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SpinalCordMedicine

AssociateEditors
EdwardC.Benzel,MD
EmeritusChairmanofNeurosurgery
ClevelandClinic,ClevelandOhio
StephenP.Burns,MD
Director,SpinalCordInjuryService
VAPugetSoundHealthCareSystem;
AssociateProfessor
DepartmentofRehabilitationMedicine
UniversityofWashington
Seattle,Washington
EdelleC.Field-Fote,PT,PhD,FAPTA
Director,SpinalCordInjuryResearchProgram,CrawfordResearchInstitute,
ShepherdCenter;
Professor,DivisionofPhysicalTherapy,DepartmentofRehabilitationMedicine,
EmoryUniversitySchoolofMedicine;
Professor,SchoolofBiologicalSciences,GeorgiaInstituteofTechnology
Atlanta,Georgia
PeterH.Gorman,MD,MS
AssociateProfessorandDivisionChief
DivisionofRehabilitationMedicine
DepartmentofNeurology
UniversityofMarylandSchoolofMedicine;

Chief,DivisionofRehabilitationMedicine
UniversityofMarylandRehabilitationandOrthopaedicInstitute
Baltimore,Maryland
SuzanneL.Groah,MD,MSPH
ChiefoftheParalysisRehabilitationandRecoveryProgramandDirectorofSCI
Research,MedStarNationalRehabilitationHospital;
ProfessorofRehabilitationMedicine,GeorgetownUniversityHospital
Washington,DC
SunilSabharwal,MD
ChiefofSpinalCordInjury
VABostonHealthCareSystem;
AssociateProfessorofPhysicalMedicineandRehabilitation
HarvardMedicalSchool
Boston,Massachusetts

SpinalCordMedicine
ThirdEdition
Editors
StevenKirshblum,MD
SeniorMedicalOfficerandDirectorofSpinalCordInjuryServices
KesslerInstituteforRehabilitation
WestOrange,NewJersey;
ProfessorandChair
DepartmentofPhysicalMedicineandRehabilitation
RutgersNewJerseyMedicalSchool
Newark,NewJersey;
ChiefMedicalOfficer
KesslerFoundation;
ChiefAcademicOfficer
SelectMedicalRehabilitationDivision
VernonW.Lin,MD,PhD
ProfessorandChief
DivisionofPhysicalMedicineandRehabilitation
DepartmentofNeurosurgery
UniversityofMississippiMedicalCenter;

MedicalDirector
MethodistRehabilitationCenter;
StaffPhysician
G.V.(Sonny)MontgomeryVAMedicalCenter
Jackson,Mississippi

Visitourwebsiteatwww.Springerpub.com
ISBN:9780826137746
ebookISBN:9780826137753
AcquisitionsEditor:BethBarry
Compositor:ExeterPremediaServicesPvtLtd.
Copyright©2019SpringerPublishingCompany.
DemosMedicalPublishingisanimprintofSpringerPublishingCompany,LLC.
All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording,orotherwise,withoutthepriorwrittenpermissionofthepublisher.
Medicine is an ever-changing science. Research and clinical experience are continually expanding our
knowledge,inparticularourunderstandingofpropertreatmentanddrugtherapy.Theauthors,editors,and
publisherhavemadeeveryefforttoensurethatallinformationinthisbookisinaccordancewiththestate
ofknowledgeatthetimeofproductionofthebook.Nevertheless,theauthors,editors,andpublisherarenot
responsible for errors or omissions, or for any consequences from application of the information in this
bookandmakenowarranty,expressedorimplied,withrespecttothecontentsofthepublication.Every
readershouldexaminecarefullythepackageinsertsaccompanyingeach drug and should carefully check
whetherthedosageschedulesmentionedthereinorthecontraindicationsstatedbythemanufacturerdiffer
fromthestatementsmadeinthisbook.Suchexaminationisparticularlyimportantwithdrugsthatareeither
rarelyusedorhavebeennewlyreleasedonthemarket.
LibraryofCongressCataloging-in-PublicationData
Names:Kirshblum,Steven,editor.|Lin,VernonW.,1959-editor.
Title:Spinalcordmedicine/editors,StevenKirshblum,VernonW.Lin.
Othertitles:Spinalcordmedicine(Kirshblum)
Description:Thirdedition.|NewYork:DemosMedicalPublishing,[2019]|Includesbibliographical
referencesandindex.
Identifiers:LCCN2018035149|ISBN9780826137746|ISBN9780826137753(ebook)
Subjects:|MESH:SpinalCordInjuries|SpinalCordDiseases
Classification:LCCRD594.3|NLMWL403|DDC617.4/82044—dc23
LCrecordavailableathttps://lccn.loc.gov/2018035149
Contactustoreceivediscountratesonbulkpurchases.
Wecanalsocustomizeourbookstomeetyourneeds.
Formoreinformationpleasecontact:sales@springerpub.com

PrintedintheUnitedStatesofAmerica.
1819202122/54321

TomymotherBeverlyandinmemoryofmyfatherJudah,whotogethertaught
methatwithoutcompassion,knowledgeisempty.
Tomygrandfather,RabbiMaxKirshblum,whoinstilledinmetheimportanceof
caringforothers,especiallythosewhoarenotbeingcaredfor.
Tomymentors,whohavegenerouslysharedtheirwisdom,andtheSCIfellows
andresidentsIhavehadthepleasureofbeinginvolvedintraining,whohave
trustedmetoguidetheirclinicalgrowth.Ihavelearnedsomuchfromallof
them.
TomycolleaguesatKesslerInstituteforRehabilitationandRutgersNewJersey
MedicalSchoolfortheirsteadfastsupport.
Tomypatients,whocontinuetoinspiremeandgivemeaningtomywork.
Mostimportantly,tomywifeAnnaandmychildrenAryehandSepha,Renaand
Jonathan,andMax,whotrulygivemeaningtomylife.
StevenKirshblum,MD
Tomyparents,Dr.HanchungGregoryandPeilanGraceLin,whodevotedtheir
healthcareerstothepreventionanderadicationoftuberculosisinTaiwan
(RepublicofChina).
Tomymaternalgrandmother,SarahMaoChao,whoreceivedthegospelof
JesusChristfromanAmericanmissionaryintheShanxiProvince,Chinainthe
1920s.
Tomywife,ChunyingGraceandmychildren,Jang-EnSarah,Jang-DerDaniel,
andJang-AiRebecca,whohavetaughtmethemeaningoflife.
Tomymentors,colleagues,andpatients,whohavealwaysinspiredmeto
innovate,collaborate,problemsolve,andprovidethebestcarepossibleforthe
preventionandtreatmentofdisablinghumanconditions.
VernonW.Lin,MD,PhD

Contents
Contributors
Preface
ShareSpinalCordMedicine,ThirdEdition
PARTI.INTRODUCTION
1. HistoryofSpinalCordMedicine
JohnF.Ditunno,Jr.,WilliamH.Donovan,andChristinaV.Oleson
2. Development,Anatomy,andFunctionoftheSpinalCord
HarryG.Goshgarian
3. PathologyoftheSpinalCord
RonaldC.KimandMariPerez-Rosendahl
4. EpidemiologyofSpinalCordInjury
YuyingChenandMichaelJ.DeVivo
5. NeurologicalAssessmentandClassificationofSpinalCordInjury
StevenKirshblumandRyanSolinsky
6. ImagingoftheSpinalCord
RolandR.LeeandBlaineL.Hart
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