Spine Disorders: Medical and Surgical Management

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Preface......Page 11
Acknowledgments......Page 12
Scope of the problem......Page 13
Epidemiology......Page 14
The vertebral column......Page 15
Detailed spinal cord anatomy......Page 21
The spinal nerves......Page 23
Vascular supply of the spinal cord and cauda equina......Page 25
Trauma......Page 26
Bacterial infections......Page 27
Viral infections......Page 28
Inflammatory demyelinating myelopathies......Page 29
Toxic, metabolic, and hereditary myelopathies......Page 30
Pathophysiology - intrinsic, primary conditions of the spine......Page 31
Intervertebral disks......Page 32
Bones and joints......Page 34
Congenital anomalies of the spine......Page 35
Spinal stenosis......Page 37
Spondylolysis and spondylolisthesis......Page 38
Vertebral hemangioma......Page 39
Syringomyelia......Page 41
So why does it hurt?......Page 42
Further reading......Page 44
The history......Page 45
The general examination......Page 46
Neurologic examination......Page 48
Special examinations......Page 49
Cervical radiculopathy......Page 51
Treatment......Page 52
Cervical myelopathy......Page 54
Differential diagnosis......Page 55
Investigation......Page 56
Neck pain......Page 57
Investigation......Page 58
Treatment......Page 59
Further reading......Page 60
The history......Page 61
Neurologic examination......Page 62
Thoracic radiculopathy......Page 63
Differential diagnosis......Page 64
Investigation......Page 65
Treatment......Page 66
Differential diagnosis......Page 67
Thoracic spine pain......Page 69
Investigation......Page 70
Treatment......Page 71
Further reading......Page 72
The history......Page 73
The general examination......Page 75
Neurologic examination......Page 76
Special examinations......Page 78
Lumbar radiculopathy......Page 81
Investigation......Page 83
Treatment......Page 85
Treatment......Page 87
Lumbar spinal stenosis......Page 88
Investigation......Page 90
Treatment......Page 91
Acute and chronic low back pain......Page 93
Investigation......Page 94
Treatment......Page 95
Further reading......Page 99
Introduction......Page 101
How the study is performed......Page 102
Less helpful aspects......Page 103
Risks......Page 104
Less helpful aspects......Page 106
Helpful aspects......Page 107
How is the procedure performed?......Page 108
Electromyography......Page 109
Nerve conduction studies......Page 111
Less helpful aspects......Page 112
Visual evoked potentials (VEPs) and brain stem auditory evoked potentials (BAEPs)......Page 113
Helpful aspects......Page 114
Introduction......Page 115
How is the procedure performed?......Page 116
Cerebrospinal fluid (CSF) examination......Page 117
Further reading......Page 118
General considerations......Page 120
To whom to refer your patients for spine surgery......Page 121
Objective criteria for selecting a spine surgeon......Page 124
Other information......Page 125
Personality issues......Page 126
The practice setting itself......Page 127
Important questions for you and the surgeon......Page 128
Websites......Page 129
The wrong patient......Page 130
The wrong diagnosis......Page 131
The wrong time......Page 132
Incomplete surgery......Page 133
Early complications directly related to surgery......Page 134
Worsening of original disease......Page 135
Worsening after spinal fusion......Page 136
Complications related to placement of an artificial disk......Page 137
Laboratory and diagnostic imaging studies......Page 138
Usual causes of failed low back surgery......Page 140
An approach to the patient with persistent or new symptoms following surgery......Page 142
Treatment of the patient with residual or new symptoms following spine surgery......Page 143
Further reading......Page 144
Safety issues and contraindications......Page 146
Complications of gadolinium-based contrast agents......Page 148
Upright magnetic resonance imaging......Page 149
Computed tomography myelography......Page 150
Radionuclide bone scanning......Page 151
Discography......Page 152
Selective nerve root block......Page 154
Further reading......Page 155
Diagnostic pitfalls......Page 156
Bone graft considerations......Page 159
Vascular injury......Page 163
Airway and swallowing complications......Page 164
Infection......Page 165
Cervical disk herniation with radiculopathy and/or myelopathy......Page 166
Natural history and approaches to treatment......Page 169
Cervical stenosis with deformity......Page 171
Trauma......Page 172
Subaxial (C3-C7) injuries......Page 173
Intradural tumor......Page 174
Syringomyelia......Page 177
Rheumatoid disease of the cervical spine......Page 178
Thoracic outlet syndrome......Page 179
Stability of the cervical spine......Page 181
Clearing the cervical spine......Page 182
Spinal cord injury......Page 183
Pain management in spinal cord injury......Page 184
Halo vest......Page 185
Prophylactic surgery......Page 186
Donor site reconstruction......Page 187
Conclusions......Page 188
Further reading......Page 189
Inflammatory lesion versus intramedullary tumor......Page 190
Surgical indications and approaches......Page 191
Infection......Page 192
Patient evaluation......Page 193
Percutaneous techniques of vertebral augmentation......Page 194
New fracture development......Page 197
Vertebral augmentation in the high thoracic region......Page 198
Future directions in vertebral augmentation......Page 199
Spinal metastatic disease......Page 200
Thoracic disk herniation......Page 201
Vascular lesions of the spinal cord......Page 202
Cavernous malformation......Page 203
Acute fracture......Page 204
Penetrating spinal trauma......Page 205
Spinal deformity......Page 207
Scheuermann kyphosis......Page 208
Meningeal diverticulum with CSF leak: a cause of intracranial hypotension......Page 209
Spinal cord biopsy......Page 210
Management of the indeterminate bony lesion......Page 211
Further reading......Page 212
Diagnostic pitfalls......Page 214
Surgical indications and approaches......Page 216
Vascular complications......Page 217
Late complications......Page 219
SPORT study, Part I (lumbar disk herniation)......Page 220
How much disk tissue should be removed?......Page 221
Lumbar spinal stenosis......Page 222
Role of fusion in lumbar stenosis......Page 224
Illustration of lumbar decompression and posterolateral fusion with pedicle screw fixation......Page 225
Spondylolisthesis......Page 226
Clinical findings......Page 227
SPORT study, Part II (degenerative spondylolisthesis)......Page 228
Discogenic back pain......Page 229
Trauma......Page 230
Sacral insufficiency fracture......Page 231
Intradural tumor......Page 232
Spinal infection......Page 234
Ankylosing spondylitis......Page 235
Bone growth stimulators for spinal fusion......Page 236
Bone morphogenetic proteins......Page 237
Conclusions......Page 239
Further reading......Page 240
Philosophy of minimally invasive spine surgery......Page 241
Central nucleectomy procedures......Page 242
Thermal disk decompression......Page 243
Minimally invasive spinal fusion......Page 244
Spinal cord stimulation......Page 245
Intrathecal drug pumps......Page 246
Intradiscal electrothermal therapy......Page 248
X-Stop interspinous decompression......Page 249
Conclusions......Page 251
Further reading......Page 252
Lumbar artificial disk......Page 253
Cervical artificial disk......Page 255
Nucleus replacement......Page 258
Facet bone dowels......Page 259
Gene therapy for intervertebral disk degeneration......Page 260
Dynamic stabilization......Page 261
Metallic bone graft substitutes......Page 262
Biological vertebral augmentation......Page 263
Advantages......Page 264
Assessment of new devices and procedures......Page 266
Government regulation of new devices......Page 267
Further reading......Page 268
Management of anti-coagulant and anti-platelet medications......Page 269
Beta-blockers......Page 270
Deep venous thrombosis/pulmonary embolism - treatment......Page 271
Informed consent......Page 272
Surgical site bleeding and hemostasis......Page 273
Post-operative analgesia......Page 274
Return to work following spinal surgery......Page 275
Further reading......Page 276
Too many symptoms......Page 277
Taking shortcuts......Page 278
“It's only a disk”......Page 279
Premature investigation......Page 280
The need to make a diagnosis......Page 281
Going against and going along with the previous diagnosis......Page 282
Telling the patient what they want to hear......Page 283
Further reading......Page 284
Glossary......Page 285
Index......Page 292