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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6011_Библиотеки_им_академика_М_И_Перельмана.pdf
C H A P T E R 7 0 e Biochemistry of Spinal Implants
TA BL E 70 3 Bon e Graft ing
Bone Graft Family Description Classes
465
Osteoconductive Provides structure or scaffold to support bone formation Ca-Phosphate, ceramics, synthetic polymers,
Osteoinductive Induces differentiation of cells and new bone growth BMP, demineralized bone matrix
Osteogenesis Provides stem cells with osteogenic potential that directly form new bone Bone marrow aspirate
Combined Combinations of above Autograft
BMP or bone morphogenic protein is an osteogenic substance that has
significant potential for increasing union rates in orthopedic surgery, but
which is a source of significant controversy. Infuse (Medtronic), or rHBMP2, has had tremendous results in demonstrating efficacy of bone production
and increasing fusion rates. This product appears to have a great application
in high-risk patients undergoing lumbar fusion. These indications for its use
are very specific and should be limited to this small set of patients. Recently,
the FDA notified health care professionals of life-threatening complications
material’s wear and degradation processes and properties reflect on their
suitability as implants.
Biologic implants such as bone graft are usually biologically inert or biocompatible. Different bone grafts are divided based on the materials’ ability
to stimulate bone production directly, induce the growth of bone from host
tissue, or be a scaffold to facilitate the ingrowth of bone produced by the
host. It is crucial when using these products that specific goals or indications
are used, in order to achieve successful surgical outcomes.
bioactive glass, allograft
associated with the recombinant human bone morphogenic protein
(rhBMP) when it is used in the cervical spine. The agency had received 38
reports of complications during the previous 4 years, associated with its use
in cervical spine fusions, for which it is not approved. The complications
included swelling of neck and throat tissue, which resulted in compression
of the airway and/or neurological structures in the neck. Some reports
describe difficulty swallowing, breathing, or speaking. NASS and AANS
have all come out with statements recommending that surgeons not use
BMP off-label in the cervical spine.
SUMMARY
Biocompatibility of a biomaterial is directly dependent upon the response of
the host tissue. Factors that influence this response are the site of implantation, the function and size of the implant, and the duration of implantation.
An unintentional consequence of implanting objects into a host is the solubility of implanted material and its dissemination into bodily tissue. This
dissemination may be local or throughout the body at distant sites, with
little or no effect or with potentially life-threatening effects.
Metals used today (titanium, Co-Cr, and stainless steel 316L) have generally good biologic profiles and are considered safe to implant. Hypersensitivity reactions may occur and are most likely with nickel exposure. No good
screening tests are available to determine who may experience an exaggerated immune response with metal implantation. Corrosion is another large
part of a metal’s biocompatibility profile and plays a part in a potential
hypersensitivity reaction which in itself can lead to mechanical failure of the
implant.
Plastic compounds are a growing area of research and have been safely
References
1. M. Rang, The story of orthopaedics, Saunders Publishing Philadelphia, 2000.
2. J.M. Anderson, et al., Foreign body reaction to biomaterials, Sem Immunology 20 (2008)
86–100.
3. C.G. Lewis, et al., Metal carcinogenesis in total arthoplasty, Clin. Orthop. 329S (1996)
S264–S268.
4. J.A. Disegi, et al., Stainless steel in bone surgery, Injury 31 (2000) S-D2–6.
5. American Society for Testing and Materials, Handbook.
6. F.W. Sunderman, et al., Cobalt, chromium, and nickel concentrations in body fluids of
patients with porous-coated knee or hip prostheses, J. Ortho. Research. 7 (1989) 307–315.
7. R.M. Urban, et al., Dissemination of wear particles to the liver, spleen, and abdominal
lymph nodes of patients with hip or knee replacement, J. Bone Joint Surg. 82-A (4) (2000)
457–477.
8. A. Katzer, et al., In vitro toxicity and mutagenicity of CoCrMo and Ti6Al wear particles,
Toxicology 190 (2003) 145–154.
9. International Agency for Research on Cancer, Surgical implants and other foreign bodies,
IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 74, 1999.
10. N. Hallab, et al., Metal sensitivity in patients with orthopaedic implants, J. Bone Joint Surg
83-A (3) (2001) 428–436.
11. S.M. Kurtz, et al., The clinical performance of UHMWPE in the spine, in: S.M. Kurtz
(Ed.), Ultra-high molecular weight polyethylene in total joint replacement and medical
devices, Academic Press, , 2009.
12. E. Ingham, J. Fisher, Biological reactions to wear debris in total joint replacement, Inst. Mech.
Eng. 214 (1) (2000) 21–37.
13. S.M. Kurtz, J.N. Devin, PEEK Biomaterials in trauma, orthopaedic, and surgical implants,
Biomaterials 28 (32) (2007) 4845–4869.
14. W.J. Ciccone, et al., Bioabsorbable implants in orthopaedics: new developments and clinical
applications, JAAOS 9 (5) (2001) 280–288.
15. D.J. Hak, The use of osteoconductive bone graft substitutes in orthopaedic trauma, JAAOS
Vol. 15 (9) (2007) 525–536.
16. Electrochemical Corrosion. http://www.chem1.com/acad/webtext/elchem/ec7.html.
Accessed February 18, 2010.
used in orthopedic surgery. They accord numerous advantages, including
radiolucency and elasticity. While the vast majority are biologically inert, the
Index
A
Accuray MultiplanÔ System, 321, 323f
Acetaminophen, 120, 122t
Acupuncture
clinical presentation, 113
case 1, 113
case 2, 113
case 3, 113
case discussion, 113
complications, 113
needle description, 110, 111f
operative techniques, 110–112, 111f
HTJJ points, 112, 112f
meridian theory application, 111–112
needle insertion, 110–111
needle manipulation, 111
other, 111
overview, 110, 110b, 113
research background, 112–113
Acute traumatic central cord syndrome (ATCCS)
basic science, 161–162
functional theory, 162
neuroanatomical theory, 161–162
pathophysiology, 161
recovery in elderly, 162
causes, 161f
clinical challenges, 163
definition, 161
factors predicting motor recovery, 161b
features, 161b
future treatments, 163
imaging, 162
cord deformation/signal change in cord, 162
extradural compression, 162
modalities, 162, 162b
MRI, 162
skeletal injury, 162
incidence/age regarding, 161
mechanism, 160–161, 161f
overview, 160, 160b
treatment, 162–163, 163b
Aebi scoliosis, 337, 338f–340f, 340t
AFRS. See Anatomic Facet Replacement SystemÔ
Agingspecific subject
Agni (digestion), 34
Alendronate treatment, in rheumatoid arthritic patients,
48–49, 49f
Alendronate/teriparatide comparison, for osteoporosis
treatment, 48, 49f
ALIF. See Anterior lumbar interbody fusion
Allergy, metal, 371
Allograft, 385
Anabolic agents, osteoporosis and, 72–73
Analgesics, oral, for chronic low back pain
anticonvulsants, 125–126, 126t
antidepressants, 125, 125t
muscle relaxants/antispasticity medications, 124, 124t
narcotic, 121, 123t–124t
nonopioid agents, 120–121, 122t
acetaminophen, 120, 122t
aspirin, 121, 122t
COX-2, 121, 122t
flavocoxid, 121
NSAIDs, 120–121, 122t
overview, 120, 120b, 126
Anatomic Facet Replacement SystemÔ (AFRS), 376,
377f
Anatomy
disk, intervertebral, 11, 133–135, 419–420
innervation of spine and, 12
intervertebral foramen, 12
ligaments, 11–12, 134f, 135, 164
intraspinal, 11–12
muscular, 12
nerve roots, 12
nutritional support for, 12
overview, 9b
pathologic aging changes, 12–14
degenerative scoliosis/kyphosis, 14
DISH, 14
spinal stenosis, 13
spondylolisthesis, 14
pelvic, 415
vertebrae, 9–11
cervical, 10, 133
lumbosacral, 11
thoracic, 10–11
Anesthesia
endoscopic rhizotomy and, 438
endoscopic surgical pain management and, 431
LSS and, 390
PVA and, 262
StaXx FX Structural Kyphoplasty System and,
256
Vessel-X and, 272
Ankylosing spondylitis (AS)
characteristics of, 448
fractures and, 170–174
Anomalies
congenital spinal, 6–7
defects of formation, 6–7
defects of segmentation, 7
hermimetameric pairing, 6, 7f
spina bifida, 7
embryology of spine
associated, 6
congenital, 6–7
defects of formation, 6–7
defects of segmentation, 7
hermimetameric pairing, 6, 7f
spina bifida, 7
Anterior cervical microforaminotomy, 199–200
lower vertebral transcorporeal approach, 199–200
transuncal approach, 199
upper vertebral transcorporeal approach, 199
Anterior lumbar interbody fusion (ALIF), 398, 402f
Anticonvulsants, 125–126, 126t
Antidepressants, 125, 125t
Antiresorptive agents, 71–72
bisphosphonates, 71t, 72
calcitonin, 72
estrogen, 71
SERMs, 72
Antispasticity medications, 124, 124t
Aquatic Physical erapy
basic science, 103
fluid resistance, 103
pain reduction, 103
water pressure, 103
clinical case examples, 103
clinical practice guidelines, 104
Aquatic Physical erapy (Continued)
contraindications, 104
evidence base, 104
indications, 104
physician evaluation/prescription, 104
discussion, 104
overview, 103–104, 103b
treatment/clinical challenges/future treatment, 104b
ArthritisOsteoarthritis; Rheumatoid arthritis; Rheumatoid
arthritis, cervical spine
Arthrodesis, 366
Arthropathy, facet
CT imaging, 89–93, 89f–90f, 93f–94f
MRI, 89–93, 91f, 93f–94f
Arthroplasty, lumbar disk
arthrodesis compared with, 366
clinical case examples, 367b–368b
case 1, 367f, 371f
case 2, 368f, 372f
discussion, 371b–372b
clinical practice guidelines, 366–373
contraindications, 369–373
abdominal surgery, prior, 370–371
absolute/relative, 370, 370t
anatomic/vascular considerations, 371–373
facet joints, 370
infection/malignancy, 370
metal allergy, 371
obesity, 371
osteopenia/osteoporosis, 370
psychosocial factors, 373
scoliosis, 370
spondylolysis/spondylolisthesis, 370
studies on, 369–370
factors influencing outcomes following, 366
indications, 366–369
disk height, 369
four categories, 369
nondegenerative facets/posterior element stability, 369
patient education, 369
primary, 366–367
skeletal maturity, 367–369
overview, 366, 366b, 373
scenarios to consider, 366
TDR and, 366
TFAS and, 376, 377f
AS. See Ankylosing spondylitis
Asians, OLF and, 312
Aspirin, 121, 122t
Astrocytomas, 189
ATCCS. See Acute traumatic central cord syndrome
Atherosclerosis, 65
Atlas, 164
Attention, 117
Autologous implantation of cultivated/modified cells, 421f, 423
Autonomic nervous system regulation, 117
Axis, 164
Ayurvedaspecific proposition, 33–35
aging and, 35–37
diagnostic methods in, 35
ethical framework of, 33
history/derivation of, 34
introduction/overview regarding, 30b, 31, 33
management of bone aging, 35–37
propositions of, 33–34
treatment methods in, 35–36
Page numbers followed by f indicate figures; t, tables; b, boxes
467
468
Index
B
BCT. See Biomechanical computed tomography
Biochemical changes, degenerative cascade and, 21
Biologics
BMPs, 384–385
iliac crest bone graft and, 384
implants and, 464–465, 465t
other bone graft alternatives, 385
allograft, 385
bone marrow aspirates, 385
demineralized bone matrix, 385
synthetic materials, 385
other potential applications, 385–386
disk degeneration, 386
vertebral body augmentation, 385–386
overview, 384, 384b, 386
Biologics, intradiskal
overview, 419, 419b, 424
therapeutic strategies, 420–424
autologous implantation of cultivated/modified cells,
421f, 423
gene therapy approaches, 421f, 422
injection of biologically active factor, 420–422, 421f
MSCs implantation, 421f, 423–424
Biomechanical changes, degenerative cascade and, 21, 22f
Biomechanical computed tomography (BCT)
advantages of, 45
basic science, 47–48
clinical case examples
alendronate treatment in rheumatoid arthritic patients,
48–49, 49f
alendronate/teriparatide comparison for osteoporosis
treatment, 48, 49f
fracture risk in postmenopausal women, 49
clinical practice guidelines, 48
discussion, 49–50
strength capacity and, 48
Biomechanics of aging spine
assessing anatomical changes, 42
BMD/instrumented procedures and, 42–43,
43f
DXA/mechanical strength and, 43
modic classification and, 43–44
new insights into, 59–60
inter-vertebral hypomobility, 59, 60f
low IVA variation, 59, 59t
spondylolisthesis age-related differences,
59–60
osteoporosis and, 42
overview of, 41, 41b
RoM, 41–42, 42f
Biopsychospiritual model, 31–32
Biosensors/biochips, 450, 450f–451f
Bisphosphonates
complications of, 72
fusion regarding, 73
long term use of, 72
mechanism of action of, 72
for osteoporosis treatment, 69t, 72
BMD. See Bone mineral density
BMPs. See Bone morphogenetic proteins
Bone
access needle, 275–276, 276f
Ayurveda and, 35–37
cement, 382
demineralized bone matrix, 385
graft
biochemistry of implants, 464–465, 465t
iliac crest, 384
graft, other alternatives, 385
allograft, 385
bone marrow aspirates, 385
demineralized bone matrix, 385
synthetic materials, 385
homeostasis phases, 68
Kiva system and, 241, 242f
low/high turnover osteoporosis and, 68
markers, 70
occipital, 164
remodeling biochemistry, 68, 69f
remodeling/turnover, 68
Bone marrow aspirates, 385
Bone mineral density (BMD), 42. See also Osteoporosis
instrumented procedures and, 42–43, 43f
measurement gold standard, 68–69
Bone morphogenetic proteins (BMPs), 308–309, 384–385, 444
Breema, 116
C
Calcitonin, osteoporosis and, 72
Calcium supplementation, 71
Carcinogenicity, 462
CD Horizon Legacy Peek Rod SystemÔ, 378, 379f
Cements
Kiva system and, 241, 242f
types of, 239
Cervical microendoscopic decompression of stenosis (CMEDS)
advantages/disadvantages, 153b
clinical presentation/evaluation, 151, 152f
complications/avoidance, 153
devices description, 151
discussion, 153
indications/contraindications, 151
introduction, 151
operative techniques, 151–153, 153f
Cervical spineAcute traumatic central cord syndrome;
Chordoma, cervical; Fusion, stenosis without deformity;
Infections, cervical spine; Kyphosis, cervical; Myelopathy,
cervical; Occipital-cervical/upper cervical spine fractures;
Rheumatoid arthritis, cervical spine; Spondylosis, cervical;
Subaxial cervical/upper thoracic spine fractures; Surgery,
minimally invasive cervical spine; Tumors, cervical spine
anatomy, 10, 133–135, 164–165
atlas, 164
axis, 164
intervertebral disks, 133–135
joints, 134f, 135
ligaments, 134f, 135, 164
occipital bone, 164
osseous components, 133, 134f
vascular system, 134f, 135
vertebral artery, 165
biomechanics, 154–156
cervical motion/spinal cord, 154
degenerative processes, 154–156, 155f
inflammatory arthritides, 156
Chemodiscolysis, 457
Chordoma, cervical
en bloc resection/treatment
case example, 194
other therapies and, 194
stages, 194–195
imaging, 194, 195f–196f
overview, 194
CMEDS. See Cervical microendoscopic decompression of
stenosis
Cobalt-chrome, 460, 461t
CoflexÔ
device, 360, 361f
dynamic stabilization and, 374, 375f
as extension stopper, 360–361
results, 361
summary, 361
surgical technique, 361
uses of, 360
Complementary alternative therapies
basic science, 117–119
attention and pain, 117
autonomic nervous system regulation, 117–118
clinical case example, 118b
discussion, 118–119
energy-based therapies, 116
mind-body therapies, 116–117
guided imagery, 117
mindfulness meditation, 116–117
spirituality/religiousness, 117
overview, 115, 115b, 119
Qi Gong, 116
clinical practice guidelines, 116
Tai Chi, 115–116, 116f
clinical practice guidelines, 116
Computed tomography (CT). See also Biomechanical
computed tomography
advantages of, 45
discussion, 49–50
facet arthropathy, 89–93, 89f–90f, 93f–94f
infections, cervical spine, 179
interpretation challenges of, 47
intervertebral disk degeneration, 88–89, 89f–90f
Congenital
anomalies, 6–7
defects of formation, 6–7
defects of segmentation, 7
hermimetameric pairing, 6, 7f
spina bifida, 7
disorders, 447–448
AS, 448
arthritis, 448
osteophytes, 448
medical history, 25
Conus medullaris development, 6
Corrosion, 461, 461f–462f
COX-2. See Cyclooxygenase inhibitors
Crosstrees Percutaneous Vertebral Augmentation (PVA)
advantages/disadvantages, 263b
contraindications, 260–261
absolute, 260–261, 261t
relative, 260–261, 261t
device description, 261, 261f
discussion, 263
indications, 260–261
relative, 260, 261t
operative technique, 262–263
anesthesia, 262
position, 262
surgical procedure, 262–263
overview, 260, 260b, 263
postoperative care, 263
procedure principles, 261–262
surgical procedure, 262–263
extrapedicular approach, 263
PMMA delivery, 263, 263t
transpedicular approach, 262–263
testing/clinical outcomes background, 262
CT. See Computed tomography
CyberKnifeÔ system
Accuray MultiplanÔ System for, 321, 323f
device description, 317–319, 319f
history leading to, 317
inception of, 317
lesions treatable with, 319t
Cyclooxygenase inhibitors (COX-2), 121, 122t
D
DDS. See Degenerative de novo scoliosis
DecompressionCervical microendoscopic decompression of stenosis;
Laser decompression; Microendoscopic decompressive
laminotomy; Ozone decompression; specific subject
Defects
of formation, 6–7
of segmentation, 7
Deformity correction, case study approach to
imaging evaluation, 344–345, 346f
indications for surgery, 345
natural history, 344
degenerative curves, 344
idiopathic curves, 344
overview, 344, 344b, 352
role of conservative management, 345
surgical planning, 346–347
decompression only, 347
deformity correction, 347
deformity role in clinical presentation, 347
surgical techniques, 347
anterior release/anterior-only, 347–348, 349f
extension of fusion to sacrum, 349–350, 350f–351f
extent of fusion, 348–349
osteotomies/spinal column shortening, 350–352,
352f
posterior instrumentation, 347, 348f
Degenerative cascade
natural history of
biochemical changes, 21
biomechanical changes, 21, 22f
clinical instability/diagnostic imaging, 23–24,
23f–24f
lumbar pathogenesis, 21
overview, 20, 20b, 24, 99
pain anatomy/mechanisms, 20–21
stages of instability, 21–23, 23t
rehabilitation, land based, and, 99
Degenerative de novo scoliosis (DDS), 84
Demineralized bone matrix, 385
Index
469
DIAMÔ implant
device, 362, 362f
dynamic stabilization and, 374, 375f
as dynamic/rigid stabilizer, 362–363
results, 362
summary, 362–363
surgical technique, 362, 362f
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
anatomy and, 14
fractures and, 174
Direct lateral interbody fusion (DLIF), 398, 398f–402f
Directed cement flow kyphoplasty. See Shield Kyphoplasty
System
DISH. See Diffuse Idiopathic Skeletal Hyperostosis
DiskArthroplasty, lumbar disk; Total disk replacement
biologics regarding, 386
cervical spondylosis artificial replacement, 145–147,
147f
Disk, intervertebral
anatomy, 11, 133–135, 419–420
cervical spine, 11
degeneration, 17, 17f, 419–420, 419f–420f
CT and, 88–89, 89f–90f
MRI and, 89, 90f–91f
radiography and, 88–89, 88f
histological changes, 16–17, 16f–17f
nutritional support, 12
overview, 419, 419b, 424
Disk disease, degenerative
causes, 420
congenital disorders, 447–448
AS, 448
arthritis, 448
osteophytes, 448
injections, 107–108
pain diagnosis, 107, 108t
therapeutic biological strategies, 420–424
therapeutic strategies
autologous implantation of cultivated/modified cells,
421f, 423
gene therapy approaches, 421f, 422
injection of biologically active factor, 420–422, 421f
MSCs implantation, 421f, 423–424
Diskectomy
micro vs. endoscopic, 428–429, 429t–430t
microendoscopic, 201, 202f, 203
microsurgical anterior cervical foramino, 202
percutaneous endoscopic, 201, 203
DLIF. See Direct lateral interbody fusion
Dorsal ramus, lumbar. See also Endoscopic rhizotomy
anatomy, 439–441
L1 to L4, 441
L5, 441
lateral branch, 441f
medial branch, 440f
spinal nerve, 441, 442f
transverse process, 440f
Doshas (humors), 34
DSS Spine Stabilization SystemÔ, 379, 379f
Dual-energy x-ray absorptiometry (DXA)
as assessment tool, 42
discussion regarding, 49–50
drawbacks of, 45
mechanical strength and, 43
DXA. See Dual-energy x-ray absorptiometry
DynaboltÔ, 379
Dynamic rods. See Pedicle based dynamic rods
Dynamic stabilization. See also Interspinous spacers
clinical application, 379–380
canal, 380
facet, 379–380
ligament, 379
osteopenia, 380
devices, 374–379
facet, 375–377
interspinous spacers, 374–375
pedicle based dynamic rods, 377–379
facet devices, 375–377
AFRSÔ, 376, 377f
FenixÔ, 376, 377f
introduction, 375–376
TFASÔ, 376, 377f
TOPSÔ, 377, 378f
ZyreÔ, 376, 376f
interspinous spacers, 374–375
CoflexÔ, 374, 375f
Dynamic stabilization (Continued)
DIAMÔ, 374, 375f
ExtenSureÔ, 374–375, 376f
introduction, 374
, 375, 376f
In SpaceÔ
SuperionÔ, 375, 376f
WallisÔ, 374, 375f
X-StopÔ, 374, 375f
overview, 374, 374b, 380
pedicle based dynamic rods, 377–379
CD Horizon Legacy Peek Rod SystemÔ, 378,
379f
DSS Spine Stabilization SystemÔ, 379, 379f
DynaboltÔ, 379
Dynamic TTL-RodÔ, 378, 379f
DynesysÔ, 377–378, 378f
introduction, 377
N-HanceÔ, 377, 378f
Stabilimax NZÔ, 377, 378f
Dynamic TTL-RodÔ, 378, 379f
DynesysÔ, 377–378, 378f
E
Eastern perspectives, on medicine/psychology,
33
Economics
back pain
baby boomers and, 444
BMPs and, 444
cervical spine and, 444–445
in changing population, 444–445
cost of devices and, 444
cost-effectiveness of surgery, 444
osteoporosis and, 445
TDR and, 444
work absenteeism and, 445
compensation and, 445
cost effectiveness and, 445
future regarding, 445–446
introduction, 443
medical tourism and, 445
overview of healthcare and, 443
overview of spine care and, 443–444
Embryology of spine
associated anomalies, 6
congenital anomalies, 6–7
defects of formation, 6–7
defects of segmentation, 7
hermimetameric pairing, 6, 7f
spina bifida, 7
gastrulation, 3–4, 3f–4f
neural development, 5–6
overview, 3, 3b, 7–8
sacrum/conus medullaris development, 6
somite period, 4–5, 4f
ossification in, 5
upper cervical spine, 5
Endoscopic rhizotomy
advantages/disadvantages, 439b
clinical presentation/evaluation, 438
complications/avoidance, 439
device description, 437, 437f
discussion, 439–441
indications/contraindications, 435–437
ideal indications, 435–436
poor indications, 436–437
relative indications, 436
operative technique, 438, 439f
position, 438
procedure, 438, 439f
overview, 435, 435b, 439–441, 441b
postoperative care, 438
scientific testing/clinical outcomes, 437–438
study inclusion criteria, 437–438, 438t
study results, 437–438, 438t
Endoscopic surgical pain management
advantages/disadvantages, 434b
cadaver microdissection and, 427–428, 428f
clinical presentation/evaluation, 431
complications/avoidance, 433–434
device description, 428, 429f
discussion, 434
fusion and, 427
indications/contraindications, 428
Endoscopic surgical pain management (Continued)
operative techniques, 431–433
anesthesia, 431
position, 431
procedure, 431–433
overview, 427–428, 427b, 434
postoperative care, 433
scientific testing/clinical outcomes, 428–431
micro vs. endoscopic diskectomy, 428–429,
429t–430t
range of conditions and, 429–431
Energy-based therapies, 116
Ependymomas, 188–189
Epidural steroid injection, 105–106
Estrogen, osteoporosis and, 71
Etiologies, spinal, 447–448
deformity, 448
degenerative disk/congenital disorders, 447–448
AS, 448
arthritis, 448
osteophytes, 448
osteoporosis, 448
spinal stenosis, 448
tumors, 448
Exercises
abdominal strengthening, 100–101, 100f–101f
back/buttock, 101, 101f
core stabilization, 100–102
extension-based, 100
flexion-based, 100
role of, 28–29, 28b
Tai Chi vs. other, 115
trunk/full body, 101, 101f–102f
Yoga, 127–128, 128t
ExtenSureÔ, 374–375, 376f
eXtreme Lateral Interbody Fusion (XLIF)
advantages of, 408
clinical study, 408, 409f–410f
complications/avoidance, 410, 412f
indications/contraindications, 408
overview, 408, 408b, 410
postoperative care, 409
preoperative assessment/planning, 408–409
incision/retroperitoneal access, 408, 411f
operative technique, 408–409, 411f
patient positioning, 408, 411f
transpsoas access, 408–409, 411f
F
Facet joint
arthroplasty contraindication and, 370
histological changes, 18–19, 18f–19f
injections
complications, 106
conflicting results, 106
diagnostic, 106
procedures, 106–107
summary of literature support, 107t
pain, referred, 106
pain diagnosis, 106
FacetsAnatomic Facet Replacement SystemÔ; Arthropathy,
facet; Dynamic stabilization; Total Facet Arthroplasty
SystemÔ
fusion and, 85
nondegenerative, 369
FenixÔ, 376, 377f
Finite element analysis, 45, 47–48
Five Great Gross Elements, 34
Flavocoxid (Limbrel), 121
Fluoroscopy
dynamic images and, 57
Vessel-X, 277, 279f
Foraminodiskectomy, microsurgical anterior cervical, 202
Foraminotomy, 86. See also Anterior cervical microforami-
notomy
Fracture Risk Assessment Tool (FRAX), 70–71, 71t
FracturesOccipital-cervical/upper cervical spine fractures;
Subaxial cervical/upper thoracic spine fractures;
oracic vertebral fractures, treatment of; Vertebral
body compression fractures
AS and, 170–174
acuity, 217
DISH and, 174
osteoporosis and, 70–71, 71t
470
Index
FracturesOccipital-cervical (Continued)
pathologic, 414f, 415–417, 416f
risk assessment tool, 70–71, 71t
risk in postmenopausal women, 49
FRAX. See Fracture Risk Assessment Tool
Functional diagnostics
new biomechanics insights, 59–60
overview of, 51, 51b
suggestions for clinical use of, 60
current standard of care and, 60, 61t
recently-developed methods and0, 51, 61t
technical advances regarding, 57–59
fluoroscopy, 57
IVA observer-related variability, 57
IVA subject-related variability, 57–58
OSMIA system, 58–59, 58f–59f
testing method, current state of, 51–57
implications for practitioner of, 55–57
IVA measurement variability, 54–55
normative IVA data and, 54, 55t–56t
RoM measurement variability, 53–54, 54f
RoM measurements, 51–53, 52f–53f
FusionGuided lumbar interbody fusion; Pelvic fixation;
Stenosis with spondylolisthesis, spinal
ALIF, 398, 402f
bisphosphonates and, 73
DLIF, 398, 398f–402f
endoscopic surgical pain management and, 427
occipitocervical, 166–167, 166f
osteoarthritis and, 77
scoliosis, 84, 348–350, 350f–351f
TLIF, 402, 402f
XLIF
advantages of, 408
clinical study, 408, 409f–410f
complications/avoidance, 410, 412f
incision/retroperitoneal access, 408, 411f
indications/contraindications, 408
operative technique, 408–409, 411f
overview, 408, 408b, 410
patient positioning, 408, 411f
postoperative care, 409
preoperative assessment/planning, 408–409
transpsoas access, 408–409, 411f
Fusion, stenosis with deformity
adult scoliosis classification, 337
Aebi, 337, 338f–340f, 340t
idiopathic adolescent, 337
primary degenerative, 337
Schwab, 337, 338f–340f, 340t
secondary adult curves, 337
complex of symptoms, 336–337
activity-related limitations, 337
back pain, 337
deformity-related issues, 337
neurologic pain, 336–337
definition of stenotic degenerative disease in deformity, 336
extension of fusion to sacrum, 349–350, 350f–351f
goals of treatment, 338–340, 341t
levels, principles for selecting, 341
nonsurgical/surgical management considerations, 337–338
operative treatment
guidelines/principles, 342t
of lumbar scoliosis, 341, 341f–342f, 348–349
overview, 336, 336b, 342
pathoanatomic changes, 336
pedicle screw fixation, 341
surgery complication rate, 339f, 341
surgical
decompression outcomes, 340
procedures, 340
Fusion, stenosis with spondylolisthesis options, 84–85
decompression/instrumented posterolateral fusion, 85
decompression/noninstrumented posterolateral fusion, 84–85
facet fusion, 85
fusion with biologics, 85
fusion with transforaminal lumbar interbody graft, 85
Fusion, stenosis without deformity
cervical
basic science, 329
case study, 330b
clinical practice guidelines, 331–332
imaging, 330f–331f
lumbar
basic science, 333
case study, 334b
Fusion, stenosis without deformity (Continued)
clinical practice guidelines, 333–335
imaging, 334f–335f
overview, 329–335, 329b
thoracic
basic science, 332
case study, 332b
clinical practice guidelines, 332–333
imaging, 332f–333f
G
Gastrulation, 3–4, 3f–4f
Gene therapy approaches, 421f, 422
Genetics
gene therapy approaches, 421f, 422
as premature aging factor, 65–66
GLIF. See Guided lumbar interbody fusion
Graft
BMP and, 308–309
types, 308–309
Guided imagery, 117
Guided lumbar interbody fusion (GLIF)
advantages/disadvantages, 455b
clinical presentation/evaluation, 453
complications/avoidance, 454–455
device description, 452, 453f
discussion, 455–456
indications/contraindications, 452
operative technique, 453–454, 453f–454f
overview, 452, 452b, 455–456
postoperative care, 454
scientific testing/clinical outcomes, 452–453
H
Hemangioblastomas, 189
Hermimetameric pairing, 6, 7f
Histological changes
facet joint, 18–19, 18f–19f
intervertebral disk, 16–17, 16f–17f
muscle/ligament, 19
overview of, 16, 16b, 19
vertebral body, 17–18, 17f–18f
History
Ayurveda, 34
CyberKnifeÔ system, 317
hydrogels, 464
neurological, 25–26
origin of pain, 25
overview of, 25, 25b
past medical, 25
comorbidities, 25
congenital/familial/genetic, 25
occupational/environmental/psychological, 25
pelvic fixation, 413
radiosurgery, 317
surgical, 26
TDR, 366
vertebroplasty, 214
HPANs. See Hydrolyzed pan hydrogels
HTJJ pointsHua Tuo Jia Ji points
Hua Tuo Jia Ji (HTJJ) points, 112, 112f
Hydrogels, 463–464
development/history, 464
synthetic, 463–464
Hydrolyzed pan hydrogels (HPANs), 464
Hypersensitivity, 462
I
IDEMIntradural extramedullary tumors
Idiopathic adolescent scoliosis, 337
Iliac crest bone graft, 384
ImagingBiomechanical computed tomography; Computed
tomography; Fluoroscopy; Magnetic Resonance Imaging;
Objective Spinal Motion Imaging Assessment; Radiography;
specific subject
Implant. See also Interspinous spacers
OsseoFix device
implant deployment comparison chart, 233t
implant insertion/deployment, 237f
Shield Kyphoplasty System device, 243–244, 244f
Implants, biochemistry of
biologics, 464–465
bone graft, 464–465, 465t
historical background, 459
tissue response to biomaterials, 459, 460t
hydrogels, 463–464
development/history, 464
synthetic, 463–464
metals, 459–462, 461t
in body fluids, 461
carcinogenicity, 462
cobalt-chrome, 460, 461t
corrosion, 461, 461f–462f
hypersensitivity, 462
mutagenesis, 461–462
stainless steel, 460, 461t
tantalum, 460–461, 461t
titanium, 460, 461t
overview, 459b, 465
polymers, 462–463
implant performance/failure, 463
PEEK, 463
PLA/PGA, 463
UHMWPE, 463
IMSCT. See Intramedullary spinal cord tumors
Infections, cervical spine
basic science, 178
clinical case example, 180f, 180b
clinical practice guidelines, 178–180
clinical presentation, 178–179
laboratory/imaging studies, 179
risk factors, 178
treatment, 179–180
CT and, 179
discussion, 180
most common, 178
MRI and, 179
overview, 178, 178b, 180
radiography and, 179
routes, 178
types of, 178
Infections, spine
as arthroplasty contraindication, 370
classification of, 301
improved management of, 301
increase in, 301
osteomyelitis, 301, 302f
overview of, 301
tuberculosis, 301, 303, 303f
Infections, thoracic spine
clinical presentation, 303
osteomyelitis, 303
tuberculosis, 303
diagnostic evaluation, 303–304
imaging, 303–304
management, 304–309
anterior approach, 305–306, 307f
anterior approach with anterior fixation, 306
graft type, 308–309
indications for surgical intervention, 304
medical therapy, 304
minimally-invasive surgery, 309
percutaneous technology, 309, 310f
posterior approach, 305, 305f–306f
single-stage anterior/posterior procedure, 306–307
surgery, 304–309
two-staged anterior/posterior procedure,
307–308
use of instrumentation, 308
overview, 301, 301b, 310–311
pathophysiology, 301–303
bacterial pathogenesis, 302–303, 302f
risk factors, 301
tuberculosis pathogenesis, 303, 303f
prognosis, 309–310
improvement of, 309
neurologic recovery, 309
pain, 309–310
Injections, spinal
epidural steroid, 105–106
approaches summarized, 106t
facet joint procedures, 106–107
summary of literature support, 107t
overview, 105, 105b, 108
sacroiliac joint procedures, 107
specific degenerative conditions, 107–108
Index
471
Injections, spinal (Continued)
disk disease, 107–108
lumbar spondylolisthesis, 108
spinal stenosis, 108
Innervation of spine, 12
InSpaceÔ, 375, 376f
benefits of, 358–359
device, 358–360, 359f
as extension stopper, 358–361
indications, 358–359
results, 359
summary, 359–360
surgical technique, 359, 359f–360f
Interlaminar fenestration, 86
Interspinous spacers, 374–375
dynamic/rigid stabilizers, 361–364
DIAMÔ implant, 362–363, 362f, 374, 375f
purpose of, 361–362
WallisÔ implant, 363–364, 363f, 374, 375f
extension stoppers, 358–361
CoflexÔ, 360–361, 361f, 374, 375f
InSpaceÔ, 358–361, 359f
other types, 360–361, 360f
X-StopÔ, 358, 359f, 374, 375f
how they work, 358
other, 364, 364f
overview, 358, 358b, 364
results
CoflexÔ, 361
DIAMÔ implant, 362
InSpaceÔ, 359
WallisÔ implant, 363
X-StopÔ, 358
summary
CoflexÔ, 361
DIAMÔ implant, 362–363
InSpaceÔ, 359–360
WallisÔ implant, 363–364
X-StopÔ, 358
surgical technique
CoflexÔ, 361
DIAMÔ implant, 362, 362f
InSpaceÔ, 359, 359f–360f
WallisÔ implant, 363, 363f
X-StopÔ, 358, 359f
Intervertebral angle (IVA)
low variation in, 59, 59t
measurement variability, 54–55
normal motion detection using, 54, 55t–56t
observer-related variability reduction, 57
subject-related variability reduction, 57–58
Intervertebral foramen, 12
Intradural extramedullary (IDEM) tumorsTumors, cervical
spine; Tumors, thoracic spine
Intramedullary spinal cord tumors (IMSCT)Tumors, cervical
spine; Tumors, thoracic spine
IVA. See Intervertebral angle
K
Kapha (water humor), 34
Kiva system
clinical presentation/evaluation, 240
material/methods, 240
coil, 240f
complications/avoidance, 241
contraindications, 239
device description, 240
discussion, 241–242
distraction sleeve deployment, 241, 241f
handle, 240f
indications, 239
overview, 239, 239b, 241–242
PMMA bone cement injection, 241, 242f
postoperative care, 241
precautions, 239–240
results, 240
KyphoplastyRadiofrequency kyphoplasty; Shield Kyphoplasty
System; StaXx FX Structural Kyphoplasty System
advantages/disadvantages, 212b
brief description, 207
clinical presentation/evaluation, 208, 209f
complications/avoidance, 210–212
device description, 208
discussion, 212
KyphoplastyRadiofrequency kyphoplasty (Continued)
indications/contraindications, 207–208
operative technique, 209–210, 210f–211f
OsseoFix device compared with, 232–235
overview, 207, 207b, 212
pitfalls of, 237–238
postoperative care, 210
scientific testing/clinical outcomes background,
208
thoracic vertebral fractures and, 284f, 284b
vertebral body stenting compared with, 219f
vertebroplasty compared with, 253–254
Kyphosis
anatomy and, 14
etiology, 448
Kyphosis, cervical
biomechanics and, 154–156
cervical motion/spinal cord, 154
degenerative processes, 154–156, 155f
inflammatory arthritides, 156
clinical case example, 155f, 155b
treatment/clinical challenges, 158b, 158f
discussion, 158–159
management, 156–158
imaging, 157
patient assessment, 156–157
surgical approach, 157–158, 157f
surgical complications, 158
surgical decision-making, 157
overview, 154, 154b, 158–159
L
Laminectomy, 85
Laminoplasty, restorative, 86
Laminotomy, 86, 389. See also Microendoscopic
decompressive laminotomy
Laser decompression
overview, 457–458, 457b
treatment, 457
Ligament. See also Ligamentum flavum
anatomy, 11–12, 134f, 135, 164
dynamic stabilization and, 379
histological changes, 19
injuries, 165
Ligamentum flavum
hypertrophy, 79
OLF
Asians and, 312
pathology, 312
as stenosis cause, 312, 313f
Limbrel, 121
LSS. See Lumbar spinal stenosis
Lumbar spinal stenosis (LSS)
MISS clinical outcomes/complications, 393–394
MISS emerging technologies, 394–395, 395f
MISS technique advances for, 389
MISS technique steps, 390–393
anesthesia, 390
METRxÔ, 390, 391f
set-up, 390, 390f
MISS techniques, indications for use of, 389–393
overview, 388, 388b
pathophysiology, 388
postoperative management, 393
treatment options/guidelines, 388–389
Lumbar spineArthroplasty, lumbar disk; Biologics; Biologics,
intradiskal; Dynamic stabilization; eXtreme Lateral
Interbody Fusion; Fusion, stenosis with deformity;
Fusion, stenosis without deformity; Interspinous spac-
ers; Minimally invasive scoliosis treatment; Minimally
invasive spinal surgical techniques, lumbar spine; Pedicle
screw fixation; Pelvic fixation; Scoliosis
degenerative cascade and, 21
M
Magnetic Resonance Imaging (MRI)
ATCCS, 162
facet arthropathy, 89–93, 91f, 93f–94f
40-year-old men/women and, 44
infections, cervical spine, 179
intervertebral disk degeneration, 89, 90f–91f
RA, cervical spine, 183
Magnetic Resonance Imaging (MRI) (Continued)
stenosis, 93–95, 94f–95f
vertebral marrow changes/osteophyte formation, 89, 92f
Marrow changes, 89, 92f
Medical tourism, 445
MEDL. See Microendoscopic decompressive laminotomy
Meningiomas, 191–192
MESCC. See Metastatic epidural spinal cord compression
Mesenchymal stem cells (MSCs) implantation, 421f,
423–424
Metals, 459–462
allergy, 371
in body fluids, 461
carcinogenicity, 462
corrosion, 461, 461f–462f
hypersensitivity, 462
mutagenesis, 461–462
types of, 460–461, 461t
cobalt-chrome, 460, 461t
stainless steel, 460, 461t
tantalum, 460–461, 461t
titanium, 460, 461t
Metastatic epidural spinal cord compression (MESCC),
288
Metastatic tumors, 288
cervical spine, 193–194
SRS treatment of, 321–322, 324t
METRxÔ, 390, 391f
Microendoscopic decompressive laminotomy (MEDL)
clinical outcomes/complications, 393–394
indications for use of, 389–393
introduction to, 389
surgical techniques, 390–393
Microendoscopic diskectomy, 201, 202f, 203
Micro/nanotechnology
aging spine and, 448–450
biosensors/biochips, 450, 450f–451f
drug delivery therapies, 448–449, 449f
nanocoatings, 449–450
smart polymer technologies, 449
etiologies, spinal, and, 447–448
deformity, 448
degenerative disk/congenital disorders, 447–448
osteoporosis, 448
spinal stenosis, 448
tumors, 448
overview, 447
potential, 450–451
Microsurgical anterior cervical foraminodiskectomy, 202
Mindfulness meditation, 116–117
Minimally invasive scoliosis treatment
basic science, 396
case studies, 396b, 404b, 405f
clinical practice guidelines, 396–407
DLIF, 398, 398f–402f
iliac fixation, 402–407
percutaneous pedicle screw fixation, 402, 405f
posterior only approaches, 402
unilateral radiculopathy decompression, 397–398,
397f
discussion, 407
overview, 396, 396b, 407
Minimally invasive spinal surgical (MISS) techniques, lumbar
spine
advances in, 389
basic science, 396
clinical outcomes/complications, 393–394
emerging technologies, 394–395, 395f
indications for use of, 389–393
MEDL and, 389
overview, 388, 388b
postoperative management, 393
surgical techniques, 390–393
anesthesia, 390
METRxÔ, 390, 391f
set-up, 390, 390f
unilateral microscopic hemilaminotomy and, 389
MISS techniquesMinimally invasive scoliosis treatment;
Minimally invasive spinal surgical techniques, lumbar
spine
Modic classification
degenerative process significance of, 44
40-year-old men/women and, 44
of vertebral endplate change, 43–44
MRI. See Magnetic Resonance Imaging
MSCsMesenchymal stem cells implantation
472
Index
Muscle
anatomy, 12
histological changes, 19
relaxants, 124, 124t
Mutagenesis, 461–462
Myelopathy, cervical. See also Cervical microendoscopic
decompression of stenosis
causes, 150
common treatments, 150
overview, 150–151, 150b, 153
pathophysiology, 150
Ranawat grading scale for, 182t
symptoms, 150
N
Nanocoatings, 449–450
Nanotechnology. See Micro/nanotechnology
Narcotic analgesics, 121, 123t–124t
Nerve
decompression, 287
lumbar dorsal ramus and, 441, 442f
roots anatomy, 12
sheath tumors, 191
Neural development, 5–6
Neurofibromas, 288
N-HanceÔ, 377, 378f
Nonopioid agents, 120–121, 122t
acetaminophen, 120, 122t
aspirin, 121, 122t
COX-2, 121, 122t
flavocoxid, 121
NSAIDs, 120–121, 122t
Nonsteroidal antiinflammatory drugs (NSAIDs), 120–121,
122t
NSAIDs. See Nonsteroidal antiinflammatory drugs
Nutrition
role of, 28–29, 28b
support for anatomy, 12
O
OAD. See Occipitoatlantal dislocation
Obesity
as arthroplasty contraindication, 371
as premature aging factor, 65
role of, 28–29, 28b
Objective Spinal Motion Imaging Assessment (OSMIA),
58–59, 58f–59f
Occipital bone, 164
Occipital-cervical/upper cervical spine fractures
anatomy, 164–165
atlas, 164
axis, 164
ligaments, 164
occipital bone, 164
vertebral artery, 165
complications, 168–169
conservative management, 166
injuries of craniocervical junction, 165–166
C1 fractures/transverse ligament, 165
C2 fractures, 165–166, 165f
OAD, 165
occipital condyle fractures, 165
occipitocervical instability, 165
overview, 165
RA, 166
overview, 164, 164b, 169
surgical approaches/techniques, 166–168
C1-2 harms, 167–168
C1-2 transarticular screws, 168, 168f
C-2 laminar screws, 168, 168f–169f
occipitocervical fusion, 166–167, 166f
odontoid screw, 167, 167f
ventral vs. dorsal, 166
Occipitoatlantal dislocation (OAD), 165
Ojas (vital energy), 34
OLF. See Ossification of ligamentum flavum
Operative techniquesspecific disorder
OptiMesh
advantages/disadvantages, 267b
clinical presentation/evaluation, 266, 267f
complications/avoidance, 267–268
device description, 265–266
OptiMesh (Continued)
discussion, 268
indications/contraindications, 265
operative technique, 266–267, 267f
overview, 265, 265b, 268
postoperative care, 267
testing/clinical outcomes background, 266, 266f
OSMIA. See Objective Spinal Motion Imaging Assessment
OsseoFix device
biomechanical studies, 232–235, 233f–234f
conclusion, 235
kyphoplasty compared with, 232–235
results-study 1, 233, 235f
results-study 2, 234–235, 235t
clinical data, 235, 236f
description, 232–235, 233f
discussion, 236–237
implant deployment comparison chart, 233t
indications/contraindications, 232
operative technique steps, 235–237
access channel creation, 237f
cement delivery, 236–237
implant insertion/deployment, 237f
positioning, 235–237
overview, 232, 232b, 238
pitfalls/complications, 235–236
treatment alternatives, 236
Ossification, 5
Ossification of ligamentum flavum (OLF)
Asians and, 312
pathology, 312
as stenosis cause, 312, 313f
Osteoarthritis
basic science, 74–75
case example evaluations, 74
case 1: degenerative lumbar spondylolisthesis, 74, 75f
case 2: degenerative cervical spondylosis, 74, 75f
case 3: atlantoaxial instability, 74, 76f
case example treatments/challenges, 77–78
case 1: degenerative lumbar spondylolisthesis, 77–78, 78f
case 2: degenerative cervical spondylosis, 78
case 3: atlantoaxial instability, 78, 78f
clinical practice guidelines, 76–77
conservative therapy, 77
evaluation, 76–77
instrumented spinal fusion, 77
minimally invasive alternatives, 77
neurological decompression, 77
operative therapy, 77
degenerative mechanics, 76
discussion, 78
epidemiology/risk factors, 75
inflammation and, 75
natural history, 76
overview, 74, 74b, 78, 448
pathophysiology, 75
Osteomyelitis spinal
clinical presentation of, 303
overview, 301, 302f
Osteopenia
as arthroplasty contraindication, 370
dynamic stabilization and, 380
economics, 445
Osteophyte formation, 89, 92f, 448
Osteoporosis
alendronate/teriparatide comparison for treating, 48, 49f
antiresorptive agents, 71–72
bisphosphonates, 71t, 72
calcitonin, 72
estrogen, 71
SERMs, 72
as arthroplasty contraindication, 370
basic science
aging of spine, 46–47, 47f
BCT, 47–48, 48f
biomechanics of aging spine and, 42
bone remodeling/turnover and, 68
Crosstrees PVA and, 260
diagnosis, 68–69
classification, 69
measurement gold standard, 68–69
WHO-based criteria for, 68–69, 69t
dynamic stabilization and, 380
economics, 445
etiology, 448
evaluation, 69–71
Osteoporosis (Continued)
fall/fracture risk, 70–71, 71t
laboratory investigations, 70, 70t, 70f
screening, 69–70
for secondary, 69t, 70
fracture risk in postmenopausal women and, 49
future directions, 73
imaging modalities, 45
low/high turnover, 68
need for identification of, 45
overview, 68, 68b
pedicle screw fixation, 381–383
bone cement, 382
expandable screws, 383, 383f
screw placement, 381–382, 382f
transverse connectors, 382, 382f
undertapping screws, 382
pelvic fixation and, 415
primary, 69
risk factors, 69–70
scoliosis and, 356–357
secondary, 69–70, 69t
statistics on, 260
stenosis with spondylolisthesis and, 83–84
surgery complicated by, 45
treatment, 71–73
anabolic agents, 72–73
antiresorptive agents, 71–72
nonpharmacologic, 71
pharmacologic, 71–73
pharmacologic agents and spinal fusion, 73
as underdiagnosed/undertreated, 45
VBCFs and, 260
Osteotomies
scoliosis and, 350–352, 352f, 355
thoracic vertebral fracture and, 285b, 286f–287f
Ozone decompression
chemodiscolysis, 457
overview, 457–458, 457b
P
PainAnalgesics, oral, for chronic low back pain; Endoscopic
surgical pain management
anatomy/mechanisms, 20–21
aquatic physical therapy and, 103
attention and, 117
axial, 84
degenerative cascade and, 20–21
diagnosis, 107, 108t
economics
baby boomers and, 444
BMPs and, 444
cervical spine and, 444–445
in changing population, 444–445
cost of devices and, 444
cost-effectiveness of surgery, 444
osteoporosis and, 445
TDR and, 444
work absenteeism and, 445
facet joint, 106
fusion, stenosis with deformity, and, 336–337
infections, thoracic spine, and, 309–310
origin of, 25
scoliosis, 396
Shield Kyphoplasty System and, 247, 247f
Vessel-X and, 270–272, 272f
Pedicle based dynamic rods, 377–379
CD Horizon Legacy Peek Rod SystemÔ, 378, 379f
DSS Spine Stabilization SystemÔ, 379, 379f
DynaboltÔ, 379
Dynamic TTL-RodÔ, 378, 379f
DynesysÔ, 377–378, 378f
introduction, 377
N-HanceÔ, 377, 378f
Stabilimax NZÔ, 377, 378f
Pedicle screw fixation
fusion, stenosis with deformity, and, 341
minimally invasive treatment and, 396, 402
in osteoporotic spine, 381–383
bone cement, 382
expandable screws, 383, 383f
screw placement, 381–382, 382f
transverse connectors, 382, 382f
undertapping screws, 382
Index
473
Pedicle screw fixation (Continued)
overview, 381, 381b, 383
scoliosis and, 355, 398f, 402
screw size relationship, 381t
thoracic vertebral fractures and, 285b, 286f–287f
PEEK. See Polyether ether ketone
Pelvic fixation
basic science, 415
anatomy, 415
osteoporosis, 415
pivot point, 415, 415f
zones, sacropelvic, 415, 415f
case studies, 413b
pathologic fracture, 414f, 415–417, 416f
scoliosis, 413b, 414f, 415–417, 416f
clinical practice guidelines, 415
history of, 413
overview, 413–415, 413b, 417–418
screw placement, 417, 417f
treatment/future challenges, 415–417
Percutaneous cervical nucleoplasty, 200–202, 201f
Percutaneous endoscopic diskectomy, 201, 203
Percutaneous technology, 309, 310f. See also Crosstrees
Percutaneous Vertebral Augmentation
Percutaneous vertebral augmentation. See Crosstrees
Percutaneous Vertebral Augmentation
Physical examination
gait, 26
global balance, 26
neurological, 26
specific cervical neurological levels, 26–27
C5 neurological findings, 26
C6 neurological findings, 26
C7 neurological findings, 26
C8 neurological findings, 26
L2 to L4 neurological findings, 26–27
L4 neurological findings, 27
L5 neurological findings, 27
S1 neurological findings, 27
S2-4 neurological findings, 27
T1 neurological findings, 26
T12 to L3 neurological findings, 26
thoracic/abdominal neurological findings, 26
vascular, 27
Pitta (fire humor), 34
Pivot point, pelvic, 415, 415f
PLA/PGA. See Polylactic acid/polyglycolic acid
PMMA. See Polymethylmethacrylate
Polyether ether ketone (PEEK), 463
Polylactic acid/polyglycolic acid (PLA/PGA), 463
Polymers, 462–463
implant performance/failure, 463
PEEK, 463
PLA/PGA, 463
UHMWPE, 463
introduction, 462–463
PEEK, 463
PLA/PGA, 463
UHMWPE, 463
Polymethylmethacrylate (PMMA)
drawbacks of, 265
Kiva system and, 241, 242f
PVA delivery of, 263, 263t
Postmenopausal women, fracture risk in, 49
Premature aging
clinical relevance and, 66
discussion, 66
factors, 63–66
atherosclerosis, 64–65, 64f
biochemical, 63
biomechanical, 63
genetic, 65–66
lifestyle, 65
obesity, 65
smoking, 65
overview, 63, 63b
radiological changes/clinical symptoms and, 63, 64f
Primary degenerative scoliosis, 337
Primary malignant tumors, 194
Psychology
eastern perspectives on, 33
introduction/overview regarding, 30–31, 30b, 37
medical history and, 25
patients perspective and, 31
western perspectives on aging and, 31–32
PVA. See Crosstrees Percutaneous Vertebral Augmentation
Q
Qi Gong
autonomic nervous system regulation, 117–118
background of, 116
clinical practice guidelines, 116
as energy-based therapy, 116
R
RARheumatoid arthritis; Rheumatoid arthritis, cervical spine
Radiofrequency kyphoplasty
discussion, 251–252
materials/methods, 249–250
height restoration/intravertebral pressure evaluation,
249–250, 250f
StabiliT Vertebral Augmentation System, 249, 249f
overview, 248–249, 248b
results, 250
StabiliT system clinical experience, 251, 251f–252f
Radiography
infections, cervical spine, 179
intervertebral disk degeneration, 88–89, 88f
spondylolisthesis, 93, 94f
Radiosurgery. See also Stereotactic radiosurgery
history of, 317
types of, 317
Ranawat grading scale for myelopathy, 182t
Range of motion (RoM)
biomechanics of aging spine and, 41–42, 42f
measurement practitioner implications, 55–57
measurement variability, 53–54, 54f
measurements, 51–53, 52f–53f
Rehabilitation, land based
abdominal strengthening exercises, 100–101,
100f–101f
back/buttock exercises, 101, 101f
comorbidity influence on, 100
core stabilization exercises, 100–102
degenerative cascade and, 99
extension-based exercises, 100
flexion-based exercises, 100
focus, 99
overview, 99, 99b
pathophysiological basis for, 99–100
spinal stabilization physiologic factors, 100
trunk/full body exercises, 101, 101f–102f
Reiki, 116
Religiousness, 117
Rheumatoid arthritis (RA)
alendronate treatment for, 48–49, 49f
craniocervical manifestations of, 166
Rheumatoid arthritis (RA), cervical spine
case report, 186f, 186b–187b
clinical presentation, 182, 182t
cranial settling and, 182–183, 182f–184f, 185
CT, 183
epidemiology/natural history, 181
laboratory data, 182
management, 184–186
atlantoaxial subluxation, 185, 185f
cranial settling, 185
nonoperative, 184
operative, 185–186
preoperative assessment, 185
subaxial subluxation, 185–186
surgical indications, 184–185
MRI, 183
overview, 181, 181b, 186–187
pathophysiology, 181–182
radiographic analysis, 182–183
plain radiographs, 182–183, 183f–184f
RoM. See Range of motion
S
Sacroiliac joint injections, 107
Sacropelvic zones, 415, 415f
Sacrum
anatomy, 11
development, 6
extension of fusion to, 349–350, 350f–351f
Samprapti (pathogenesis), 34
Schwab scoliosis, 337, 338f–340f, 340t
Schwannomas
cervical spine, 192
thoracic spine, 288
SCI. See Spinal cord injuries
ScoliosisDegenerative de novo scoliosis; eXtreme Lateral
Interbody Fusion; Minimally invasive scoliosis treatment
anatomy and, 14
as arthroplasty contraindication, 370
classifications of adult, 337, 344
Aebi, 337, 338f–340f, 340t
idiopathic adolescent, 337
primary degenerative, 337
Schwab, 337, 338f–340f, 340t
secondary adult curves, 337
degenerative curves, 344
elderly patient
complications from surgery, 357
evaluation, 354
osteoporosis and, 356–357
outcomes of treatment, 357
surgery, 354–355
surgical techniques, 355–356
treatment, 354
etiology, 448
idiopathic curves, 344
imaging evaluation, 344–345, 346f
indications for surgery, 345
operative treatment of lumbar, 341, 341f–342f
overview, 354, 354b
pain, 396
pelvic fixation for, 413b, 415–417, 416f
prevalence of, 344
role of conservative management, 345
surgical planning, 346–347
decompression only, 347
deformity correction, 347
deformity role in clinical presentation, 347
surgical techniques, 347, 355–356
anterior access, 355
anterior release/anterior-only, 347–348, 349f
balance as goal of, 355
extension of fusion to sacrum, 349–350, 350f–351f
extent of fusion, 348–349
osteotomies, 350–352, 352f, 355
pedicle screws, 355
posterior approach, 355
posterior instrumentation, 347, 348f
supplemental iliac fixation, 355, 356f
Screw. See also Pedicle screw fixation
C1-2 transarticular, 168, 168f
C-2 laminar, 168, 168f–169f
odontoid, 167, 167f
placement, pelvic fixation, 417, 417f
Secondary adult curves, 337
Selective estrogen receptor modulators (SERMs), 72
SERMs. See Selective estrogen receptor modulators
Shield Kyphoplasty System
biomechanical testing, 244
cyclic loading, 244, 245f
failure load comparison, 244, 244f
clinical outcomes, 246–247
leakage rates/classification, 247, 247t
pain scores, 247, 247f
components, 243, 244f
contraindications, 244
description, 243–244
implant device, 243–244, 244f
indications, 244
overview, 243–244, 243b, 247
surgical technique, 246
cavity cutter, 246, 246f
cement injection, 246, 246f
channel cannula, 245f, 246
needle approach, 245f, 246
Smart polymer technologies, 449
Smoking, 65
Somite period, 4–5, 4f
Spina bifida, 7
Spinal cord injuries (SCI), 160, 160f. See also Acute traumatic
central cord syndrome
Spinal stenosis. See Stenosis, spinal
Spirituality, 117
Spondylolisthesis. See also Stenosis with spondylolisthesis,
spinal
age-related differences, 59–60
anatomy and, 14
474
Index
Spondylolisthesis (Continued)
arthroplasty contraindication and, 370
imaging, 93, 94f
injections for, 108
osteoarthritis and, 74, 75f, 77–78, 78f
Spondylolysis, 370
Spondylosis, cervical. See also Myelopathy, cervical
anterior surgical techniques, 139–142, 141f–144f
artificial disk replacement, 145–147, 147f
clinical presentation, 135–137
diagnostic modalities, 137
neurophysiology, 137
neuroradiology, 136f, 137
natural history of, 137–138
osteoarthritis and, 74, 75f, 78
overview, 133, 133b, 147–148
pathophysiology, 135, 136f
posterior surgical techniques, 138–139, 138f–140f
surgical complications, 144–145, 146f
surgical outcomes, 142–144, 145f
treatment/decision making, 138
SRS. See Stereotactic radiosurgery
Stabilimax NZÔ, 377, 378f
StabiliT Vertebral Augmentation System
clinical experience, 251, 251f–252f
discussion, 251–252
materials/methods, 249–250
height restoration/intravertebral pressure evaluation,
249–250, 250f
system description, 249, 249f
overview, 248–249, 248b
results, 250
Stainless steel, 460, 461t
StaXx FX Structural Kyphoplasty System
advantages/disadvantages, 259b
case studies, 258f, 258b–259b
clinical presentation/evaluation, 255, 255f
complications/avoidance, 258–259
device description, 254
discussion, 259
indications/contraindications, 254
introduction regarding, 253–254
operative technique, 256
anesthesia, 256
needle placement, 256, 256f–257f
position, 256, 256f
procedure, 256, 257f–258f
overview, 253b, 254, 259
testing/clinical outcomes background, 254–255
Stenosis, spinalCervical microendoscopic decompression
of stenosis; Fusion, stenosis with deformity; Fusion,
stenosis with spondylolisthesis options; Fusion, stenosis
without deformity; Lumbar spinal stenosis
anatomy and, 13
basic science, 79–80
lumbar spine, 79–80
pathogenesis, 79, 80t
pathomechanism of ligamentum flavum hypertrophy,
79
clinical case example, 79, 80f
clinical practice guidelines, 80
surgery, 80
discussion, 81
etiology, 448
injections for, 108
MRI, 93–95, 94f–95f
OLF as cause of, 312, 313f
overview, 79, 79b, 81
Stenosis, thoracic spinal
causes of, 312
clinical presentation, 313–314
diagnosis, 314
OLF and, 312
other causes, 315
neoplasms, 315
synovial cysts, 315
overview, 312, 312b, 316
pathology, 312–313
prognosis, 315–316
treatment, 314–315
Stenosis with spondylolisthesis, spinal
clinical decision making, 83–84
elderly and, 83
evaluation, 83
imaging studies, 83
indications for fusion, 84
Stenosis with spondylolisthesis, spinal (Continued)
multiple comorbidities, 83
nonfusion, 84
osteoporosis, 83–84
specific patient populations/situations, 83–84
fusion options, 84–85
decompression/instrumented posterolateral fusion,
85
decompression/noninstrumented posterolateral fusion,
84–85
facet fusion, 85
fusion with biologics, 85
fusion with transforaminal lumbar interbody graft, 85
indications for fusion, 84
axial pain, 84
concomitant de novo scoliosis, 84
lateral listhesis, 84
management, 84–86
fusion options, 84–85
nonfusion options, 85–86
nonsurgical, 84
surgical, 84–86
nonfusion options, 85–86
foraminotomy, 86
laminectomy, 85
laminotomy/interlaminar fenestration, 86
minimally invasive techniques, 86
motion-sparing technologies, 86
restorative laminoplasty, 86
overview, 82, 82b, 86–87
understanding, 82–83
epidemiology, 82
natural history, 82–83
pathophysiology, 82
Stereotactic radiosurgery (SRS)
clinical case examples, 317b–318b
case 1, 318f
case 2, 318f
complications, 323
categorization of, 323
neurological, 323
side effects, 323
contraindications, 319, 319t
history regarding, 317
indications, 319, 319t
lesions treatable with, 319t
overview, 317, 317b, 323
treatment
of intradural extramedullary lesions, 322
of intramedullary lesions, 322–323
of metastases, 320f, 321–322
treatment details, 319–321
imaging, 321, 321f–324f
implanted fiducials, 320f, 321
masks/cradles, 319, 320f
positioning, 321
types of, 317–319
Strength analysis, CT scan
basic science, 46–48
aging of spine, 46–47, 47f
BCT and, 45, 46f, 47–48, 48f
clinical case, 46b, 47t
clinical case examples, 48–49
alendronate treatment in rheumatoid arthritic patients,
48–49, 49f
alendronate/teriparatide comparison for osteoporosis
treatment, 48, 49f
fracture risk in postmenopausal women, 49
clinical practice guidelines, 48
discussion, 49–50
overview, 45–46, 45b
strength capacity and, 48
Subaxial cervical/upper thoracic spine fractures
AS and, 170–174
basic science, 170
biomechanics, 174–175
classification, 174–175, 175t
clinical case examples, 171b–172b, 176–177
clinical practice guidelines, 175–176
DISH, 174
instrumentation regarding, 175
overview, 170, 170b, 177
SuperionÔ, 375, 376f
SurgeryEndoscopic surgical pain management; Minimally invasive
spinal surgical techniques, lumbar spine; Radiosurgery;
Stereotactic radiosurgery; specific disorder; specific modality
Surgery, minimally invasive cervical spine
Anterior cervical microforaminotomy, 199–200
lower vertebral transcorporeal approach, 199–200
transuncal approach, 199
upper vertebral transcorporeal approach, 199
basic science, 198
case studies, 199f–200f, 199b
discussion, 201–203
microendoscopic diskectomy, 203
microsurgical anterior cervical foraminodiskectomy, 202
percutaneous cervical nucleoplasty, 202
percutaneous endoscopic diskectomy, 203
indications/preparation, 198
overview, 198, 198b, 203
radiological evaluation, 198–199
techniques, 199–201
anterior cervical microforaminotomy, 199–200
microendoscopic diskectomy, 201, 202f
percutaneous cervical nucleoplasty, 200–201, 201f
percutaneous endoscopic diskectomy, 201
Synovial cysts, thoracic spine, 315
Synthetic materials, 385
T
Tai Chi, 116f
attention and, 117
autonomic nervous system regulation and, 117
benefits of, 115–116
case discussion, 118–119
clinical case example, 118b
clinical practice guidelines, 116
other exercise compared with, 115
overview, 115, 115b
styles of, 115
Tantalum, 460–461, 461t
TCM. See Traditional Chinese medicine
TDR. See Total disk replacement
TFAS. See Total Facet Arthroplasty SystemÔ
erapeutic touch, 116
oracic spineCrosstrees Percutaneous Vertebral Augmenta-
tion; Fusion, stenosis without deformity; Infections,
thoracic spine; Kiva system; Kyphoplasty; OptiMesh;
OsseoFix device; Radiofrequency kyphoplasty; Shield
Kyphoplasty System; StaXx FX Structural Kyphoplasty
System; Stenosis, thoracic spinal; Stereotactic
radiosurgery; Subaxial cervical/upper thoracic spine
fractures; Tumors, thoracic spine; Vertebral body
stenting; Vertebroplasty; Vessel-X
anatomy, 10–11
basic science, 283
blood supply, 312
fusion, stenosis without deformity
basic science, 332
case study, 332b
clinical practice guidelines, 332–333
imaging, 332f–333f
injury vulnerability, 312–313
natural curvature of, 283
neurological deficits, 283
physical examination and, 26
rib cage and, 283
synovial cysts, 315
oracic spine osteoporotic surgical treatment modalities-
Vertebral body stenting; Vertebroplasty
oracic vertebral fractures, treatment of
basic science, 283
clinical case examples, 284–287
case 1: kyphoplasty, 284f, 284b
case 2: percutaneous instrumentation, 285f, 285b
case 3: pedicle subtraction osteotomy, 285b, 286f–287f
clinical practice guidelines, 283–287
deformity correction, 287
spinal cord/nerve decompression, 287
stable fractures, 283–287
thoracic stabilization, 287
discussion, 287
overview, 283, 283b, 287
oracoscopic spinal surgery, 309
Titanium, 460, 461t
TLIF. See Transforaminal lumbar interbody fusion
TOPS. See Total Posterior SystemÔ
Total disk replacement (TDR)
economics, 444
history, 366