The Comprehensive Treatment of the Aging Spine

Front Cover
Title Page
Copyright Page
Dedication Page
Contributors
Preface
Part 1: Introduction to the Aging Spine
	Chapter 1 - Embryology of the Spine
		INTRODUCTION
		GASTRULATION
		SOMITE PERIOD
		UPPER CERVICAL SPINE
		NEURAL DEVELOPMENT
		SACRUM AND CONUS MEDULLARIS DEVELOPMENT
		ASSOCIATED ANOMALIES
		CONGENITAL SPINAL ANOMALIES
			Defects of Formation
			Defects of Segmentation
			Spina Bifida
		CONCLUSION
		References
	Chapter 2 - Applied Anatomy of the Normal and Aging Spine
		THE VERTEBRAE
		Cervical Vertebrae
			Thoracic Vertebrae
			Lumbosacral Spine
		INTERVERTEBRAL DISC
		LIGAMENTS
			Intraspinal Ligaments
		THE NERVE ROOTS
		THE INTERVERTEBRAL FORAMEN
		INNERVATION OF THE SPINE
		NUTRITIONAL SUPPORT FOR THE VERTEBRA AND DISC
		MUSCULAR ANATOMY
		PATHOLOGIC CHANGES IN AGING
			Spinal Stenosis
			Spondylolisthesis
			Diffuse Idiopathic Skeletal Hyperostosis (DISH)
			Degenerative Scoliosis and Kyphosis
		References
	Chapter 3 - Histological Changes in the Aging Spine
		INTRODUCTION
			INTERVERTEBRAL Disk
		VERTEBRAL BODIES
		FACET JOINTS
		MUSCLES AND LIGAMENTS
		SUMMARY
		References
	Chapter 4 - Natural History of the Degenerative Cascade
		NATURAL HISTORY OF THE DEGENERATIVE CASCADE
			ANATOMY AND GENERAL MECHANISMS OF PAIN
		PATHOGENESIS OF LUMBAR DEGENERATION
		BIOCHEMICAL CHANGES
		BIOMECHANICAL CHANGES
		THE THREE STAGES OF INSTABILITY
		CLINICAL INSTABILITY AND DIAGNOSTIC IMAGING
		CONCLUSION
		References
	Chapter 5 - History and Physical Examination of the Aging Spine
		INTRODUCTION
			PAST MEDICAL HISTORY
				Congenital/Familial/Genetic
				Occupational/Environmental/Psychological
				Comorbidities
			HISTORY
				Origin of Pain
				Neurological History
		Past Surgical History
		PHYSICAL EXAMINATION
			Global Balance
			Gait
			Neurological
			Specific Cervical Neurological Levels
				C5 Neurological Findings
				C6 Neurological Findings
				C7 Neurological Findings
				C8 Neurological Findings
				T1 Neurological Findings
				Thoracic and Abdominal Neurological Findings
				T12 to L3 Neurological Findings
				L2 to L4 Neurological Findings
				L4 Neurological Findings
				L5 Neurological Findings
				S1 Neurological Findings
				S2-4 Neurological Findings
			Vascular
			Summary
	Chapter 6 - The Role of Nutrition, Weight, and Exercise on the Aging Spine
		INTRODUCTION
			NUTRITION
			OBESITY
		EXERCISE
		SUMMARY
		References
	Chapter 7 - The Psychology of the Aging Spine, Treatment Options, and Ayurveda as a Novel Approach
		INTRODUCTION AND OVERVIEW
		UNDERSTANDING THE PATIENT’S PERSPECTIVE
		WESTERN PERSPECTIVES ON THE PSYCHOLOGY OF AGING
		WESTERN PERSPECTIVES ON MANAGING THE AGING PROCESS
		EASTERN PERSPECTIVES ON MEDICINE AND PSYCHOLOGY
		AYURVEDA: TRADITIONAL INDIAN MEDICINE
		AYURVEDIC PERSPECTIVES ON AGING
		AYURVEDIC PERSPECTIVES ON MANAGING THE AGING PROCESS WITH RESPECT TO BONE
		CONCLUSION
		References
Part 2: Basic Science of the Aging Spine
	Chapter 8 - Biomechanics of the Senescent Spine
		INTRODUCTION
		AGING AND DEGENERATIVE CHANGES ON THE EFFECTS OF BIOMECHANICAL RANGE OF MOTION
		ASSESSING ANATOMICAL CHANGES
		OSTEOPOROSIS, AGING, AND BIOMECHANICAL PROPERTIES
		BMD AND IMPLICATIONS ON INSTRUMENTED PROCEDURES
		DUAL ENERGY X-RAY ABSORPTIOMETRY AND MECHANICAL STRENGTH
		MODIC CLASSIFICATION OF VERTEBRAL ENDPLATE CHANGE
		Magnetic Resonance Imaging and Modic Changes in 40-Year-Old Men and Women
		Significance of the Modic Classification to the Degenerative Process in the Spine
		References
	Chapter 9 - Non-Invasive Strength Analysis of the Spine Using Clinical CT Scans
		INTRODUCTION
		BASIC SCIENCE
			Aging of the Spine
			Finite Element Analysis of CT Scans — Biomechanical Computed Tomography
		CLINICAL PRACTICE GUIDELINES
		CLINICAL CASE EXAMPLES
			Comparing Teriparatide and Alendronate for Treatment of Osteoporosis
			Alendronate Treatment in Rheumatoid Arthritic Patients
			Assessing Risk of Vertebral Fracture in Postmenopausal Women
		DISCUSSION
		Acknowledgements
		References
	Chapter 10 - Kinematics of the Aging Spine: A Review of Past Knowledge and Survey of Recent Developments, with a Focus on Patient-Management ...
		AN INTRODUCTION TO FUNCTIONAL DIAGNOSTICS OF THE SPINE
		THE CURRENT STATE OF THE ART: DIAGNOSTIC EFFICACY OF TODAY’S FUNCTIONAL TESTING METHOD
			Range of Motion (RoM) Measurements
			Measurement Variability in Range of Motion (RoM) Measurements
			Using Normative IVA Data to Detect Normal Motion, Hypomobility, and Hypermobility
			Effects of IVA Measurement Variability on the Diagnostic Efficacy of Functional Testing of the Spine
			Conclusions: Implications for the Practitioner Regarding the Clinical Application of RoM Measurements
		TECHNOLOGICAL ADVANCES THAT IMPROVE THE DIAGNOSTIC EFFICACY OF SPINAL FUNCTIONAL TESTING
		Reducing IVA Observer-Related Variability by Improving the Reliability of Image Analysis Techniques
		Collecting Dynamic Images “During the Bend” through the Diagnostic Use of Fluoroscopy for Functional Testing of the Spine
		Reducing the Subject-Related IVA Variability Introduced through Uncontrolled BendingDuring Imaging
		Motion Control Technology Used in Combination with Digital Videofluoroscopy and Automated Image Analysis Software
		NEW INSIGHTS INTO THE BIOMECHANICS OF THE AGING SPINE
			Physiologic Variation in sIVA among Normal Subjects Is Very Low
			Rethinking the Conventional Wisdom Regarding Intervertebral Hypomobility and Age
		Age-Related Differences in the Functional Presentations of Degenerative Spondylolisthesis Patients
		SUGGESTIONS FOR THE CLINICAL USE OF FUNCTIONAL TESTING METHODS
			Suggestions Regarding the Clinical Use of the Current Standard of Care
			Suggestions Regarding the Clinical Use of Recently Developed Methods for Conducting Functional Testing of the Spine
		References
	Chapter 11 - Causes of Premature Aging of the Spine
		INTRODUCTION
		PREMATURE AGING FACTORS
			Biochemical
			Biomechanical
		Atherosclerosis
		Lifestyle Factors
			Smoking
			Obesity
			Genetic Factors
		DISCUSSION
		CLINICAL RELEVANCE
		References
	Chapter 12 - Osteoporosis and the Aging Spine: Diagnosis and Treatment
		PHYSIOLOGY OF BONE REMODELING AND BONE TURNOVER
		DIAGNOSIS OF OSTEOPOROSIS
		EVALUATION FOR OSTEOPOROSIS
			Screening for Osteoporosis with Bone Mineral Density Measurement
			Laboratory Investigations for Osteoporosis
			Evaluation for Secondary Osteoporosis
			Assess for Risk of Falls and Fractures
		TREATMENT IN OSTEOPOROSIS
			Nonpharmacologic Treatment
			Calcium and Vitamin D Supplementation
			Pharmacologic Treatment
				Antiresorptive Agents
				Anabolic Agents
			Pharmacologic Agents and Spinal Fusion
		FUTURE DIRECTIONS
		SUMMARY
		References
	Chapter 13 - Osteoarthritis and Inflammatory Arthritides of the Aging Spine
		CLINICAL CASE EXAMPLES
			Clinical Case #1 (Degenerative Lumbar Spondylolisthesis)
				Clinical Case #2 (Degenerative Cervical Spondylosis)
				Clinical Case #3 (Atlantoaxial Instability)
		BASIC SCIENCE
		EPIDEMIOLOGY AND RISK FACTORS
		PATHOPHYSIOLOGY
		DEGENERATIVE MECHANICS
		NATURAL HISTORY
		CLINICAL PRACTICE GUIDELINES
			Evaluation
			Conservative Therapy
			Operative Therapy
				Neurological Decompression
				Instrumented Spinal Fusion
				Minimally Invasive Alternatives
		CLINICAL CASE EXAMPLES
			Discuss Treatment, Clinical Challenges, and Future Treatments
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 14 - Spinal Stenosis Without Spondylolisthesis
		CLINICAL CASE EXAMPLE
		BASIC SCIENCE
		CLINICAL PRACTICE GUIDELINES
			Surgery
		CONCLUSIONS AND DISCUSSION
		Acknowledgments
		References
	Chapter 15 - Spinal Stenosis with Spondylolisthesis
		PART ONE: UNDERSTANDING THE CONDITION
			Pathophysiology
				Epidemiology
				Natural History
		PART TWO: CLINICAL DECISION MAKING
			Evaluation
			Imaging Studies
			Specific Patient Populations and Situations
				Elderly
				Multiple Comorbidities
				Osteoporosis
			Indications for Fusion
				Lateral Listhesis
				Concomitant de Novo Scoliosis—Significant Curve and Progressing Curve
				Axial Pain
			Nonfusion Decision Making
		PART THREE: MANAGEMENT
			Nonsurgical
			Surgical
				Fusion Options with or without Instrumentation
					Decompression and Noninstrumented Posterolateral Fusion
					Fusion with Biologics
					Decompression and Posterolateral Fusion with Instrumentation
					Facet Fusion
					Fusion with Transforaminal Lumbar Interbody Graft
					Laminotomy or Interlaminar Fenestration
					Foraminotomy
					Restorative Laminoplasty
					Minimally Invasive Techniques
					Motion-Sparing Technologies
		CONCLUSION
		References
	Chapter 16 - Imaging of the Aging Spine
		IMAGING OF DEGENERATIVE SPINE DISEASE
			Intervertebral Disc Degeneration
		Vertebral Marrow Changes and Osteophyte Formation
			Facet Arthropathy
			Spondylolisthesis and Segmental Instability of the Spine
			Spinal Stenosis
		SUMMARY
		References
Part 3: Conservative Treatment Modalities
	Chapter 17 - Land Based Rehabilitation and
the Aging Spine
		THE “DEGENERATIVE CASCADE”
		THE FOCUS OF REHABILITATION
		PATHOPHYSIOLOGIC BASIS FOR REHABILITATION
		COMORBIDITY INFLUENCE ON REHABILITATION
		PHYSIOLOGIC FACTORS OF SPINAL STABILIZATION
		CORE STABILIZATION EXERCISES
		References
	Chapter 18 - Aquatic Physical Therapy
		CLINICAL CASE EXAMPLES
			BASIC SCIENCE
		CLINICAL PRACTICE GUIDELINES
			Physician Evaluation and Prescription
			Indications
			Contraindications
			Evidence Base
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 19 - The Role of Spinal Injections in Treating the Aging Spine
		EPIDURAL STEROID INJECTIONS
		FACET JOINT PROCEDURES
		SACROILIAC JOINT PROCEDURES
		SPECIFIC DEGENERATIVE CONDITIONS
			Degenerative Disc Disease
			Degenerative Lumbar Spondylolisthesis
			Degenerative Lumbar Spinal Stenosis
		CONCLUSION
		References
	Chapter 20 - Acupuncture in Treatment of Aging Spine–Related Pain Conditions
		DESCRIPTION OF THE needle
			OPERATIVE TECHNIQUES
				Needle Insertion Techniques
					Finger pressing insertion.
		Pinching needle insertion.
			Pinching skin insertion.
				Tight skin insertion.
			Needle Manipulation
			Other Modalities and Techniques Related to Acupuncture and the Meridian System
			Application of Meridian Theory in Spine-Related Pain Conditions
			Hua Tuo Jia Ji Points
		RESEARCH BACKGROUND OF BASIC SCIENCES AND CLINICAL OUTCOMES
		COMPLICATIONS
		CLINICAL PRESENTATION AND DISCUSSION
			Case One
			Case Two
			Case Three
			Case Discussions
		CONCLUSIONS
		References
	Chapter 21 - Tai Chi, Qi Gong, and Other Complementary Alternative Therapies for Treatment of the Aging Spine and Chronic Pain
		INTRODUCTION
			TAI CHI
		Clinical Practice Guidelines
		FROM QI GONG TO ENERGY-BASED THERAPIES
			Clinical Practice Guidelines
		MIND-BODY THERAPIES
			Mindfulness Meditation
			Guided Imagery
			Spirituality and Religiousness
		BASIC SCIENCE
			Attention and Pain
			Regulation of the Autonomic Nervous System
			Case Discussion
		CONCLUSION
		References
	Chapter 22 - Oral Analgesics for Chronic Low Back Pain in Adults
		INTRODUCTION
			NONOPIOID ANALGESIC AGENTS: ACETAMINOPHEN, NSAIDs, ASPIRIN
				Acetaminophen
				Nonsteroidal Antiinflammatory Drugs (NSAIDs)
		Cyclooxygenase Inhibitors (COX-2)
			Aspirin
			Flavocoxid (Limbrel®)
		Opioid Analgesics
		MUSCLE RELAXANTS AND ANTISPASTICITY MEDICATIONS
		ANTIDEPRESSANTS
		ANTICONVULSANTS
		CONCLUSION
		References
	Chapter 23 - Yoga and the Aging Spine
		INTRODUCTION
			CLINICAL AND BASIC SCIENCE
		CONCLUSION
		ACKNOWLEDGMENT
		References
Part 4: Surgical Treatment Modalities: Cervical Spine
	Chapter 24 - Cervical Stenosis: Radiculopathy – Review of Concepts, Surgical
Techniques, and Outcomes
		INTRODUCTION
		REGIONAL ANATOMY OF THE CERVICAL SPINE
			Osseous Components
			Intervertebral Discs
			Ligaments and Joints
			Vascular Supply
		PATHOPHYSIOLOGY OF CERVICAL SPONDYLOSIS
		CLINICAL PRESENTATION OF CERVICAL SPONDYLOSIS
		DIAGNOSTIC MODALITIES
			Neuroradiology
			Neurophysiology
		NATURAL HISTORY OF CERVICAL RADICULOPATHY
		TREATMENT AND DECISION-MAKING
		POSTERIOR CERVICAL SURGICAL TECHNIQUES
		ANTERIOR CERVICAL SURGICAL TECHNIQUES
		SURGICAL OUTCOMES
		COMPLICATIONS OF SURGERY
		EMERGING TECHNOLOGIES: ARTIFICIAL Disc REPLACEMENT
		CONCLUSION
		References
	Chapter 25 - Cervical Stenosis:Myelopathy
		INTRODUCTION
		INDICATIONS/CONTRAINDICATIONS
		CLINICAL PRESENTATION AND EVALUATION
		DESCRIPTION OF THE DEVICES
		OPERATIVE TECHNIQUES
		COMPLICATIONS AND AVOIDANCE
		CONCLUSION/DISCUSSION
		References
	Chapter 26 - Cervical Kyphosis
		INTRODUCTION
			BIOMECHANICS OF THE CERVICAL SPINE
				Cervical Motion and the Spinal Cord
				Degenerative Processes in the Cervical Spine
		Cervical Kyphosis and Inflammatory Arthritides
		MANAGEMENT OF THE PATIENT WITH CERVICAL KYPHOSIS
			Patient Assessment
			Imaging
			Surgical Decision-Making
			The Surgical Approach
			Surgical Complications
		CONCLUSIONS/DiskUSSION
		References
	Chapter 27 - Surgical Treatment Modalities for Cervical Stenosis: Central Cord Syndrome and Other Spinal Cord Injuries in the Elderly
		INTRODUCTION
			MECHANISM
		DEFINITION OF CENTRAL CORD SYNDROME
		INCIDENCE AND AGE
		BASIC SCIENCE
			Pathophysiology of Acute Traumatic Central Cord Syndrome (ATCCS)
			Theory of Somatotopic Organization of Corticospinal Tracts (Neuroanatomical Theory)
			Theory of Increased Upper Limb and Hand Functional Representation of CST (Functional Theory)
			Neurological and Functional Recovery of Central Cord Syndrome in the Elderly
		IMAGING IN ACUTE TRAUMATIC SPINAL CORD INJURY13
			Imaging Modalities Used to Assess Cervical Spine Injury (Box 27-4)
				MRI Findings in Traumatic SCI
					Skeletal Injury
					Extradural Compression
					Cord Deformation and Signal Change within the Cord
		TREATMENT
			Clinical Challenges
			Future Treatments
		SUMMARY
		References
	Chapter 28 - Occipital-Cervical and Upper Cervical Spine Fractures
		OVERVIEW
			ANATOMY
				Occipital Bone
				The Atlas
				The Axis
				Ligaments of the Craniocervical Junction
		The Vertebral Artery
		INJURIES OF THE CRANIOCERVICAL JUNCTION
			Overview
			Occipitocervical Instability
			Occipitoatlantal Dislocation
			Occipital Condyle Fractures
			C1 Fractures and Transverse Ligament Injuries
			C2 Fractures
			Craniocervical Manifestations of Rheumatoid Arthritis
		CONSERVATIVE MANAGEMENT OF OCCIPITOCERVICAL INJURIES IN THE AGING SPINE
		SURGICAL APPROACHES AND TECHNIQUES
			Ventral vs. Dorsal Approaches
			Occipitocervical Fusion
			Odontoid Screw
			C1-2 Harms
			C1-2 Transarticular Screws
			C2 Laminar Screws
		COMPLICATIONS
		CONCLUSIONS
		References
	Chapter 29 - Subaxial Cervical and Upper Thoracic Spine Fractures in the Elderly
		INTRODUCTION
			BASIC SCIENCE
			ANKYLOSING SPONDYLITIS
		DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS
		BIOMECHANICS AND CLASSIFICATION OF SUBAXIAL SPINE FRACTURES
		INSTRUMENTATION OF OSTEOPOROTIC LOWER CERVICAL AND UPPER THORACIC SPINE
		CLINICAL PRACTICE GUIDELINES
		CLINICAL CASE EXAMPLES: TREATMENT, CLINICAL CHALLENGES, AND FUTURE TREATMENTS
			Case 1
			Case 2
		CONCLUSION
		References
	Chapter 30 - Infections of the Cervical Spine
		INTRODUCTION
			BASIC SCIENCE
			CLINICAL PRACTICE GUIDELINES
				Risk Factors
				Clinical Presentation
		Laboratory and Imaging Studies
			Treatment
		CONCLUSIONS/DISCUSSION
		References
	Chapter 31 - Rheumatoid Arthritis of the Cervical Spine
		INTRODUCTION
			EPIDEMIOLOGY AND NATURAL HISTORY
			PATHOPHYSIOLOGY
		CLINICAL PRESENTATION
		LABORATORY DATA
		RADIOGRAPHIC ANALYSIS
			Plain Radiographs
			Magnetic Resonance Imaging
			Computed Tomography
		MANAGEMENT
			Nonoperative Management
			Surgical Indications
			Preoperative Assessment
			Operative Management
				Atlantoaxial Subluxation
				Cranial Settling
				Subaxial Subluxation
				Odontoid Resection
		CONCLUSION
		References
	Chapter 32 - Tumors of the Cervical Spine
		INTRODUCTION
			INTRAMEDULLARY SPINAL TUMORS
				General Information, Clinical Presentation, and Imaging
					Ependymomas
		Astrocytomas
			Hemangioblastomas
		OPERATIVE TECHNIQUES (See Figures 32-1 and 32-2)
			Intramedullary Tumors
			Postsurgical Management
		INTRADURAL-EXTRAMEDULLARY SPINAL CORD TUMORS
			General Information, Clinical Presentation, and Imaging
				Nerve Sheath Tumors
				Meningiomas
		OPERATIVE TECHNIQUES
			Intradural-Extramedullary Tumors
				Spinal Schwannomas
				Spinal Meningiomas
			Postsurgical Management
		EXTRADURAL SPINAL CORD TUMORS
			General Information, Clinical Presentation, and Imaging
			Operative and Postoperative Management
				Spinal Metastatic Tumors
				Primary Malignant Tumors
				En Bloc Resection and Treatment of Cervical Chordoma (See Figures 32-3 through 32-5)
		CONCLUSIONS
		References
	Chapter 33 - Role of Minimally Invasive Cervical Spine Surgery in the Aging Spine
		INTRODUCTION
			BASIC SCIENCE
			SURGICAL INDICATIONS AND PREPARATION
			RADIOLOGICAL EVALUATION
		SURGICAL TECHNIQUES
			Anterior Cervical Microforaminotomy
				Transuncal Approach
				Upper Vertebral Transcorporeal Approach
				Lower Vertebral Transcorporeal Approach
			Percutaneous Cervical Nucleoplasty
			Percutaneous Endoscopic Discectomy
			Microendoscopic Discectomy
		DISCUSSION
			Microsurgical Anterior Cervical Foraminodiscectomy
			Percutaneous Cervical Nucleoplasty(PCN)
			Percutaneous Endoscopic Cervical Discectomy
			Microendoscopic Discectomy
		CONCLUSIONS
		References
Part 5: Osteoporotic Surgical Treatment Modalities: Thoracic Spine
	Chapter 34 - Kyphoplasty
		INTRODUCTION
		BRIEF DESCRIPTION
		INDICATIONS AND CONTRAINDICATIONS
		DESCRIPTION OF THE DEVICE
		BACKGROUND OF SCIENTIFIC TESTING AND CLINICAL OUTCOMES
		CLINICAL PRESENTATION AND EVALUATION
		OPERATIVE TECHNIQUE
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 35 - Vertebroplasty
		INTRODUCTION
		HISTORY OF VERTEBROPLASTY
		PATIENT SELECTION/INDICATIONS
		Absolute Contraindications
			Relative Contraindications
		TECHNIQUE
			Transpedicular Approach
			Parapedicular (Transcostovertebral) Approach
			Posterolateral Approach
			Anterolateral Approach
			Procedure
		INJECTION MATERIALS
		COMPLICATIONS
		NEJM RANDOMIZED CONTROLLED TRIALS
			Fracture Acuity
			Enrollment
			Control Group as an “Alternative Intervention”
			Crossover
		CONCLUSION
		References
	Chapter 36 - Vertebral Body Stenting
		INTRODUCTION
			VERTEBRAL BODY STENT
				How to Restore and Maintain Vertebral Height
				In Vitro Testing
				Clinical Application
					Indications
		Surgical Technique
			Clinical Experience
				Results
		DISCUSSION
		References
	Chapter 37 - Structural Osteoplasty: The Treatment of Vertebral Body Compression Fractures Using the OsseoFix Device
		INTRODUCTION
		CLINICAL INDICATIONS AND CONTRAINDICATIONS
		DESCRIPTION OF THE OSSEOFIX DEVICE
			Biomechanical Studies
		Results – Study 1
		Results – Study 2
		CONCLUSION
		CLINICAL DATA
		OPERATIVE TECHNIQUE
			Step 1: Positioning.
				Step 2: Creating an access channel into the vertebral body
					Step 3: Insertion and deployment of the implant
						Step 4: Cement delivery.
		PITFALLS AND COMPLICATIONS OF THE PROCEDURE
		TREATMENT ALTERNATIVES
		DISCUSSION AND CONCLUSION
		References
	Chapter 38 - Kiva System in the Treatment of Vertebral Osteoporotic Compression Fractures
		INTRODUCTION
		INDICATIONS
		CONTRAINDICATIONS
		PRECAUTIONS
		DESCRIPTION OF THE DEVICE
		CLINICAL PRESENTATION AND EVALUATION
			Material and Methods
		RESULTS
		OPERATIVE TECHNIQUE
		DEPLOYMENT OF THE DISTRACTION SLEEVE
		INJECTING PMMA BONE CEMENT
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 39 - Directed Cement Flow Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures
		INTRODUCTION
		SYSTEM OVERVIEW
		INDICATIONS
		CONTRAINDICATIONS
		BIOMECHANICAL TESTING
		THE SHIELD KYPHOPLASTY SYSTEM SURGICAL TECHNIQUE
		CLINICAL OUTCOMES
		CONCLUSIONS
		References
	Chapter 40 - Radiofrequency Kyphoplasty: A Novel Approach to Minimally Invasive Treatment of Vertebral Compression Fractures
		INTRODUCTION
		MATERIALS AND METHODS
			The StabiliT Vertebral Augmentation System
			In Vitro Evaluation of Height Restoration and Intravertebral Pressure in Three Minimally Invasive Procedures Using an Osteoporotic Cadaver Bone Model
		RESULTS
		RF KYPHOPLASTY CLINICAL EXPERIENCE WITH THE StabiliT VERTEBRAL AUGMENTATION SYSTEM
		DISCUSSION
		References
	Chapter 41 - Structural Kyphoplasty: The StaXx FX System
		INTRODUCTION
		INDICATIONS AND CONTRAINDICATIONS
		DESCRIPTION OF THE DEVICE
		BACKGROUND OF SCIENTIFIC TESTING AND CLINICAL OUTCOMES
		CLINICAL PRESENTATION AND EVALUATION
		OPERATIVE TECHNIQUE
			Anesthesia
			Position
			Procedure
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 42 - Crosstrees Percutaneous Vertebral Augmentation
		INTRODUCTION
			INDICATIONS AND CONTRAINDICATIONS
		DESCRIPTION OF THE DEVICE
		PRINCIPLES OF PROCEDURE
		BACKGROUND OF SCIENTIFIC TESTING AND CLINICAL OUTCOMES
		OPERATIVE TECHNIQUE
			Anesthesia
			Position
			Surgical Procedure for the Crosstrees System
				Transpedicular Approach
				Extrapedicular Approach (Usually Recommended in Thoracic Spine)
				Delivery of PMMA
		POSTOPERATIVE CARE
		CONCLUSIONS AND DISCUSSIONS
		References
	Chapter 43 - Biologic Treatment of Osteoporotic Compression Fractures: OptiMesh
		INTRODUCTION
			INDICATIONS AND CONTRAINDICATIONS
			DESCRIPTION OF THE DEVICE
		BACKGROUND OF SCIENTIFIC TESTING AND CLINICAL OUTCOMES
		CLINICAL PRESENTATION AND EVALUATION
		OPERATIVE TECHNIQUE
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 44 - Vessel-X
		INTRODUCTION
			INDICATIONS AND CONTRAINDICATIONS
				Indications
				Contraindications
			DESCRIPTION OF THE DEVICE
		BACKGROUND OF SCIENTIFIC TESTING AND CLINICAL OUTCOMES
		OPERATIVE TECHNIQUE
			Anesthesia
			Position
		PROCEDURE
		POSTOPERATIVE CARE
		COMPLICATIONS AND CAUTIONS
		CONCLUSION
		References
Part 6: Other Surgical Treatment Modalities: Thoracic Spine
	Chapter 45 - Treatment of Thoracic Vertebral Fractures
		INTRODUCTION
		BASIC SCIENCE
		CLINICAL PRACTICE GUIDELINES
			Stable Thoracic Vertebral Fractures
		CLINICAL CASE EXAMPLES
			Thoracic Stabilization
			Spinal Cord or Nerve Decompression
			Deformity Correction
		CONCLUSIONS/DISCUSSION
		References
	Chapter 46 - Tumors of the Thoracic Spine
		INTRODUCTION
		Metastatic Tumors
		Intradural Extramedullary Tumors
		Intramedullary Spinal Cord Tumors
		Primary Vertebral Column Tumors
		BASIC SCIENCE
		CLINICAL PRACTICE GUIDELINES
		CLINICAL CASE EXAMPLES
		DISCUSSION
		References
	Chapter 47 - Infections of the Thoracic Spine
		INTRODUCTION
		PATHOPHYSIOLOGY
		Bacterial Pathogenesis
			Pathogenesis of Tuberculosis
		CLINICAL PRESENTATION
		DIAGNOSTIC EVALUATION
			Imaging
		MANAGEMENT
			Medical Therapy
			Indications for Surgical Intervention
			Surgical Management
				Posterior Approach
				Anterior Approach
				Anterior Approach with Anterior Fixation
				Single-Stage Anterior and Posterior Procedure
				Two-Staged Anterior-Posterior Procedure
				Use of Instrumentation
				Graft Type
				Minimally Invasive Surgery
					Thoracoscopic Spinal Surgery
					Percutaneous Technology
		PROGNOSIS
		CONCLUSION
		References
	Chapter 48 - Thoracic Spinal Stenosis
		INTRODUCTION
		PATHOLOGY
		CLINICAL PRESENTATION
		DIAGNOSIS
		TREATMENT
		OTHER CAUSES FOR THORACIC SPINAL STENOSIS
			Neoplasms
			Synovial Cysts
		PROGNOSIS
		CONCLUSIONS
		References
	Chapter 49 - Stereotactic Radiosurgery for Spine Tumors
		INTRODUCTION
		RADIOSURGERY
		INDICATIONS FOR SPINAL RADIOSURGERY
		TREATMENT DETAILS
		TREATMENT OF SPINAL METASTASES
		TREATMENT OF INTRADURAL EXTRAMEDULLARY LESIONS
		TREATMENT OF INTRAMEDULLARY LESIONS
		COMPLICATIONS
		CONCLUSION
		References
Part 7: Surgical Treatment Modalities: Lumbar Spine
	Chapter 50 - The Role of Spinal Fusion and the Aging Spine: Stenosis without Deformity
		INTRODUCTION
		Basic Science
			Clinical Practice Guidlines
			Basic Science
			Clinical Practice Guidelines
			Basic Science
			Clinical Practice Guidelines
		CONCLUSIONS
		References
	Chapter 51 - The Role of Spinal Fusion and the Aging Spine: Stenosis with Deformity
		INTRODUCTION
			PATHOANATOMIC CHANGES
			DEFINITION OF STENOTIC DEGENERATIVE DISEASE IN DEFORMITY
			CLINICAL COMPLEX OF SYMPTOM PRESENTATION
		ADULT SCOLIOSIS CLASSIFICATION
		CONSIDERATIONS FOR NONSURGICAL OR SURGICAL MANAGEMENT
		GOALS OF TREATMENT
		SURGICAL PROCEDURES
		OUTCOMES ASSOCIATED WITH SPINAL DEFORMITY TREATED WITH SURGICAL DECOMPRESSION
		OPERATIVE TREATMENT OF DEGENERATIVE LUMBAR SCOLIOSIS ASSOCIATED WITH SPINAL STENOSIS
		PRINCIPLES FOR SELECTING FUSION LEVELS IN ADULT SPINAL DEFORMITY WITH LUMBAR CURVES
		SPINAL STENOSIS WITH SCOLIOSIS
		RATE OF COMPLICATIONS IN SCOLIOSIS SURGERY
		SUMMARY
		References
	Chapter 52 - A Case Study Approach to the Role of Spinal Deformity Correction in the Aging Spine
		INTRODUCTION
			NATURAL HISTORY
				Idiopathic Curves
				Degenerative Curves
			IMAGING EVALUATION
		THE ROLE OF CONSERVATIVE MANAGEMENT
		INDICATIONS FOR SURGERY
		SURGICAL PLANNING
			The Role of Decompression Only in Adult Scoliosis Surgery
			The Role of Deformity Correction and Fusion
			The Role of Deformity in the Clinical Presentation
		SURGICAL TECHNIQUES
			Posterior Instrumentation
			Anterior Release or Anterior-Only Surgery
			Extent of Fusion
			Extension of Fusion to the Sacrum
			The Role of Osteotomies and Spinal Column Shortening in Adult Deformity Patients
		SUMMARY
		References
	Chapter 53 - Assessment and Avoiding Complications in the Scoliotic Elderly Patient
		INTRODUCTION
			PATIENT EVALUATION
			TREATMENT
			SURGERY
		SURGICAL TECHNIQUES
		OSTEOPOROSIS AND SCOLIOSIS
		COMPLICATIONS
		OUTCOMES
		References
	Chapter 54 - Interspinous Spacers for ­Minimally Invasive Treatment of Dynamic Spinal Stenosis and Low Back Pain
		INTRODUCTION: INTERSPINOUS SPACERS – HOW DO THEY WORK?
			THE “EXTENSION STOPPERS”
				X - Stop (Medtronic) (Figure 54-1)
					Surgical Technique
						Results
						Summary
					InSpace (Synthes, Paoli, PA, USA) (Figure 54-3)
		Surgical Technique
			Results
				Summary
			Other Implant Types (Figure 54-7)
				Coflex (Paradigm Spine, New York, NY, USA) (Figure 54-8)
					Surgical Technique
					Results
					Summary
		DYNAMIC/RIGID INTERSPINOUS STABILIZERS
			The DIAM Implant (Medtronic, Minneapolis, MN, USA) (Figure 54-11)
				Surgical Technique
					Results
					Summary
				The Wallis Implant (Abbott Spine, Austin, TX, USA) (Figure 54-14)
					Surgical Technique
					Results
					Summary
			Other Implants
		CONCLUSION
		References
	Chapter 55 - Lumbar Disc Arthroplasty: Indications and Contraindications
		INTRODUCTION
		CLINICAL PRACTICE GUIDELINES
			Indications
		Contraindications
			Osteopenia and Osteoporosis
				Infection or Malignancy
				Facet Joints
				Scoliosis
				Spondylolysis and Spondylolisthesis
				Prior Abdominal Surgery
				Obesity
				Metal Allergy
				Anatomic and Vascular Considerations
				Psychosocial Factors
		CONCLUSIONS
		References
	Chapter 56 - The Role of Dynamic Stabilization and the Aging Spine
		INTRODUCTION
			DEVICES
				Interspinous Spacers
					X-Stop (Kyphon)
					Wallis (Zimmer Spine)
					Diam (Medtronic)
					Coflex (Paradigm)
					ExtenSure (NuVasive)
		In-Space (Synthes)
			Superion (Vertiflex)
			Facet Devices
				Zyre (Quantum Orthopedics)
				Fenix (Gerraspine AG)
				Anatomic Facet Replacement System (Facet Solutions)
				Total Facet Arthroplasty System (Archus)
				Total Posterior System (Impliant)
			Pedicle-Based Dynamic Rods
				N-Hance (Synthes)
				Stabilimax NZ (Applied Spine)
				Dynesys (Zimmer Spine)
				Dynamic TTL-Rod (Scient’x)
				CD Horizon Legacy Peek Rod System (Medtronic)
				DSS Spine Stabilization System (Paradigm)
				Dynabolt (VertiFlex)
		CLINICAL APPLICATION
			Ligament
			Facet
			Canal
			Osteopenia
		CONCLUSION
		References
	Chapter 57 - Pedicle Screw Fixation in the Aging Spine
		INTRODUCTION
		PEDICLE SCREWS IN THE OSTEOPOROTIC SPINE
			Screw Placement
		Undertapping Pedicle Screws
			Transverse Connectors
			Bone Cement
			Expandable Screws
		CONCLUSION
		References
	Chapter 58 - The Role for Biologics in the Aging Spine
		INTRODUCTION
		BONE MORPHOGENETIC PROTEINS
		OTHER BONE GRAFT ALTERNATIVES
			Allograft
			Demineralized Bone Matrix
			Synthetic Materials (Ceramics)
			Bone Marrow Aspirates
		OTHER POTENTIAL APPLICATION OF BIOLOGICS IN THE AGING SPINE
			Vertebral Body Augmentation in Vertebral Body Compression Fractures
			Nonfusion Applications: Addressing Disc Degeneration Directly
		CONCLUSION
		References
	Chapter 59 - Minimally Invasive Spinal Surgery (MISS) Techniques for the Decompression of Lumbar Spinal Stenosis
		INTRODUCTION
		PATHOPHYSIOLOGY
		TREATMENT OPTIONS AND GUIDELINES
		SURGICAL RATIONALE
		INDICATIONS FOR MISS DECOMPRESSIVE TECHNIQUES
			Surgical Technique
		POSTOPERATIVE MANAGEMENT
		CLINICAL OUTCOMES AND COMPLICATIONS
		EMERGING TECHNOLOGIES
		References
	Chapter 60 - Minimally Invasive Scoliosis Treatment
		INTRODUCTION
		BASIC SCIENCE OF MINIMALLY INVASIVE SPINE SURGERY
		CLINICAL PRACTICE GUIDELINES
		Endoscopic Transforaminal Decompression for Unilateral Radiculopathy
			Deformity Correction via Direct Lateral Anterior Interbody Fusion
			Minimally Invasive Posterior-Only Approaches
			Percutaneous Pedicle Screw Fixation
			MIS Iliac Fixation
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 61 - Lateral XLIF Fusion Techniques
		INTRODUCTION
		INDICATIONS AND CONTRAINDICATIONS
		CLINICAL STUDY
		PREOPERATIVE ASSESSMENT AND PLANNING
			Operative Technique
				Patient Positioning
				Incision and Retroperitoneal Access
				Transpsoas Access
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSION
		References
	Chapter 62 - Pelvic Fixation of the Aging Spine
		INTRODUCTION
		BASIC SCIENCE AND BIOMECHANICAL STUDIES
		CLINICAL PRACTICE GUIDELINES
		CLINICAL CASE EXAMPLES: TREATMENT AND FUTURE CHALLENGES
		CONCLUSION
		References
	Chapter 63 - Intradiscal Biologics: A Potential Minimally Invasive Cure for Symptomatic Degenerative Disc Disease?
		INTRODUCTION
		FUNCTIONAL ANATOMY OF THE INTERVERTEBRAL Disc
		CAUSES OF DEGENERATIVE DISC DISEASE
		THERAPEUTIC BIOLOGIC STRATEGIES
			Intradiscal Injection of a “Naked” Biologically Active Factor
			Gene Therapy Approaches
			Autologous Implantation of Cultivated, Modified Cells
			Implantation of Mesenchymal Stem Cells
		CONCLUSIONS
		References
Part 8: The Future of the Aging Spine
	Chapter 64 - Endoscopic Surgical Pain Management in the Aging Spine
		INTRODUCTION
		INDICATIONS AND CONTRAINDICATIONS
		DESCRIPTION OF THE DEVICE
		BACKGROUND OF SCIENTIFIC TESTING AND CLINICAL OUTCOMES
		CLINICAL PRESENTATION AND EVALUATION
		OPERATIVE TECHNIQUE(S)
			Anesthesia
			Position
			Procedure
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSIONS AND DISCUSSION
		References
	Chapter 65 - Dorsal Endoscopic Rhizotomy for Chronic Nondiscogenic Axial Low Back Pain
		INTRODUCTION
		INDICATIONS AND CONTRAINDICATIONS
		Ideal Indications
		Relative Indications
		Patients with Poor Indications for Dorsal Ramus Rhizotomy
		DESCRIPTION OF THE DEVICE
		BACKGROUND OF SCIENTIFIC TESTING AND CLINICAL OUTCOMES
		CLINICAL PRESENTATION AND EVALUATION
		OPERATIVE TECHNIQUE
			Anesthesia
			Position
			Procedure
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSIONS AND DISCUSSION
			Anatomy of the Lumbar Dorsal Ramus
			L1 to L4 Dorsal Rami
			L5 Dorsal Ramus
		References
	Chapter 66 - Economics of Spine Care
		INTRODUCTION
		OVERVIEW OF THE ECONOMY AND HEALTHCARE
		OVERVIEW OF SPINE CARE
		BACK PAIN IN A CHANGING POPULATION
		Osteoporosis
		COMPENSATION
		MEDICAL TOURISM
		COST-EFFECTIVENESS
		WHERE TO GO FROM HERE
		References
	Chapter 67 - Micro- and Nanotechnology and the Aging Spine
		INTRODUCTION
			SPINAL ETIOLOGIES
				Degenerative Disc and Congenital Disorders
		Spinal Stenosis
			Osteoporosis
			Spinal Deformity (Scoliosis, Kyphosis)
			Spinal Tumors
		NANOMEDICINE AND THE AGING SPINE
			Drug Delivery Therapies7,19
			Micro- and Nanoscale Smart Polymer Technologies
			Nanocoatings
			Biosensors and Biochips
		THE POTENTIAL FOR MICRO/NANOTECHNOLOGY IN THE AGING SPINE
		References
	Chapter 68 - Guided Lumbar Interbody Fusion
		INTRODUCTION
		INDICATIONS/CONTRAINDICATIONS
		DESCRIPTION OF THE DEVICE
		BACKGROUND OF SCIENTIFIC TESTING / CLINICAL OUTCOMES
		CLINICAL PRESENTATION AND EVALUATION
		OPERATIVE TECHNIQUE
		POSTOPERATIVE CARE
		COMPLICATIONS AND AVOIDANCE
		CONCLUSION/DISCUSSION
		References
	Chapter 69 - Laser and Ozone Spinal Decompression
		INTRODUCTION
			LASER DECOMPRESSION
			OZONE CHEMODISCOLYSIS
			CONCLUSION
			References
	Chapter 70 - The Biochemistry of Spinal Implants: Short- and Long-Term Considerations
		HISTORICAL BACKGROUND
			Tissue Response to Biomaterials
			METALS
		Metal Types
			Titanium
				Cobalt-Chrome
				Stainless Steel (316L)
				Tantalum
			Corrosion
			Distribution of Metal in Body Fluids
			Mutagenesis
			Carcinogenicity
			Hypersensitivity
		POLYMERS
			Introduction
				UHMWPE
				PEEK
				PLA and PGA
			Implant Performance and Failure
				UHMWPE
				PEEK
				PLA and PGA
		HYDROGELS
			Synthetic Hydrogels
				Hydrolyzed Pan Hydrogels – Development and History
		BIOLOGICS
			Bone Graft
		SUMMARY
		References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y
	Z