vertebrae | 86 | ||
| Sacrum and Coccyx | 88 | ||
| Vertebral End Plates | 88 | ||
| Intervertebral Discs | 88 | ||
| Muscles | 88 | ||
| Anomalous Anatomy | 89 | ||
| Key References | 89 | ||
| References | 90 | ||
| 6 Muscular Support of the Spine | 91 | ||
| Summary of Key Points | 91 | ||
| Functions of the Back Muscles and Their Fascia | 91 | ||
| Compressive Loads and Strength of the Back Muscles | 92 | ||
| Histochemistry | 92 | ||
| Back Muscle as a Source of Pain | 92 | ||
| Muscle Training to Improve Spinal Stability and Relieve Pain | 93 | ||
| Anatomy | 94 | ||
| Psoas Major | 94 | ||
| Quadratus Lumborum | 94 | ||
| Lumbar Back Muscles | 94 | ||
| Deep Intersegmental Muscles | 94 | ||
| Multifidus | 95 | ||
| Lumbar Erector Spinae | 95 | ||
| Longissimus | 95 | ||
| Iliocostalis | 96 | ||
| Erector Spinae Aponeurosis | 96 | ||
| Thoracolumbar Fascia | 96 | ||
| Abdominal Muscles | 96 | ||
| Muscle “Sparing” Surgery | 96 | ||
| Conclusion | 97 | ||
| Key References | 97 | ||
| References | 98 | ||
| 7 Practical Anatomy and Fundamental Biomechanics | 102 | ||
| Summary of Key Points | 102 | ||
| Vertebral Column | 102 | ||
| Vertebrae | 102 | ||
| Cervical Vertebrae | 102 | ||
| Thoracic Vertebrae | 103 | ||
| Lumbar Vertebrae | 104 | ||
| Sacrum and Coccyx | 105 | ||
| Vertebral End Plates | 105 | ||
| Intervertebral Discs | 105 | ||
| Ligaments | 105 | ||
| Anterior Longitudinal Ligament | 106 | ||
| Posterior Longitudinal Ligament | 106 | ||
| Ligamenta Flava | 106 | ||
| Interspinous and Supraspinous Ligaments | 106 | ||
| Upper Cervical Spine Ligaments | 106 | ||
| Muscles | 106 | ||
| Spinal Cord | 107 | ||
| Fundamental Biomechanics | 108 | ||
| Scalar and Vector | 108 | ||
| Cartesian Coordinate System | 108 | ||
| Deformation | 108 | ||
| Kinetics and Kinematics | 108 | ||
| Force Deformation Response | 108 | ||
| Flexibility, Stiffness, and Range of Motion | 110 | ||
| Coupling | 110 | ||
| Bending Moment | 110 | ||
| Instantaneous Axis of Rotation | 111 | ||
| Clinical Biomechanics | 111 | ||
| Internal Deformation | 111 | ||
| Facet Joints | 112 | ||
| Spinal Cord | 113 | ||
| Pedicle | 114 | ||
| Intervertebral Disc | 114 | ||
| Ligaments | 115 | ||
| Muscles | 116 | ||
| Regional Characteristics | 118 | ||
| Cervical Spine | 118 | ||
| Upper Cervical Spine and Craniocervical Junction | 118 | ||
| Mid- and Lower Cervical Spine | 119 | ||
| Thoracic Spine | 119 | ||
| Lumbar Spine | 119 | ||
| Spinal Stability | 120 | ||
| Quantification of Acute Instability | 121 | ||
| Anomalous Anatomy | 121 | ||
| Soft Tissue Biomechanics | 122 | ||
| Gender Effects | 122 | ||
| Loading/Strain Rate Effects | 123 | ||
| Vertebrae | 123 | ||
| Ligaments | 124 | ||
| Columns | 124 | ||
| Intact Human Cadaver Studies | 126 | ||
| Acknowledgments | 126 | ||
| Key References | 126 | ||
| References | 127 | ||
| 8 Applied Anatomy of the Cervical Spine | 129 | ||
| Summary of Key Points | 129 | ||
| Spinal Column | 129 | ||
| Occipitocervical Junction | 129 | ||
| Osseous Elements | 129 | ||
| Ligamentous Structures | 130 | ||
| Subaxial Cervical Spine | 131 | ||
| Osseous Structures | 131 | ||
| Discoligamentous Structures | 133 | ||
| Neural Elements | 134 | ||
| Cervical Spinal Cord | 134 | ||
| Cervical Spinal Nerves | 134 | ||
| Vascular Anatomy | 135 | ||
| Arterial Anatomy | 135 | ||
| Spinal Cord Perfusion | 135 | ||
| Vertebral Artery Anatomy | 137 | ||
| Venous Anatomy | 138 | ||
| Surgically Relevant Adjacent Structures | 138 | ||
| Key References | 140 | ||
| References | 141 | ||
| 9 Applied Anatomy of the Thoracic and Lumbar Spine | 142 | ||
| Summary of Key Points | 142 | ||
| Spinal Alignment | 142 | ||
| Vertebrae and Ligaments | 142 | ||
| Vertebral Body | 142 | ||
| Intervertebral Disc and Vertebral End Plate | 143 | ||
| Anterior Longitudinal Ligament | 146 | ||
| Posterior Longitudinal Ligament | 146 | ||
| Pedicle | 146 | ||
| Facet and Pars Interarticularis | 148 | ||
| Transverse Process | 148 | ||
| Rib Articulations of the Thoracic Spine | 148 | ||
| Lamina and Spinous Process | 149 | ||
| Ligamentum Flavum | 150 | ||
| Interspinous and Supraspinous Ligaments | 150 | ||
| Spinal Canal | 150 | ||
| Neural Anatomy | 151 | ||
| Spinal Segmentation | 151 | ||
| Spinal Cord | 151 | ||
| Intradural Roots and the Cauda Equina | 152 | ||
| Lateral Recess, the Neural Foramen, and the Intraforaminal Root | 152 | ||
| Extraforaminal Spinal Nerve | 153 | ||
| Innervation of the Spine | 153 | ||
| Anomalous Root Anatomy | 153 | ||
| Vascular Anatomy | 154 | ||
| Upper Thoracic Spine Arterial Supply | 154 | ||
| Middle Thoracic, Lower Thoracic, and Lumbar Arterial Supply: The Segmental System | 154 | ||
| Spinal Cord Arterial Supply | 155 | ||
| Artery of Adamkiewicz | 156 | ||
| Nerve Root and Cauda Equina Arterial Supply | 157 | ||
| Venous Drainage of the Spinal Cord and Cauda Equina | 157 | ||
| Anatomic Variation and Surgical Localization | 159 | ||
| Key References | 160 | ||
| References | 161 | ||
| 10 Applied Anatomy of the Sacral Spine | 162 | ||
| Summary of Key Points | 162 | ||
| Osseous Structure | 162 | ||
| Ligamentous Anatomy | 162 | ||
| Neurovascular Anatomy | 163 | ||
| Applied Surgical Anatomy | 164 | ||
| Conclusions | 166 | ||
| Key References | 166 | ||
| References | 167 | ||
| 11 Intervertebral Disc | 168 | ||
| Summary of Key Points | 168 | ||
| Anatomy | 168 | ||
| Intervertebral Disc | 168 | ||
| Nucleus Pulposus | 168 | ||
| Annulus Fibrosus | 168 | ||
| Cartilage End Plate | 169 | ||
| Vascular Supply | 169 | ||
| Innervation | 169 | ||
| Physiology | 170 | ||
| Extracellular Matrix | 170 | ||
| Metabolic Balance | 170 | ||
| Disc Nutrition | 170 | ||
| Biomechanics | 171 | ||
| Aging | 171 | ||
| Extracellular Matrix Changes | 171 | ||
| Structural and Functional Changes | 172 | ||
| Summary | 172 | ||
| Key References | 172 | ||
| References | 173 | ||
| 12 Physical and Neurologic Examination | 174 | ||
| Summary of Key Points | 174 | ||
| History Taking | 174 | ||
| General Physical Examination | 174 | ||
| Components of the Neurologic Examination | 175 | ||
| Inspection | 175 | ||
| Cutaneous Abnormalities | 175 | ||
| Posture | 175 | ||
| Gait Analysis | 175 | ||
| Alterations of Gait Associated with Cord Compression. | 175 | ||
| Other Characteristic Gaits. | 175 | ||
| Palpation and Range of Motion Testing of the Spine and Related Areas | 175 | ||
| Cervical Spine | 175 | ||
| Thoracic Spine | 176 | ||
| Lumbar Spine and Related Areas | 176 | ||
| Motor Examination | 176 | ||
| Cervical Spine | 176 | ||
| Lumbar Spine | 176 | ||
| Sensory Examination | 176 | ||
| Reflex Examination | 178 | ||
| Deep Tendon Reflexes | 178 | ||
| Superficial Reflexes | 178 | ||
| Pathologic Reflexes | 179 | ||
| Provocative Nerve Root Testing | 179 | ||
| Cervical Spine | 179 | ||
| Lumbar Spine | 179 | ||
| Straight Leg Raising Test (Lasègue Sign). | 179 | ||
| Reverse Straight Leg Raising Test (Femoral Stretch Test). | 180 | ||
| Crossed Straight Leg Raising Test (Well Leg/Straight Leg Raising Test). | 180 | ||
| Hoover Test. | 180 | ||
| Differentiating Spinal Cord and Peripheral Nerve Pathology from Bony or Soft Tissue Pathology | 180 | ||
| Cervical Radiculopathy versus Upper Extremity Pathology | 180 | ||
| Shoulder | 180 | ||
| Elbow | 180 | ||
| Sacroiliac Joint | 180 | ||
| Hip Joint | 181 | ||
| Key References | 181 | ||
| References | 182 | ||
| 13 Differential Diagnosis of Surgical Disorders of the Spine | 183 | ||
| Summary of Key Points | 183 | ||
| Spinal Pain | 183 | ||
| Pain Associated with Fever and Weight Loss | 183 | ||
| Vertebral Osteomyelitis | 183 | ||
| Epidural Abscess | 183 | ||
| Discitis | 184 | ||
| Granulomatous Infections | 185 | ||
| Tuberculous Spondylitis | 185 | ||
| Fungal Infections | 185 | ||
| Coccidioidomycosis | 185 | ||
| Blastomycosis | 185 | ||
| Cryptococcus | 185 | ||
| Pain Associated with Recumbency and Night Pain | 185 | ||
| Benign Bone Tumors | 185 | ||
| Osteochondroma. | 185 | ||
| Osteoid Osteoma and Osteoblastoma. | 185 | ||
| Giant Cell Tumor. | 185 | ||
| Aneurysmal Bone Cyst. | 186 | ||
| Hemangioma. | 186 | ||
| Eosinophilic Granuloma. | 186 | ||
| Malignant Bone Tumors | 186 | ||
| Chondrosarcoma. | 186 | ||
| Osteogenic Sarcoma and Ewing Sarcoma. | 186 | ||
| Chordoma. | 186 | ||
| Multiple Myeloma. | 186 | ||
| Lymphoma. | 186 | ||
| Metastatic Disease. | 186 | ||
| Spinal Cord Tumors. | 187 | ||
| Extradural Lesions. | 187 | ||
| Intradural-Extramedullary Lesions. | 187 | ||
| Intradural-Intramedullary Tumors. | 187 | ||
| Pain Associated with Morning Stiffness | 187 | ||
| Ankylosing Spondylitis | 187 | ||
| Rheumatoid Arthritis | 188 | ||
| Mechanical Pain | 188 | ||
| Spinal Stenosis | 188 | ||
| Spondylolisthesis and Spondylolysis | 188 | ||
| Herniated Nucleus Pulposus | 188 | ||
| Scoliosis | 188 | ||
| Neurologic Deficits | 188 | ||
| Congenital Lesions | 188 | ||
| Trauma | 189 | ||
| Vascular Lesions | 189 | ||
| Ischemia | 189 | ||
| Vascular Malformations | 189 | ||
| Demyelinating Lesions | 190 | ||
| Multiple Sclerosis | 190 | ||
| Transverse Myelitis | 190 | ||
| Degenerative Disorders | 190 | ||
| Upper Motor Neuron Syndromes | 190 | ||
| Lower Motor Neuron Syndromes | 191 | ||
| Combined Upper and Lower Motor Neuron Syndromes | 191 | ||
| Miscellaneous Disorders | 191 | ||
| Subacute Combined Degeneration | 191 | ||
| Guillain-Barré Syndrome | 192 | ||
| Familial Periodic Paralysis | 192 | ||
| Paraneoplastic Syndromes | 192 | ||
| Conclusion | 192 | ||
| Key References | 192 | ||
| References | 193 | ||
| 14 Anatomy and Physiology of Congenital Spinal Lesions | 196 | ||
| Summary of Key Points | 196 | ||
| Preoperative Considerations | 196 | ||
| Craniovertebral Junction Abnormalities | 196 | ||
| Basilar Invagination | 196 | ||
| Assimilation of the Atlas | 197 | ||
| Atlantoaxial Instability | 197 | ||
| Anomalies of the Odontoid Process | 197 | ||
| Aplasia-Hypoplasia of the Dens | 197 | ||
| Os Odontoideum | 197 | ||
| Disorders of the Subaxial Cervical Spine | 198 | ||
| Klippel-Feil Syndrome | 198 | ||
| Iniencephaly | 199 | ||
| Disorders of the Thoracolumbar Spine | 200 | ||
| Congenital Scoliosis | 200 | ||
| Congenital Kyphosis | 200 | ||
| Congenital Lordosis | 201 | ||
| Lumbar Spine Abnormalities | 201 | ||
| Congenital Spinal Stenosis | 201 | ||
| Developmental Spinal Stenosis | 201 | ||
| Segmented Spinal Dysgenesis | 203 | ||
| Spondylolisthesis | 203 | ||
| Disorders of the Sacral Spine | 203 | ||
| Sacral Agenesis | 203 | ||
| Teratomas | 203 | ||
| Spinal Dysraphism | 204 | ||
| Diastematomyelia | 205 | ||
| Neurenteric Cysts | 205 | ||
| Lipomas | 205 | ||
| Dermoids and Dermal Sinus Tracts | 205 | ||
| Tethered Cord | 206 | ||
| Syringomyelia | 206 | ||
| Summary | 206 | ||
| Key References | 206 | ||
| References | 207 | ||
| 15 Anatomy and Pathophysiology of Acquired and Systemic Spinal Disorders | 208 | ||
| Summary of Key Points | 208 | ||
| Degenerative Disc Disease and Spondylosis | 208 | ||
| Rheumatoid Arthritis | 210 | ||
| Scheuermann Disease (Juvenile Kyphosis) | 212 | ||
| Paget Disease | 213 | ||
| Ankylosing Spondylitis | 214 | ||
| Ossification of the Posterior Longitudinal Ligament (OPLL) | 215 | ||
| Spondylolisthesis and Spondylolysis | 216 | ||
| Dysplastic Spondylolisthesis | 218 | ||
| Isthmic Spondylolisthesis | 218 | ||
| Degenerative Spondylolisthesis | 219 | ||
| Traumatic, Pathologic, and Iatrogenic Spondylolisthesis | 219 | ||
| Summary | 219 | ||
| Key References | 219 | ||
| References | 220 | ||
| 16 Intervertebral Disc Process of Degeneration | 224 | ||
| Summary of Key Points | 224 | ||
| Physiology and Pathophysiology | 224 | ||
| Normal Intervertebral Disc | 224 | ||
| Annulus Fibrosus | 224 | ||
| Nucleus Pulposus | 224 | ||
| Cartilaginous End Plate | 225 | ||
| Matrix of the Intervertebral Disc | 225 | ||
| Nutrition of the Intervertebral Disc | 225 | ||
| Modulation and Regulation of Disc Matrix | 225 | ||
| Anabolic Influences | 225 | ||
| Catabolic Influences | 226 | ||
| Degeneration | 226 | ||
| Gross and Histologic Changes | 227 | ||
| Radiographic Changes | 228 | ||
| Biochemical Changes | 228 | ||
| Disc Material Properties and Disc Degeneration | 229 | ||
| Etiology of Disc Degeneration | 230 | ||
| Genetic Influences | 230 | ||
| Nutritional Influences | 230 | ||
| Mechanical Influences | 231 | ||
| Toxic Exposure | 232 | ||
| Disc Degeneration and Back Pain | 232 | ||
| Future Treatment for Intervertebral Disc Degeneration | 232 | ||
| Molecular Therapies | 233 | ||
| Genetic Therapies | 233 | ||
| Cellular Therapies | 233 | ||
| Summary | 233 | ||
| Key References | 234 | ||
| References | 235 | ||
| 17 Intradiscal Pressure | 239 | ||
| Summary of Key Points | 239 | ||
| Intradiscal Pressure in the Normal and Degenerated Discs | 239 | ||
| Limitations and New Technologies in Intradiscal Pressure Measurement | 240 | ||
| Key References | 240 | ||
| References | 242 | ||
| 18 Definition and Assessment of Dysfunctional Segmental Motion | 243 | ||
| Summary of Key Points | 243 | ||
| Biomechanics of Stable Motion Segment | 243 | ||
| Biomechanics of a Dysfunctional Motion Segment | 243 | ||
| In Vivo Assessment of Three-Dimensional Functional Spinal Unit Kinematics | 244 | ||
| Key References | 245 | ||
| References | 246 | ||
| 19 Neural Injury at the Molecular Level | 247 | ||
| Summary of Key Points | 247 | ||
| Microbiology of the Oligodendrocyte | 247 | ||
| Apoptosis | 248 | ||
| Molecular Mechanisms of Apoptosis | 248 | ||
| Apoptosis in Traumatic Spinal Cord Injury | 249 | ||
| Apoptosis in Chronic Spinal Cord Compression | 249 | ||
| Prevention of Apoptosis | 250 | ||
| Biomechanical Deformation as an Epigenetic Factor in Neuronal and Oligodendrocytic Apoptosis | 251 | ||
| Discussion | 251 | ||
| Key References | 251 | ||
| References | 253 | ||
| 20 Pathophysiology of Cervical Myelopathy | 257 | ||
| Summary of Key Points | 257 | ||
| Patterns of Cervical Spondylotic Myelopathy | 257 | ||
| Histopathology of Cervical Spondylotic Myelopathy | 258 | ||
| Spinal Cord Ischemia and Cervical Spondylotic Myelopathy | 258 | ||
| Biomechanical Factors and Cervical Spondylotic Myelopathy | 258 | ||
| Pathophysiology of Deformative Stress Injury of the Cervical Spinal Cord | 259 | ||
| Mathematical Models of Spinal Cord Stretch Injury | 259 | ||
| Finite Element Models of Spinal Cord Stretch Injury | 260 | ||
| Spinal Cord Tethering and Shear Injury | 260 | ||
| Histopathology of Spinal Cord Shear Injury | 261 | ||
| Relationship between Ischemia and Shear Injury | 262 | ||
| Apoptosis | 263 | ||
| New Technology: Diffusion Tensor Tractography | 263 | ||
| Summary | 263 | ||
| Key References | 264 | ||
| References | 265 | ||
| 21 Pathophysiology of Thoracic Myelopathy | 268 | ||
| Summary of Key Points | 268 | ||
| Biomechanical Anatomy of the Thoracic Vertebral Column | 268 | ||
| Histopathology of Spinal Cord Injury | 268 | ||
| Pathophysiology | 268 | ||
| Prevalence, Evaluation, Treatment, and Prognosis | 269 | ||
| Disc Herniation | 269 | ||
| Ligamentous Ossification | 269 | ||
| Trauma | 270 | ||
| Tumor, Cyst, Abscess | 270 | ||
| Dural Arteriovenous Fistula | 270 | ||
| Spinal Deformity | 270 | ||
| Spinal Myelopathy Secondary to Intrathecal Catheterization | 270 | ||
| Idiopathic Spinal Cord Herniation | 270 | ||
| Conclusion | 270 | ||
| Key References | 271 | ||
| References | 272 | ||
| 22 Anatomy of Nerve Root Compression, Nerve Root Tethering, and Spinal Instability | 273 | ||
| Summary of Key Points | 273 | ||
| Understanding Motion Segments | 273 | ||
| Causes of Back Pain | 273 | ||
| Spinal Degeneration | 273 | ||
| Neuropathic Pain in Spinal Degeneration | 275 | ||
| Motion of Neural Elements in the Spine: How Nerve Roots Can Be Stretched | 275 | ||
| Ventral Olisthesis and Loss of Disc Height | 276 | ||
| Lateral Olisthesis | 276 | ||
| Neural, Biomechanical, and Physiologic Considerations of Nerve Stretch | 276 | ||
| Basic Science of Chronic Spinal Pain and Stretch-Induced Nerve Root Injury | 277 | ||
| Role of Nerve Root Vascularization and Perfusion | 277 | ||
| Conclusion | 278 | ||
| Key References | 278 | ||
| References | 279 | ||
| 23 Fundamentals of Spine Surgery | 281 | ||
| Summary of Key Points | 281 | ||
| Decision-Making Process | 281 | ||
| Patient Selection | 281 | ||
| Consent for Surgery | 281 | ||
| Informed Consent | 282 | ||
| Beyond Informed Consent | 282 | ||
| Surgical Considerations | 282 | ||
| Spinal Anatomy and Biomechanics | 282 | ||
| Technology and the Spine | 283 | ||
| Economics | 283 | ||
| Summary | 284 | ||
| Key References | 284 | ||
| References | 285 | ||
| 24 Preoperative and Surgical Planning for Avoiding Complications | 286 | ||
| Summary of Key Points | 286 | ||
| General Precautions | 286 | ||
| Antibiotics | 286 | ||
| Steroids | 286 | ||
| Intubation | 286 | ||
| Positioning | 286 | ||
| Air Embolism | 287 | ||
| Paradoxic Air Embolism | 287 | ||
| Doppler and End-Tidal CO2 Monitoring | 287 | ||
| Intravascular Volume Control | 287 | ||
| Intraoperative Radiographs | 287 | ||
| Incidental Durotomy, Cerebrospinal Fluid Fistula, and Pseudomeningocele | 287 | ||
| Iliac Crest Graft Harvest Complications | 288 | ||
| Thromboembolism | 288 | ||
| Operative Technique | 288 | ||
| Upper Cervical Spine: Complication Avoidance | 288 | ||
| Transoral Approach | 288 | ||
| Cerebrospinal Fluid Fistula | 288 | ||
| Severe Tongue Swelling | 288 | ||
| Hemorrhage | 288 | ||
| Meningitis | 288 | ||
| Retropharyngeal Abscess and Palatal and Pharyngeal Wound Dehiscence | 288 | ||
| Neurologic Worsening and Instability | 289 | ||
| Median Labiomandibular Glossotomy | 289 | ||
| Transcervical Retropharyngeal Approach | 289 | ||
| Lateral Transcondylar Approach | 289 | ||
| Subaxial Cervical Spine: Complication Avoidance | 289 | ||
| Subaxial Ventral Approaches | 289 | ||
| Spinal Cord Damage | 289 | ||
| Cervical Nerve Root Injury | 289 | ||
| C5 Radiculitis | 289 | ||
| Dural Tears | 289 | ||
| Major Vessel Injury | 290 | ||
| Brachiocephalic Vein Injury. | 290 | ||
| Vertebral Artery Injury. | 290 | ||
| Carotid Artery Injury. | 290 | ||
| Dysphagia | 290 | ||
| Esophagus and Trachea Injury | 290 | ||
| Recurrent Laryngeal Nerve Injury | 290 | ||
| Hypoglossal Nerve Injury | 291 | ||
| Thoracic Duct Injury | 291 | ||
| Sympathetic Chain Injury | 291 | ||
| Excessive Bleeding | 291 | ||
| Postoperative Hematoma | 291 | ||
| Graft Bed Preparation | 291 | ||
| Graft Dislocation | 291 | ||
| Graft Pseudarthrosis | 291 | ||
| Vertebral Avascular Necrosis | 291 | ||
| Ventral Plating Complications | 291 | ||
| Subaxial Dorsal Approaches | 291 | ||
| Neurologic Deterioration | 291 | ||
| Postoperative Instability and Kyphosis | 292 | ||
| Cervicothoracic Junction (C7-T3): Complication Avoidance | 292 | ||
| Cervicothoracic Junction Ventral Surgery Complications | 292 | ||
| Recurrent Laryngeal Nerve Injury | 292 | ||
| Thoracic Duct Injury | 292 | ||
| Major Vessel, Lung Apex, and Gland Injuries | 292 | ||
| Brachial Plexus Injury | 292 | ||
| Intercostal Neuralgia | 292 | ||
| Chest Wall Deformity and Scar | 292 | ||
| Thoracic, Lumbar, and Sacral Spine: Complication Avoidance | 292 | ||
| Dorsal Surgery Complications | 292 | ||
| Instability and Deformity | 292 | ||
| Instrumented Fusion Complications | 293 | ||
| Neurologic Deterioration | 293 | ||
| Ventral Surgery Complications | 293 | ||
| Anterior Lumbar Interbody Fusion Complications | 293 | ||
| Pulmonary Injury | 293 | ||
| Lumbar Sympathetic Plexus Injury | 293 | ||
| Superior Hypogastric Plexus Injury | 293 | ||
| Great Vessel Injury | 293 | ||
| Visceral Injury | 293 | ||
| Artery of Adamkiewicz | 293 | ||
| Deep Vein Thrombosis | 293 | ||
| Abdominal Incisional Hernia, Prolonged Ileus, and Hemorrhage | 294 | ||
| Shoulder-Girdle Dysfunction | 294 | ||
| Minimally Invasive Spine Surgery: Complication Avoidance | 294 | ||
| Thoracoscopic Approaches | 294 | ||
| Extreme Lateral Lumbar Interbody Fusion | 294 | ||
| Vertebroplasty and Kyphoplasty | 294 | ||
| Key References | 294 | ||
| References | 295 | ||
| 25 Patient Selection for Spine Surgery | 297 | ||
| Summary of Key Points | 297 | ||
| Patient Evaluation | 297 | ||
| Low Back Pain: Evidence for Treatment | 298 | ||
| Low Back Surgery for Adult Low-Grade Spondylolisthesis | 298 | ||
| Conservative versus Surgical Treatment | 298 | ||
| Low-Grade Spondylolisthesis: To Fuse or Not to Fuse? What is the Role of Instrumentation and the Best Approach? | 298 | ||
| Lumbar Fusion for Back Pain without Signs of Instability | 300 | ||
| Clinical Results for the Conservative and Surgical Treatment of Mechanical Low Back Pain | 300 | ||
| Nonsurgical Options | 301 | ||
| Conclusions | 301 | ||
| Key References | 302 | ||
| References | 303 | ||
| 26 Masqueraders of Spinal Pathology | 305 | ||
| Summary of Key Points | 305 | ||
| Musculoskeletal System | 305 | ||
| Shoulder | 305 | ||
| Impingement Syndrome/Rotator Cuff Tear | 305 | ||
| Glenohumeral Osteoarthritis | 306 | ||
| Hip | 307 | ||
| Hip Osteoarthritis | 307 | ||
| Greater Trochanteric Pain Syndrome | 308 | ||
| Sacroiliac Joint | 308 | ||
| Sacroiliac Joint Dysfunction | 308 | ||
| Nervous System | 309 | ||
| Compression Neuropathy | 309 | ||
| Upper Extremity Compression Neuropathies | 309 | ||
| Thoracic Outlet Syndrome. | 309 | ||
| Median Neuropathy. | 311 | ||
| Carpal Tunnel Syndrome. | 311 | ||
| Ulnar Neuropathy. | 312 | ||
| Cubital Tunnel Syndrome. | 312 | ||
| Radial Neuropathy. | 312 | ||
| Lower Extremity Compression Neuropathies | 312 | ||
| Piriformis Syndrome. | 312 | ||
| Meralgia Paresthetica. | 313 | ||
| Metabolic Neuropathy: Diabetic Neuropathy | 313 | ||
| Visceral Organs and Related Systems | 314 | ||
| Cardiovascular System | 314 | ||
| Myocardial Ischemia | 314 | ||
| Aortic Aneurysm | 314 | ||
| Vascular Claudication | 315 | ||
| Infective (Bacterial) Endocarditis | 316 | ||
| Pulmonary System: Pancoast Tumor | 316 | ||
| Gastrointestinal System | 316 | ||
| Genitourinary System | 317 | ||
| Urolithiasis (Kidney Stones) | 317 | ||
| Gynecologic System | 317 | ||
| Summary | 318 | ||
| Key References | 318 | ||
| References | 319 | ||
| 27 Bone Modeling and Remodeling | 321 | ||
| Summary of Key Points | 321 | ||
| Types of Bone | 321 | ||
| Bone Formation | 321 | ||
| Vertebral Bone Formation | 322 | ||
| Ossification Centers of the Vertebrae | 322 | ||
| Bone Modeling and Remodeling | 322 | ||
| Bone Modeling during Growth | 322 | ||
| Physiologic Bone Remodeling after Growth | 322 | ||
| Bone Modeling and Remodeling and the Basic Multicellular Unit | 322 | ||
| Age-Related Bone Remodeling (Bone Loss) | 323 | ||
| Modeling and Remodeling in Response to Mechanical Forces | 323 | ||
| Mechanotransduction | 324 | ||
| Genetic Factors | 325 | ||
| Systemic Hormones | 325 | ||
| Exercise | 326 | ||
| Prostaglandins and Growth Factors | 326 | ||
| Stem Cells | 326 | ||
| Key References | 327 | ||
| References | 328 | ||
| 28 Spine Fusion | 331 | ||
| Summary of Key Points | 331 | ||
| Anatomy of the Bone-Bone Interface | 331 | ||
| Histologic Components | 331 | ||
| Biomechanical Properties of Graft Material | 332 | ||
| Incorporation of Bone Graft | 332 | ||
| Differences in Cancellous and Cortical Bone Graft Incorporation | 332 | ||
| Biomechanics of Graft Incorporation | 333 | ||
| Temporal Profile of Graft Incorporation | 333 | ||
| Host Response and Incorporation of Autograft and Allograft | 334 | ||
| Modeling and Remodeling Associated with Spine Fusion | 334 | ||
| Growth Factors and Cytokines in Regulating Bone Remodeling | 334 | ||
| Biomechanics of Fusion | 335 | ||
| Biomechanics of the Fusion Mass | 335 | ||
| Positioning of Bone Graft | 335 | ||
| Kyphotic Deformity and Bone Graft Positioning | 336 | ||
| Load Sharing | 336 | ||
| Stress Shielding | 338 | ||
| Biomechanical Consideration at Specific Sites | 338 | ||
| Conclusion | 339 | ||
| Acknowledgment | 339 | ||
| Key References | 339 | ||
| References | 340 | ||
| 29 Biology of Spine Fusion | 342 | ||
| Summary of Key Points | 342 | ||
| Local Factors | 342 | ||
| Graft Properties: Osteoinduction, Osteogenicity, Osteoconduction, and Connectivity | 342 | ||
| Graft Material | 342 | ||
| Autograft | 342 | ||
| Demineralized Bone Matrix | 343 | ||
| Allograft | 343 | ||
| Xenograft | 343 | ||
| Ceramics | 344 | ||
| Animal Studies. | 344 | ||
| Human Studies. | 344 | ||
| Mechanical Stability | 344 | ||
| Animal Studies: Spinal Instrumentation | 344 | ||
| Human Studies: Spinal Instrumentation | 345 | ||
| Graft Site Preparation | 345 | ||
| Soft Tissue Bed | 345 | ||
| Systemic Factors | 346 | ||
| Nicotine | 346 | ||
| Drugs | 346 | ||
| Osteoporosis | 346 | ||
| Hormones | 346 | ||
| Fusion Enhancers | 346 | ||
| Electrical Stimulation | 346 | ||
| Electrical Devices | 347 | ||
| Human Studies | 347 | ||
| Growth Factors | 347 | ||
| Animal Studies | 347 | ||
| Human Studies | 348 | ||
| Bone Morphogenetic Proteins: Adverse Events | 348 | ||
| Ectopic Bone Formation: Animal Studies | 348 | ||
| Ectopic Bone Formation: Human Studies | 349 | ||
| Posterior and Transforaminal Lumbar Interbody Fusions. | 349 | ||
| Swelling, Hematoma, and Dysphagia in Anterior Cervical Discectomy and Fusion | 349 | ||
| Bony Resorption and Graft Subsidence | 349 | ||
| Cancer-Related Risks | 349 | ||
| Painful Seroma and Mass Effect in Minimally Invasive Lumbar Spine Surgery | 349 | ||
| Bone Morphogenetic Proteins and the Rising Costs of Health Care | 349 | ||
| Future Directions and Emerging Technologies | 350 | ||
| Key References | 350 | ||
| References | 351 | ||
| 30 Osteointegration (Osseointegration) | 356 | ||
| Summary of Key Points | 356 | ||
| Osteointegration (Osseointegration) | 356 | ||
| Osteoconductivity | 356 | ||
| Biomaterials | 356 | ||
| Metals | 356 | ||
| Surface Texture | 356 | ||
| Other Materials | 357 | ||
| Surgical Applications | 358 | ||
| Interbody Fusion | 358 | ||
| Pedicle Screws | 358 | ||
| Spacers, Scaffold, Carrier | 359 | ||
| Artificial Discs | 359 | ||
| Vertebral Augmentation | 360 | ||
| Summary | 360 | ||
| Key References | 361 | ||
| References | 362 | ||
| 31 Bone Void Fillers | 364 | ||
| Summary of Key Points | 364 | ||
| Use of Cancellous Bone Grafts Versus Substitutes | 364 | ||
| Role of Cancellous Bone | 364 | ||
| General Characteristics of a Successful Bone Graft | 364 | ||
| Osteogenesis | 365 | ||
| Osteoinduction | 365 | ||
| Osteoconduction | 365 | ||
| Potential Uses of Natural and Synthetic Bone Grafts | 365 | ||
| Graft Materials | 365 | ||
| Autograft | 365 | ||
| Pro | 365 | ||
| Con | 365 | ||
| Osteoconductive Matrices | 366 | ||
| Allograft | 366 | ||
| Pro | 366 | ||
| Con | 366 | ||
| Demineralized Bone Matrix | 367 | ||
| Xenograft | 367 | ||
| Ceramics | 367 | ||
| Noninjectable Ceramics | 367 | ||
| Rapidly Resorbing Ceramics | 367 | ||
| Intermediate Resorbing Ceramics | 368 | ||
| Slowly Resorbing Ceramics | 368 | ||
| Injectable Ceramics: Calcium Phosphate Cement | 368 | ||
| Collagen | 368 | ||
| Nonbiologic Osteoconductive Substrates | 368 | ||
| Qualitative Assessment of Ceramics | 368 | ||
| Biologic and Synthetic Composite Grafts | 370 | ||
| Osteogenic and Osteoinductive Bone Marrow Aspirate | 370 | ||
| Background | 370 | ||
| Gene Therapy | 370 | ||
| Bone Marrow Aspirate and Bone Composites | 371 | ||
| Bone Marrow Aspirate and Synthetic Composites | 371 | ||
| Bone Morphogenetic Protein and Synthetic Composites | 371 | ||
| Summary | 373 | ||
| Key References | 373 | ||
| References | 374 | ||
| 32 Biologics in Spine Fusion Surgery | 376 | ||
| Summary of Key Points | 376 | ||
| Autograft | 376 | ||
| Iliac Crest Bone Graft | 376 | ||
| Local Bone Graft | 377 | ||
| Bone Graft Extenders | 377 | ||
| Allograft | 377 | ||
| Demineralized Bone Matrix | 377 | ||
| Ceramics | 377 | ||
| Mesenchymal Stem Cells | 378 | ||
| Recombinant Bone Morphogenetic Protein–2 (rhBMP-2) | 378 | ||
| Conclusion | 379 | ||
| Key References | 380 | ||
| References | 381 | ||
| 33 Materials and Material Properties | 384 | ||
| Summary of Key Points | 384 | ||
| Forces | 384 | ||
| Atomic Bonds, Structures, and Property Relationships | 385 | ||
| Mechanical Properties | 386 | ||
| Spinal Implants: Rigid Versus Dynamic | 387 | ||
| Biologic Materials | 388 | ||
| Stainless Steel | 388 | ||
| Titanium-Based Alloys | 388 | ||
| Surface Structure and Modifications of Alloys | 388 | ||
| Tantalum | 389 | ||
| Synthetic Polymers | 389 | ||
| Bone Morphogenetic Protein | 390 | ||
| Summary | 391 | ||
| Key References | 391 | ||
| References | 392 | ||
| 34 Biomechanical Testing | 393 | ||
| Summary of Key Points | 393 | ||
| Background | 393 | ||
| Bench-Type Tests for Approval by the U.S. Food and Drug Administration | 394 | ||
| Analysis | 394 | ||
| In Vitro Testing | 396 | ||
| Terminology | 396 | ||
| Specimen Selection | 399 | ||
| Species | 399 | ||
| Classification | 399 | ||
| Sample Size | 399 | ||
| Number of Segments | 399 | ||
| Sequence | 399 | ||
| Testing Environment | 399 | ||
| Specimen Handling and Preparation | 399 | ||
| Safety. | 399 | ||
| Storage. | 399 | ||
| Preparation. | 399 | ||
| Testing Apparatus | 399 | ||
| Spinal Loading Simulator | 399 | ||
| Motion Measurement System | 399 | ||
| Testing Methods | 400 | ||
| Static Strength Testing | 400 | ||
| Stability Testing | 400 | ||
| Hybrid Testing | 400 | ||
| Presurgery. | 400 | ||
| Postsurgery. | 400 | ||
| Load Versus Displacement Control | 400 | ||
| Analog Tissue Testing | 400 | ||
| In Silico Testing | 401 | ||
| Background | 401 | ||
| Model Development | 401 | ||
| In Silico Study | 402 | ||
| Clinical Objective | 404 | ||
| Summary | 404 | ||
| Acknowledgments | 404 | ||
| Key References | 404 | ||
| References | 405 | ||
| 35 Computational Modeling of the Spine | 407 | ||
| Summary of Key Points | 407 | ||
| Finite Element Models | 407 | ||
| Modeling of Spinal Elements | 407 | ||
| Three-Dimensional Reconstruction and Structural Modeling | 407 | ||
| Material Definition | 408 | ||
| Vertebral Bodies, End Plates, and Facet Cartilages. | 408 | ||
| Intervertebral Disc: Anulus Fibrosus and Nucleus Pulposus. | 408 | ||
| Ligaments. | 409 | ||
| Articular Facet Joints. | 409 | ||
| Loads and Boundary Conditions | 410 | ||
| Biomechanical Applications | 410 | ||
| Disc Degeneration and Vertebral Osteoporosis Simulation | 410 | ||
| Modeling and Analysis of the Instrumented Spine | 411 | ||
| Analysis of Fusion | 411 | ||
| Analysis of Arthroplasty | 412 | ||
| Analysis of Dynamic Systems | 412 | ||
| Analysis of Cement Augmentation | 412 | ||
| Summary | 413 | ||
| Key References | 413 | ||
| References | 414 | ||
| 36 Electrodiagnostic Studies | 416 | ||
| Summary of Key Points | 416 | ||
| Key Anatomy for Electrodiagnosis | 416 | ||
| Nerve Fiber Injury Types and Relevance | 416 | ||
| Components of the Electrodiagnostic Examination | 417 | ||
| Nerve Conduction Studies | 417 | ||
| Motor Conduction Studies | 418 | ||
| Sensory Conduction Studies | 418 | ||
| Needle Electrode Examination | 419 | ||
| Late Responses | 420 | ||
| H Reflex. | 420 | ||
| F Waves. | 420 | ||
| Electrodiagnostic Localization of Spinal Disorders | 420 | ||
| Radiculopathy | 420 | ||
| Case Studies | 422 | ||
| Polyradiculopathy | 422 | ||
| Cervical Root Avulsion | 422 | ||
| Lumbar Canal Stenosis | 423 | ||
| Postoperative Electrodiagnostic Examination | 423 | ||
| Recommendations for the Referring Physician | 424 | ||
| Key References | 425 | ||
| References | 426 | ||
| 37 Intraoperative Monitoring in Routine and Complex Surgery | 427 | ||
| Summary of Key Points | 427 | ||
| Brief History | 427 | ||
| How They Work | 427 | ||
| SSEPs | 427 | ||
| MEPs | 427 | ||
| EMGs | 428 | ||
| Use in Routine Spine Surgery | 428 | ||
| Use in Complex Spine Surgery | 429 | ||
| Conclusion | 429 | ||
| Key References | 429 | ||
| References | 430 | ||
| 38 Big Data in Health Care | 432 | ||
| Summary of Key Points | 432 | ||
| What is Big Data Analytics? | 432 | ||
| Role of Big Data in Health Care | 432 | ||
| Evidence-Based Medicine | 432 | ||
| Big Data and Research | 433 | ||
| Value | 433 | ||
| Communicating with Patients | 433 | ||
| Decreasing Cost | 434 | ||
| Limitations of Big Data | 434 | ||
| A Tipping Point in the Big Data Revolution | 434 | ||
| Big Data Going Forward | 435 | ||
| Which Data to Collect | 435 | ||
| Components of Big Data | 435 | ||
| Novel Health Care Data Infrastructure Systems | 436 | ||
| The Future of Big Data | 436 | ||
| Key References | 436 | ||
| References | 437 | ||
| 39 Spine Registries | 438 | ||
| Summary of Key Points | 438 | ||
| Registry Design | 438 | ||
| Current Status | 439 | ||
| Defining High-Quality Registries | 439 | ||
| Active Prospective Spine Registries | 439 | ||
| High-Volume Registries | 439 | ||
| Evaluating Cost Effectiveness Using Registry Data | 439 | ||
| Device and Implant-Based Registries | 439 | ||
| Subspecialty Registries | 439 | ||
| Future Trends/Areas for Improvement | 442 | ||
| Conclusions | 442 | ||
| Key References | 442 | ||
| References | 443 | ||
| 40 Basic Biomechanically Relevant Anatomy | 444 | ||
| Summary of Key Points | 444 | ||
| Biomechanics | 444 | ||
| Cartesian Coordinate System | 444 | ||
| Vectors, Scalars, Bending Moments, and the Instantaneous Axis of Rotation | 444 | ||
| Free Body Analysis | 445 | ||
| Newton’s Laws | 445 | ||
| Hooke’s Law and Stress-Strain Curves | 445 | ||
| Elastic Modulus | 446 | ||
| Section Modulus and Moment of Inertia | 446 | ||
| Basic Biomechanics of Bone | 446 | ||
| Avulsion Fracture | 446 | ||
| Anterior Wedge Compression Fractures | 446 | ||
| Flexion-Distraction Fracture (Chance Fracture) | 447 | ||
| Burst Fracture | 447 | ||
| Torsion | 447 | ||
| Basic Anatomy of the Spine | 447 | ||
| Vertebral Body | 448 | ||
| Intervertebral Disc | 448 | ||
| Facet Joints | 449 | ||
| Dorsal Elements | 450 | ||
| Ligaments | 451 | ||
| Musculature | 452 | ||
| Application of Basic Principles to Instrumentation | 453 | ||
| Implant Properties | 453 | ||
| Application to Implants | 454 | ||
| Summary | 457 | ||
| Key References | 457 | ||
| References | 458 | ||
| 41 Spinal Implant Attributes | 459 | ||
| Summary of Key Points | 459 | ||
| Distraction Fixation | 459 | ||
| Three-Point Bending Fixation | 459 | ||
| Terminal Three-Point Bending Fixation | 461 | ||
| Combined Distraction and Three-Point Bending Fixation | 461 | ||
| Tension Band (Compression) Fixation | 462 | ||
| Loading of Rigid or Semirigid Distraction and Compression Constructs | 463 | ||
| Comparison of Three-Point Bending and Tension Band Fixation | 464 | ||
| Key References | 465 | ||
| References | 466 | ||
| 42 Implant Attributes | 467 | ||
| Summary of Key Points | 467 | ||
| Cantilever | 467 | ||
| Cantilevers in Spinal Instrumentation | 467 | ||
| Bone-Screw Cantilever | 467 | ||
| Resistance to Shear Stress | 467 | ||
| Resistance to Bending Moment | 468 | ||
| Other Forces and Moments at the Bone-Screw Interface | 469 | ||
| Screw-Rod Interface | 469 | ||
| Clinical Modes of Failure and Strategies to Reduce Their Incidence | 470 | ||
| Bone-Screw Interface Failure | 470 | ||
| Strategies to Increase the Resistive Moment | 470 | ||
| Strategies to Decrease the Applied Moment | 471 | ||
| Screw-Rod Interface Failure | 471 | ||
| Strategies to Reduce the Incidence of Implant Failure at the Screw-Rod Interface | 472 | ||
| Conclusion | 472 | ||
| Key References | 472 | ||
| References | 473 | ||
| 43 Iatrogenic Spine Destabilization | 474 | ||
| Summary of Key Points | 474 | ||
| Biomechanical Considerations | 474 | ||
| Ligamentous Disruption | 474 | ||
| 9780323415217v2_WEB | 1238 | ||
| Front Cover | 1238 | ||
| Benzel's Spine Surgery, 2-Volume Set | 1239 | ||
| Copyright Page | 1242 | ||
| Dedication | 1243 | ||
| Contributors | 1244 | ||
| Preface | 1257 | ||
| Risk Taking | 1257 | ||
| Repetition | 1257 | ||
| What Is a Complication? | 1257 | ||
| Bias and Conflict of Interest | 1259 | ||
| In Memoriam | 1260 | ||
| Table Of Contents | 1261 | ||
| Video Contents | 1268 | ||
| 4.4 Tumors, Vascular Malformations, and Related Lesions | 1269 | ||
| 108 Cellular Injection Techniques for Discogenic Pain | 1269 | ||
| Summary of Key Points | 1269 | ||
| Cellular Therapy for Disc Repair | 1270 | ||
| Cell Preparation Techniques | 1270 | ||
| Procedure | 1270 | ||
| Discussion | 1271 | ||
| Key References | 1272 | ||
| References | 1273 | ||
| 109 Primary and Metastatic Bone Lesions | 1275 | ||
| Summary of Key Points | 1275 | ||
| Symptoms | 1275 | ||
| Radiologic Evaluation | 1275 | ||
| Management | 1276 | ||
| Biopsy | 1276 | ||
| Medical Staging | 1276 | ||
| Surgical Staging and Classification | 1276 | ||
| Treatment | 1277 | ||
| Medical Therapy | 1277 | ||
| Surgery | 1277 | ||
| Complications | 1277 | ||
| Radiotherapy | 1278 | ||
| Primary Lesions | 1278 | ||
| Benign Primary Tumors | 1278 | ||
| Osteochondroma | 1278 | ||
| Hemangioma | 1278 | ||
| Imaging. | 1278 | ||
| Histology. | 1278 | ||
| Management. | 1278 | ||
| Eosinophilic Granuloma | 1279 |