Textbook of Spinal Surgery 2nd Revised edition [Hardback]

Section I General Considerations 3(138) 1 Preoperative Nursing Care 3(8) Christy Baldus Kathy Blanke Nursing Role in Preoperative Evaluation and Education Physical Evaluation Patient Education How and What to Explain in Preoperative Teaching Postoperative Pain Management Other Considerations 2 Perioperative and Postoperative Nursing Care for the Spinal Surgery Patient 11(20) Mary Faut Rodts Nursing Considerations Perioperative Nursing Care Postoperative Nursing Care Conclusion 3 Preoperative and Postoperative Anesthetic Considerations for the Spinal Surgery Patient 31(8) Carl Helge Nielsen History and Physical Examination The Spinal Patient With Concurrent Disease Risk Assessment Intraoperative Considerations Postoperative Considerations Summary 4 Monitoring During Surgery for Spinal Deformities 39(22) Jeffrey H. Owen Types of Spinal Cord Insults Overview of a Successful Monitoring Program Neurophysiologic Procedures Versus Surgical Procedures Instrumentation Neurophysiologic Tests: Methodology Interpretation of Somatosensory Evoked Potentials Motor Evoked Potentials Brachial Plexopathy Versus Intraoperative Monitoring Summary and Conclusion 5 Nerve Root Monitoring 61(16) Jeffrey H. Owen J. Richard Toleikis Background Dermatomal Somatosensory Evoked Potentials Versus Electromyograms: Advantages and Disadvantages Dermatomal Somatosensory Evoked Potentials: Elicitation and Recording Electromyograms: Recording and Elicitation Summary of EMG Methodologies Summary 6 Intraoperative Spinal Cord Monitoring With Motor Evoked Potentials Elicited by Transcranial Magnetic Stimulation 77(8) R. Dean Linden John R. Johnson Christopher B. Shields Harvey L. Edmonds Jr. Steven D. Glassman Methods of Monitoring Spinal Cord Motor Function Intraoperatively Intraoperative Monitoring With Transcranial Magnetic Stimulation General Observations Safety Considerations Summary 7 Somatosensory Evoked Potentials for Spinal Cord Monitoring 85(8) Vedran Deletis Gordon L. Engler Risks in Spinal Surgery Importance of Somatosensory Evoked Potential Monitoring Source of Somatosensory Evoked Potentials Cortical Versus Subcortical Somatosensory Evoked Potentials Stimulating and Recording Techniques Technical Requirements for Evoked-Potential Monitoring Criteria for Interpretation of Intraoperative Evoked Potentials Effects of Anesthesia on Evoked Potentials Specificity and Sensitivity of Somatosensory Evoked Potentials Use of the SCEPs/SEPs During Spinal Surgery or Manipulation Procedures Summary 8 Deep Vein Thrombosis in the Adult Spinal Deformity Patient 93(8) James L. West III Mechanisms of Formation Literature Review of Deep Vein Thrombosis and Pulmonary Embolism in Spinal Surgery Patients Methods of Diagnosing Deep Vein Thrombosis and Pulmonary Embolism Treatment Regimens Overall Recommendations and Conclusions 9 Implications of Malnutrition in the Surgical Patient 101(12) Oheneba Boachie-Adjei Nutritional Requirements Effect of Protein and Calorie Malnutrition Nutritional Assessment Nutritional Supplementation Surgical Outcomes Conclusion 10 Pulmonary Evaluation of the Patient With Spinal Deformity 113(8) James S. Kemp Rationale for Respiratory Evaluation of the Spinal Deformity Patient Common Tests of Respiratory Function Impact of Spinal Deformity on Respiratory Function Medical History in Patients With Spinal Deformity The Physical Examination and Radiographic Findings Pertinent to Respiratory Function Ventilatory Assessment and Acute Postoperative Issues Summary 11 Basic Techniques of Posterior Segmental Spine Internal Fixation 121(20) Lawrence G. Lenke Wires and Cables Hooks Screws Techniques of Performing a Posterior Lumbar Interbody Fusion Conclusions Section II Biomechanics 141(44) 12 General Considerations, Evaluation, and Testing 141(14) W. Thomas Edwards Hansen A. Yuan Conditions Required for Stabilization Lumbar Spine Thoracic Spine Cervical Spine Goals of Stabilization Limitations of Testing Versus Clinical Experience 13 Principles of Load Sharing 155(12) Gary L. Lowery Jurgen Harms Biomechanics and Spinal Architecture Load Sharing Principle and Spinal Instrumentation Summary 14 Biomechanics of Cervical Spine Instrumentation 167(8) Timothy D. Bassett Thomas A. Zdeblick Spinal Stability Physiologic Cervical Lordosis Instrumentation Testing Upper Cervical Fixation Lower Cervical Fixation Conclusion 15 Biomechanics of Three-Dimensional Scoliosis Correction 175(10) Johannes P. Giehl Thomas R. Haher Andrew Merola Richard Zipnick John Gorup Klaus Zielke General Considerations In Vitro Measurements In Vivo Measurements Conclusions Section III Anatomic Approaches 185(91) 16 Normal Spinal Anatomy: Normal Sagittal Plane Alignment 185(8) Mark Bernhardt Development, Anatomy, and Function Three-Dimensional Spinal Alignment Terminology of Spinal Alignment Spinal Balance: The Plumb Line Normal Thoracic Kyphosis Normal Lumbar Lordosis Thoracolumbar Junction Lumbopelvic Alignment Summary 17 Posterior and Posterolateral Approaches to the Spine 193(24) Lawrence G. Lenke General Operative Considerations Specific Posterior Spinal Approaches and Pertinent Anatomy Summary 18 Anterior Approaches to the Cervical Spine 217(10) Robert W. Jyung J. Gershon Spector The Lower Cervical Spine The Middle and Upper Cervical Spine The Clivus and Atlas Complications 19 Anterior Retropharyngeal Approach to the Upper Cervical Spine 227(10) Andrew Cappuccino Paul C. McAfee Cary D. Glastein Background Demographics Surgical Technique Postoperative Management Discussion 20 The Modified Anterior Approach to the Cervicothoracic Junction 237(6) Lawrence T. Kurz Jeffrey S. Fischgrund Stewart E. Pursel Harry N. Herkowitz Anatomy Indications Surgical Technique Comparative Techniques Results Complications Conclusion 21 A Combined Cervical and Thoracic Anterior Approach to the Spine 243(10) Roger M. Lyon Lyle J. Micheli Indications Contraindications Positioning Cervical Approach Thoracic Approach Complications Options 22 Anterior Exposure of the Thoracolumbar Spine 253(8) Ronald L. DeWald Surgical Technique 23 Anterior Lumbar Approaches to the Spine 261(6) Rene Louis Anterolateral Retroperitoneal Approach to L2-L5 of the Lumbar Spine Transperitoneal Midline Approach to L3-S1 24 Paramedian Retroperitoneal Approach to the Anterior Lumbar Spine 267(9) Brent T. Allen Keith H. Bridwell Technique Summary Section IV Dysplastic/Congenital Deformity 276(149) 25 Dysplastic Scoliosis: Neurofibromatosis 276(23) Alvin H. Crawford Keith R. Gabriel Diagnostic Criteria Spinal Deformities Cervical Deformity Thoracic and Lumbar Spine Soft Tissue Problems Summary 26 Marfans Spinal Pathology 299(8) David H. Donaldson Courtney W. Brown Natural History Treatment Complications 27 Spinal Deformity in Skeletal Dysplasia Conditions 307(14) Vernon T. Tolo Achondroplasia Spondyloepiphyseal Dysplasia Pseudoachondroplasia Diastrophic Dysplasia Mucopolysaccharidoses Miscellaneous Syndromes 28 The Spine in Osteogenesis Imperfecta 321(16) John P. Lubicky Incidence and Pathogenesis of Spinal Deformity Treatment Anesthetic Considerations Craniocervical and Cervical Abnormalities Spondylolysis and Spondylolisthesis Spine Fractures Conclusions 29 Spinal Deformity in Familial Dysautonomia 337(8) Paul T. Rubery Stephen W. Burke David B. Levine Spinal Deformity Nonoperative Treatment Perioperative Medical Considerations Surgery Postoperative Care and Complications Conclusion 30 Congenital Scoliosis 345(20) John P. Lubicky Classification and Natural History Genetics Patient Evaluation Radiographic Evaluation Treatment Posterior Fusion and Instrumentation Hemiepiphysiodesis Hemivertebra Excision 31 Congenital Intraspinal Anomalies: Spinal Dysraphism--Embryology, Pathology, and Treatment 365(36) Bruce A. Kaufman Definitions History Epidemiology Normal Embryology Open Dysraphic States Closed Dysraphic States Chiari Malformations and Syringomyelia Associated Care Issues in Spinal Dysraphism Summary 32 Infantile and Juvenile Scoliosis 401(24) Steven M. Mardjetko Spinal Growth Infantile Idiopathic Scoliosis Juvenile Idiopathic Scoliosis Operative Management for Infantile and Juvenile Idiopathic Scoliosis Summary Section V Adolescent Idiopathic Scoliosis 425(288) 33 Idiopathic Adolescent Scoliosis: Indications and Expectations 425(26) Michael O. LaGrone Howard A. King Natural History of Untreated Scoliosis Indications for Surgical Treatment Identification of Curve Patterns and Selection of Fusion Levels Prevention and Management of Trunk Decompensation Surgical Treatment Complications Correction and Maintenance Long-Term Effects 34 Thoracoplasty: Posterior Technique 451(12) Randal R. Betz History Indications Contraindications Technique Surgical Procedure Complications Clinical Reviews Summary 35 Thoracoplasty: Anterior Technique 463(6) Harry L. Shufflebarger Operative Technique Clinical Application Application 36 The Role of Harrington Rods and Wisconsin Wires in Idiopathic Scoliosis 469(20) Neil E. Green Harrington System Harrington Instrumentation With Sublaminar Wiring Interspinous Segmental Spinal Instrumentation Summary 37 Cotrel-Dubousset Instrumentation in the Treatment of Adolescent Idiopathic Scoliosis 489(46) John Carlisle Brown History of Posterior Spinal Instrumentation Before Cotrel-Dubousset Instrumentation Development of Cotrel-Dubousset Instrumentation Design of Implants Determination of the Strategic Vertebrae Method of Insertion and Application of Forces Concepts of Three-Dimensional Correction Complications Clinical Problems With Design Clones and the Future Summary 38 TSRH Universal Spine Instrumentation 535(34) Charles E. Johnston II Richard B. Ashman B. Stephens Richards J. Anthony Herring Overview of Implants Deformity Applications Pelvic Fixation Conclusion 39 Isola Spinal Instrumentation System for Scoliosis 569(42) Marc A. Asher Principles Components Biomechanics Instruments Techniques Surgical Applications Conclusion 40 Ventral Correction of Thoracic Scoliosis 611(16) Jurgen Harms Dezso Jeszenszky Bruno Beele Problems With Multisegmental Hook Systems Indications for Ventral Instrumentation for Treatment of Thoracic Scoliosis Surgical Technique Indication for Surgery Postoperative Treatment Complications Results Discussion Summary 41 Anterior Zielke Instrumentation in Thoracolumbar and Lumbar Curves 627(14) Johannes P. Giehl Klaus Zielke Principles of Anterior Scoliosis Correction Implants and Instruments Patient Selection and Preoperative Planning Surgical Technique Rehabilitation Results Complications Conclusions 42 Kaneda Anterior Multisegmental Instrumentation--Two-Rod System for the Treatment of Thoracolumbar and Lumbar Scoliotic Curvatures 641(24) Kiyoshi Kaneda Yasuhiro Shono Review of Anterior Instrumentation and the Treatment of Scoliosis Implant Components of Kaneda Anterior Multisegmental Instrumentation--Two Rod System Surgical Instruments Biomechanical Study of Materials and Methods Results Surgical Procedure Postoperative Management Indications Clinical Results Complications and Pitfalls Discussion Summary 43 Short Segment Anterior Instrumentation for Thoracolumbar Scoliosis 665(10) John E. Hall Michael B. Millis Brian D. Snyder History Preoperative Preparation Technique Complications Discussion Predicting Bone Screw Stability in Anterior Spinal Instrumentation Does Bracing Affect Bone Mineral Density in Scoliosis Patients During Growth 44 Moss Miami Instrumentation 675(20) Harry L. Shufflebarger Design Rationale Biomechanical Data Theoretical Considerations Clinical Application Initial Clinical Results 45 Paragon Spinal Instrumentation 695(18) Denis S. Drummond Jim Van Hoeck Yoshinori Nakata Historical Perspective Design Criteria and Goals Biomechanical Standards Simplicity and Cost Containment Paragon Implants and Instruments Implants Details of Hook and Sleeve Testing Details of Rod Interlock Testing Details of Parallel Rod to Rod Connectors Instruments Rod Insertion Techniques Posterior Derotation Persuasion Modification of Posterior Derotation Preoperative Planning Cantilever Correction Translational Correction Distraction and Compression Clinical Experience Summary Section VI Adult Scoliosis and Related Deformities 713(124) 46 Adult Scoliosis: The Thoracic Spine 713(20) Richard A. Balderston Epidemiology and Natural History Patient Evaluation Indications for Surgery How the Surgical Management of Adult Scoliosis Differs from Scoliosis Surgery in the Adolescent Thoracic Curve Types and Their Specific Management Thoracoplasty Summary 47 Adult Scoliois: The Lumbar Spine 733(44) John P. Kostuik Scoliosis Beginning Before Skeletal Maturity and Presenting in the Adult Problems Related to Adjacent Motion Segments Following Old Fusion for Scoliosis Iatrogenic Flat-Back Deformities Lateral Lumbar Circumferential Osteotomy With the Imbalanced Adult Scoliotic Degenerative Adult Scoliosis Complications in Adult Scoliosis Summary 48 Degenerative Scoliosis 777(20) Keith H. Bridwell Classification Treatment Alternatives for Anterior Column Support Posterior Instrumentation Mistakes to Avoid Pain Patterns Caudal Extent of Fusion Breakdown Above a Previous Fusion Anterior Versus Posterior Surgery Summary 49 Complications and Revision Surgery in Adult Spinal Deformity 797(24) Howard S. An J. Michael Glover Preoperative Considerations Operative Considerations Operative Complications Salvage and Reconstruction Surgery Summary 50 Osteotomies for Fixed Deformities in the Thoracic and Lumbar Spine 821(16) Keith H. Bridwell Indications for Osteotomies Size and Number of Osteotomies Location of Osteotomies Posterior Osteotomies Alone Without Anterior Surgery Posterior Osteotomies Preceded by Anterior Releases and Morselized Graft Posterior Osteotomies Followed With Structural Support to the Anterior Column Instrumentation and Fusion Extended to the Sacrum for Flat Back Syndrome Versus Stopping Short of the Sacrum Principles of Reconstruction Following Osteotomies Technical Performance of the Osteotomies One Day Versus Staged Surgery for Flat Back Syndrome Goals of Osteotomy Surgery for Sagittal Plane Pathology Complications and Patient Satisfaction Section VII Paralytic Deformity 837(112) 51 Paralytic Scoliosis 837(44) James E. Shook John P. Lubicky Neuromuscular Scoliosis Causes of Neuromuscular Scoliosis Treatment of Neuromuscular Scoliosis Uncontrolled Spinal Deformities in the Child Cerebral Palsy Friedreichs Ataxia Charcot-Marie-Tooth Disease Syringomyelia Spinal Deformities Secondary to Spinal Cord Injury Spinal Muscular Atrophy Arthrogryposis Duchennes Muscular Dystrophy 52 The Treatment of Flaccid Neuromuscular Scoliosis 881(22) Richard E. McCarthy Edward H. Saer III Duchennes and Beckers Muscular Dystrophy Bracing and Seating Adaptations Spinal Muscular Atrophy Friedreichs Ataxia Surgery Surgical Timing Surgical Approaches Bone Grafting Techniques Expectations From Surgery Complications Summary 53 Spinal Deformity in Myelomeningocele 903(30) John P. Lubicky Treatment Scoliosis Kyphosis Paralytic Kyphosis Congenital Kyphosis 54 Cotrel-Dubousset Instrumentation for Paralytic Neuromuscular Spinal Deformities With Emphasis on Pelvic Obliquity 933(16) Jean Dubousset Strategies for Treatment The Pelvic Vertebra Strategy for Correction Examples Problem Situations Postoperative Care and Results Complications Summary Section VIII Kyphosis and Postlaminectomy Deformity 949(250) 55 Congenital Anomalies of the Pediatric Cervical Spine 949(20) Denis S. Drummond Arnold-Chiari Malformation Anomalies of the Occipitocervical Junction Congenital Atlantooccipital Fusion Congenital Atlantoaxial Instability Diagnostic Radiology Congenital Anomalies of the Odontoid Process Down Syndrome Treatment of Atlantoaxial Instability Problems Occurring in the Lower Cervical Spine Treatment Techniques Occipitocervical Arthrodesis Atlantoaxial Arthrodesis Arthrodesis in the Lower Cervical Spine 56 Cervical Instability (Rheumatoid, Dwarfism, Degenerative, Others) 969(42) Ronald Moskovich Spinal Cord Injuries--Pathoanatomic Classification Cervical Instability--Anatomy and Biomechanics Rotatory Subluxation Subaxial Spine Measuring Translation Indications for Surgery Inflammatory Arthritis Rotatory Subluxation Dwarfing Dysplasia Surgical Techniques Posterior Fixation Techniques Subaxial Stabilization Dewar Posterior Arthrodesis Lateral Mass Plate Fixation Transarticular Screw Fixation of C1-2 Anterior Approaches to the Cervical Spine Transoral Surgery Conclusion 57 Indications and Techniques for Transoral and Foramen Magnum Decompression 1011(16) Arnold H. Menezes Neurodiagnostic Imaging and Treatment Algorithms Surgical Approaches to the Foramen Magnum Conclusion 58 Cervical Kyphosis 1027(12) Jeffrey M. Spivak Carl P. Giordano Etiology Anatomy and Biomechanics Neurologic Consequences Prevention Surgical Treatment 59 Occipitocervical and Upper Cervical Methods of Fusion and Fixation 1039(16) Chester E. Sutterlin III Anatomy Occipitocervical and Upper Cervical Methods of Fusion and Fixation Biomechanics Summary 60 Postlaminectomy Deformities: Thoracic and Lumbar Spine 1055(22) John E. Lonstein Incidence Pathogenesis Types of Deformities Natural History Prevention Treatment Principles of Surgery Early Deformity Established Deformity Reconstructive Surgery Lordosis Complications Summary 61 Congenital Kyphosis 1077(20) Robert B. Winter Definition and Classification Review of the Literature Natural History Nonoperative Treatment Operative Treatment Role of Skeletal Traction in Congenital Kyphosis 62 Kyphosis in the Elderly 1097(12) Kim W. Hammerberg Pathogenesis Classification Nonoperative Treatment Operative Treatment Surgical Techniques Kyphosis Senile Burst Fractures Complications Summary 63 Ankylosing Spondylitis 1109(20) Kim W. Hammerberg Pathogenesis Pathology Clinical Manifestations Diagnosis Medical Management Surgical Treatment Summary 64 The Cervical Spine in Ankylosing Spondylitis 1129(30) Edward H. Simmons Atlantoaxial Instability Atlantooccipital Disability Kyphotic (Flexion) Deformity of the Cervical Spine Muscle Disease as a Cause of Kyphotic Deformity in Ankylosing Spondylitis 65 Kyphosis Correction in Ankylosing Spondylitis Using Transpedicular Instrumentation 1159(10) Johannes P. Giehl Hans-Joachim Hehne Klaus Zielke Historical Aspects Biomechanical Considerations of Surgical Correction Surgery Surgical Techniques Rehabilitation Results Complications Discussion 66 The Etiology of Scheuermanns Disease 1169(4) Gordon C. Robin 67 Scheuermanns Disease 1173(26) Thomas G. Lowe Clinical Evaluation Radiographic Findings Natural History Treatment Nonoperative Treatment Operative Treatment Postoperative Management Surgical Complications Section IX Spondylolisthesis 1199(172) 68 Spondylolisthesis 1199(12) Ronald L. DeWald 69 Classification of Spondylolisthesis as a Guideline for Treatment 1211(44) Pier Giorgio Marchetti Pietro Bartolozzi Classification of Spondylolisthesis Summary 70 Developmental Spondylolisthesis Without Lysis 1255(8) Perry L. Schoenecker 71 Nonoperative Treatment and Surgical Repair of Lumbar Spondylolysis 1263(6) Bruce E. van Dam Making the Diagnosis Nonoperative Treatment Surgical Repair Summary 72 Adult Spondylolisthesis with Lysis 1269(30) Lawrence G. Lenke Keith H. Bridwell Classification Natural History Clinical Syndrome Radiology in Isthmic Spondylolisthesis Nonoperative Treatment Options Operative Treatments Author Recommended Treatment Conclusion 73 Acquired Degenerative Spondylolisthesis Without Lysis 1299(18) Keith H. Bridwell Literature Review Classification Treatment Postoperative Management and Complications Summary 74 Reduction of Spondylolisthesis 1317(20) Charles C. Edwards Pathomechanics of Spondylolisthesis Shortcomings of In Situ Fusion Potential Advantages of Reduction and Fixation Development of a Reduction Capability Indications for Reduction-Fixation Options for Reduction of Spondylolisthesis and Spondyloptosis Gradual Instrumented Reduction: Surgical Technique Future Role of Spondylolisthesis Reduction 75 True Spondylolisthesis Reduction and Monosegmental Fusion in Spondylolisthesis 1337(12) Jurgen Harms Dezso Jeszenszky Dieter Stoltze Heinrich Bohm Classification and Objective Measurements Biomechanics of the Lumbosacral Joint Surgical Treatment Reduction Dorsal Instrumentation and Compression Reconstruction of the Ventral Column Results Complications Subjective Evaluation Objective Results for the Measurable Parameters Discussion Summary 76 Posterior Decompression, Sacrectomy, and Anterior Fibular Lumbosacral and Posterolateral Fusion for High-Grade Spondylolisthesis 1349(8) Michael D. Smith Henry H. Bohlman Operative Indications Operative Technique Postoperative Management Anticipated Results Complications Conclusion 77 The L5 Vertebrectomy Approach for the Treatment of Spondyloptosis 1357(14) Robert W. Gaines Jr. Spondyloptosis Patient Presentation Operative Procedure Second-Stage Procedure Postoperative Care Clinical Series Summary Section X The Degenerative Spine 1371(308) 78 Cervical Disc Disease 1371(26) Louis H. Rappoport Patrick F. OLeary Anatomic Considerations Biomechanical Considerations Natural History Differential Diagnosis Clinical Presentation Diagnostic Evaluation Nonoperative Treatment Surgical Indications Surgical Treatment Complications Results Summary 79 Cervical Spondylosis 1397(24) Michael D. Smith Definitions Pathophysiology Clinical Presentation Diagnostic Studies Nonoperative Management Operative Indications Operative Treatment Anterior Discectomy and Fusion Anterior Corpectomy Anterior Microdiscectomy Anterolateral Vertebral Artery Decompression Anticipated Results Complications Controversial Issues Conclusion 80 Indications and Techniques For Cervical Laminoplasty 1421(6) Shinya Kawai Indications for Surgery Procedures Postoperative Management Complications Results Discussion 81 Complications of Cervical Spine Surgery 1427(12) Sanford E. Emery Michael J. Bolesta Intraoperative Complications Early Postoperative Complications Stabilization and Instrumentation Complications Late Complications Kyphosis Adjacent Levels 82 Surgery for Rheumatoid Arthritis of the Cervical Spine 1439(18) Randolph OHara Vincent Silvaggio William F. Donaldson III David R. Kraus Pathoanatomy Natural History and Prevalence Clinical Features Diagnostic Evaluation Measurement of Instability Indications for Surgical Intervention Surgical Management Atlantoaxial Arthrodesis Occipitocervical Arthrodesis Subaxial Subluxation Occipitocervicothoracic Arthrodesis Results 83 Revision Lumbar and Cervical Degenerative Spine Surgery--Indications and Techniques 1457(38) Alexander R. Vaccaro Srdjan Mirkovic R. David Bauer Steven R. Garfin Revision Cervical Spine Surgery Revision Lumbar Spine Surgery Electromyography/Nerve Conduction Velocity Nonspinal Evaluation 84 Thoracic Disc Herniation 1495(8) James W. Ogilvie Diagnosis Treatment Summary 85 The Source of Pain in the Lumbar Spine 1503(12) Nobuhiro Hayashi Hwan-Mo Lee James N. Weinstein Discogenic Pain Facet Joint Pain Radiculopathy Muscle-Induced Pain Referred Pain Dorsal Root Ganglion Neurochemistry Chemical Mediators of Pain: Nonneurogenic Pain Mediators Neurogenic Pain Mediators Summary 86 Low Back Pain in Athletes 1515(18) David G. Schwartz Michael F. Schafer History Physical Examination Laboratory Studies Diagnostic Studies Establishing a Diagnosis Treatment Musculoligamentous Injuries Spondylolysis Spondylolisthesis Herniated Nucleus Pulposus Scheuermanns Disease and Postural Roundback Trauma Tumor and Infection Exercise Prescription Conditioning and Rehabilitation Summary 87 Perspectives on the Indications and Surgical Management of Patients With Selected Degenerative Disorders of the Lumbar Spine 1533(14) Dan M. Spengler Indications for Surgical Management Disc Herniation Degenerative Spondylolisthesis Lumbar Spinal Stenosis Degenerative Scoliosis Degenerative Hypermobility (Instability) of the Motion Segment Revision Surgery of the Lumbar Spine (Salvage Surgery) Complications of Lumbar Spine Surgery Postoperative Management Summary 88 Lumbar Intervertebral Disc Surgery 1547(14) David L. Spencer Avi J. Bernstein Pathophysiology Clinical Presentation Surgical Treatment Microdiscectomy Techniques Conclusion 89 Spinal Stenosis 1561(20) John R. Whiffen Michael G. Neuwirth Classification Pathogenesis Clinical Presentation Differential Diagnosis Nonoperative Management Indications for Surgery Preoperative Evaluation Surgical Techniques Central Canal Stenosis Medical Facetectomy Lateral Recess Stenosis Degenerative Spondylolisthesis Failure to Relieve Pain Postoperative Care Results of Surgery Summary 90 Indications for Internal Fixation and Fusion in the Degenerative Lumbar Spine 1581(20) Thomas S. Whitecloud, III Michael W. Wolfe Development of Internal Fixation Fusion in the Degenerative Lumbar Spine Indications for Internal Fixation in the Degenerative Lumbar Spine The Role of Anterior Column Support Posterior Lumbar Interbody Fusion Anterior Lumbar Interbody Fusion Relative Contraindications Absolute Contraindications Complications and Risk-Benefit Ratio Nonsurgical Factors Summary 91 Posterior Lumbar Interbody Fusion with Variable Screw Placement and Isola Instrumentation 1601(22) Louis Keppler Arthur D. Steffee Jr. Robert S. Biscup History Our Experience Present-Day Status Indications Contraindications Goals Technique Aftercare Complications Results Conclusions 92 Compact Cotrel-Dubousset Instrumentation for the Degenerative Lumbar Spine 1623(18) Jean-Paul Steib Evoluation of Spinal Instrumentation Implants and Ancillary Instruments Sacral Fixation Implant Insertion Principles of Reduction and Assembly Types of Montages Special Indications Clinical Series of Patients Operated On with the Compact Cotrel-Dubousset System Results Facts Regarding the Surgery and the Pathology Conclusion 93 Texas Scottish Rite Hospital Instrumentation for Adult Lumbar Fusions 1641(22) Carl P. Giordano Michael G. Neuwirth Adult Lumbar Fusions Surgical Techniques Complications Postoperative Care 94 The Moss System for Degenerative Lumbar Disease 1663(6) Stanley D. Gertzbein The Moss System and Biomechanical Principles for its Use Clinical Study Conclusion 95 Complications of Degenerative Lumbar Spine Surgery 1669(10) Thomas W. McNeill Gunnar B. J. Andersson Epidemiology Preoperative Failure Intraoperative Complications Complications in the Immediate Postoperative Period Late Complications Summary Section XI Trauma 1679(278) 96 Cervical Spinal Fractures: Changing Management Concepts 1679(64) Paul R. Meyer, Jr. Injury Etiology General Considerations and Initial Management Anatomic Variations Management of Spine Injuries Other Processes Involving the Cervical Spine Indications for Myleography Injuries to the Cervical Spine: Stable and Unstable Factors Influencing Management of Cervical Spine Injuries Surgical Considerations Surgical Approaches and Fixation Procedures 97 Anterior and Posterior Screw and Plate Techniques Used in the Cervical Spine 1743(20) Pasquale X. Montesano Screw Fixation of the Odontoid Process C1-2 Posterior Screw Arthrodesis Anterior Cervical Plates Posterior Cervical Plating Occipitocervical Fusion Cervicothoracic Fusions 98 Thoracic and Lumbar Fractures: Diagnosis and Management 1763(76) Thomas R. Haher William Tallman Felmly Michael OBrien Philosophy of Spinal Stabilization Anatomy Spinal Stability Recognition of Spinal Injury Fractures of the Thoracic and Lumbar Spine Transverse Plane Types of Instrumentation Discussion Classification of Spinal Fractures 99 Surgical Management of Thoracic and Lumbar Burst Fractures 1839(42) Mark Weidenbaum Jean-Pierre C. Farcy Biomechanics and Classification Preoperative Evaluation Indications for Surgery Surgical Techniques Complications Controversies in Management Authors Preferred Method 100 Lumbar Burst Fractures: Fixation With Pedicle Instrumentation and Reduction by Adjustable Contoured Translating Axes 1881(18) Roger P. Jackson Biomechanics of Burst Fractures Biomechanical Testing of Short Posterior Constructs and Fracture Reductions In Vitro Force Application Strategies and Axes of Angular Correction Fracture Model Studies The Construct (6SDH) Clinical Experience, Studies, and Results Indications and Conclusions Nonoperative Treatment and Other Considerations 101 Kaneda Instrumentation for Spinal Fractures 1899(26) Eldin Karaikovic Kiyoshi Kaneda Behrooz A. Akbarnia Robert W. Gaines Jr. Indications Technical Data Application of the Device The Kaneda Device in the Treatment of Different Spinal Conditions Complications Summary 102 Transpedicular Posterolateral Decompression in Spinal Fractures and Tumors 1925(10) Behrooz A. Akbarnia Indications Preoperative Assessment Planning Technique Results Complications Discussion 103 Surgical Treatment of Thoracic and Lumbar Spinal Injuries With the Moss System 1935(14) Dieter Stoltze Jurgen Harms Indications for Surgical Treatment Objective of Surgical Treatment Classification of Vertebral Column Injuries Measures for Preoperative Diagnosis of Spinal Injuries Instrumentation Systems Screw--Rod System--Moss System Patient Evaluation General Complications Special Complications Results Discussion Summary 104 The Use of the AO Fixateur Interne for Thoracic and Lumbar Fractures 1949(8) E. Shannon Stauffer Historical Background Technique Summary Section XII Tumors and Osteomyelitis 1957(228) 105 Benign Tumors of the Spine 1957(26) Daniel E. Gelb Keith H. Bridwell Presentation Work-Up Treatment Radiation Postoperative Considerations Tumor Recurrence 106 Treatment of Primary Malignant Tumors of the Spine and Sacrum 1983(24) Alan M. Levine Dennis G. Crandall Clinical Presentation Radiologic Evaluation Biopsy Techniques Primary Malignant Tumors Primary Sarcomas of the Spine Round Cell Tumors Surgical Technique 107 Metastatic Disease of the Spine 2007(44) Paul L. Asdourian Natural History of Metastatic Spinal Disease Clinical Characteristics Diagnosis and Evaluation of Vertebral Metastases Laboratory Evaluation Classification Systems 108 Radiation Therapy for Metastatic Disease of the Spine 2051(6) Fred V. Orcutt Gene Wong Radiation Physics Radiobiology Decision Making Regarding Spinal Metastases Associated Considerations Nonoperative Treatment Operative Intervention Problem Areas Treatment Results Specific Tumors Preferred Methods Future Directions 109 Anterior Reconstruction for Metastatic Thoracic and Lumbar Spine Disease 2057(14) Edward Donald Simmons Jr. Approaches to the Anterior Thoracic and Lumbar Spine Exposure of the Lower Thoracic Spine Exposure of the Thoracolumbar Junction Exposure of the Middle and Lower Lumbar Spine Anterior Decompression of the Thoracic and Lumbar Spine Reconstruction of the Anterior Thoracic and Lumbar Spine 110 Reconstruction with a Ceramic Vertebral Prosthesis and Kaneda Device Following Subtotal or Total Vertebrectomy in Metastatic Thoracic and Lumbar Spine 2071(18) Kiyoshi Kaneda Naoki Takeda Principles in Treatment of Metastatic Thoracic and Lumbar Disease Indications for Surgery Tumor Evaluation Surgical Approaches Anterolateral Approach for Vertebrectomy and Reconstruction Case Presentation: Case Studies 1 through 6 Conclusion 111 Intramedullary Spinal Cord Tumors 2089(14) Marc E. Eichler Ralph G. Dacey, Jr. Epidemiology Clinical Presentation Diagnostic Tests Pathology Management Surgical Technique Long-Term Outcome and Adjunctive Therapy Conclusions 112 Intradural Extramedullary Spinal Tumors 2103(14) Dennis G. Vollmer Epidemiologic Considerations Clinical Presentation Radiologic Investigations Operative Approaches Specific Tumor Types 113 Spinal Vascular Malformations 2117(14) Ralph G. Dacey, Jr. Marc E. Eichler Classification Spinal Dural Arteriovenous Malformations (Type I) Intramedullary Spinal Vascular Malformations (Types II and III) Intradural Perimedullary Arteriovenous Fistulas (Type IV) Spinal Cavernous Malformations 114 Pediatric and Adult Intramedullary Spinal Cord Tumors 2131(10) Shlomo Constantini Fred Epstein Epidemiology and Pathology Clinical Presentation Neurodiagnostic Techniques Surgery Surgical Complications The Role of Radiation and Chemotherapy Summary 115 Spinal Infection 2141(44) Andrew V. Slucky Frank J. Eismont History Classification Pyogenic Infections Granulomatous Infections Postoperative Infections Section XIII Innovative Surgical Techniques 2185(206) 116 Insertion of Intrasacral Rods for Enhanced Sacral Fixation and Correction by In Situ Rod Contouring 2185(26) Roger P. Jackson Principles of Intrasacral Fixation Screws With Oblique Canals and Lateral Rod Connectors In Situ Contouring Principles and Techniques Clinical Applications for In Situ Contouring Techniques In Situ Benders Surgical Techniques Clinical Experience, Results, Measurements, and Complications Discussion and Comments Conclusions 117 The Use of and Techniques for Vascularized Rib Pedicle Grafts 2211(16) John W. Shaffer David S. Bradford History of Vascularized Bone Grafts Experimental Work Indications Surgical Technique Alternatives Summary 118 Vertebral Column Resections for Severe Deformities 2227(16) David S. Bradford Paul A. Glazer History Indications Planning and Imaging Studies Surgical Techniques Postoperative Considerations Complications 119 Anterior Interbody Fusion of the Lumbar Spine Using a Bone Graft Containing Hollow, Rigid Interbody Device--The Bagby and Kuslich Method of Spinal Fusion 2243(14) Stephen D. Kuslich Tissues and Diseases Responsible for Chronic Low Back Pain Rationale for the BAK Method of Interbody Stabilization History of BAK Advantages of Anterior Interbody Arthrodesis Preclinical Testing BAK Versus Other Stabilization Devices In Vivo Animal Testing Description of the BAK Device for Human Use Indications and Contraindications Anterior Surgical Method Early Results Laparoscopic Anterior Interbody BAK Fusion Summary 120 Intervertebral Disc Replacement 2257(10) John P. Kostuik Design Criteria A Proposed Prosthesis Testing of the Dynamic IDP in Sheep Summary Conclusion 121 Artificial Intervertebral Disc Prosthesis 2267(8) Noshir A. Langrana Casey K. Lee Monica Vuono-Hawkins Degenerative Disc Disease Present Decompressive Treatments Review of Disc Prosthesis Research UMDNJ-Rutgers Project Summary 122 Total Disc Replacement 2275(14) Paul Enker Arthur D. Steffee Historical Review Acroflex TDR Acroflex-100 Patient Selection Considerations Indications Surgical Technique Postoperative Management Clinical Experience: First Generation Clinical Experience: Second Generation Discussion 123 Intervertebral Disc Regeneration 2289(8) Kirkham B. Wood David S. Bradford Clinical Problem Spine Fusions Disc Replacement Disc Regeneration 124 Spinal Endoscopy: Evolution, Foundations, and Applications 2297(16) Hallett H. Mathews History and Applications Imaging: Adjuncts for Spinal Endoscopy Radiation Safety In Endoscopic Spine Surgery Optics and Physics In Endoscopic Visualization Discography: The Path To Endoscopic Visualization and Intervention Endoscopic Anatomy and Approaches Sixty-Five Years of Progress and Beyond 125 Thoracoscopy and Laparoscopy of the Spine 2313(20) John J. Regan Paul C. McAfee Video-Assisted Thoracoscopy of the Spine Specialized Technology Surgical Technique Thoracic Disc Herniation Anterior Release for Spinal Deformity Corpectomy for Excision of Tumor or Fracture Preliminary Results 126 Laparoscopy of the Spine 2333(14) Paul C. McAfee John J. Regan Laparoscopic Surgical Instruments Surgical Technique (L5-S1 Approach, Fusion, and Instrumentation) Laparoscopic Retroperitoneal Approach to L1 to L4 127 Allografts in Spinal Surgery 2347(14) Erik N. Zeegen Edgar G. Dawson Freeze-Dried ad Frozen Alloimplant Autolysed, Antigen-Extracted Allogenic Bone Demineralized Bone Matrix 128 Acute Spinal Cord Injury: Pathophysiology and Pharmacologic Treatments 2361(18) Michael F. OBrien Lawrence G. Lenke Michael E. Joyce Experimental Models for SCI Gross Pathology and Histopathology in SCI Secondary Injury in SCI Pharmacologic Treatment of Clinical and Experimental Acute Spinal Cord Injury Conclusion 129 Use of Osteoinductive Implants to Facilitate Spine Fusions 2379(6) Stephen D. Cook Thomas S. Whitecloud III Bone Grafts Demineralized Bone Matrix Osteoinductive Bone Extracts Recombinant Osteogenic Proteins Summary 130 Biologic Materials to Facilitate Spinal Fusions 2385(6) Ronald Moskovich Sally Frenkel Mechanisms of Spinal Fusion Fracture Healing Fusion Augmentation: Mechanical and Electrical Fusion Augmentation: Biologic Agents Conclusion INDEX 2391