BOOK
Rothman-Simeone The Spine E-Book
Steven R. Garfin | Frank J. Eismont | Gordon R. Bell | Christopher M Bono | Jeffrey Fischgrund
(2017)
Additional Information
Book Details
Abstract
Get comprehensive, practical coverage of both surgical and non-surgical treatment approaches from the world’s most trusted authorities in spine surgery and care. Rothman-Simeone and Herkowitz’s The Spine, 7th Edition, edited by Drs. Steven R. Garfin, Frank J. Eismont, Gordon R. Bell, Jeffrey S. Fischgrund, and Christopher M. Bono, presents state-of-the-art techniques helping you apply today’s newest developments in your practice.
- Highlights critical information through the use of pearls, pitfalls, and key points throughout the text, as well as more than 2,300 full-color photographs and illustrations.
- Offers a newly revised, streamlined format that makes it easier than ever to find the information you need.
- Contains new chapters on the clinical relevance of finite element modeling and SI joint surgery.
- Includes an expanded section on minimally invasive spine surgery, including recent developments and future directions.
- Provides the latest evidence-based research from high-quality studies, including new randomized controlled trials for lumbar stenosis, surgery, fusion, and injections.
- Presents the knowledge and expertise of new international contributors, as well as new editorial leadership from Dr. Steven Garfin.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Rothman and Simeone The Spine, 2-Volume Set | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | xx | ||
| Acknowledgment | xxii | ||
| Table Of Contents | xxiii | ||
| I Basic Science | 1 | ||
| 1 Development of the Spine | 3 | ||
| Early Embryologic Spine Precursors: Day 17 to Week 4 | 3 | ||
| From Somites to Spinal Column | 5 | ||
| Precartilaginous (Mesenchymal) Stage: Weeks 4 and 5 | 5 | ||
| Cartilaginous Stage: Weeks 6 and 7 | 6 | ||
| Ossification Stage: Week 8 and Beyond | 6 | ||
| Fate of the Notochord | 7 | ||
| From Neural Tube to Spinal Cord | 8 | ||
| Development of the Costal Elements | 9 | ||
| Development of the Intervertebral Disc | 9 | ||
| Spinal Ligament Development | 10 | ||
| Influence of Fetal Movement | 10 | ||
| Development of Specialized Vertebral Regions | 10 | ||
| Occipitocervical Complex | 10 | ||
| Atlantoaxial Complex | 10 | ||
| Sacrum | 12 | ||
| Genetic Control of Spinal Segmentation | 12 | ||
| Links Between Fly and Human | 13 | ||
| Congenital Syndromes: Genetic Evidence of Segmentation in Humans | 13 | ||
| Klippel-Feil Syndrome | 13 | ||
| Caudal Dysplasias | 13 | ||
| Acknowledgment | 14 | ||
| Key References | 14 | ||
| References | 14 | ||
| 2 Applied Anatomy of the Spine | 17 | ||
| Vertebrae | 17 | ||
| Pars Interarticularis | 17 | ||
| Regional Characteristics | 18 | ||
| Cervical Vertebrae | 19 | ||
| Atlantoaxial Complex | 21 | ||
| Thoracic Vertebrae | 21 | ||
| Lumbar Vertebrae | 22 | ||
| Sacral Vertebrae | 22 | ||
| Coccyx | 23 | ||
| Arthrology of the Spine | 23 | ||
| Articulations of the Vertebral Arches | 24 | ||
| Special Articulations | 25 | ||
| Articulations of the Vertebral Bodies | 26 | ||
| Intervertebral Disc | 26 | ||
| Nucleus Pulposus | 26 | ||
| Anulus Fibrosus | 27 | ||
| Regional Variations of the Disc | 28 | ||
| Spinal Ligaments | 28 | ||
| Anterior Longitudinal Ligament | 28 | ||
| Posterior Longitudinal Ligament | 28 | ||
| Relationships of the Roots of the Spinal Nerves | 29 | ||
| Intervertebral Foramen | 30 | ||
| Lumbosacral Nerve Root Variations | 31 | ||
| Innervation of the Spine | 31 | ||
| Spinal Motion Segment | 35 | ||
| Nutrition of the Intervertebral Disc | 35 | ||
| Blood Supply of the Vertebral Column | 36 | ||
| Regional Variations in Spinal Vasculature | 38 | ||
| Cervical Region | 38 | ||
| Atlantoaxial Complex | 38 | ||
| Sacroiliolumbar Arterial System | 40 | ||
| Fourth Lumbar Arteries | 40 | ||
| Iliolumbar Artery | 41 | ||
| Sacral Arteries | 41 | ||
| Lateral Sacral Arteries | 41 | ||
| Middle Sacral Artery | 41 | ||
| Functional Significance | 42 | ||
| Venous System of the Vertebral Column | 42 | ||
| Blood Supply of the Spinal Cord | 44 | ||
| Anterior Spinal Artery | 45 | ||
| Lateral Spinal Arteries of the Cervical Cord | 47 | ||
| Intrinsic Vascularity of the Spinal Cord | 47 | ||
| Intrinsic Venous Drainage of the Spinal Cord | 48 | ||
| Vascularization of the Spinal Nerve Roots | 48 | ||
| Functional Anatomy of the Spine | 50 | ||
| Specific Regional Considerations | 51 | ||
| Biomechanics of the Intervertebral Disc | 52 | ||
| Acknowledgments | 52 | ||
| Key References | 52 | ||
| References | 53 | ||
| 3 Skeletal Muscle | 57 | ||
| Cross-Bridge Cycle | 57 | ||
| Muscle Fiber Types | 57 | ||
| Fiber Type Distribution of Paraspinal Muscles | 58 | ||
| Muscle Injury | 58 | ||
| Muscle Architecture | 59 | ||
| Basic Architectural Definitions | 59 | ||
| Experimental Determination of Skeletal Muscle Architecture | 60 | ||
| Mechanical Properties of Muscles With Different Architectures | 61 | ||
| Comparison of Two Otherwise Identical Muscles With Different PCSAs | 61 | ||
| Comparison of Two Otherwise Identical Muscles With Different Fiber Lengths | 61 | ||
| Interplay of Muscle Architecture and Moment Arm | 61 | ||
| Summary | 62 | ||
| Key References | 62 | ||
| References | 63 | ||
| 4 Spinal Musculature | 65 | ||
| Anatomy and Architecture of Spinal Musculature | 65 | ||
| Intrinsic Spinal Muscles in the Lumbar, Thoracic, or Cervical Spine | 65 | ||
| Intrinsic Spinal Muscles Specific to the Cervical Spine | 68 | ||
| Splenius Capitis and Cervicis | 68 | ||
| Semispinalis Capitis and Cervicis | 68 | ||
| Longus Capitis and Colli | 69 | ||
| Suboccipital Muscles | 70 | ||
| Extrinsic Muscles Linking Vertebrae to the Pelvis | 70 | ||
| Extrinsic Muscles Linking Vertebrae or Skull to the Shoulder Girdle or Rib Cage | 70 | ||
| Implications of Spinal Muscle Anatomy and Architecture for Motor Control | 71 | ||
| Fascicle Length Changes With Posture | 71 | ||
| Moment Arm Changes With Posture | 72 | ||
| Implications of Spinal Muscle Anatomy and Architecture for Injury and Pain | 73 | ||
| Muscle Injury Resulting From Eccentric Contraction | 73 | ||
| Muscles Altering Load Distribution in Other Anatomic Structures | 73 | ||
| Muscle Effects on Spinal Stiffness and Stability | 73 | ||
| Summary | 75 | ||
| Key References | 75 | ||
| References | 75 | ||
| 5 The Intervertebral Disc | 79 | ||
| Normal Disc | 79 | ||
| Disc Anatomy | 79 | ||
| Cartilaginous Endplates | 79 | ||
| Nucleus Pulposus | 79 | ||
| Anulus Fibrosus | 80 | ||
| Blood Supply, Nutrition, and Innervation | 80 | ||
| Blood Supply | 80 | ||
| Nutrition | 80 | ||
| Innervation | 81 | ||
| Disc Composition | 81 | ||
| Water | 82 | ||
| Macromolecules | 82 | ||
| Intervertebral Disc Degeneration | 82 | ||
| Degeneration | 82 | ||
| Matrix Macromolecule Changes | 83 | ||
| Cellular Changes | 83 | ||
| Structural Changes | 83 | ||
| Neovascularization and Sensory Nerve Innervation | 84 | ||
| Etiology of Intervertebral Disc Degeneration | 84 | ||
| Aging | 85 | ||
| Genetic Predisposition | 85 | ||
| Nutrition | 85 | ||
| Environmental Factors | 86 | ||
| Facet Joints, Ligaments, and Vertebral Bodies | 86 | ||
| Facet Joints | 86 | ||
| Ligaments | 86 | ||
| Vertebral Bodies | 86 | ||
| References | 87 | ||
| 6 Biomechanics of the Spinal Motion Segment | 91 | ||
| Assessing the Biomechanics of the Spinal Motion Segment | 91 | ||
| Physical Charcteristics of the Spine Structures | 91 | ||
| Support Structures | 92 | ||
| Disc | 94 | ||
| Spinal Ligaments | 94 | ||
| Coordinate System and Force/Movement Definitions | 95 | ||
| Tissue Load Characteristics | 96 | ||
| Mechanical Degeneration: Tissues at Risk | 97 | ||
| In Vitro Spine Biomechanics | 98 | ||
| Motion Characteristics (Kinematics) of the Spinal Motion Segments | 98 | ||
| Axis of Rotation | 98 | ||
| Motion Coupling | 100 | ||
| Neutral Zone Limits | 102 | ||
| Load Tolerance of the Spinal Motion Segments | 103 | ||
| Muscle and Tendon Strain | 103 | ||
| Ligament and Bone Tolerance | 103 | ||
| Contact Force Tolerance | 103 | ||
| Tolerance of Specific Spine Structures | 103 | ||
| Compression | 103 | ||
| Shear | 105 | ||
| Torsion | 106 | ||
| Flexion and Extension | 106 | ||
| Lateral Motion | 107 | ||
| In Vivo Spine Biomechanics | 107 | ||
| Overview | 107 | ||
| Quantitative Assessment of in Vivo Spinal Motion | 108 | ||
| Overall Spine Kinematics (Extrinsic Measurements) | 108 | ||
| Spine Kinematics (Intrinsic Measurements) | 108 | ||
| Quantitative Assessment of in Vivo Spinal Loading | 110 | ||
| In Silico Modeling in the Spine | 110 | ||
| The System | 112 | ||
| Summary | 114 | ||
| Key References | 114 | ||
| References | 114 | ||
| 7 Nerve Root Pain in Disc Herniation and Spinal Stenosis | 119 | ||
| Mechanical Effects on Nerve Roots | 119 | ||
| Chronic Experimental Nerve Root Compression | 120 | ||
| Spinal Stenosis: Experimental-Clinical Correlation | 120 | ||
| Mechanical Nerve Root Deformation and Pain | 121 | ||
| Neuropathologic Changes and Pain | 121 | ||
| Biologic and Biochemical Effects on Nerve Roots | 121 | ||
| Biologic Effects of Nucleus Pulposus | 122 | ||
| Nucleus Pulposus and Sciatic Pain | 122 | ||
| Other Consequences of Herniated Nucleus Pulposus | 123 | ||
| Chemical Components of Nucleus Pulposus | 124 | ||
| Cytokines as Mediators of Nerve Dysfunction and Pain | 124 | ||
| Clinical Use of Cytokine Inhibitors for Treatment of Sciatica | 126 | ||
| Summary | 126 | ||
| Key References | 127 | ||
| References | 127 | ||
| 8 Basic Concepts in Genetics and Intervertebral Disc Degeneration and Scoliosis | 133 | ||
| Introduction to Genetics | 133 | ||
| Chromosomes and DNA | 133 | ||
| Genetic Variations | 134 | ||
| Mutations and Polymorphisms | 134 | ||
| Terminology and Types of Disease | 134 | ||
| Gene Mapping | 134 | ||
| Linkage Analysis | 135 | ||
| Association Studies | 135 | ||
| Newer Technologies | 136 | ||
| Interpretation of Results | 137 | ||
| Disc Degeneration Genetics | 137 | ||
| Scoliosis Genetics | 139 | ||
| Early-Onset Scoliosis and Congenital Scoliosis | 139 | ||
| Adolescent Idiopathic Scoliosis | 140 | ||
| Conclusions and the Future | 141 | ||
| Key References | 142 | ||
| References | 142 | ||
| 9 Twin Studies | 145 | ||
| Twin Studies | 145 | ||
| Critical Importance of Phenotype | 147 | ||
| Genetic Versus Environmental Influences on Lumbar Degenerative and Pathoanatomic Findings | 147 | ||
| Disc Degeneration | 147 | ||
| Modic Changes | 150 | ||
| Schmorl’s Nodes and Endplate Defects | 150 | ||
| Lumbar Spinal Stenosis | 150 | ||
| Genetic Versus Environmental Influences on Back Pain | 151 | ||
| Specific Environmental and Behavioral Influences on Disc Degeneration and Back Pain | 152 | ||
| Exposure-Discordant Twin Studies of Disc Degeneration | 152 | ||
| Cohort and Matched Case-Control Studies of Back Pain | 152 | ||
| Summary | 152 | ||
| Key References | 153 | ||
| References | 153 | ||
| 10 Outcomes Research for Spinal Disorders | 155 | ||
| Need for Outcomes Research | 155 | ||
| Measuring Outcomes in Spinal Disorders | 156 | ||
| Importance of Study Design in Outcomes Research | 158 | ||
| Understanding Threats to Study Validity | 159 | ||
| Chance | 159 | ||
| Bias | 159 | ||
| Confounding | 160 | ||
| Randomized Controlled Trials | 161 | ||
| Observational Cohort Studies | 161 | ||
| Case-Control Studies | 162 | ||
| Case Series | 163 | ||
| Levels of Evidence | 163 | ||
| Cost-Effectiveness Analysis | 163 | ||
| Future of Outcomes Research: Patient-Specific Recommendations | 164 | ||
| Key Points | 164 | ||
| Key References | 164 | ||
| References | 165 | ||
| 11 Finite Element Analysis | 167 | ||
| Introduction | 167 | ||
| Finite Element Modeling of the Spine | 168 | ||
| Low Back Pain | 168 | ||
| Modeling of the Lumbar Spine | 169 | ||
| Vertebral Body and Posterior Bone | 170 | ||
| Intervertebral Disc | 170 | ||
| Apophyseal (Facet) Joint | 171 | ||
| Ligaments | 171 | ||
| Validation of the Lumbar Model | 171 | ||
| Finite Element Model of the Cervical Spine | 173 | ||
| Conversion of CT and MRI Scans to 3D Solid Model | 173 | ||
| Meshing | 173 | ||
| Finite Element Analysis (Using Abaqus Version 6.11) | 173 | ||
| Vertebral Body and Posterior Bone | 173 | ||
| Facet Joints | 173 | ||
| Intervertebral Disc and Luschka’s Joints | 174 | ||
| Ligaments | 174 | ||
| Application of the Finite Element Model of the Spine | 175 | ||
| Clinical Application of the Finite Element Models of the Spine | 176 | ||
| Conclusion | 178 | ||
| Key References | 179 | ||
| References | 179 | ||
| II Diagnosis | 181 | ||
| 12 Patient History and Physical Examination | 183 | ||
| Differential Diagnosis | 183 | ||
| Biomedical Factors and the Medical History | 185 | ||
| Red Flags: What Not to Miss | 185 | ||
| Historical Features of the Presenting Complaint | 187 | ||
| Axial Versus Radicular Pain | 187 | ||
| Patient Demographics | 188 | ||
| Past Medical History | 189 | ||
| Family History | 190 | ||
| Yellow Flags: Predictors of Poor Outcome in the Patient’s History | 190 | ||
| Obtaining a Psychosocial History | 191 | ||
| Additional Assessment Tools | 191 | ||
| Physical Examination | 192 | ||
| Observation | 193 | ||
| Palpation | 193 | ||
| Neurologic Examination | 194 | ||
| Special Tests and Provocative Maneuvers | 195 | ||
| Nonorganic Signs | 196 | ||
| Additional Orthopaedic Assessment | 196 | ||
| Risk Stratification | 196 | ||
| Summary | 197 | ||
| Key Points | 197 | ||
| Key References | 197 | ||
| References | 197 | ||
| 13 Spine Imaging | 201 | ||
| Modalities | 201 | ||
| Radiographs | 201 | ||
| Myelography | 201 | ||
| Computed Tomography | 202 | ||
| Magnetic Resonance Imaging | 202 | ||
| Routine Magnetic Resonance Imaging | 203 | ||
| Dynamic Magnetic Resonance Imaging | 203 | ||
| Magnetic Resonance Myelography | 203 | ||
| Magnetic Resonance Neurography | 204 | ||
| Diffusion-Weighted Imaging | 205 | ||
| Cerebrospinal Fluid Flow Imaging | 205 | ||
| Magnetic Resonance Spectroscopy | 205 | ||
| Magnetic Resonance Imaging Safety and Patient Issues | 205 | ||
| Spinal Angiography | 206 | ||
| Discography | 206 | ||
| Nuclear Medicine Examinations | 208 | ||
| Imaging Artifacts | 208 | ||
| Pathology | 208 | ||
| Degenerative Disc Disease | 208 | ||
| Intervertebral Disc | 210 | ||
| Degenerative Endplate Changes | 210 | ||
| Lumbar Stenosis | 211 | ||
| Facet Disease | 212 | ||
| Instability | 212 | ||
| Cervical Radiculopathy and Myelopathy | 213 | ||
| Postoperative Imaging | 213 | ||
| Epidural Fibrosis and Disc Herniations | 215 | ||
| Stenosis | 216 | ||
| Arachnoiditis | 216 | ||
| Infection | 218 | ||
| Intramedullary Lesions | 220 | ||
| Neoplasms | 220 | ||
| Inflammation | 222 | ||
| Intradural Extramedullary Lesions | 224 | ||
| Extradural Lesions | 226 | ||
| Bone Marrow Imaging | 226 | ||
| Ossification of Posterior Longitudinal Ligament | 226 | ||
| Spinal Cysts | 227 | ||
| Trauma | 227 | ||
| Hemorrhage | 232 | ||
| Key Points | 232 | ||
| Key References | 233 | ||
| References | 233 | ||
| 14 Electrodiagnostic Examination | 241 | ||
| Pathophysiology | 241 | ||
| General Concepts of Electrodiagnostic Examination | 242 | ||
| Nerve Conduction Studies | 242 | ||
| Motor Nerve Conduction Studies | 242 | ||
| Sensory Nerve Conduction Studies | 243 | ||
| Late Responses (H Responses and F Waves) | 244 | ||
| Needle Electrode Examination | 244 | ||
| Insertional Phase | 244 | ||
| At-Rest Phase | 245 | ||
| Activation Phase | 245 | ||
| Recruitment | 245 | ||
| Morphology | 245 | ||
| Electrodiagnostic Findings in Radiculopathy | 246 | ||
| Nerve Conduction Studies | 246 | ||
| Routine Studies | 246 | ||
| Late Responses | 247 | ||
| Needle Electrode Examination | 247 | ||
| Determining Duration of Radiculopathy: Acute Versus Chronic | 251 | ||
| Determining Severity of Radiculopathy | 251 | ||
| Electrodiagnostic Findings at Specific Root Levels | 252 | ||
| Cervical Radiculopathy | 252 | ||
| Differential Diagnoses | 252 | ||
| Thoracic Radiculopathy | 252 | ||
| III Surgical Anatomy and Approaches | 315 | ||
| 18 Cervical Spine | 317 | ||
| Surgical Anatomy | 317 | ||
| Surface Anatomy and Skin | 317 | ||
| Osseous Anatomy and Bony Articulation | 317 | ||
| Ligaments | 319 | ||
| Intervertebral Discs | 320 | ||
| Neural Elements | 321 | ||
| Vascular Structures | 322 | ||
| Musculature | 323 | ||
| Fascial Layers | 323 | ||
| Triangles of the Neck | 324 | ||
| Surgical Approaches | 324 | ||
| Anterior Approaches to Upper Cervical Spine | 324 | ||
| Transoral Technique | 325 | ||
| Complications | 325 | ||
| Anteromedial Retropharyngeal Technique | 326 | ||
| Anterolateral Retropharyngeal Technique | 327 | ||
| Complications | 329 | ||
| Anterior Exposure of Lower Cervical Spine | 329 | ||
| Anteromedial Approach | 330 | ||
| Anterolateral Approach | 330 | ||
| Complications | 330 | ||
| Anterior Approach to Cervicothoracic Junction | 331 | ||
| Modified Anterior Approach | 331 | ||
| Sternal-Splitting Approach | 332 | ||
| Transthoracic Approach | 333 | ||
| Complications | 333 | ||
| Posterior Approaches | 333 | ||
| Posterior Approach to Upper Cervical Spine | 333 | ||
| Posterior Approach to Lower Cervical Spine | 334 | ||
| Posterior Approach to Cervicothoracic Junction | 335 | ||
| Complications | 336 | ||
| Pearls | 336 | ||
| Pitfalls | 336 | ||
| Key Points | 336 | ||
| Key References | 336 | ||
| References | 336 | ||
| 19 Anatomy of the Anterior Cervicothoracic Spine | 339 | ||
| Surgical Approaches to the Anterior Thoracic Spine | 339 | ||
| Low Anterior Cervical and High Transsternal Approach | 339 | ||
| Transpleural Transthoracic Third Rib Resection | 341 | ||
| Thoracotomy (Anterior) Approach to the Thoracic Spine | 343 | ||
| Endoscopic Anterior Approach to the Thoracic Spine | 344 | ||
| Anterior Anatomy of the Thoracolumbar Junction | 345 | ||
| Anterior Approach to the Thoracolumbar Spine | 345 | ||
| Posterior Anatomy of the Thoracic Spine | 348 | ||
| Posterior Approaches to the Thoracic Spine | 349 | ||
| Posterior Approach for Decompressive Laminectomy and Fusion | 349 | ||
| Transpedicular Approach | 351 | ||
| Costotransversectomy | 351 | ||
| Lateral Extracavitary Approach | 352 | ||
| Minimally Invasive Approaches to the Thoracic and Thoracolumbar Spine | 353 | ||
| Key Points | 353 | ||
| Low Anterior Cervical and High Transsternal Approach | 353 | ||
| Transpleural Transthoracic Third Rib Approach | 354 | ||
| Thoracotomy (Anterior) Approach to the Thoracic Spine | 354 | ||
| Endoscopic Anterior Approach to the Thoracic Spine | 354 | ||
| Anterior Approach to the Thoracolumbar Spine | 354 | ||
| Posterior Approach for Decompressive Laminectomy and Fusion | 354 | ||
| Transpedicular Approach | 354 | ||
| Costotransversectomy | 354 | ||
| Lateral Extracavitary Approach | 354 | ||
| Minimally Invasive Approaches | 354 | ||
| Key References | 354 | ||
| References | 355 | ||
| 20 Lateral and Posterior Approaches to the Lumbosacral Spine | 357 | ||
| Selection of Approach to the Lumbar Spine | 357 | ||
| Minimally Invasive Lateral Approach to the Spine | 357 | ||
| Technique | 357 | ||
| Complications | 360 | ||
| Posterior Approach to the Lumbar Spine | 361 | ||
| Technique | 362 | ||
| Posterolateral Approach to the Lumbar Vertebral Bodies | 364 | ||
| Technique | 364 | ||
| Pearls | 365 | ||
| Pitfalls | 365 | ||
| Key Points | 365 | ||
| Key References | 366 | ||
| References | 366 | ||
| 21 Lateral Lumbar Interbody Fusion | 367 | ||
| History | 367 | ||
| Indications | 367 | ||
| Advantages | 367 | ||
| Contraindications | 367 | ||
| Technique | 368 | ||
| Anatomic Considerations | 372 | ||
| Lumbar Plexus | 372 | ||
| Vascular Anatomy | 374 | ||
| High Iliac Crest/Lumbosacral Junction | 375 | ||
| Scoliosis | 375 | ||
| Thoracolumbar Junction | 375 | ||
| Thoracic Spine | 376 | ||
| Complications | 376 | ||
| Outcomes | 376 | ||
| Summary | 378 | ||
| Key References | 378 | ||
| References | 378 | ||
| 22 Anatomy, Nonoperative Results, Preoperative Injections, and Prescriptions | 383 | ||
| Anatomic Considerations in Spinal Pain | 383 | ||
| Zygapophyseal Joint (Facet Joint) | 383 | ||
| Sacroiliac Joint | 384 | ||
| Intervertebral Disc | 384 | ||
| Ligaments of the Spine | 384 | ||
| Nerve Root | 384 | ||
| Cervical Spine Injections | 384 | ||
| Procedure: Cervical Interlaminar Epidural Steroid Injection | 385 | ||
| Procedure: Cervical Transforaminal Epidural Steroid Injection | 386 | ||
| Procedure: Cervical Medial Branch Blocks and Radiofrequency Ablation | 387 | ||
| Lumbar Spine Injections | 388 | ||
| Procedure: Lumbar Interlaminar Epidural Steroid Injection | 388 | ||
| Procedure: Caudal Epidural Steroid Injection | 388 | ||
| Procedure: Lumbar Transforaminal Epidural Steroid Injection | 390 | ||
| Procedure: Lumbar Zygapophyseal Joint Injections (Facet Joint) | 391 | ||
| Procedure: Lumbar Medial Branch Blocks and Radiofrequency Ablation | 391 | ||
| Procedure: Sacroiliac Joint Injection | 393 | ||
| Summary | 393 | ||
| References | 394 | ||
| 23 Sacroiliac Joint Pain | 397 | ||
| Introduction | 397 | ||
| Background | 397 | ||
| Anatomy | 397 | ||
| Pathology | 398 | ||
| Diagnosis | 399 | ||
| Clinical History | 399 | ||
| Physical Examination | 400 | ||
| Role of Imaging | 400 | ||
| Diagnostic Injection | 400 | ||
| Summary | 400 | ||
| References | 402 | ||
| 24 Outcomes of Nonsurgical and Surgical Treatment of Chronic Sacroiliac Joint Pain | 405 | ||
| Nonsurgical Treatment | 405 | ||
| Medication Management | 405 | ||
| Physical Therapy | 405 | ||
| Pelvic Bracing | 405 | ||
| Sacroiliac Joint Injection | 405 | ||
| Radiofrequency Ablation | 405 | ||
| Surgical Treatment | 406 | ||
| Open Surgery | 406 | ||
| Minimally Invasive Surgery | 407 | ||
| Outcomes From Minimally Invasive Sacroiliac Joint Fusion | 407 | ||
| Complications From Minimally Invasive Surgical Sacroiliac Joint Fusion | 409 | ||
| Minimally Invasive Surgical Fusion Technique | 409 | ||
| Summary | 410 | ||
| References | 411 | ||
| IV Pediatrics | 415 | ||
| 25 Back Pain in Children and Adolescents | 417 | ||
| Introduction | 417 | ||
| History | 417 | ||
| Physical Examination | 418 | ||
| Diagnostic Studies | 418 | ||
| Radiographs | 418 | ||
| Bone Scan | 419 | ||
| Computed Tomography | 419 | ||
| Magnetic Resonance Imaging | 419 | ||
| Laboratory Tests | 419 | ||
| Differential Diagnosis | 419 | ||
| Muscle Strain | 419 | ||
| Disc Herniation | 419 | ||
| Apophyseal Ring Fracture/Slipped Vertebral Apophysis | 420 | ||
| Vertebral Fractures | 420 | ||
| Developmental Disorders | 421 | ||
| Spondylolysis and Spondylolisthesis | 421 | ||
| Scheuermann Kyphosis | 422 | ||
| Lumbar Scheuermann Disease | 423 | ||
| Idiopathic Scoliosis | 423 | ||
| Syringomyelia | 423 | ||
| Tethered Spinal Cord | 424 | ||
| Idiopathic Juvenile Osteoporosis | 424 | ||
| Infectious and Inflammatory Etiologies | 424 | ||
| Discitis | 424 | ||
| Vertebral Osteomyelitis | 425 | ||
| Ankylosing Spondylitis and Rheumatologic Conditions | 425 | ||
| Hematologic Conditions | 426 | ||
| Sickle Cell Anemia | 426 | ||
| Neoplasms | 426 | ||
| Aneurysmal Bone Cysts | 426 | ||
| Osteoid Osteoma | 426 | ||
| Osteoblastoma | 427 | ||
| Eosinophilic Granuloma/Langerhans Cell Histiocytosis | 427 | ||
| Malignant Tumors | 428 | ||
| Leukemia | 428 | ||
| Vertebral Malignant Tumors | 429 | ||
| Spinal Metastasis | 429 | ||
| Spinal Cord Tumors | 429 | ||
| Nonorthopaedic Causes of Pain | 429 | ||
| Psychosomatic Pain (Conversion Reaction) | 429 | ||
| Key Points | 429 | ||
| Use of Diagnostic Tests | 429 | ||
| Likely Diagnoses Based on Age | 429 | ||
| References | 429 | ||
| 26 Congenital Scoliosis | 435 | ||
| Embryology | 435 | ||
| Normal Development | 435 | ||
| Associated Anomalies | 435 | ||
| Genetic Etiology | 436 | ||
| Environmental Etiology | 437 | ||
| Classification | 437 | ||
| Failures of Formation | 437 | ||
| Failures of Segmentation | 437 | ||
| Mixed Deformity | 438 | ||
| Natural History | 438 | ||
| Location | 439 | ||
| Progression of Curvature by Deformity Type and Location | 439 | ||
| Effects on Thoracic Contents | 440 | ||
| Assessment of Patient | 440 | ||
| Physical Examination | 440 | ||
| Associated Anomalies | 440 | ||
| Imaging | 441 | ||
| Radiographs | 441 | ||
| Computed Tomography | 441 | ||
| Magnetic Resonance Imaging | 442 | ||
| Treatment | 442 | ||
| Nonoperative | 442 | ||
| Operative | 442 | ||
| Posterior Spine Fusion | 443 | ||
| Combined Anterior and Posterior Spine Fusion | 443 | ||
| Convex Hemiepiphysiodesis | 443 | ||
| Hemivertebra Excision | 444 | ||
| Osteotomies | 445 | ||
| Vertebral Column Resection | 445 | ||
| Guided Growth Procedures | 445 | ||
| Conclusion | 446 | ||
| Key Points | 446 | ||
| Key References | 446 | ||
| References | 447 | ||
| 27 Idiopathic Scoliosis | 451 | ||
| Epidemiology | 451 | ||
| Etiology | 451 | ||
| Genetics | 451 | ||
| Natural History | 452 | ||
| Evaluation | 452 | ||
| History and Physical Examination | 452 | ||
| Radiographic Evaluation | 453 | ||
| Classification Systems | 453 | ||
| Three-Dimensional Classification | 453 | ||
| Treatment Options | 454 | ||
| Observation | 454 | ||
| Bracing and Casting | 455 | ||
| Operative Intervention | 455 | ||
| Surgical Techniques | 455 | ||
| Upper and Lower Instrumented Vertebra Selection | 458 | ||
| Selective Fusions | 459 | ||
| Adjuncts to Correction | 461 | ||
| Direct Vertebral Rotation | 461 | ||
| Osteotomies | 462 | ||
| Minimally Invasive Techniques | 462 | ||
| Postoperative Care | 462 | ||
| Complications | 462 | ||
| Summary | 464 | ||
| Pearls and Pitfalls | 464 | ||
| Key Points | 465 | ||
| Key References | 465 | ||
| References | 465 | ||
| 28 Neuromuscular Scoliosis | 469 | ||
| General Principles | 469 | ||
| Classification | 469 | ||
| Natural History and Associated Complications | 469 | ||
| Treatment Principles | 469 | ||
| Nonoperative Treatment | 470 | ||
| Medical Treatment | 470 | ||
| Spinal Muscular Atrophy | 470 | ||
| Cerebral Palsy | 471 | ||
| Duchenne Muscular Dystrophy | 471 | ||
| Genetic and Family Counseling | 472 | ||
| Bracing | 472 | ||
| Operative Treatment | 473 | ||
| Preoperative Considerations | 475 | ||
| Neurologic | 475 | ||
| Pulmonary | 476 | ||
| Gastrointestinal | 476 | ||
| Cardiovascular | 476 | ||
| Hematologic | 476 | ||
| Radiographic Assessment | 477 | ||
| History of Instrumentation in Neuromuscular Scoliosis | 477 | ||
| Pelvic and Sacral Fixation | 479 | ||
| Anterior Spinal Release and Fusion | 482 | ||
| Indications | 482 | ||
| Instrumentation | 483 | ||
| Intraoperative Considerations | 483 | ||
| Patient Positioning | 483 | ||
| Spinal Cord Monitoring | 484 | ||
| Blood Conservation | 484 | ||
| Bone Graft | 484 | ||
| Timing of Combined Procedures | 484 | ||
| Anterior Surgical Approaches | 485 | ||
| Transthoracic Approach | 485 | ||
| Thoracoscopic Approach | 485 | ||
| Thoracoabdominal Approach | 485 | ||
| Retroperitoneal Lumbar Approach | 485 | ||
| Vertical Expandable Prosthetic Titanium Rib | 485 | ||
| Postoperative Care | 486 | ||
| Intensive Care Unit | 486 | ||
| Bracing | 486 | ||
| Complications | 486 | ||
| Wound Infections | 486 | ||
| Respiratory Complications | 487 | ||
| Urinary Tract Infections | 487 | ||
| Cerebral Palsy | 487 | ||
| Scoliosis in Cerebral Palsy | 487 | ||
| Treatment Options | 488 | ||
| Bracing | 488 | ||
| Surgical Management | 488 | ||
| Authors’ Recommendations | 489 | ||
| Myelodysplasia | 489 | ||
| Scoliosis in Myelodysplasia | 489 | ||
| Treatment Options | 491 | ||
| Bracing | 491 | ||
| Surgical Management | 492 | ||
| Anterior Fusion | 492 | ||
| Posterior Fusion | 492 | ||
| Fusion to the Pelvis | 493 | ||
| Kyphosis Treatment | 494 | ||
| Spinal Muscular Atrophy | 495 | ||
| Spinal Muscular Atrophy Types | 495 | ||
| Scoliosis in Spinal Muscular Atrophy | 495 | ||
| Treatment Options | 496 | ||
| Bracing | 496 | ||
| Surgical Management | 497 | ||
| Our Recommendations | 498 | ||
| Duchenne Muscular Dystrophy | 498 | ||
| Scoliosis in Duchenne Muscular Dystrophy | 498 | ||
| Treatment Options | 499 | ||
| Surgical Management | 500 | ||
| Our Recommendations | 500 | ||
| Rett Syndrome | 500 | ||
| Scoliosis in Rett Syndrome | 500 | ||
| Pearls | 501 | ||
| Pitfalls | 501 | ||
| Key References | 501 | ||
| References | 502 | ||
| 29 Thoracoscopic Approach for Spinal Conditions | 509 | ||
| Thoracoscopic Anterior Release and Fusion | 509 | ||
| Indications | 509 | ||
| Scoliosis | 509 | ||
| Kyphosis | 511 | ||
| Congenital Deformity | 511 | ||
| Contraindications | 511 | ||
| Surgical Technique | 512 | ||
| Outcomes | 514 | ||
| Thoracoscopic Anterior Scoliosis Instrumentation | 515 | ||
| Indications | 515 | ||
| Contraindications | 515 | ||
| Surgical Technique | 515 | ||
| Outcomes | 517 | ||
| Treatment of Other Thoracic Spine Conditions | 518 | ||
| Tumor | 518 | ||
| Trauma | 518 | ||
| Thoracic Disc Herniation | 519 | ||
| Infection | 519 | ||
| Future of Thoracoscopic Spinal Surgery | 519 | ||
| Pearls | 520 | ||
| Pitfalls | 520 | ||
| Key Points | 520 | ||
| References | 520 | ||
| 30 Pediatric Kyphosis | 525 | ||
| Scheuermann Disease | 525 | ||
| Etiology | 527 | ||
| Clinical Evaluation | 527 | ||
| Imaging Studies | 527 | ||
| Natural History | 528 | ||
| Nonsurgical Treatment | 528 | ||
| Indications for Surgery | 529 | ||
| Surgical Treatment | 529 | ||
| Surgical Principles | 532 | ||
| Degree of Deformity Correction | 532 | ||
| Selection of Fusion Levels | 533 | ||
| Spinopelvic Alignment | 533 | ||
| Complications | 535 | ||
| Junctional Kyphosis | 536 | ||
| Congenital Deformity | 537 | ||
| Classification | 538 | ||
| Imaging Studies | 539 | ||
| Clinical Evaluation | 539 | ||
| Natural History | 539 | ||
| Nonoperative Treatment | 539 | ||
| Surgical Treatment | 540 | ||
| Complications | 543 | ||
| Pseudarthrosis and Progressive Deformity | 543 | ||
| Neurologic Complications | 543 | ||
| Pearls | 543 | ||
| Key Points | 543 | ||
| Key References | 544 | ||
| References | 544 | ||
| 31 Spondylolysis and Spondylolisthesis | 549 | ||
| Pathophysiology | 549 | ||
| Epidemiology | 550 | ||
| History and Physical Examination | 551 | ||
| Radiographic Evaluation | 552 | ||
| Nonoperative Management | 553 | ||
| Surgical Treatment | 554 | ||
| Summary | 558 | ||
| Acknowledgment | 558 | ||
| Pearls | 558 | ||
| Pitfall | 558 | ||
| Key Points | 559 | ||
| Key References | 559 | ||
| References | 559 | ||
| 32 Cervical, Thoracic, and Lumbar Spinal Trauma of the Immature Spine | 565 | ||
| Epidemiology | 565 | ||
| Developmental Anatomy and Biomechanics | 565 | ||
| Transport and Evaluation | 566 | ||
| Plain Radiography of the Cervical Spine | 567 | ||
| Computed Tomography and Magnetic Resonance Imaging of the Spine | 569 | ||
| Spine Clearance | 570 | ||
| Spinal Cord Injury in Children | 572 | ||
| Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) | 573 | ||
| Atlanto-Occipital Dislocation | 573 | ||
| Fractures of the Atlas | 574 | ||
| Atlantoaxial Instability | 574 | ||
| Atlantoaxial Rotatory Subluxation | 575 | ||
| Odontoid Fractures | 576 | ||
| Os Odontoideum | 576 | ||
| Hangman’s Fracture | 576 | ||
| Lower Cervical (Subaxial) Spine Injuries | 577 | ||
| Compression Fractures | 577 | ||
| Facet Fractures and Dislocations | 577 | ||
| Burst Fractures | 578 | ||
| Vertebral Growth Plate Fractures | 578 | ||
| Pediatric Halo | 578 | ||
| Thoracolumbar Classification Systems | 578 | ||
| Compression Fractures | 579 | ||
| Burst Fractures | 579 | ||
| Chance Fractures | 579 | ||
| Fracture-Dislocations | 579 | ||
| Limbus Fractures | 580 | ||
| Key Points | 581 | ||
| Key References | 581 | ||
| References | 581 | ||
| 33 The Immature Spine and Athletic Injuries | 589 | ||
| Principles of Diagnosis | 589 | ||
| History | 589 | ||
| Genetics | 590 | ||
| Physical Examination | 590 | ||
| Imaging | 591 | ||
| Magnetic Resonance Imaging of the Spine | 591 | ||
| Bone Scintigraphy (Bone Scan) | 591 | ||
| Single-Photon Emission Computed Tomography | 591 | ||
| Principles of Treatment and Rehabilitation | 592 | ||
| Acute Treatment | 592 | ||
| Bracing | 592 | ||
| Traction | 592 | ||
| Rehabilitation | 592 | ||
| Core Stabilization | 592 | ||
| Flexibility | 592 | ||
| Muscle Performance (Strength Versus Endurance) | 592 | ||
| Sport-Specific Exercise | 592 | ||
| Deep Water Running and Swimming | 592 | ||
| Cycling | 593 | ||
| Program Guidelines | 593 | ||
| Education | 593 | ||
| Return to Play | 593 | ||
| Disorders and Treatment | 594 | ||
| Low Back Pain in Adolescent Athletes | 594 | ||
| Spondylolysis | 594 | ||
| Clinical Presentation | 595 | ||
| Diagnostic Imaging | 595 | ||
| Treatment | 595 | ||
| Return to Activity | 596 | ||
| Spondylolisthesis | 596 | ||
| Lumbar Scheuermann Disease (Juvenile Disc Disease) | 597 | ||
| Herniated Nucleus Pulposus | 598 | ||
| Apophyseal Ring Fracture | 599 | ||
| Cervical Spine Injuries | 600 | ||
| On-Field Examination | 600 | ||
| Field Treatment of Cervical Fractures | 600 | ||
| Prevention of Catastrophic Injuries to the Cervical Spine in Football | 600 | ||
| Return to Play Guidelines | 600 | ||
| Cervical Peripheral Nerve Injuries | 600 | ||
| Burners | 600 | ||
| Cervical Stenosis | 601 | ||
| Transient Spinal Cord Compression | 601 | ||
| Fracture | 601 | ||
| Fracture of the Thoracolumbar Spine | 601 | ||
| Sacral Stress Fracture | 602 | ||
| Iliac Apophysitis | 602 | ||
| Tumor | 603 | ||
| Pearls | 603 | ||
| Pitfalls | 603 | ||
| Key Points | 604 | ||
| Key References | 604 | ||
| References | 604 | ||
| 34 Congenital Anomalies of the Cervical Spine | 609 | ||
| Introduction | 609 | ||
| Modern Cervical Instrumentation in Children | 609 | ||
| Occipital Plating | 609 | ||
| C1 Screws | 609 | ||
| C2 Screws | 610 | ||
| C1–C2 Transarticular Screws | 610 | ||
| Subaxial Lateral Mass Screws | 611 | ||
| Halo | 611 | ||
| Navigation | 612 | ||
| Specific Cervical Spine Conditions | 612 | ||
| Basilar Invagination | 612 | ||
| Clinical Features | 612 | ||
| Imaging | 612 | ||
| Treatment | 613 | ||
| Occipitoatlantal Instability | 614 | ||
| Occipitoatlantal Fusion (Occipitalization, Occipitocervical Synostosis) | 614 | ||
| Clinical Features | 614 | ||
| Imaging | 616 | ||
| Treatment | 616 | ||
| Anomalies of Ring of C1 | 616 | ||
| Atlantoaxial Instability | 617 | ||
| Clinical Presentation | 618 | ||
| Imaging | 618 | ||
| Treatment | 619 | ||
| Anomalies of Odontoid (Dens) | 620 | ||
| Clinical Features | 622 | ||
| Radiographic Features | 622 | ||
| Treatment | 623 | ||
| Klippel-Feil Syndrome | 625 | ||
| Clinical Features | 626 | ||
| Associated Conditions | 627 | ||
| Scoliosis | 627 | ||
| Renal, Cardiac, Auditory Abnormalities | 627 | ||
| Mirror Motions (Synkinesis) | 628 | ||
| Imaging | 628 | ||
| Patterns of Cervical Motion | 629 | ||
| Treatment | 630 | ||
| Congenital Muscular Torticollis | 631 | ||
| Clinical Presentation | 632 | ||
| Differential Diagnosis | 632 | ||
| Imaging | 633 | ||
| Nonoperative Treatment | 634 | ||
| Surgery | 634 | ||
| Acknowledgment | 635 | ||
| References | 635 | ||
| 35 Congenital Anomalies of the Spinal Cord | 641 | ||
| Introduction | 641 | ||
| Embryology | 641 | ||
| Spina Bifida Aperta | 642 | ||
| Myelomeningocele | 642 | ||
| Embryology | 642 | ||
| Epidemiology | 642 | ||
| Prenatal Diagnosis | 642 | ||
| Initial Management | 643 | ||
| Postnatal Surgery for MMC Closure | 644 | ||
| In Utero Closure | 645 | ||
| Ventriculoperitoneal Shunts | 646 | ||
| Endoscopic Third Ventriculostomy | 646 | ||
| Surgical Complications | 647 | ||
| Latex Allergy | 647 | ||
| Late Deterioration | 647 | ||
| Shunt Malfunction/Increased Intracranial Pressure | 647 | ||
| Tethered Cord | 648 | ||
| Chiari Malformations | 648 | ||
| Hydromyelia | 649 | ||
| Spina Bifida Occulta | 649 | ||
| Embryology | 649 | ||
| Epidemiology | 649 | ||
| Clinical Presentation | 650 | ||
| Investigation | 650 | ||
| Specific Spina Bifida Occulta | 652 | ||
| Lipomyelomeningocele | 652 | ||
| Filum Terminale Syndrome | 652 | ||
| Sacral Agenesis and Caudal Regression | 652 | ||
| Congenital Dermal Sinus | 653 | ||
| Split Cord Anomalies | 653 | ||
| Neurenteric Cyst | 654 | ||
| Conclusion | 656 | ||
| References | 656 | ||
| V Cervical Degenerative Disorders | 661 | ||
| 36 Cervical Spinal Disorders Associated With Skeletal Dysplasias and Metabolic Diseases | 663 | ||
| Skeletal Dysplasias and Metabolic Diseases | 663 | ||
| Patient Evaluation | 663 | ||
| Imaging | 663 | ||
| Treatment | 665 | ||
| Complications | 667 | ||
| Skeletal Dysplasias | 667 | ||
| Achondroplasia | 667 | ||
| Pseudoachondroplasia | 667 | ||
| Spondyloepiphyseal Dysplasia | 668 | ||
| Kniest Dysplasia | 668 | ||
| Metaphyseal Chondrodysplasia | 668 | ||
| Metatropic Dysplasia | 668 | ||
| Chondrodysplasia Punctata | 669 | ||
| Diastrophic Dysplasia | 669 | ||
| Camptomelic Dysplasia | 670 | ||
| Larsen Syndrome | 670 | ||
| 22q11.2 Deletion Syndrome | 670 | ||
| Mucopolysaccharidoses | 670 | ||
| Hurler Syndrome: Mucopolysaccharidosis Type 1 | 670 | ||
| Hunter Syndrome: Mucopolysaccharidosis Type 2 | 670 | ||
| Morquio Syndrome: Mucopolysaccharidosis Type 4 | 671 | ||
| Summary | 671 | ||
| Key References | 673 | ||
| References | 673 | ||
| 37 Pathophysiology, Natural History, and Clinical Syndromes of Cervical Disc Disease | 677 | ||
| Axial Neck Pain | 677 | ||
| Pathophysiology | 677 | ||
| Epidemiology and Natural History | 678 | ||
| Clinical Syndromes of Axial Neck Pain | 679 | ||
| Cervical Radiculopathy | 679 | ||
| Pathophysiology | 679 | ||
| Epidemiology and Natural History | 680 | ||
| Clinical Syndromes of Cervical Radiculopathy | 680 | ||
| Cervical Myelopathy | 683 | ||
| Pathophysiology | 683 | ||
| Natural History | 683 | ||
| Clinical Syndromes of Cervical Myelopathy | 685 | ||
| Summary | 686 | ||
| References | 686 | ||
| 38 Medical Myelopathies | 689 | ||
| Spinal Cord Anatomy | 689 | ||
| Longitudinal Orientation | 689 | ||
| Transverse Orientation | 689 | ||
| Ascending Lateral Spinothalamic Tracts | 689 | ||
| Ascending Dorsal Column–Medial Lemniscus Tracts | 689 | ||
| Descending Lateral Corticospinal (Pyramidal) Tracts | 689 | ||
| Vascular Diseases of the Spinal Cord | 690 | ||
| Infarctions of the Spinal Cord | 690 | ||
| Arterial Spinal Cord Infarctions | 690 | ||
| Evaluation of Suspected Stroke of the Spinal Cord | 690 | ||
| Imaging | 690 | ||
| Spinal Cord Vascular Lesions | 690 | ||
| Cavernous Hemangioma (Cavernomas) | 691 | ||
| Hemangioblastomas | 691 | ||
| Arteriovenous Malformations and Arteriovenous Fistulas | 691 | ||
| Inflammatory Spinal Cord Disorders | 691 | ||
| Transverse Myelitis | 691 | ||
| Multiple Sclerosis | 692 | ||
| Neuromyelitis Optica | 694 | ||
| Myelopathy Due to Connective Tissue Conditions and Diseases | 694 | ||
| Rheumatoid Arthritis | 694 | ||
| Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome | 694 | ||
| Sjögren Disease | 695 | ||
| Behçet Disease | 695 | ||
| Neurosarcoidosis | 695 | ||
| Infectious Myelopathies | 695 | ||
| Viral Myelitis | 695 | ||
| Human Immunodeficiency Virus Infection | 695 | ||
| Human T-Cell Lymphotropic Virus Type 1 | 696 | ||
| Herpesviruses | 696 | ||
| Myelopathies Resulting From Bacterial Diseases | 696 | ||
| Syphilis | 696 | ||
| Tabes Dorsalis and Syphilitic Meningomyelitis | 696 | ||
| Tuberculosis | 697 | ||
| Spinal Epidural Abscesses | 697 | ||
| Nutritional Myelopathies | 698 | ||
| Vitamin B12 Deficiency | 698 | ||
| Copper Deficiency | 699 | ||
| References | 700 | ||
| 39 Nonoperative Management of Disc and Degenerative Disorders | 705 | ||
| Introduction | 705 | ||
| General Treatment Approach | 705 | ||
| Mechanical Treatment Modalities | 706 | ||
| Immobilization | 706 | ||
| Temperature Therapy | 706 | ||
| Passive Modalities | 706 | ||
| Traction | 706 | ||
| Pharmacotherapy | 707 | ||
| Nonsteroidal Antiinflammatory Drugs | 707 | ||
| Oral Corticosteroids | 707 | ||
| Opioids | 707 | ||
| Neuropathic Pain | 708 | ||
| Muscle Relaxants | 708 | ||
| Exercise and Physical Therapy | 708 | ||
| Manipulation | 709 | ||
| Injections | 709 | ||
| Epidural Injections | 709 | ||
| Selective Nerve Root Blocks | 709 | ||
| Complications and Efficacy | 709 | ||
| Diagnostic Injections | 710 | ||
| Biotechnology and Future Treatment Strategies | 710 | ||
| Medications | 710 | ||
| Direct Injection | 710 | ||
| Gene Therapy | 710 | ||
| Cell-Based Therapies | 711 | ||
| Summary | 711 | ||
| Key References | 711 | ||
| References | 711 | ||
| 40 Surgical Management of Axial Neck Pain | 715 | ||
| Etiology and Pathophysiology of Axial Neck Pain | 715 | ||
| Natural History and Prognosis Factors for Neck Pain | 716 | ||
| Clinical Evaluation of the Patient With Neck Pain | 717 | ||
| Imaging Studies | 717 | ||
| Radiographs | 717 | ||
| Advanced Imaging Studies | 718 | ||
| Cervical Discography | 719 | ||
| Surgery for Axial Neck Pain | 720 | ||
| Axial Neck Pain Secondary to Pseudarthrosis From Prior Surgery | 721 | ||
| Outcome After Surgery for Axial Neck Pain | 722 | ||
| Summary | 723 | ||
| Key References | 724 | ||
| References | 724 | ||
| 41 Cervical Radiculopathy | 727 | ||
| Introduction | 727 | ||
| Pathophysiology | 727 | ||
| Radiographic Evaluation | 728 | ||
| Surgical Indications | 730 | ||
| Surgical Treatment | 730 | ||
| Anterior Approach | 730 | ||
| Anterior Cervical Discectomy and Fusion | 731 | ||
| Multilevel Pathology | 732 | ||
| Cervical Arthroplasty | 732 | ||
| Posterior Cervical Foraminotomy | 733 | ||
| Indications for Posterior Cervical Foraminotomy | 734 | ||
| Open Technique | 734 | ||
| Minimally Invasive Technique | 734 | ||
| Surgical Outcomes | 735 | ||
| Summary | 736 | ||
| Pearls | 736 | ||
| Pitfalls | 736 | ||
| References | 736 | ||
| 42 Management of Cervical Myelopathy | 739 | ||
| Introduction | 739 | ||
| Pathophysiology | 739 | ||
| Natural History | 739 | ||
| Classification | 740 | ||
| History and Physical Examination | 740 | ||
| Imaging | 741 | ||
| Goals of Management | 742 | ||
| Surgical Approach Considerations | 742 | ||
| Anterior Procedures for the Cervical Spine | 743 | ||
| Anterior Approach to the Cervical Spine | 743 | ||
| Complications and Risks of the Anterior Approach to the Cervical Spine | 744 | ||
| Anterior Cervical Discectomy and Fusion | 745 | ||
| Procedure | 745 | ||
| Outcomes, Complications, and Other Considerations | 746 | ||
| Anterior Cervical Corpectomy and Fusion | 746 | ||
| Procedure | 746 | ||
| Outcomes, Complications, and Other Considerations | 750 | ||
| Anterior Cervical Discectomy and Fusion Versus Anterior Cervical Corpectomy and Fusion | 750 | ||
| Posterior Procedures for the Cervical Spine | 751 | ||
| Posterior Approach to the Cervical Spine | 751 | ||
| Laminectomy and Fusion | 752 | ||
| Procedure | 752 | ||
| Outcomes, Complications, and Other Considerations | 753 | ||
| Cervical Laminoplasty | 753 | ||
| Open-Door Laminoplasty Procedure | 753 | ||
| Outcomes, Complications, and Other Considerations | 756 | ||
| Laminectomy With Fusion Compared With Laminoplasty | 756 | ||
| Dome Laminectomy | 756 | ||
| Combined Approaches | 756 | ||
| Conclusion | 757 | ||
| Key References | 757 | ||
| References | 757 | ||
| 43 Ossification of the Posterior Longitudinal Ligament | 763 | ||
| Etiology | 763 | ||
| Genetic Factors | 763 | ||
| Environmental Factors | 763 | ||
| Pathology | 764 | ||
| Classification | 764 | ||
| Natural History | 764 | ||
| Clinical Features | 764 | ||
| Risk Factors for Myelopathy | 764 | ||
| Imaging | 764 | ||
| Plain Radiographs | 764 | ||
| Computed Tomography | 765 | ||
| Magnetic Resonance Imaging | 765 | ||
| Treatment for OPLL Involving the Cervical Spine | 765 | ||
| Conservative Treatment | 765 | ||
| Surgical Treatment | 767 | ||
| Anterior Approaches | 767 | ||
| Posterior Approaches | 767 | ||
| Outcome of Surgical Treatment | 767 | ||
| Factors Associated With Poor Surgical Outcome | 767 | ||
| Treatment for OPLL Involving Thoracic Spine | 767 | ||
| Summary | 768 | ||
| References | 768 | ||
| 44 Cervical Disc Replacement | 771 | ||
| Background | 771 | ||
| History of Disc Arthroplasty and Device Design | 772 | ||
| Indications for Use, Contraindications, and Complications | 774 | ||
| Preoperative Imaging | 776 | ||
| Technique of Implantation | 777 | ||
| Postoperative Imaging | 778 | ||
| Clinical Studies | 778 | ||
| Prestige Disc | 778 | ||
| ProDisc-C | 779 | ||
| Bryan Disc | 779 | ||
| Mobi-C | 779 | ||
| Future Direction | 780 | ||
| Biomechanics | 780 | ||
| Pearls | 781 | ||
| Pitfalls | 781 | ||
| Key Points | 781 | ||
| Key References | 782 | ||
| References | 782 | ||
| VI Thoracic and Lumbar Disc Disease | 785 | ||
| 45 Thoracic Disc Disease | 787 | ||
| Historical Background | 787 | ||
| Epidemiology | 787 | ||
| Etiology | 788 | ||
| Pathogenesis | 789 | ||
| Clinical Presentation | 789 | ||
| Level and Classification of Herniation | 790 | ||
| Natural History | 791 | ||
| Differential Diagnosis | 791 | ||
| Diagnostic Evaluation | 792 | ||
| Spine Radiographs | 792 | ||
| Myelography | 792 | ||
| Computed Tomography | 792 | ||
| Magnetic Resonance Imaging | 794 | ||
| Discography | 795 | ||
| Treatment | 796 | ||
| Video-Assisted Thoracoscopic Surgery | 799 | ||
| Minimally Invasive Techniques | 800 | ||
| Summary | 801 | ||
| Pearls | 801 | ||
| Pitfalls | 801 | ||
| Key Points | 801 | ||
| Key References | 801 | ||
| References | 802 | ||
| 46 Lumbar Disc Disease | 807 | ||
| Introduction | 807 | ||
| Natural History | 807 | ||
| Relevant Anatomy | 808 | ||
| Nucleus Pulposus | 808 | ||
| Anulus Fibrosus | 808 | ||
| End Plate Cartilage | 808 | ||
| Defining the IVD Niche: Molecular Characters | 809 | ||
| Changes in Disc Structure With Aging and Degeneration | 811 | ||
| Associated Factors | 811 | ||
| Pathophysiology | 812 | ||
| Internal Disc Disruption | 812 | ||
| Degenerative Disc Disease | 812 | ||
| Defining Features of the Degenerating Disc | 813 | ||
| Subclinical Bacterial Infection of the Spinal Motion Segment as a Possible Initiator of Low Back Pain | 813 | ||
| Damage-Associated Molecular Patterns as Mediators of Chronic Inflammation and Low Back Pain | 814 | ||
| Systemic Metabolic Syndrome as a Driver of Disc Inflammation and Low Back Pain | 815 | ||
| Effect of Disc Degeneration on Nerves | 815 | ||
| Clinical Picture | 816 | ||
| Internal Disc Disruption | 816 | ||
| Degenerative Disc Disease | 816 | ||
| Diagnostic Imaging | 816 | ||
| Plain Radiography | 816 | ||
| Computed Tomography | 817 | ||
| Magnetic Resonance Imaging | 817 | ||
| Contrast-Enhanced Magnetic Resonance Imaging | 818 | ||
| High-Intensity Zone | 818 | ||
| Dark Disc | 819 | ||
| Modic End Plate Changes | 819 | ||
| Axially and Vertically Loaded Magnetic Resonance Imaging | 820 | ||
| Discography | 820 | ||
| Treatment | 821 | ||
| Nonoperative Treatment | 821 | ||
| Bed Rest and Advice to Stay Active | 822 | ||
| Orthotics | 822 | ||
| Physical Therapy | 823 | ||
| Adjunctive Modalities | 823 | ||
| Manual Therapy and Complementary/Alternative Medicine Therapies | 823 | ||
| Pharmacotherapy | 824 | ||
| Nonsurgical Interventional Therapies | 825 | ||
| Epidural Spinal Injection | 825 | ||
| Intradiscal Injection | 825 | ||
| Thermal Annuloplasty | 826 | ||
| Surgical Treatment | 827 | ||
| Spinal Fusion | 827 | ||
| Fusion Technologies | 828 | ||
| Adjacent-Segment Degeneration | 828 | ||
| Biologic Treatment of Degenerative Disc Disease | 828 | ||
| Summary | 828 | ||
| Key Points | 828 | ||
| Key References | 828 | ||
| References | 829 | ||
| 47 Lumbar Disc Herniations | 839 | ||
| Pathoanatomy | 839 | ||
| Pathophysiology | 840 | ||
| Disc Degeneration and Herniation | 840 | ||
| Disc Herniation and Sciatica | 841 | ||
| Disc Herniation and Back Pain | 842 | ||
| Classification of Disc Herniations | 842 | ||
| Morphology | 842 | ||
| Location | 842 | ||
| Timing | 842 | ||
| History and Symptoms | 843 | ||
| Physical Examination | 844 | ||
| Inspection | 844 | ||
| Palpation and Percussion | 845 | ||
| Neurologic Examination | 845 | ||
| Specific Tests | 845 | ||
| Differential Diagnosis | 846 | ||
| Diagnostic Imaging | 846 | ||
| Plain Radiographs | 847 | ||
| Magnetic Resonance Imaging | 847 | ||
| Magnetic Resonance Imaging in the Postoperative Spine | 848 | ||
| Myelography | 848 | ||
| Computed Tomography | 849 | ||
| Natural History | 849 | ||
| Methods of Nonoperative Treatment | 849 | ||
| Physiotherapy | 849 | ||
| Pharmacologic Treatment | 850 | ||
| Operative Versus Nonoperative Treatment | 850 | ||
| Operative Treatment | 851 | ||
| Indications | 851 | ||
| Available Techniques | 852 | ||
| Open Simple Discectomy | 852 | ||
| Timing | 852 | ||
| Technique | 853 | ||
| Postoperative Care and Rehabilitation | 855 | ||
| Outcomes | 856 | ||
| Complications | 858 | ||
| Recurrent Disc Herniations | 858 | ||
| Discectomy in Children | 859 | ||
| Discectomy in Elderly Patients | 859 | ||
| Foraminal and Extraforaminal (Far-Lateral) Herniations | 859 | ||
| Cauda Equina Syndrome | 860 | ||
| Alternatives to Standard Discectomy | 861 | ||
| Endoscopic Discectomy | 861 | ||
| Percutaneous Automated Discectomy | 862 | ||
| Chemonucleolysis | 863 | ||
| Pearls | 863 | ||
| Pitfalls | 863 | ||
| Key Points | 863 | ||
| Key References | 863 | ||
| References | 864 | ||
| 48 Annular Repair | 869 | ||
| Introduction | 869 | ||
| Anulus Fibrosus | 869 | ||
| Effect of Aging on the Anulus Fibrosus | 869 | ||
| Healing of the Anulus | 870 | ||
| Biologic Repair | 870 | ||
| Surgical Repair | 870 | ||
| Summary | 871 | ||
| Key References | 871 | ||
| References | 871 | ||
| 49 Lumbar Disc Degeneration | 873 | ||
| Anterior Lumbar Surgical Approach | 873 | ||
| Indications for Interbody Fusions | 877 | ||
| Interbody Implants and Graft Material | 877 | ||
| Indications for Total Disc Replacement | 880 | ||
| Implants and Design | 880 | ||
| Postoperative Management | 884 | ||
| Complications | 884 | ||
| Acknowledgment | 885 | ||
| Pearls and Pitfalls: ALIF | 885 | ||
| Pearls: TDR | 886 | ||
| Pitfalls: TDR | 886 | ||
| Key Points: ALIF | 886 | ||
| Key Points: TDR | 886 | ||
| Key References | 886 | ||
| References | 887 | ||
| 50 Posterior Lumbar Interbody Fusion | 891 | ||
| Introduction | 891 | ||
| Historical Perspective | 891 | ||
| Indications for Interbody Fusion | 892 | ||
| Biomechanics of Interbody Fusion | 893 | ||
| Cage Characteristics | 894 | ||
| Subsidence | 896 | ||
| Our Preferred Technique | 897 | ||
| Optimal Graft Material | 900 | ||
| Posterior Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion | 901 | ||
| Outcome and Complications of Posterior Lumbar Interbody Fusion | 903 | ||
| Summary | 903 | ||
| References | 904 | ||
| 51 Posterolateral and Lateral Corpectomies | 907 | ||
| Posterolateral and Lateral Corpectomy in the Thoracic Spine | 907 | ||
| Historical Perspective | 907 | ||
| Indications and Choice of Approach | 908 | ||
| Surgical Technique | 908 | ||
| Posterolateral Approaches | 908 | ||
| Lateral Approaches | 909 | ||
| Outcomes | 910 | ||
| Disc Herniation | 910 | ||
| Posterolateral and Lateral Corpectomy in the Lumbar Spine | 910 | ||
| Historical Perspective | 910 | ||
| Indications | 911 | ||
| Technique | 911 | ||
| Posterolateral | 911 | ||
| Lateral Transpsoas Approach (Extreme or Direct Lateral Approach) | 911 | ||
| Outcomes | 912 | ||
| Lateral Extracavitary Approach | 912 | ||
| Costotransversectomy | 913 | ||
| Lateral/Posterolateral/Posterior Minimally Invasive Surgical Thoracic and Lumbar Corpectomy | 913 | ||
| Summary | 914 | ||
| References | 914 | ||
| 52 Dynamic Stabilization | 917 | ||
| Understanding Spinal Instability | 917 | ||
| Biomechanical Goals of a Posterior Dynamic Stabilization Device | 917 | ||
| Motion Preservation | 917 | ||
| Load Transmission | 918 | ||
| Resistance to Fatigue Failure | 918 | ||
| Dynamic Stabilization Devices | 920 | ||
| Indications for Pedicle Screw–Based Posterior Dynamic Stabilization | 920 | ||
| Indications for Interspinous Process Distraction | 920 | ||
| Clinical Experience With Dynamic Stabilization | 920 | ||
| Pedicle Screw–Based Posterior Dynamic Stabilization Devices | 920 | ||
| Dynesys Dynamic Stabilization System | 921 | ||
| Interspinous Distraction Devices | 925 | ||
| Summary | 928 | ||
| Pearls | 928 | ||
| Pitfalls | 929 | ||
| Key References | 929 | ||
| References | 929 | ||
| VII Minimally Invasive Surgery | 933 | ||
| 53 Rationale of Minimally Invasive Spine Surgery | 935 | ||
| Introduction | 935 | ||
| Anatomy of the Posterior Paraspinal Muscles | 935 | ||
| Multifidus Muscle | 935 | ||
| Erector Spinae Muscles | 936 | ||
| Interspinales, Intertransversarii, and Short Rotator Muscles | 937 | ||
| Innervation of the Posterior Paraspinal Muscles | 937 | ||
| Fiber Type Characteristics of the Paraspinal Muscles | 937 | ||
| Paraspinal Muscle Injury | 938 | ||
| Characteristics of Paraspinal Muscles in the Postsurgical Spine | 938 | ||
| Mechanism of Paraspinal Muscle Injury During Surgery | 938 | ||
| Correlation of Muscle Injury With Clinical Outcomes | 939 | ||
| Preservation of Muscle Function and Integrity | 939 | ||
| Preservation of the Bone-Ligament Complex | 939 | ||
| Summary | 940 | ||
| Key References | 941 | ||
| References | 941 | ||
| 54 Minimally Invasive Posterior Approaches to the Spine | 945 | ||
| Surgical Anatomy of the Posterior Paraspinal Muscles | 945 | ||
| Key Concepts for Minimally Invasive Spine Retraction Systems | 945 | ||
| Minimally Invasive Spine Surgical Corridor | 945 | ||
| Posterior Lumbar Approaches | 945 | ||
| Tubular Microdiscectomy | 945 | ||
| Lumbar Decompression | 946 | ||
| Posterior Lumbar Interbody Fusion | 949 | ||
| Percutaneous Pedicle Screw Instrumentation | 952 | ||
| Limitations and Drawbacks | 952 | ||
| Radiation Exposure | 952 | ||
| Learning Curve for Minimally Invasive Spinal Surgery | 953 | ||
| Summary | 955 | ||
| Pearls | 955 | ||
| Pitfalls | 955 | ||
| Key Points | 955 | ||
| Key References | 955 | ||
| References | 956 | ||
| 55 Minimally Invasive Posterior Lumbar Instrumentation | 959 | ||
| Overview | 959 | ||
| Indications and Contraindications | 959 | ||
| Technical Outcomes of Transpedicular Lumbar Instrumentation | 961 | ||
| Traditional (“Mini-Open”) Pedicle Screws | 961 | ||
| Percutaneous Pedicle Screws | 962 | ||
| Technique of Percutaneous Pedicle Screw Placement | 962 | ||
| Studies Comparing Mini-Open and Percutaneous Pedicle Screws | 964 | ||
| Consideration for Radiation Exposure | 965 | ||
| Fluoroscopic Versus Navigation-Assisted Spinal Instrumentation | 965 | ||
| Intraoperative Electrophysiological Monitoring | 966 | ||
| Pearls and Pitfalls | 966 | ||
| Key Points | 966 | ||
| Key References | 966 | ||
| References | 966 | ||
| 56 Minimally Invasive Posterior Lumbar Fusion Techniques | 969 | ||
| Introduction | 969 | ||
| Principles of Minimally Invasive Spinal Surgery | 969 | ||
| Surgical Setup for a Posterior Fusion Procedure | 970 | ||
| Setup and Imaging | 970 | ||
| Surgical Incisions and Approach | 971 | ||
| Spinal Decompression | 972 | ||
| Posterior Interbody and Transforaminal Interbody Fusion | 972 | ||
| Posterolateral Fusion (Intertransverse Onlay Fusion) | 973 | ||
| Facet Fusion | 973 | ||
| Pedicle Screw Instrumentation | 973 | ||
| Cannulated Pedicle Screw Insertion | 974 | ||
| Technical Tips | 977 | ||
| Direct Pedicle Screw Insertion via a Paramedian Approach | 978 | ||
| Facet Screw Instrumentation | 978 | ||
| Patient Selection | 979 | ||
| Summary | 980 | ||
| References | 980 | ||
| 57 Posterolateral Endoscopic Lumbar Discectomy | 983 | ||
| History | 983 | ||
| Anatomy | 985 | ||
| Indications and Contraindications | 985 | ||
| Posterolateral Endoscopic Lumbar Discectomy | 987 | ||
| Step-by-Step Operative Technique | 987 | ||
| Patient Positioning | 987 | ||
| Anesthesia | 987 | ||
| Needle Placement | 987 | ||
| Evocative Chromodiscography | 989 | ||
| Instrument Placement | 989 | ||
| Performing the Discectomy | 989 | ||
| Clinical Outcomes | 990 | ||
| Complications and Avoidance | 991 | ||
| Future Considerations | 991 | ||
| Pearls | 991 | ||
| Pitfalls | 992 | ||
| Key Points | 992 | ||
| Key References | 992 | ||
| References | 992 | ||
| 58 Interspinous Process Decompressive Devices | 995 | ||
| Introduction | 995 | ||
| Design Rationale | 995 | ||
| Surgical Technique | 997 | ||
| Clinical Results | 997 | ||
| Summary | 998 | ||
| Pearls | 998 | ||
| Pitfalls | 998 | ||
| Key Points | 998 | ||
| Key References | 998 | ||
| References | 998 | ||
| 59 Minimally Invasive Cervical Spine Techniques | 1001 | ||
| Introduction | 1001 | ||
| Anterior Cervical Minimally Invasive Applications | 1001 | ||
| Endoscopic Anterior Discectomy | 1001 | ||
| Indications and Contraindications | 1001 | ||
| Clinical Evaluation | 1002 | ||
| Surgical Technique | 1002 | ||
| Clinical Outcomes and Published Studies | 1002 | ||
| Cervical Microendoscopic Discectomy and Fusion | 1003 | ||
| Indications and Contraindications | 1003 | ||
| Clinical Evaluation | 1003 | ||
| Surgical Technique | 1003 | ||
| Clinical Outcomes and Published Studies | 1005 | ||
| Posterior Cervical Minimally Invasive Applications | 1005 | ||
| Minimally Invasive Cervical Laminoforaminotomy | 1005 | ||
| Indications and Contraindications | 1005 | ||
| Clinical Evaluation | 1005 | ||
| Surgical Technique | 1005 | ||
| Clinical Outcomes and Published Studies | 1007 | ||
| Minimally Invasive Lateral Mass Fixation | 1007 | ||
| Indications and Contraindications | 1007 | ||
| Surgical Technique | 1007 | ||
| Clinical Outcomes and Published Studies | 1008 | ||
| Conclusions | 1008 | ||
| Key References | 1009 | ||
| References | 1009 | ||
| 60 Future Directions in Minimally Invasive Spinal Surgery | 1011 | ||
| Minimally Invasive Approaches to the Spine: Understanding the Anatomy and Designing Retractors | 1011 | ||
| Percutaneous Pedicle Screw Placement, Image Guidance and Robotics | 1011 | ||
| Motion Preservation Techniques | 1012 | ||
| Spinal Radiosurgery for the Treatment of Metastatic Spine Diseases | 1012 | ||
| Spinal Biologics | 1013 | ||
| Summary | 1013 | ||
| References | 1013 | ||
| VIII Spinal Stenosis | 1017 | ||
| 61 Spinal Stenosis | 1019 | ||
| Anatomy | 1019 | ||
| Disc | 1019 | ||
| Facet Joints | 1020 | ||
| Intervertebral Foramen | 1020 | ||
| Cauda Equina | 1021 | ||
| Classification | 1021 | ||
| Deformity and Instability | 1022 | ||
| Pathophysiology | 1022 | ||
| Natural History | 1022 | ||
| Clinical Presentation | 1023 | ||
| Physical Examination | 1024 | ||
| Diagnostic Studies | 1024 | ||
| Radiography | 1024 | ||
| Computed Tomography With and Without Myelography | 1025 | ||
| Magnetic Resonance Imaging | 1026 | ||
| Electromyography, Nerve Conduction Studies, and Somatosensory Evoked Potentials | 1026 | ||
| Differential Diagnosis | 1027 | ||
| Summary | 1028 | ||
| Pearls | 1029 | ||
| Pitfalls | 1029 | ||
| Key Points | 1029 | ||
| Key References | 1029 | ||
| References | 1029 | ||
| 62 Nonoperative Management of Lumbar Spinal Stenosis | 1033 | ||
| Clinical Aspects | 1033 | ||
| Natural History of Lumbar Spinal Stenosis | 1033 | ||
| Nonoperative Management | 1034 | ||
| Drug Therapy | 1034 | ||
| Physical Therapy | 1034 | ||
| Epidural Corticosteroid Injection | 1035 | ||
| Lumbar Spinal Stenosis: Evidence-Informed Approach to Management | 1035 | ||
| Pearls | 1036 | ||
| Pitfalls | 1036 | ||
| Key Points | 1036 | ||
| Key References | 1036 | ||
| References | 1036 | ||
| 63 Surgical Management of Lumbar Spinal Stenosis | 1039 | ||
| Indications for Surgery | 1039 | ||
| Laminectomy | 1039 | ||
| Outcomes of Laminectomy | 1043 | ||
| Arthrodesis After Laminectomy | 1044 | ||
| Laminotomy | 1045 | ||
| Fenestration | 1046 | ||
| Laminoplasty | 1046 | ||
| Microendoscopic Decompressive Laminotomy | 1047 | ||
| Interspinous Process Devices | 1049 | ||
| Postoperative Care | 1050 | ||
| Complications | 1051 | ||
| Pearls and Pitfalls | 1053 | ||
| Key Points | 1053 | ||
| Key References | 1053 | ||
| References | 1054 | ||
| 64 Degenerative Spondylolisthesis | 1059 | ||
| Epidemiology and Biomechanics | 1059 | ||
| Natural History | 1060 | ||
| Clinical Features | 1060 | ||
| Radiographic Diagnosis | 1061 | ||
| Treatment | 1062 | ||
| Decompression Without Fusion | 1062 | ||
| Noninstrumented Posterolateral Fusion | 1063 | ||
| Posterior Instrumented Fusion | 1065 | ||
| Posterior Fusion With Anterior Column Support | 1068 | ||
| Alternative Surgical Strategies | 1069 | ||
| Summary of Treatment Options | 1070 | ||
| Summary | 1070 | ||
| Pearls and Pitfalls | 1071 | ||
| Key References | 1071 | ||
| References | 1071 | ||
| IX Spinal Fusion and Instrumentation | 1075 | ||
| 65 Techniques and Complications of Bone Graft Harvesting | 1077 | ||
| Surgical Anatomy and Techniques | 1077 | ||
| Anterior Iliac Crest | 1077 | ||
| Posterior Iliac Crest | 1079 | ||
| Rib | 1079 | ||
| Fibula | 1079 | ||
| Complications of Bone Graft Harvesting | 1081 | ||
| General | 1081 | ||
| Hematoma | 1081 | ||
| Infection | 1081 | ||
| Anterior Iliac Crest | 1081 | ||
| Nerve Injuries | 1082 | ||
| Pain | 1082 | ||
| Posterior Iliac Crest | 1082 | ||
| Cluneal Nerve Injury | 1082 | ||
| Sciatic Nerve Injury | 1082 | ||
| Superior Gluteal Artery Injury | 1082 | ||
| Pain | 1083 | ||
| Fracture | 1083 | ||
| Fibula | 1083 | ||
| Rib | 1083 | ||
| Key References | 1083 | ||
| References | 1084 | ||
| 66 Principles of Bone Fusion | 1085 | ||
| Biology of Fusion Sites | 1085 | ||
| Bone Graft Biology and Materials | 1086 | ||
| Autogenous Cancellous Bone | 1087 | ||
| Autologous Cortical Bone | 1088 | ||
| Vascularized Autologous Grafts | 1088 | ||
| Autologous Bone Marrow | 1088 | ||
| RIA (Reamer-Irrigator-Aspirator) | 1090 | ||
| Structural Bone Allografts and Cages | 1090 | ||
| Demineralized Allograft Bone Matrix | 1092 | ||
| Deproteinated Heterologous Bone | 1093 | ||
| Synthetic Bioactive Bone Graft Materials | 1093 | ||
| Bone Morphogenetic Proteins | 1093 | ||
| Risks and Adverse Events Associated With Use of Bone Morphogenetic Proteins in Spine Fusion | 1095 | ||
| Opportunities for Improving or Refining the Use of BMPs and Other Bioactive Molecules | 1100 | ||
| Other Growth Factors | 1101 | ||
| Collagen | 1101 | ||
| Noncollagenous Matrix Proteins | 1101 | ||
| Ceramics | 1102 | ||
| Systemic/Patient-Specific Factors Influencing Bone Healing in Spine Fusion | 1103 | ||
| Local Factors Influencing Bone Healing in Spine Fusion | 1103 | ||
| Future Considerations | 1105 | ||
| Key Points | 1105 | ||
| Key References | 1105 | ||
| References | 1106 | ||
| 67 Bone Substitutes | 1123 | ||
| Allografts | 1123 | ||
| Ceramics | 1125 | ||
| Demineralized Bone Matrices | 1125 | ||
| Osteoinductive Growth Factors | 1126 | ||
| Autologous Platelet Concentrate | 1128 | ||
| Mesenchymal Stem Cells | 1128 | ||
| Gene Therapy | 1129 | ||
| Conclusion | 1130 | ||
| Key Points | 1130 | ||
| Key References | 1130 | ||
| References | 1130 | ||
| 68 Electrical Stimulation for Spinal Fusion | 1137 | ||
| History of Electrical Stimulation | 1137 | ||
| Methods of Electrical Stimulation | 1137 | ||
| Direct Current Electrical Stimulation | 1137 | ||
| Direct Current Stimulation: Mechanism of Action | 1137 | ||
| Direct Current Stimulation: Clinical Application | 1138 | ||
| Capacitive Coupling Electrical Stimulation | 1138 | ||
| Capacitive Coupling Stimulation: Mechanism of Action | 1138 | ||
| Capacitive Coupling Stimulation: Clinical Application | 1138 | ||
| Inductive Coupling Electrical Stimulation | 1139 | ||
| Pulsed Electromagnetic Fields: Mechanism of Action | 1139 | ||
| Clinical Studies of Pulsed Electromagnetic Fields | 1139 | ||
| Electrical Stimulators: Quality of the Evidence | 1139 | ||
| Conclusions and Future Direction | 1140 | ||
| Key Points | 1140 | ||
| Key References | 1140 | ||
| References | 1140 | ||
| 69 Cervical Instrumentation | 1143 | ||
| Introduction and Overview | 1143 | ||
| Relevant Anatomy for Spinal Instrumentation | 1143 | ||
| Fluoroscopy and Navigation for Cervical Spine Instrumentation | 1146 | ||
| Selecting the Biomechanically Correct Implant | 1147 | ||
| Biomechanical Principles and Functional Modes | 1148 | ||
| Anterior Spinal Instrumentation | 1149 | ||
| Anterior Screw Stabilization of the Upper Cervical Spine | 1150 | ||
| Anterior Cervical Plating | 1150 | ||
| Evolution and Mechanics of Anterior Cervical Plates | 1151 | ||
| Cervical Plating: Indications and Rationale | 1153 | ||
| Cervical Plating: Technique | 1153 | ||
| Cervical Plating: Outcomes and Complications | 1154 | ||
| Anterior Cervical Cages | 1155 | ||
| Mechanics and Rationale | 1155 | ||
| Implant Selection and Technique Notes | 1157 | ||
| Bone Graft Selection | 1158 | ||
| Technique | 1158 | ||
| Outcomes and Complications | 1158 | ||
| Cervical Disc Arthroplasty | 1159 | ||
| Posterior Cervical Instrumentation | 1160 | ||
| Occipitocervical Instrumentation | 1160 | ||
| Nonrigid Occipitocervical Systems | 1160 | ||
| Rigid Occipitocervical Instrumentation | 1161 | ||
| Outcomes and Complications | 1162 | ||
| Atlantoaxial Instrumentation | 1163 | ||
| Gallie and Brooks Techniques | 1163 | ||
| Magerl Transarticular Screws | 1164 | ||
| C1 Lateral Mass Screws and the Goel-Harms Technique | 1165 | ||
| C2 Fixation Options | 1166 | ||
| Other C1–C2 Stabilization Options | 1167 | ||
| Posterior Subaxial Instrumentation | 1167 | ||
| Posterior Wiring | 1167 | ||
| Rigid Posterior Mid-Cervical Instrumentation | 1168 | ||
| Cervical Hooks | 1169 | ||
| Lateral Mass Screws | 1169 | ||
| Mid and Lower Cervical Pedicle Screws | 1171 | ||
| Lower Cervical Transarticular Screws | 1172 | ||
| Posterior Cervical Rods and Cross-Links | 1172 | ||
| Facet Spacers | 1172 | ||
| Laminoplasty Implants | 1172 | ||
| Conclusions | 1173 | ||
| Key Points | 1173 | ||
| Key References | 1173 | ||
| References | 1174 | ||
| 70 Thoracic and Lumbar Instrumentation | 1187 | ||
| Introduction | 1187 | ||
| Overview and History | 1187 | ||
| Relevant Anatomy | 1188 | ||
| Biomechanics of Thoracolumbar Instrumentation | 1190 | ||
| Implant Materials and Fusion Characteristics | 1191 | ||
| Demand Matching, Improving Fixation, and the Implications of Osteoporosis | 1193 | ||
| Posterior Thoracolumbar Instrumentation | 1195 | ||
| Interspinous Process Stabilization | 1195 | ||
| Facet-Based Stabilization | 1197 | ||
| Laminar Wires, Ribbons, and Hooks | 1198 | ||
| Pedicle Screws | 1199 | ||
| Cortical Screws | 1203 | ||
| Pelvic Fixation | 1203 | ||
| Access and Guidance | 1204 | ||
| Rods and Cross-Links | 1205 | ||
| Dynamic Rods | 1205 | ||
| Variable Stiffness Rods | 1206 | ||
| Growing Rods | 1206 | ||
| Cross-Links | 1206 | ||
| Anterior Thoracolumbar Instrumentation | 1207 | ||
| Cages and Struts | 1208 | ||
| Anterior Plates and Screw-Rod Systems | 1214 | ||
| Lumbar Disc Arthroplasty, Nuclear Replacement, and Other Motion-Sparing Approaches | 1215 | ||
| Summary | 1217 | ||
| Key References | 1217 | ||
| References | 1217 | ||
| X Adult Deformity | 1227 | ||
| 71 Adult Isthmic Spondylolisthesis | 1229 | ||
| Introduction | 1229 | ||
| Classification | 1229 | ||
| Natural History/Incidence | 1229 | ||
| Pathophysiology | 1229 | ||
| Biomechanics | 1231 | ||
| Diagnosis | 1231 | ||
| History | 1231 | ||
| Physical Examination | 1232 | ||
| Imaging | 1232 | ||
| Differential Diagnosis | 1233 | ||
| Treatment | 1233 | ||
| Nonoperative Treatment | 1233 | ||
| Operative Treatment | 1233 | ||
| Indications | 1233 | ||
| Contraindications | 1233 | ||
| Surgery | 1233 | ||
| Decompression | 1234 | ||
| Direct Pars Repair | 1234 | ||
| Fusion | 1234 | ||
| Reduction of High-Grade Spondylolisthesis | 1235 | ||
| Pearls | 1235 | ||
| Pitfalls | 1235 | ||
| Key Points | 1236 | ||
| Key References | 1236 | ||
| References | 1236 | ||
| 72 Adult Scoliosis | 1239 | ||
| Introduction | 1239 | ||
| Terminology | 1239 | ||
| Current Understanding of Spinal Alignment | 1239 | ||
| Spinopelvic Parameters and Health-Related Quality of Life Measures | 1242 | ||
| Ideal Values for Spinopelvic Parameters | 1243 | ||
| Classification Systems for Adult Spinal Deformity | 1243 | ||
| Clinical Presentation of Adult Spinal Deformity Patients | 1245 | ||
| Clinical Evaluation | 1245 | ||
| Imaging Evaluation | 1246 | ||
| Treatment of Adult Scoliosis | 1246 | ||
| Nonoperative Management | 1247 | ||
| Operative Management | 1247 | ||
| Perioperative Considerations | 1248 | ||
| Operative Decision Making | 1248 | ||
| Decompression | 1248 | ||
| Decompression With Limited Fusion | 1248 | ||
| Surgical Approaches in Adult Scoliosis Surgery | 1249 | ||
| Complications of Adult Scoliosis Surgery | 1250 | ||
| Summary | 1251 | ||
| Case Studies | 1251 | ||
| References | 1256 | ||
| 73 Fixed Sagittal Imbalance | 1261 | ||
| Introduction | 1261 | ||
| Etiology | 1261 | ||
| Evaluation | 1261 | ||
| Radiographic Assessment | 1263 | ||
| Surgical Management | 1264 | ||
| Surgical Technique | 1264 | ||
| Technique | 1266 | ||
| Surgical Technique | 1266 | ||
| Exposure | 1266 | ||
| Removal/(Re)Instrumentation | 1266 | ||
| Revision/Primary Decompression | 1267 | ||
| Osteotomy and Closure | 1267 | ||
| Assessment of Spinal Balance and Bone Grafting | 1267 | ||
| Avoidance of Complications | 1267 | ||
| Cervical/Cervicothoracic Posterior Osteotomies | 1267 | ||
| Surgical Technique | 1267 | ||
| Midcervical Osteotomy for Fixed Sagittal Imbalance | 1268 | ||
| Vertebral Column Resection | 1268 | ||
| Surgical Technique | 1268 | ||
| Minimally Invasive Surgery | 1269 | ||
| Summary | 1270 | ||
| Key References | 1270 | ||
| References | 1270 | ||
| XI Spine Trauma | 1273 | ||
| 74 Basic Science of Spinal Cord Injury | 1275 | ||
| Pathophysiologic Response to Spinal Cord Injury | 1275 | ||
| Hemorrhage and Circulatory Collapse | 1275 | ||
| Oxidative Damage | 1275 | ||
| Excitotoxicity | 1275 | ||
| Mitochondrial Collapse and Cytotoxicity | 1276 | ||
| Neuroimmunologic Response | 1276 | ||
| Astroglial Scar | 1276 | ||
| Basic Science of a Cure | 1277 | ||
| Methylprednisolone | 1277 | ||
| Ganglioside GM-1 | 1279 | ||
| Thyrotropin-Releasing Hormone | 1279 | ||
| Nimodipine and Gacyclidine | 1279 | ||
| Regeneration Strategies | 1280 | ||
| Rho Antagonist | 1280 | ||
| Anti-Nogo Antibody | 1280 | ||
| Peripheral Nerve and Schwann Cell Transplantation | 1280 | ||
| Olfactory Ensheathing Glial Cell Transplantation | 1280 | ||
| Stem Cell Strategies | 1280 | ||
| Genetic Modification Strategies | 1281 | ||
| Key Points | 1281 | ||
| Pearls AND Pitfalls | 1281 | ||
| References | 1281 | ||
| 75 Injuries of the Upper Cervical Spine | 1285 | ||
| Demographics | 1285 | ||
| Anatomy of the Upper Cervical Spine (Craniocervical Junction) | 1286 | ||
| Clinical Evaluation | 1287 | ||
| Imaging | 1288 | ||
| Initial Stabilization | 1289 | ||
| Specific Injuries to the Upper Cervical Spine | 1289 | ||
| Occipital Condyle Fractures | 1289 | ||
| Atlanto-Occipital Injuries | 1290 | ||
| Fractures of the Atlas | 1295 | ||
| Atlantoaxial Subluxation and Dislocation | 1295 | ||
| Rupture of the Transverse Ligament | 1298 | ||
| Fractures of the Odontoid | 1301 | ||
| Traumatic Spondylolisthesis of the Axis | 1303 | ||
| Summary | 1305 | ||
| Pearls and Pitfalls | 1305 | ||
| Key Points | 1305 | ||
| Key References | 1307 | ||
| References | 1307 | ||
| 76 Lower Cervical Spine Injuries | 1311 | ||
| Introduction | 1311 | ||
| Anatomy | 1311 | ||
| Bony Anatomy | 1311 | ||
| Ligamentous Anatomy | 1311 | ||
| Neurovascular Anatomy | 1311 | ||
| Mechanism of Injury | 1312 | ||
| Assessment of the Spine-Injured Patient | 1312 | ||
| Initial Evaluation | 1312 | ||
| Clearing the Cervical Spine | 1312 | ||
| Asymptomatic Patients | 1312 | ||
| Temporarily Not Evaluable | 1312 | ||
| Symptomatic Patients | 1313 | ||
| Obtunded Patients | 1313 | ||
| Neurologic Examination | 1313 | ||
| Spinal Cord Injury Classification | 1313 | ||
| Classification of Injuries | 1315 | ||
| Fracture Stability | 1315 | ||
| Cervical Spine Injury Severity Score | 1315 | ||
| Subaxial Cervical Injury Classification System | 1315 | ||
| AO Cervical Spine Classification | 1316 | ||
| AO Type A Injuries | 1316 | ||
| AO Type B Injuries | 1316 | ||
| AO Type C Injuries | 1316 | ||
| Facet Fractures | 1316 | ||
| General Approach to Treatment of Injuries | 1317 | ||
| Nonoperative Care of Subaxial Cervical Injuries | 1317 | ||
| Soft Collar | 1317 | ||
| Hard Collar | 1317 | ||
| Cervicothoracic Orthosis | 1317 | ||
| Halo Vest | 1318 | ||
| Treatment of Acute Spinal Cord Injury | 1318 | ||
| Transport | 1318 | ||
| Immediate Care of the Spinal-Injured Patient | 1318 | ||
| Hemodynamic Support | 1318 | ||
| Magnetic Resonance Imaging in Acute Spinal Cord Injuries | 1318 | ||
| Neuroprotection | 1318 | ||
| Fracture-Dislocation Reduction | 1319 | ||
| Timing of Surgery | 1319 | ||
| Cranial Tong Technique | 1319 | ||
| Guidelines for Initial Closed Reduction of Subaxial Cervical Fractures | 1319 | ||
| Cranial Tong Insertion | 1319 | ||
| Reduction Technique | 1319 | ||
| Surgical Treatment of Subaxial Cervical Spine Injuries | 1320 | ||
| Surgical Goals | 1320 | ||
| Indications | 1320 | ||
| Surgical Approach | 1320 | ||
| Anterior Decompression and Fusion | 1321 | ||
| Posterior Approach | 1321 | ||
| Anteroposterior Approach | 1321 | ||
| Treatment of Specific Fracture Types | 1321 | ||
| AO Compression Injuries Type A1 and A2 | 1321 | ||
| AO Compression Injuries Type A3 and Type 4 | 1321 | ||
| AO Distractive Injuries Type B1 | 1322 | ||
| AO Distractive Injuries Type B2 | 1322 | ||
| AO Distractive Injuries Type B3 | 1322 | ||
| AO Translational/Rotational Injuries Type C | 1322 | ||
| Unilateral Facet Dislocations | 1322 | ||
| Bilateral Facet Dislocations | 1322 | ||
| Traumatic Spondylolisthesis | 1326 | ||
| Hyperextension Subluxations | 1326 | ||
| AO Facet Fractures F1 and F2 | 1326 | ||
| AO Facet Fractures F3 | 1327 | ||
| AO Facet Fractures F4 | 1327 | ||
| Special Cases | 1327 | ||
| Fractures in Patients With Ankylosed Spines | 1327 | ||
| Vertebral Artery Injury | 1327 | ||
| Central Cord Syndrome | 1327 | ||
| Traumatic Disc Herniation | 1327 | ||
| Adverse Events | 1327 | ||
| Neurologic Deterioration | 1327 | ||
| Wound Infections | 1328 | ||
| Loss of Reduction | 1328 | ||
| Venous Thromboembolism | 1330 | ||
| Pulmonary Events | 1330 | ||
| Summary | 1330 | ||
| Pearls | 1330 | ||
| Pitfalls | 1330 | ||
| Key Points | 1330 | ||
| Key References | 1330 | ||
| References | 1331 | ||
| 77 Thoracic and Lumbar Spinal Injuries | 1333 | ||
| Incidence | 1333 | ||
| Anatomic Considerations | 1333 | ||
| Mechanisms of Injury | 1333 | ||
| Initial Evaluation and Management | 1333 | ||
| Initial Neurologic Evaluation | 1334 | ||
| Neurologic Injury Classification | 1335 | ||
| Radiologic Evaluation | 1336 | ||
| Concept of Spinal Stability and Its Role in Fracture Classification Systems | 1336 | ||
| Fracture Classification Systems | 1337 | ||
| Description and Diagnosis of Specific Fracture Types | 1338 | ||
| Sprains | 1338 | ||
| Disc Herniations | 1339 | ||
| Minor Fractures | 1339 | ||
| Compression Fractures | 1339 | ||
| Burst Fractures | 1339 | ||
| Flexion-Distraction Injuries (Chance Fractures and Chance Variants) | 1340 | ||
| Fracture-Dislocations | 1340 | ||
| Extension and Extension-Distraction Injuries | 1341 | ||
| Penetrating Injuries | 1342 | ||
| General Treatment Principles: Operative and Nonoperative | 1342 | ||
| Bracing Principles | 1342 | ||
| Surgical Principles | 1344 | ||
| Surgical Principle Number 1: Achieving and Maintaining Anatomic Reduction and Stability—Surgical Approach and Instrumentation Choice | 1344 | ||
| Surgical Principle Number 2: Decompression | 1344 | ||
| Surgical Principle Number 3: Minimization of Construct Length | 1344 | ||
| Surgical Principle Number 4: Appropriate Surgical Timing | 1345 | ||
| Surgical Principle Number 5: Avoidance of Complications | 1345 | ||
| Contemporary Concepts in Surgical Treatment of Thoracolumbar Spine Injuries | 1345 | ||
| Spinal Stabilization Without Fusion | 1345 | ||
| Minimally Invasive Stabilization Using Percutaneous Instrumentation | 1346 | ||
| Balloon-Assisted Reduction and Cement Augmentation of Thoracolumbar Fractures | 1350 | ||
| Treatment of Specific Injuries | 1350 | ||
| Sprains and Minor Fractures | 1350 | ||
| Traumatic Disc Herniations | 1350 | ||
| Compression Fractures | 1351 | ||
| Burst Fractures | 1351 | ||
| Flexion-Distraction Injuries (Chance Fractures and Chance Variants) | 1353 | ||
| Fracture-Dislocations | 1354 | ||
| Extension and Extension-Distraction Injuries | 1354 | ||
| Penetrating Injuries: Gunshot Wounds | 1356 | ||
| Summary | 1357 | ||
| Pearls | 1357 | ||
| Pitfalls | 1357 | ||
| Key Points | 1357 | ||
| Key References | 1358 | ||
| References | 1358 | ||
| 78 Sacral Fractures | 1365 | ||
| Anatomic and Biomechanical Considerations | 1365 | ||
| History and Classification | 1368 | ||
| Evaluation | 1372 | ||
| General Principles | 1375 | ||
| Nonoperative Treatment | 1378 | ||
| Operative Treatment | 1378 | ||
| Neurologic Decompression | 1378 | ||
| Fracture Reduction Techniques | 1380 | ||
| Unilateral Injuries | 1380 | ||
| Bilateral Injuries | 1380 | ||
| Surgical Stabilization Techniques | 1382 | ||
| AO Sacral Fracture Classification Type A Injuries | 1382 | ||
| AO Sacral Fracture Classification Type B Injuries | 1382 | ||
| AO Sacral Fracture Classification Type C Injuries | 1383 | ||
| Summary | 1384 | ||
| Pearls | 1384 | ||
| Pitfalls | 1384 | ||
| Key Points | 1384 | ||
| Key References | 1385 | ||
| References | 1385 | ||
| 79 Acute Treatment of Patients With Spinal Cord Injury | 1389 | ||
| Introduction | 1389 | ||
| Epidemiology | 1389 | ||
| Initial Evaluation | 1389 | ||
| Blood Pressure Management | 1390 | ||
| Surgical Timing | 1392 | ||
| Neuroprotective Strategies | 1393 | ||
| Steroids | 1393 | ||
| GM-1 Ganglioside | 1393 | ||
| Hypothermia | 1394 | ||
| Managing Body Systems Complications Related to Spinal Cord Injury | 1394 | ||
| Pulmonary | 1394 | ||
| Integument | 1394 | ||
| Thromboembolic | 1394 | ||
| Urinary | 1395 | ||
| Nutrition | 1395 | ||
| Rehabilitation | 1395 | ||
| Summary | 1395 | ||
| Pearls | 1395 | ||
| Pitfalls | 1395 | ||
| Key Points | 1395 | ||
| Key References | 1396 | ||
| References | 1396 | ||
| 80 Vertebral Artery Injuries Associated With Cervical Spine Trauma | 1399 | ||
| Anatomy | 1399 | ||
| Epidemiology | 1399 | ||
| Mechanism and Types of Arterial Injury | 1400 | ||
| Clinical Diagnoses | 1401 | ||
| Imaging Modalities | 1402 | ||
| Screening | 1403 | ||
| Treatment | 1404 | ||
| Summary | 1404 | ||
| Pearls | 1405 | ||
| Pitfalls | 1405 | ||
| Key Points | 1405 | ||
| Key References | 1405 | ||
| References | 1405 | ||
| 81 Spinal Orthoses for Traumatic and Degenerative Disease | 1409 | ||
| Biomechanics and Biomaterials | 1409 | ||
| Cervical Orthoses | 1410 | ||
| Cervicothoracic Orthoses | 1414 | ||
| Halo Vest | 1416 | ||
| Application Principles | 1417 | ||
| Biomechanical Analysis | 1418 | ||
| Complications | 1419 | ||
| Pediatric Considerations | 1420 | ||
| Noninvasive Halo | 1420 | ||
| Thoracolumbar and Sacral Orthoses | 1420 | ||
| Flexible Thoracolumbosacral and Lumbosacral Orthoses | 1420 | ||
| Rigid Thoracolumbosacral and Lumbosacral Orthoses | 1421 | ||
| Summary | 1426 | ||
| Acknowledgment | 1426 | ||
| Pearls | 1426 | ||
| Pitfalls | 1426 | ||
| Key Points | 1426 | ||
| Key References | 1427 | ||
| References | 1427 | ||
| 82 Spinal Cord Injury Rehabilitation | 1431 | ||
| Epidemiology | 1431 | ||
| Incidence, Race, Age, and Gender | 1431 | ||
| Life Expectancy | 1432 | ||
| Mortality | 1432 | ||
| Etiology | 1432 | ||
| Classification of SCI | 1432 | ||
| Clinical Syndromes | 1434 | ||
| Central Cord Syndrome | 1434 | ||
| Anterior Cord Syndrome | 1434 | ||
| Posterior Cord Syndrome | 1434 | ||
| Brown-Séquard Syndrome | 1434 | ||
| Conus Medullaris, Epiconus, and Cauda Equina Syndromes | 1434 | ||
| Therapy Approaches | 1435 | ||
| Medical Management | 1437 | ||
| Neurogenic Bowel Dysfunction | 1437 | ||
| Neurogenic Bladder Dysfunction | 1437 | ||
| Spasticity | 1437 | ||
| Cardiovascular Complications | 1438 | ||
| Respiratory Complications | 1439 | ||
| Pressure Ulcers | 1439 | ||
| Heterotopic Ossification | 1439 | ||
| Osteoporosis and Fractures | 1440 | ||
| Pain | 1440 | ||
| Outcomes of Rehabilitation | 1440 | ||
| Length of Stay | 1440 | ||
| Discharge Disposition | 1440 | ||
| Gain of Motor Function | 1441 | ||
| Functional Independence (Charting ADL Improvement Objectively) | 1441 | ||
| Employment | 1442 | ||
| Community Integration | 1442 | ||
| Reintegration Into the Environment | 1442 | ||
| Acknowledgments | 1443 | ||
| Pearls | 1443 | ||
| Pitfalls | 1443 | ||
| Key Points | 1443 | ||
| Key References | 1443 | ||
| References | 1444 | ||
| XII Afflictions of the Vertebrae | 1447 | ||
| 83 Arthritic Disorders | 1449 | ||
| Ankylosing Spondylitis | 1449 | ||
| Epidemiology | 1449 | ||
| Pathogenesis | 1450 | ||
| Clinical History | 1450 | ||
| Neurologic Complications | 1450 | ||
| Atlantoaxial Subluxation | 1450 | ||
| Spinal Fracture | 1451 | ||
| Spondylodiscitis | 1451 | ||
| Extraarticular Manifestations | 1451 | ||
| Physical Examination | 1451 | ||
| Laboratory Data | 1452 | ||
| Radiographic Evaluation | 1452 | ||
| Differential Diagnosis | 1453 | ||
| Psoriatic Arthritis | 1454 | ||
| Reactive Arthritis | 1455 | ||
| Enteropathic Arthritis | 1456 | ||
| Diffuse Idiopathic Skeletal Hyperostosis | 1457 | ||
| Treatment | 1457 | ||
| Nonsteroidal Antiinflammatory Drugs | 1457 | ||
| Muscle Relaxants | 1457 | ||
| Corticosteroids | 1458 | ||
| Anti–Tumor Necrosis Factor-α Inhibitors | 1458 | ||
| Prognosis | 1458 | ||
| Rheumatoid Arthritis | 1458 | ||
| Epidemiology | 1458 | ||
| Pathogenesis | 1458 | ||
| Clinical History | 1458 | ||
| Cervical Subluxation | 1459 | ||
| Physical Examination | 1459 | ||
| Laboratory Data | 1460 | ||
| Radiographic Evaluation | 1460 | ||
| Differential Diagnosis | 1461 | ||
| Treatment | 1461 | ||
| Nonsteroidal Antiinflammatory Drugs | 1461 | ||
| Disease-Modifying Antirheumatic Drugs | 1461 | ||
| Biologic Therapies, Including Anti–Tumor Necrosis Factor-α Inhibitors | 1462 | ||
| Immunosuppressive Agents | 1462 | ||
| Cervical Spine Therapy | 1463 | ||
| Prognosis | 1463 | ||
| Pearls | 1463 | ||
| Pitfalls | 1463 | ||
| Key Points | 1463 | ||
| Key References | 1463 | ||
| References | 1463 | ||
| 84 Surgical Management of Rheumatoid Arthritis | 1467 | ||
| Historical Perspective | 1467 | ||
| Pathophysiology | 1467 | ||
| Natural History | 1468 | ||
| Clinical Presentation | 1468 | ||
| Radiologic Evaluation | 1469 | ||
| Nonsurgical Treatment | 1471 | ||
| Surgical Management | 1471 | ||
| Indications | 1471 | ||
| Preoperative Assessment | 1472 | ||
| Perioperative Management of Rheumatoid Medication | 1472 | ||
| Operative Procedures | 1473 | ||
| Atlantoaxial (C1–C2) Instability | 1473 | ||
| Wire Techniques | 1473 | ||
| Transarticular Screw Fixation | 1474 | ||
| Posterior C1–C2 Intraarticular Screw Fixation | 1474 | ||
| Posterior C1–C2 Screw-Rod Constructs | 1475 | ||
| Cranial Settling or Atlantoaxial Subluxation With C1 Stenosis | 1477 | ||
| Occipitocervical Fusion | 1477 | ||
| Wiring and Graft Technique | 1477 | ||
| Occipitocervical Plating | 1477 | ||
| Contoured Loop/Rod Techniques | 1478 | ||
| Resection of the Odontoid | 1478 | ||
| Subaxial Subluxation | 1479 | ||
| Anterior Fusion | 1479 | ||
| Wiring Techniques | 1480 | ||
| Lateral Mass Fixation | 1480 | ||
| Complications | 1480 | ||
| Thoracolumbar Disease | 1480 | ||
| Summary | 1481 | ||
| Pearls | 1481 | ||
| Pitfalls | 1481 | ||
| Key Points | 1481 | ||
| Key References | 1482 | ||
| References | 1482 | ||
| 85 Ankylosing Spondylitis | 1487 | ||
| Pathophysiology | 1487 | ||
| Nonorthopaedic Manifestations | 1488 | ||
| Physical Examination and Diagnosis | 1488 | ||
| Management of Acute Injury | 1488 | ||
| Deformity | 1491 | ||
| Preoperative Assessment | 1491 | ||
| Lumbar Osteotomies | 1492 | ||
| Thoracic Osteotomies | 1494 | ||
| Cervicothoracic Osteotomy | 1495 | ||
| Summary | 1498 | ||
| Pearls | 1498 | ||
| Pitfalls | 1498 | ||
| Key Points | 1499 | ||
| Key References | 1499 | ||
| References | 1499 | ||
| 86 Tumors of the Spine | 1503 | ||
| Introduction | 1503 | ||
| Imaging Techniques | 1503 | ||
| Summary of Imaging Appearance | 1504 | ||
| Biopsy Techniques | 1504 | ||
| Primary Tumors | 1504 | ||
| Benign Tumors | 1505 | ||
| Osteochondroma | 1505 | ||
| Hemangioma | 1505 | ||
| Eosinophilic Granuloma | 1506 | ||
| Osteoblastoma/Osteoid Osteoma | 1506 | ||
| Aneurysmal Bone Cyst | 1508 | ||
| Giant Cell Tumor | 1509 | ||
| Malignant Tumors | 1510 | ||
| Osteosarcoma | 1510 | ||
| Ewing Sarcoma | 1511 | ||
| Chordoma | 1511 | ||
| Chondrosarcoma | 1513 | ||
| Multiple Myeloma and Solitary Plasmacytoma | 1513 | ||
| Metastatic Tumors | 1515 | ||
| Pathophysiology of Metastasis | 1515 | ||
| Clinical Presentation | 1516 | ||
| Diagnosis | 1516 | ||
| Treatment | 1517 | ||
| Treatment | 1518 | ||
| Indications for Surgery | 1518 | ||
| Staging | 1518 | ||
| Surgical Approach | 1519 | ||
| Resections | 1520 | ||
| Decompression | 1520 | ||
| Spine Stability | 1520 | ||
| Summary | 1521 | ||
| Key Points | 1521 | ||
| Key References | 1522 | ||
| References | 1522 | ||
| 87 Infections of the Spine | 1525 | ||
| Infections of the Spine | 1525 | ||
| Historic Perspective | 1525 | ||
| Pyogenic Infections | 1526 | ||
| Postoperative Wound Infections | 1526 | ||
| Spinal Intradural Infections | 1526 | ||
| Vertebral Osteomyelitis | 1526 | ||
| Epidemiology | 1526 | ||
| Etiology | 1526 | ||
| Bacteriology | 1526 | ||
| Pathogenesis/Pathology | 1527 | ||
| Clinical Presentation | 1528 | ||
| Diagnostic Evaluation | 1530 | ||
| Laboratory Evaluation | 1530 | ||
| Imaging Studies | 1532 | ||
| Biopsy | 1536 | ||
| Management | 1536 | ||
| Surgical Treatment | 1537 | ||
| Prognosis | 1540 | ||
| Epidural Abscess | 1542 | ||
| Epidemiology | 1542 | ||
| Etiology | 1542 | ||
| Bacteriology | 1542 | ||
| Pathogenesis/Pathology | 1543 | ||
| Clinical Presentation | 1543 | ||
| Diagnostic Evaluation | 1544 | ||
| Imaging Studies | 1544 | ||
| Management | 1545 | ||
| Nonoperative Treatment in the Neurologically Intact Patient | 1545 | ||
| Surgical Treatment | 1546 | ||
| Prognosis | 1547 | ||
| Granulomatous Infections | 1547 | ||
| Tuberculosis | 1547 | ||
| Etiology | 1548 | ||
| Bacteriology | 1548 | ||
| Pathogenesis/Pathology | 1548 | ||
| Clinical Presentation | 1549 | ||
| Diagnostic Evaluation | 1550 | ||
| Management | 1552 | ||
| Surgical Treatment | 1553 | ||
| Prognosis | 1556 | ||
| Mortality | 1556 | ||
| Relapse | 1557 | ||
| Kyphosis | 1557 | ||
| Neurologic Deficit | 1558 | ||
| Fusion | 1558 | ||
| Actinomycosis | 1558 | ||
| Nocardiosis | 1559 | ||
| Brucellosis | 1559 | ||
| Fungal Infections | 1560 | ||
| Laboratory Studies | 1561 | ||
| Histology | 1561 | ||
| Imaging Studies | 1561 | ||
| Treatment | 1563 | ||
| Nonoperative Treatment | 1563 | ||
| Surgical Treatment | 1563 | ||
| Posterior Decompression Without Fusion | 1564 | ||
| Posterior Decompression With Fusion and Instrumentation | 1564 | ||
| Anterior Decompression and Fusion With Posterior Stabilization | 1564 | ||
| Percutaneous Techniques | 1564 | ||
| Coccidioidomycosis | 1564 | ||
| Blastomycosis | 1566 | ||
| Cryptococcosis | 1567 | ||
| Candidiasis | 1567 | ||
| Aspergillosis | 1568 | ||
| Syphilitic Disorders of the Spine | 1569 | ||
| Pearls | 1569 | ||
| Pitfalls | 1569 | ||
| Key Points | 1569 | ||
| Key References | 1570 | ||
| References | 1570 | ||
| 88 Metabolic Bone Disorders of the Spine | 1585 | ||
| Cellular Biology | 1585 | ||
| Bone Cells | 1585 | ||
| Bone Matrix | 1586 | ||
| Bone Mineral | 1587 | ||
| Collagen | 1587 | ||
| Ground Substance | 1587 | ||
| Skeletal Homeostasis | 1588 | ||
| Mineral Homeostasis | 1588 | ||
| Calcium | 1588 | ||
| Phosphate | 1589 | ||
| Regulators of Bone and Mineral Metabolism | 1590 | ||
| Parathyroid Hormone | 1590 | ||
| Vitamin D | 1590 | ||
| Fibroblast Growth Factor-23 (FGF-23) | 1591 | ||
| Calcitonin | 1591 | ||
| Osteoporosis | 1591 | ||
| Pathology | 1592 | ||
| Clinical Course | 1593 | ||
| Diagnosis | 1594 | ||
| Evaluation for Osteoporosis | 1595 | ||
| Laboratory Investigations for Osteoporosis | 1595 | ||
| Biochemical Markers of Bone Turnover | 1596 | ||
| Evaluation for Secondary Osteoporosis | 1596 | ||
| Prevention and Treatment | 1597 | ||
| Nutrition, Calcium, and Vitamin D Supplementation | 1597 | ||
| Exercise | 1597 | ||
| Pharmacologic Treatment | 1598 | ||
| Estrogen | 1598 | ||
| Selective Estrogen Receptor Modulators (SERMs) | 1598 | ||
| Bisphosphonates | 1598 | ||
| Calcitonin | 1599 | ||
| Anabolic Agents | 1599 | ||
| Denosumab | 1599 | ||
| Pharmacologic Agents and Spinal Fusion | 1599 | ||
| Strategies for Treatment of the Osteoporosis Spine Patient | 1599 | ||
| Future Directions | 1600 | ||
| Paget Disease of Bone (Osteitis Deformans) | 1600 | ||
| Pathology | 1600 | ||
| Clinical Course | 1601 | ||
| Diagnosis | 1602 | ||
| Radiographic Assessment | 1602 | ||
| Biochemical Markers | 1602 | ||
| Biopsy | 1602 | ||
| Treatment | 1602 | ||
| Calcium and Vitamin D | 1602 | ||
| Bisphosphonates | 1602 | ||
| Calcitonin | 1603 | ||
| Surgery | 1603 | ||
| Summary | 1603 | ||
| Pearls | 1603 | ||
| Pitfalls | 1603 | ||
| Key Points | 1603 | ||
| Key References | 1603 | ||
| References | 1604 | ||
| 89 Osteoporosis | 1611 | ||
| Osteoporotic Vertebral Compression Fractures | 1611 | ||
| Nonsurgical Treatment | 1611 | ||
| Cement Augmentation: Vertebroplasty and Kyphoplasty | 1612 | ||
| Vertebroplasty Versus Kyphoplasty | 1613 | ||
| Indications and Contraindications | 1613 | ||
| Techniques | 1614 | ||
| Vertebroplasty | 1614 | ||
| Kyphoplasty | 1614 | ||
| Complications | 1615 | ||
| Novel Implants | 1615 | ||
| Instrumentation of the Osteoporotic Spine | 1615 | ||
| Posterior Spinal Instrumentation | 1616 | ||
| Interbody Fusion | 1617 | ||
| Considerations in the Cervical Spine | 1617 | ||
| Summary | 1620 | ||
| Pearls | 1620 | ||
| Pitfalls | 1620 | ||
| Key Points | 1620 | ||
| Key References | 1620 | ||
| References | 1621 | ||
| XIII Spinal Cord | 1625 | ||
| 90 Intradural Tumors | 1627 | ||
| Intradural Tumors | 1627 | ||
| Epidemiology | 1627 | ||
| Clinical Presentation | 1627 | ||
| Radiologic Diagnosis | 1628 | ||
| Extramedullary Tumors | 1628 | ||
| Meningiomas | 1628 | ||
| Nerve Sheath Tumors | 1629 | ||
| Ependymomas of the Filum Terminale | 1629 | ||
| Less Common Extramedullary Tumors | 1630 | ||
| Paragangliomas | 1630 | ||
| Lipomas | 1631 | ||
| Arachnoid Cysts | 1631 | ||
| Synovial Cysts | 1631 | ||
| Intramedullary Tumors | 1631 | ||
| Ependymomas | 1631 | ||
| Astrocytomas | 1632 | ||
| Hemangioblastomas | 1632 | ||
| Less Common Intramedullary Lesions | 1633 | ||
| Lipomas | 1633 | ||
| Dermoid and Epidermoid Cysts | 1633 | ||
| Cavernous Angiomas | 1634 | ||
| Metastasis | 1634 | ||
| Surgical Treatment | 1634 | ||
| Intradural Extramedullary Tumors | 1634 | ||
| Intramedullary Tumors | 1635 | ||
| Radiation/Chemotherapy/Adjuvant Treatments | 1636 | ||
| XIV Complications of Spinal Surgery | 1725 | ||
| 95 Intraoperative Spinal Cord and Nerve Root Injuries | 1727 | ||
| Introduction | 1727 | ||
| Preoperative Position | 1727 | ||
| Cervical Spine Surgery | 1727 | ||
| Anterior Cervical Spine Surgery | 1727 | ||
| Posterior Cervical Spine Surgery | 1729 | ||
| Thoracolumbar Spine Surgery | 1730 | ||
| Posterior Lumbar Surgery | 1730 | ||
| Lateral Lumbar Surgery | 1731 | ||
| Anterior Lumbar Surgery | 1732 | ||
| Pediatric Deformity Correction | 1732 | ||
| Adult Deformity Correction | 1733 | ||
| Summary | 1734 | ||
| Pearls | 1734 | ||
| Pitfalls | 1734 | ||
| Key Points | 1734 | ||
| Key References | 1735 | ||
| References | 1735 | ||
| 96 Spinal Dural Injuries | 1739 | ||
| Anatomy and Pathophysiology | 1739 | ||
| Incidence | 1739 | ||
| Risk Factors | 1739 | ||
| Diagnosis | 1741 | ||
| Treatment | 1741 | ||
| Outcomes | 1743 | ||
| Summary | 1744 | ||
| Key References | 1744 | ||
| References | 1745 | ||
| 97 Vascular Complications in Spinal Surgery | 1747 | ||
| Introduction | 1747 | ||
| Cervical Spine | 1747 | ||
| Anterior Cervical Vascular Complications | 1747 | ||
| Vertebral Artery | 1748 | ||
| Carotid Artery | 1750 | ||
| Posterior Cervical Vascular Complications | 1751 | ||
| Vertebral Artery | 1752 | ||
| Internal Carotid Artery | 1754 | ||
| Thoracic Spine | 1754 | ||
| Anterior Thoracic Vascular Complications | 1754 | ||
| Segmental Arteries | 1755 | ||
| Artery of Adamkiewicz | 1755 | ||
| Posterior Thoracic Vascular Complications | 1757 | ||
| Aorta | 1757 | ||
| Lumbar Spine | 1758 | ||
| Anterior Lumbar Vascular Complications | 1758 | ||
| Aorta and Vena Cava | 1759 | ||
| Iliolumbar Vein | 1763 | ||
| Left Common Iliac Artery or Vein Thrombosis | 1764 | ||
| Posterior Lumbar Vascular Complications | 1765 | ||
| Aorta, Vena Cava, and Common Iliac Vessels | 1765 | ||
| Other Vascular Complications of Spine Surgery | 1767 | ||
| Thrombosis and Thromboembolism | 1767 | ||
| Epidural and Subdural Hematomas | 1768 | ||
| Superior Mesenteric Artery Syndrome | 1769 | ||
| Blindness via Indirect Vascular Injury | 1769 | ||
| Iliac Crest Bone Graft | 1770 | ||
| Conclusions | 1770 | ||
| Acknowledgment | 1771 | ||
| Pearls | 1771 | ||
| Pitfalls | 1771 | ||
| Key Points | 1772 | ||
| Key References | 1773 | ||
| References | 1773 | ||
| 98 Instrumentation Complications | 1783 | ||
| Introduction | 1783 | ||
| Definitions and Classification | 1783 | ||
| Biologic Failure | 1784 | ||
| Infection and Inflammatory Conditions | 1784 | ||
| Bone Quality and Osteoporosis | 1786 | ||
| Dysvascular Change | 1787 | ||
| Biomechanical Failure | 1787 | ||
| Errors in Surgical Strategy | 1789 | ||
| Technical Error in Implementation of Surgical Strategy | 1793 | ||
| Screw and Wire Misplacement | 1793 | ||
| Evolving Accuracy and Means of Detection | 1795 | ||
| Prevention | 1795 | ||
| Plate and Rod Issues | 1796 | ||
| Graft and Cage Issues | 1796 | ||
| Important Structures Affected by Spinal Implant Impingement | 1796 | ||
| Neurologic Structures | 1798 | ||
| Vascular Structures | 1798 | ||
| Bone and Joint | 1800 | ||
| Other Soft Tissue Impingement | 1800 | ||
| Conclusions | 1801 | ||
| Key Points | 1801 | ||
| Key References | 1802 | ||
| References | 1802 | ||
| 99 Postoperative Spinal Infections | 1807 | ||
| Introduction | 1807 | ||
| Incidence/Epidemiology | 1807 | ||
| Risk Factors | 1808 | ||
| Microbiology | 1810 | ||
| Diagnostic Modalities | 1810 | ||
| Clinical Presentation | 1810 | ||
| Laboratory Testing | 1811 | ||
| Imaging | 1812 | ||
| Classification | 1813 | ||
| Prevention | 1813 | ||
| Management | 1816 | ||
| Spinal Instrumentation and Infections | 1817 | ||
| Discitis | 1818 | ||
| Epidural Abscess | 1818 | ||
| Complex Wound Closure | 1819 | ||
| Length of Antibiotic Treatment | 1819 | ||
| Summary | 1819 | ||
| Key Points | 1819 | ||
| Pearls | 1819 | ||
| Pitfalls | 1820 | ||
| Key References | 1820 | ||
| References | 1820 | ||
| 100 Pseudarthrosis | 1827 | ||
| Introduction | 1827 | ||
| Risk Factors | 1827 | ||
| Spinal Instrumentation and Its Effect on Fusion | 1828 | ||
| Lumbar Spine | 1828 | ||
| Cervical Spine | 1828 | ||
| Bone Grafting and Osteobiologics | 1829 | ||
| Proper Surgical Technique | 1829 | ||
| Lumbar Pseudarthrosis | 1829 | ||
| Evaluation | 1829 | ||
| Management | 1831 | ||
| Cervical Pseudarthrosis | 1831 | ||
| Evaluation | 1831 | ||
| Management | 1832 | ||
| Cost of Pseudarthrosis | 1833 | ||
| Key References | 1833 | ||
| References | 1833 | ||
| 101 Adjacent-Segment Disease | 1839 | ||
| Definition | 1839 | ||
| Natural History | 1839 | ||
| Types of Adjacent-Level Degeneration | 1840 | ||
| Etiology | 1840 | ||
| Biomechanical | 1840 | ||
| Genetic | 1840 | ||
| Physiology | 1841 | ||
| Risk Factors | 1841 | ||
| Clinical Scenarios | 1841 | ||
| Adjacent-Segment Disease After Laminectomy | 1841 | ||
| Adjacent-Segment Disease After Lumbar Fusion | 1841 | ||
| Adjacent-Segment Disease After Scoliosis Surgery | 1842 | ||
| Adjacent-Segment Disease After Kyphoplasty | 1842 | ||
| Adjacent-Segment Disease After Sagittal Imbalance Surgery | 1843 | ||
| Surgical Strategies to Treat/Avoid Adjacent-Segment Disease | 1843 | ||
| Total Disc Replacement | 1843 | ||
| Interspinous Devices | 1843 | ||
| Pedicle Screw–Based Dynamic Stabilization | 1843 | ||
| Bone Cement Augmentation of UIV and UIV+1 | 1844 | ||
| Minimally Invasive Spine Surgery | 1844 | ||
| Lateral Interbody Fusion | 1845 | ||
| Vertebroplasty for Proximal Junctional Fracture | 1845 | ||
| Cortical Bone Trajectory Screws to Add on to a Fusion | 1845 | ||
| Summary | 1846 | ||
| Pearls | 1846 | ||
| Pitfalls | 1846 | ||
| Key Points | 1846 | ||
| Key References | 1846 | ||
| References | 1847 | ||
| 102 Failed Back Surgery Syndrome | 1851 | ||
| What Is Failed Back Surgery Syndrome? | 1851 | ||
| Economic Impact of Failed Back Surgery Syndrome | 1852 | ||
| Symptoms of Failed Back Surgery Syndrome | 1852 | ||
| Causes, Diagnosis, and Treatments of Components of Failed Back Surgery Syndrome | 1853 | ||
| Foraminal or Lateral Recess Stenosis | 1853 | ||
| Painful Disc | 1853 | ||
| Pseudarthrosis | 1854 | ||
| Recurrent Disc Herniation | 1855 | ||
| Neuropathic Pain, Epineural, Perineural, and Intradural Fibrosis (Arachnoiditis) | 1856 | ||
| Facet Joint Pain | 1857 | ||
| Sacroiliac Pain | 1857 | ||
| Sagittal Plane Imbalance and Spinal Deformity | 1858 | ||
| Other Conditions | 1859 | ||
| Summary | 1859 | ||
| Key References | 1860 | ||
| References | 1861 | ||
| XV Failed Surgery | 1865 | ||
| 103 Revision Spine Surgery | 1867 | ||
| Patient Evaluation | 1867 | ||
| Leg Pain Versus Back Pain | 1868 | ||
| Physical Examination | 1868 | ||
| Diagnostic Testing | 1868 | ||
| Plain Radiography | 1868 | ||
| Advanced Imaging | 1869 | ||
| Diagnostic Injections | 1869 | ||
| Nonoperative Treatment | 1870 | ||
| Surgical Treatment—Back Pain Predominant | 1871 | ||
| Pseudarthroses and Failed Instrumentation | 1871 | ||
| Painful Hardware | 1873 | ||
| Surgical Treatment—Leg Pain Predominant | 1874 | ||
| Revision Discectomy | 1874 | ||
| Revision Laminectomy and Treatment of Adjacent-Level Stenosis | 1875 | ||
| Preoperative Planning | 1875 | ||
| Technical Aspects of Surgery | 1876 | ||
| Revision Cervical Spine Surgery | 1878 | ||
| Patient Evaluation | 1878 | ||
| Imaging | 1878 | ||
| Additional Testing | 1879 | ||
| Early Postoperative Failure | 1880 | ||
| Late Postoperative Failure | 1881 | ||
| Adjacent-Segment Degeneration | 1881 | ||
| Pseudarthrosis | 1883 | ||
| Failed Multilevel Decompression for Cervical Myelopathy | 1883 | ||
| Pearls | 1884 | ||
| Pitfalls | 1884 | ||
| Key Points | 1884 | ||
| Key References | 1884 | ||
| References | 1884 | ||
| 104 Failed Total Disc Arthroplasty | 1889 | ||
| Background | 1889 | ||
| Prevention | 1889 | ||
| Patient Selection | 1889 | ||
| Discectomy and Endplate Preparation | 1890 | ||
| Segmental Mobilization | 1891 | ||
| Implant Sizing, Placement, and Alignment | 1892 | ||
| Failures of Total Disc Arthroplasty | 1892 | ||
| Indications and Technique Issues | 1892 | ||
| Intrinsic Implant Failure | 1893 | ||
| Bone-Implant Interface Failure | 1893 | ||
| Host Response | 1894 | ||
| Deformity/Instability | 1894 | ||
| Neurologic Failure/Neural Impingement | 1895 | ||
| Infection | 1895 | ||
| Diagnosis of Failed Disc Arthroplasty | 1896 | ||
| History | 1896 | ||
| Physical Examination | 1896 | ||
| Imaging | 1896 | ||
| Interventional Procedures | 1897 | ||
| Revision Strategies | 1897 | ||
| Cervical Revision Strategies | 1897 | ||
| Lumbar Revision Strategies | 1897 | ||
| Summary | 1898 | ||
| Key References | 1900 | ||
| References | 1900 | ||
| 105 Postoperative Deformity of the Cervical Spine | 1903 | ||
| Introduction | 1903 | ||
| Assessment of Cervical Deformity | 1903 | ||
| Clinical Evaluation | 1903 | ||
| Radiographic Evaluation | 1903 | ||
| Deformity Prevention | 1904 | ||
| Preventing Iatrogenic Cervical Malalignment During Anterior Surgery | 1904 | ||
| Positioning | 1904 | ||
| Decompression | 1905 | ||
| Noninstrumented Fusion | 1906 | ||
| Graft Selection | 1906 | ||
| Anterior Instrumentation | 1907 | ||
| Preventing Iatrogenic Cervical Malalignment During Posterior Surgery | 1907 | ||
| Positioning | 1907 | ||
| Decompression | 1908 | ||
| Noninstrumented Fusion | 1909 | ||
| Inadequate Instrumentation | 1910 | ||
| Surgical Treatment of Iatrogenic Deformity | 1912 | ||
| Cervical Osteotomy Description | 1913 | ||
| Anterior Osteotomy | 1913 | ||
| Posterior Osteotomy | 1913 | ||
| Surgical Algorithm and Case Examples | 1914 | ||
| Prior Laminectomies | 1914 | ||
| Prior Fusion | 1915 | ||
| Prior Anterior Fusion With No Posterior Fusion Mass | 1915 | ||
| Prior Posterior Fusion | 1915 | ||
| Case Study 1 | 1915 | ||
| Case Study 2 | 1916 | ||
| Case Study 3 | 1916 | ||
| Prior Circumferential Fusion | 1918 | ||
| Case Study 4 | 1918 | ||
| Case Study 5 | 1919 | ||
| Case Study 6 | 1920 | ||
| Case Study 7 | 1921 | ||
| Case Study 8 | 1923 | ||
| Case Study 9 | 1923 | ||
| Case Study 10 | 1925 | ||
| Case Study 11 | 1930 | ||
| Pearls | 1931 | ||
| Pitfalls | 1931 | ||
| Key Points | 1931 | ||
| Key References | 1931 | ||
| References | 1934 | ||
| 106 Arachnoiditis and Epidural Fibrosis | 1935 | ||
| Anatomy | 1935 | ||
| Pathogenesis | 1935 | ||
| Etiology | 1935 | ||
| Clinical Features | 1937 | ||
| Radiographic Features | 1937 | ||
| Spinal Epidural Fibrosis | 1937 | ||
| Treatment | 1938 | ||
| Summary | 1938 | ||
| Key Points | 1939 | ||
| Key References | 1939 | ||
| References | 1939 | ||
| XVI Chronic Pain and Rehabilitation | 1941 | ||
| 107 Chronic Pain | 1943 | ||
| Chronic Spinal Cord Injury Pain | 1943 | ||
| Spinal Cord Injury Pain Classification | 1943 | ||
| General Mechanism | 1944 | ||
| Recombinant Analgesic Peptides | 1945 | ||
| Neuropathic Spinal Cord Injury Animal Models | 1946 | ||
| Considerations | 1946 | ||
| Description of Spinal Cord Injury Models | 1947 | ||
| Excitotoxin Injection | 1947 | ||
| Acute Trauma to the Spinal Cord | 1947 | ||
| Compression Injury | 1948 | ||
| Photochemical Ischemia | 1949 | ||
| Dorsal Root Avulsion Model | 1949 | ||
| Mechanism of Neuropathic Spinal Cord Injury Pain in Humans | 1950 | ||
| Nonneural Molecular Targets for Spinal Cord Injury Pain | 1950 | ||
| Lipid Signaling | 1951 | ||
| Glial Inhibitors | 1951 | ||
| Summary | 1952 | ||
| Acknowledgment | 1952 | ||
| Key Points | 1952 | ||
| Key References | 1952 | ||
| References | 1953 | ||
| 108 Psychological Strategies for Chronic Pain | 1961 | ||
| Pain Perception: Nervous System Attenuation and Amplification | 1961 | ||
| Pain and the Psyche | 1962 | ||
| Psychiatric Comorbidities | 1962 | ||
| Other Psychological Contributors to Chronic Pain | 1963 | ||
| Psychogenic Pain/Somatization: Diagnostic Considerations | 1963 | ||
| Psychogenic Pain/Somatization: Pain Amplifiers | 1964 | ||
| Addiction | 1965 | ||
| Clinical Observations and Clues to Addiction | 1965 | ||
| Psychological Treatments | 1966 | ||
| Cognitive Behavioral Therapies | 1966 | ||
| Mindfulness and Acceptance-Based Therapies | 1966 | ||
| Psychodynamic and Interpersonal Therapies | 1968 | ||
| Education | 1968 | ||
| Psychophysiologic and Relaxation Training | 1968 | ||
| The Role of Exercise | 1968 | ||
| Interdisciplinary Pain Rehabilitation Programs | 1968 | ||
| Summary | 1968 | ||
| Key Points | 1969 | ||
| Key References | 1969 | ||
| References | 1969 | ||
| 109 Pharmacologic Strategies in Back Pain and Radiculopathy | 1973 | ||
| Acetaminophen | 1973 | ||
| Nonsteroidal Antiinflammatory Drugs | 1974 | ||
| Muscle Relaxants | 1975 | ||
| Antidepressants | 1975 | ||
| Opioids | 1975 | ||
| Tramadol | 1976 | ||
| Antiepileptics | 1977 | ||
| Other Treatments and Future Prospects | 1977 | ||
| Key Points | 1978 | ||
| Pearls | 1978 | ||
| Pitfalls | 1978 | ||
| Key References | 1978 | ||
| References | 1979 | ||
| 110 Physical Therapy | 1983 | ||
| Introduction | 1983 | ||
| Guidelines for Selecting a Physical Therapist | 1984 | ||
| Collaboration Between the Surgeon and the Therapist | 1986 | ||
| Active Versus Passive Physical Therapy | 1987 | ||
| Physical Therapy Levels of Care | 1988 | ||
| Summary | 1989 | ||
| Key Points | 1989 | ||
| Key References | 1990 | ||
| References | 1990 | ||
| 111 Functional Restoration in Chronic Spinal Pain | 1993 | ||
| Functional Restoration Principles | 1993 | ||
| Introduction | 1993 | ||
| Which Patients Are Likely to Benefit From Functional Restoration? | 1995 | ||
| Interdisciplinary Functional Restoration Treatment Team | 1997 | ||
| Functional Restoration Preliminaries | 1998 | ||
| Initial Physician Evaluation | 1998 | ||
| Interdisciplinary Evaluation | 1998 | ||
| Second Physician Visit | 1999 | ||
| Insurance Preauthorization | 1999 | ||
| Physical and Functional Capacity Assessment | 1999 | ||
| Range-of-Motion Assessment | 2000 | ||
| Isolated Trunk Strength Assessment | 2000 | ||
| Cardiovascular Fitness Assessment | 2001 | ||
| Whole-Body Task Performance (Functional Capacity) Assessment | 2001 | ||
| Mental Health Assessment | 2003 | ||
| Clinical Interview | 2004 | ||
| Self-Report Questionnaires | 2005 | ||
| Pain Drawing | 2006 | ||
| Function/Disability Questionnaires | 2006 | ||
| Mood Questionnaires | 2006 | ||
| Sleep Disturbance Questionnaires | 2006 | ||
| Fear-Avoidance Questionnaires | 2006 | ||
| Quality-of-Life Questionnaires | 2007 | ||
| Personality Questionnaires | 2007 | ||
| Psychiatric Assessment | 2007 | ||
| Other Symptom Inventories | 2007 | ||
| Treatment Components of Functional Restoration | 2007 | ||
| Sports Medicine Concepts and Physical Training | 2007 | ||
| Psychosocial and Educational Interventions | 2008 | ||
| Psychotherapy | 2009 | ||
| Stress Management and Self-Regulation Training | 2010 | ||
| Didactic Classes | 2011 | ||
| Case Management | 2011 | ||
| Medical Techniques Accompanying Functional Restoration | 2011 | ||
| Interventional Procedures | 2011 | ||
| Medical Psychopharmacology | 2012 | ||
| Functional Restoration Program Treatment Phases | 2013 | ||
| Initial Treatment Phase | 2013 | ||
| Intensive Phase | 2014 | ||
| Postprogram Long-Term Care Plan | 2014 | ||
| Outcome Tracking Phase | 2014 | ||
| Key Points | 2015 | ||
| Key References | 2015 | ||
| References | 2017 | ||
| 112 Surgical Procedures for the Control of Chronic Pain | 2023 | ||
| Mechanisms of Chronic Pain Production | 2023 | ||
| Deafferentation Procedures | 2025 | ||
| Rhizotomy and Ganglionectomy | 2025 | ||
| Technique | 2027 | ||
| Facet Rhizotomy | 2027 | ||
| Technique | 2028 | ||
| Sympathectomy | 2028 | ||
| Technique | 2029 | ||
| Stimulation Therapy | 2029 | ||
| Epidural and Intraspinal Implants | 2029 | ||
| Technique | 2031 | ||
| Spinal Cord Stimulation | 2031 | ||
| Technique | 2033 | ||
| Summary | 2033 | ||
| Pearls | 2034 | ||
| Pitfalls | 2034 | ||
| Key Points | 2034 | ||
| Key References | 2034 | ||
| References | 2035 | ||
| Index | i1 | ||
| A | i1 | ||
| B | i5 | ||
| C | i7 | ||
| D | i14 | ||
| E | i16 | ||
| F | i17 | ||
| G | i20 | ||
| H | i21 | ||
| I | i22 | ||
| J | i26 | ||
| K | i26 | ||
| L | i27 | ||
| M | i30 | ||
| N | i33 | ||
| O | i35 | ||
| P | i37 | ||
| Q | i41 | ||
| R | i41 | ||
| S | i43 | ||
| T | i52 | ||
| U | i55 | ||
| V | i55 | ||
| W | i56 | ||
| X | i57 | ||
| Y | i57 | ||
| Z | i57 | ||
| Inside Back Cover | ibc1 |