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Ta b l e 2 6 . 1 Ra d io g r a p h ic n d in g s
Ty p e N o t e s
26 Seronegative Spondyloarthropathies 311
Sacro iliit is e ro sio n
(Fig. 26.2)
– Reactive bone and fusion of the joint (on the lower portion
of iliac side rst)
– Bilateral and symmetric
– Magnetic resonance imaging is more sensitive than plain
lm radiographs to detect in ammatory changes in the
sacroiliac joint
Spin e – Synd e sm op hyt e fo rm at io n fro m t he m argin s o f t he
ve rt ebra l bo d ies (“bam b o o sp ine ”) (Fig. 26.3)
– Vertical paravertebral ossi cation
– Erosion of the vertebrae (“squaring of the vertebral body”)
– Osteoporosis, disk and apophyseal joint narrowing
Occult fractures – Occur with minim al traum a
– Lumbar spine and lower cervical spine are the most
comm on sites of fracture
– Plain radiographs can be di cult to interpret
– Computed tomography can be hard to interpret because
of the di culty in obtaining true axial cuts
– Magnetic resonance imaging is the most reliable test for
occult fractures and hematoma evaluation
(2) Corticosteroids (short courses with tapering dose).
(a) System ic.
(b) Topical drops (uveitis).
(3) Disease-m odifying medications.
(a) Sulfasalazine (most bene cial).
(b) Meth otrexate.
(4) Tum or necrosis factor alpha (TNF-α ) inhibitors.
(a) Adalim umab and etanercept.
(b) Never rst-line treatm ent.
(5) Bisphosphonates.
2. Surgical management.
a. Indications.
(1) Flexion deform ity associated with pain and neurological com prom ise.
(2) Loss of horizontal gaze (e.g., chin on chest deform ity).
(3) Unstable spine fractures.
b. Spinal deform ity in ankylosing spondylitis.
(1) Loss of lumbar lordosis and thoracic kyphosis.
(2) Primary location of disabling deform ity should be assessed.
312
26 Seronegative Spondyloarthropathies
(3) Osteotom ies:
(a) Cervical.
i. Osteotomy at C7–T1 junction w ith lam inectom y from C6 to T2
is considered for prim ary cer vical kyphosis.
(b) Thoracic.
i. In severe kyp h otic thoracic deform ity, m ultiple posterior
thoracic resection osteotomies can be done after anterior
osteotom ies.
ii. Costot ransverse osteotom ies.
iii. Thoracic kyphosis can often be ad dressed via a lum bar
osteotomy.
(c) Lum bar.
i. Osteotom ies are perform ed typically bet ween L2 and L4.
• Ped icle subt ract ion (closing w edge) osteotom y (CWO).
• Mod i ed Sm ith –Petersen (open in g w edge) osteotom y
(OWO) (Fig. 26.4).
ii. OWO versus CWO:
• No d i eren ce in p ost op erat ive p ain scores.
• Sim ilar rad iograp h ic ou tcom es.
▫ Sagittal vertical axis.
▫ Lumbar lordosis.
▫ Global kyphosis.
• Com p licat ions.
▫ Greater blood loss with CWO.
III. React ive a rt h r it is.
A. Ep id e m io lo g y.
1. Males > females.
2. More common in Caucasians.
3. Associated organisms.
a. Ch la m y d ia .
b. Ca m p y l o b a c t e r.
c. Yersin ia .
d. Sh igella .
e. Salm on ella.
B. Cli n ica l p re s e n t a t i o n .
▫ No signi cant di erences in other complications (e.g.,
durotomies, ileus, infections, neurological injuries).
1. Classic clinical triad.
a. Urethritis.
(1) Balanitis circinata (painless ulcer in the glans penis).
b. Conjunctivitis.
(1) Iritis.
(2) Uveitis.
(3) Episcleritis.
(4) Corneal ulceration.
26 Seronegative Spondyloarthropathies 313
a
b
Fi g . 2 6 . 4 ( a ) The closing wedge pedicle subtraction and (b) the opening wedge Smith–Petersen
osteotomy procedures.
314
26 Seronegative Spondyloarthropathies
c. Polyarthritis.
(1) Asym m etric.
(2) Appears 2 to 4 weeks after infectious event.
(3) Lower extrem ities > upper extrem ities.
(a) Rare hip involvem ent.
(4) Enthesitis (in am m ation of the connective tissue between a tendon
or ligament and bone).
(a) Achilles tendon.
(5) Lower back pain.
(a) Sacroiliitis (3–10% progress to ankylosing spondylitis).
C. Lab or at or y n d in gs .
1. Elevated ESR.
2. RF (−) and ANA (−).
3. Chronic anemia.
4. HLA-B27 (+) (> 90%).
D. Radiogr ap h ic n dings.
1. Periostitis in the heel and toes.
2. Sacroiliitis (unilateral).
3. Nonmarginal asymmetric syndesmophytes (large and bulky).
IV. Psor iatic art h rit is.
A. Ep id em io lo g y.
1. A ects 5 to 7% of patients with psoriasis.
2. A ects 0.1% of the general population.
3. Male = female.
4. Onset ranges between the third and sixth decade.
5. More common in Caucasians.
B. Cli n ica l n d in gs .
1. Arthritis (precedes skin lesions in 15% of cases).
a. Spine sti ness > 30 minutes.
b. Oligoarticular and monoarticular.
(1) Asym m etric.
(2) Distal interphalangeal (DIP) involvement.
c. Enthesitis.
d. Sacroiliitis.
2. Skin lesions.
a. Balanitis circinata.
b. Oral ulcers.
c. Keratoderma blennorrhagica.
3. Key features.
a. Nail pitting.
b. Sausage-shaped digits.
C. Lab or at or y n d in gs .
1. Elevated ESR and CRP.
2. HLA-B27 (+) (20%).
D. Rad iograp h ic nd in gs.
1. Asymmetric sacroiliitis (autofusion).
2. Bony erosion.
3. Syndesmophyte formation (bamboo spine).
E. Tr e at m en t .
1. Physical therapy.
a. Range of motion exercises.
2. Medications.
a. NSAIDs.
(1) Aspirin, indom ethacin, or naproxen.
b. Second-line.
26 Seronegative Spondyloarthropathies 315
(1) TNF-α inhibitors (in ixim ab).
(2) Methotrexate.
V. E n t e r o p a t h i c a r t h r i t i s ( i n a m m a t o r y b o w e l d i s e a s e ) .
A. Ep id em io lo g y.
1. Males > females.
2. Associated with patients with Crohn’s disease and ulcerative colitis (10–20%).
B. Clin ica l n d in g s .
1. Arthritis.
a. Asymmetric.
b. Monoarticular or polyarticular.
(1) Large joints.
(a) Peripheral arthritis im proves with gastrointestinal improvem ent.
(2) Spine (sacroiliitis).
(a) Bilateral (similar to AS).
(b) Indepen d en t of bowel disease.
2. Extra-articular symptoms.
a. Erythema nodosa (Crohn’s).
b. Pyoderma gangrenosum (UC).
c. Oral ulcers.
d. Uveitis.
C. La b or at o r y n d in gs .
1. Chronic anemia.
2. Elevated ESR and CRP.
3. RF (−) and ANA (−).
4. Antineutrophil cytoplasmic antibodies (ANCA) (+) (60%).
5. Five percent HLA-B27 (+).
316
26 Seronegative Spondyloarthropathies
Sugg este d Reading
Rav in sk y RA, Ou ellet JA, Bro d t ED, De t to r i JR. Ver t e b r a l o st e o t o m ie s in a n k ylo sin g sp on -
dylitis—comparison of outcomes following closing wedge osteotomy versus opening wedge osteotom y: a system atic review. Evid Based Spine Care J 2013;4(1):
18–29
St e im a n AJ, Po p e JE, Th ie ss e n - Ph ilb r o o k H, e t a l. No n - b i o lo gic d i s e a se -m o d if y i n g a n t i-
rheum atic drugs (DMARDs) improve pain in in amm atory arthritis (IA): a systematic literature review of random ized controlled trials. Rheum atol Int 2013;33(5):
1105–1120
Via p ia n a O, Gat t i D, Id ola zz i L, e t a l. Bisp h osp h o n at es vs in ix im a b i n a n k y lo sin g sp on d y -
litis treat m e n t . Rh eu m atology (Oxford) 201 4;5 3(1):90–94
In d e x
Note: Page nu m ber s follow ed by f an d t in dicate gu res a nd t ab les, re sp ect ively.
A
abscess
– epidural, 286–287, 288f
– subdural, 288f
achondroplasia, 253, 259
adalimum ab, 311
Ad a m s fo r w a r d b e n d t e s t , 2 3 1
Ad s o n ’s t e s t , 5 4 , 5 6 f
adult scoliosis. See scoliosis, adult
All e n -Fe r gu s o n m e ch a n ist i c
classi cation , 132t
allografts, 107, 111–112
– vs autografts, 112f
Am e r ica n M e d ic al As so cia t io n ,
145–146
Am e r ica n Sp in e In ju r y As so cia t io n
(ASIA), 1 1 7, 1 1 9 f, 12 0 t , 13 4
An la t e ra l m a ss s cr ew o r ie n t a t io n ,
90f
anatomy
– cervical spine, 13–19
– coccyx, 21–24
– disk, 148–149
– radiographic, 57–66
– sacrum, 21–24
– spinal, 1–3
– thoracolumbar, 19–21
An d e r so n a n d D’Al o n zo
classi cation of od on toid
fract u re s, 127f
An d e r so n la t er a l m a ss s cr ew
orientation, 90f
anesthesia, e ects
on intraoperative
neuromonitoring, 82
aneurysmal bone cyst, 268t
angiography, 67, 266t
ankylosing spondylitis
(in am m at or y kyp h o sis ),
249–250, 253, 307–312
– clinical ndings, 308–309
– epidemiology, 307–308
– imaging, 307f, 309, 309f, 310f, 311t
– laboratory ndings, 309
– pathogenesis, 308
– surgical management, 311–312
– treatment, 310–312
annular tears, 177
annulus brosus, 99
anterior cervical corpectomy and
fusion , 162
anterior cervical diskectomy and
fusion (ACDF), 160–162
anterior cord syndrome, 8f
anterior fusion, 95
anterior horn cell disease (spinal
muscular atrophy), 246
anterior lumbar interbody fusion
(ALIF), 1 8 9t , 1 91 , 1 9 3f
anterior odontoid screws, 85, 88f
arthritis, enteropathic
(in am mat or y b ow el d isea se),
315
arthritis, psoriatic, 314–315
arthritis, reactive, 312, 314
arthroplasty, total disk, 194–195
arti cial disks, 162
astrocytoma, 271t
atlantoaxial impaction, 298–301
atlantoaxial instabilities, 259–260,
297–298
atlantoaxial joint, 83, 84f
atlantoaxial subluxation, 303–304f
atlantodens interval (ADI), 86t,
125, 252, 253f, 297–298, 301f,
303
atlas (C1) fracture, 126–127
autogenous bone graft, 285
autografts, 107, 111
– vs allografts, 112f
axial lumbar interbody fusion
(AxiaLIF), 19 4
B
Ba b in sk i’s sign , 5 0 f, 5 1 t , 1 5 6
balance, sagittal, 83
basilar invagination, 252–256,
298–301
Be evo r’s s ig n , 5 5 t
biomechanical measurements, 86t
biomechanics, 85–89
bisphosphonates, 311
bone cells, 104–105
bone formation, 105, 106f
bone grafts, 107–109. See also
speci c graft types
bone marrow aspirate and stem
cells, 111, 114–115
bone morphogenetic proteins
(BMP-2, BMP-7), 111, 113–114
– controversies, 114
– Infuse (BMP-2), 113
– OP-1 (BMP-7), 114
– Yale Open Data Access (YODA)
project, 114
bone repair and remodeling,
106–107
bone scintigraphy, 67, 69t
– lumbar degenerative disease,
178
– spinal infections, 285t
– tumors, 266t
bony arch components, posterior,
2t
Br ow n -Se qu a r d s yn d r om e , 8 f
Br ya n Di s c a r t i c a l d is k , 1 6 2
bulbocavernous re ex, 54f, 55
burst fractures, 94, 138f, 140
C
C1 ( at la s) f r ac t u r e, 1 2 6 – 12 7
C1 l a t e r al m a s s s cr ew / C2 p e d icl e
screw, 85, 87f, 88f
C1 –C2 s u bl u xa t io n , 1 2 5
C2 t r a n s la m in a r s cr ew , 8 5
cent ral cord synd rom e, 8f
cent ral sacral vertical line (CSVL),
230
ceram ics, 111 , 112–11 3
cerebral palsy, 239, 241 , 246
cervical degen erat ive disease,
154–165
– cervical disk arthroplasty (CDA),
162
– complications, 165
– di erential diagnosis, 158, 160t
– imaging, 156–157, 158f, 159f
– postop managem ent, 165
– surgical techniques, 159–165
–– anterior cervical corpectomy
and fusion, 162
–– anterior cervical diskectomy
and fusion (ACDF), 160–162
–– laminectomy and fusion with
inst rum en tat ion , 164–165
–– laminoforaminotomy, 162–163f
–– laminoplasty, 163–164f
– treatment, 158–159
cervical disk arth rop last y (CDA),
162
cervical fusion, 89, 90f
cervical kyp hosis, 263f
cervical orth osis, 89, 91f, 9 1t
317
318
In d e x
cervical spine
– surgical approaches
–– anterior, 25–38
––– anteromedial approach (de
An d ra d e a n d M a cn a b) , 2 9
––– retropharyngeal exposure
(McAfee), 29–30
––– transoral approach to C1–C2,
28–29
–– anterolateral retropharyngeal
approach (Whiteside and
Ke l l e y ) , 3 0
–– lateral approach (Verbiest), 30
–– posterior, 24–25
cervical spine trau m a, 122–133
– atlas (C1) fracture, 126–127
com p uted tom ography (CT), 58,
59f, 67, 68t, 75f
– ankylosing spondylitis, 309f
– cervical degenerative disease,
156–157
– chondrosarcoma, 278f
– fracture-dislocation of the
thoracolumbar spine, 139f
– giant cell tumor, 276f
– herniated disk, 167, 169f
– Je erson fracture, 261f
– lumbar degenerative disease,
178, 184, 185, 186f, 187f
– neuro broma, 275f
– osteoid osteoma, 274f
– rheumatoid arthritis, 297
disk herniation, 154t, 167, 167f,
175f
– thoracic, 167, 167f, 169f
disk regeneration, biologic, 153
disk replacement, total (TDR), 195
disk space collapse, 70f
disk space infections, 287–289
diskectomy
– microscopically assisted, 180t
– open, 180t
– percutaneous, 180t
diskography, 67, 69t, 75f
– lumbar degenerative disease,
178, 185–188
disks, arti cial, 162
dislocations
– C1–C2 subluxation, 125
– clay-shoveler’s fracture, 130
– hangman’s fracture, 128, 129f,
130t
– incidence, 122
– occipital condyle fractures, 124
– occiput–C1 dislocation, 124
– odontoid fractures, 127–128
– patient evaluation, 122, 123f
– soft tissue injury, 133
– subaxial cervical traum a, 128
– teardrop fractures, 130
– traction, 122–124f
– upper cervical injuries, 124–129
– wedge compression fractures,
130
– spinal cord injury, 119
– spinal infections, 285t
– spinal stenosis, 124f
– spondylosis, 124f
– tumors, 266t
congenit al atlan to-occipit al fusion ,
258
congenit al scoliosis. See scoliosis,
congenit al
cord syn drom es, 8f
cor tical can cellou s chips, 107
costot ransversectom y, 170
CT. See com puted tom ography (CT)
D
de Andrade and Macnab
– facet, 1
– occiput–C1, 124
distraction exion injuries (seat
belt injury), 138–140
Dow n ’s syn d ro m e , 25 9
Duch en n e’s m uscu lar dyst rop hy,
241
dysdiadochokinesia, 156
dysplasia, 259
E
electrodiagnostic tests, 77–78
electromyography (EMG), 77–78,
80, 81
electromyography, triggered
(tEMG), 81
cervical spine, anatom y, 13–19
cervicot horacic ju nction
– surgical approaches, 30–38
–– low cervical approach to
C6 –T2 , 3 0
–– sternum -splitting approach to
C4 –T4 , 3 7 –3 8
–– supraclavicular approach to
C6 –T2 , 3 0
–– thoracotomy to T1–T4, 36, 37f,
38f, 39f, 40f
cervicot horacic-style orthosis, 91t
Ch a m b e rl ai n li n e , 2 9 9 f
Ch a rco t -Ma r ie -To ot h d i s e as e , 2 4 6
chem on ucleolysis, 153
chond rosarcom a, 269t, 278f
anteromedial approach to the
upper cervical spine, 29
decompression, 204, 205f
degenerative disease, cervical. See
cervical degenerative disease
degenerative disease, thoracic. See
thoracic degenerative disease
degenerative spondylolisthesis,
215, 217–219
demineralized bone matrix (DBM),
107, 111–112
Den is t h ree -colu m n classi cation ,
93, 94f, 94t, 134–135
dermatomes, 10, 11f, 12t, 53t,
54f, 155f
developmental/paralytic kyphosis,
enteropathic arthritis
(in am mat or y b ow el disea se),
315
eosinophilic granuloma, 268t
ependymoma, 271t
epidural abscess, 286–287, 288f
etanercept, 311
Ew i n g’s s a r co m a , 2 69 t
extracellular matrix (ECM), 105
F
facet d islo cat io n , 131 f
facet inje ct io n , 18 7
facet syn d r om e, 1 77
Fie ld in g cla ss i c at io n , 2 60
nger escape sign, 50f, 51t
chordom a, 269t , 279f
chronic pain, psych ological e ect s
of, 143–144
claudicat ion, 208
clay-shoveler’s fracture, 130
clon us re ex, 51t
Co b b a n gl e m e a s u re m e n t , 22 1 f,
231–232
coccyx, an atom y, 21–24
com p ression fract ures, 93–94
com p ression - exion inju ries, 138
249
diastrophic dysplasia, 259
direct pars repair, 215
disability, 145
disability and impairment
evaluation, 145–146
disease-modifying antirheumatic
drugs (DMARDs), 297
disk anatomy, 148–149
disk degeneration, 70f, 73, 99,
151f
at-back syndrome, 225, 251
exion injuries, 138–140
fou r -p o st e r- t y p e or t h o sis, 9 1t
fract ure xat ion , pe rcu t an eou s, 95
fract ures
– atlas (C1), 126–127
– burst, 94, 140
– clay-shoveler’s, 130
– compression, 93–94
– hangman’s, 85, 87f, 128, 129f,
130t, 262, 262f
In d e x 3 19
– Je erson, 261, 261f
– occipital condyle, 124
– odontoid, 127–128, 261–262
– Salter I, 257, 258f
– teardrop, 130
– thoracolumbar, 134–141
– wedge compression, 130
fract u re /d islocat ion, 9 5
Fr an k e l s ca le , 1 34
Fr ie d re ic h ’s a t a xia , 2 46
fun ct ion al restorat ion program s,
144
fusion . See speci c fusions
G
Ga e n sle n’s t est , 5 4
infect ion s, postoperative, 291–294
infect iou s kyph osis, 249, 250f
in am m ator y bowel disease
(enteropathic arthritis), 315
in am m ator y kyph osis
(ankylosing spondylitis),
249–250
in ixim ab, 315
injections, for pain, 144–145
inst rum en tat ion
– growing rod, 236, 237f
– posterior rod, 97f
– transpedicular, 95, 95f, 100–101
interbody cage devices, 161–162
interspin ou s spacers, 207
intervertebral disk, 1–2
– myelomeningocele, 247
– neuromuscular kyphosis,
246–247
– postsurgical kyphosis, 249
– posttraum atic kyphosis, 249
– postural kyphosis, 242
– Scheuermann’s disease (juvenile
kyphosis), 244–246
L
lam inectom y, 170
lam inectom y and fusion w ith
inst rum en tat ion , 164–165
lam inoforam inotomy, 162–163f
lam inop last y, 163–164f
La r s e n ’s s y n d r o m e , 2 5 9
GCS. See Glasgow Co m a Scale (GCS)
giant cell tum or, 268t, 276f
Gla sgow Com a Scale (GCS), 1 1 6,
117f
grafts. See sp eci c gra ft s
Grise l’s s yn d ro m e , 2 5 9
growing rod instrumentation,
236, 237f
Gu illain - Bar r e syn d r om e, 1 60 t
H
halo devices, 91t, 92f
hangman’s fracture, 85, 87f, 128,
129f, 130t, 262
Har m s con st r u ct, 3 03– 304f
healing period, 145
intervertebral disk (IVD)
degeneration, 171–174
– biomechanical aspects of,
148–153
– repair or regeneration, 150–153
intradiskal electrotherm al therapy,
180t
intradiskal pressure, 99
intraoperat ive neurom onitoring
(IONM), 80–82
– anesthetic e ects on, 82
inverted radial re ex, 51t
isth m ic spon dylolisthesis,
212–214
J
lateral lu m bar interbody fusion
(LLIF), 189t , 191, 194
lateral m ass screw or ient at ion, 90f
Le n k e cl a ss i c a t i o n o f s co l io s i s ,
227, 228f, 229, 236
Le v in e a n d Ed w a r d s cl a ss i c a t i o n
of atlas fractures, 126f
Le v in e cl a s s i c at i o n o f h a n g m a n ’s
fract ure , 13 0t
Lh e r m i t t e ’s g r i p r e l e a s e , 5 1 t , 1 5 6
ligam entous anatom y, 17 , 18f
low back pain. See lu m bar
degenerative disease
low cervical app roach to C6–T2, 30
lum bar degenerative disease,
171–195
healing plateau, 145
hemangioma, 268t
herniated nucleus pulposus (HNP),
177
herniated disk. See disk h er niat ion
history, medical, 47–49
Ho m an’s sign , 50f, 51t , 156
Hon g Kong procedu re, 291, 292f
Hor ner’s synd rom e, 13
How sh ip’s lacun ae, 105, 105f
hydroxychloroquine, 302
hypokyphosis, 96, 96f
I
idiopath ic adolescent scoliosis
(IAS). See scoliosis, id iopat hic
jaw-jerk re ex, 50f, 51t
Je e r s o n fr a c t u r e, 2 6 1 , 2 6 1 f
juvenile kyph osis (Scheuerm ann’s
disease), 242–246
juvenile rheum atoid arthritis, 259
juvenile scoliosis. See sco liosis,
idiop ath ic infantile and
juvenile
K
Ka d is h a n d Si m m o n s n e r v e ro o t
anomalies, 11, 12f
kinematics of the spine, 83–85
Kin g cl a ss i ca t io n o f s co li o sis ,
227, 229t
Klip p el- Fe il s yn d ro m e, 2 5 6 – 25 7
– annular tears, 177
– biochemical pathology, 175
– clinical evaluation, 176–181
–– di erential diagnosis, 176, 177t
–– neurological examination, 176
–– physical exam, 176
– conservative treatment, 179
– etiologies, 183, 184t
– facet syndrome, 177
– herniated nucleus pulposus
(HNP), 177
– herniation, 172–174
– imaging, 178–179, 183–188
– incidence, 171, 183
– intervertebral disk (IVD)
degeneration, 171–174
adolescent
idiopath ic infant ile and juvenile
scoliosis. See scoliosis,
idiopath ic infant ile and
juven ile
iliac crest bone graft (ICBG), 107
im aging, 57–66, 67–77. See also
speci c im aging modalities
im pairm ent, 145
im pairm ent an d disabilit y
evaluation, 145–146
kyphosis, 97, 97f
kyphotic deformities, 242–251
– biomechanics, 242
– classi cation, 242, 243t
– congenital kyphosis, 242–244
– developmental/paralytic
kyphosis, 249
– infectious kyphosis, 249, 250f
– in ammatory kyphosis
(ankylosing spondylitis),
249–250
– myofascial syndromes, 177
– pathogenesis, 171–175
– risk factors, 183
– spondylolysis, 177
– stenosis, 177
– surgical management, 179, 180f,
180t, 181f, 187–195
–– anterior lumbar interbody
fusion (ALIF), 189t , 191, 193f
–– axial lumbar interbody fusion
(Axia LIF), 1 9 4
320
In d e x
lum bar degenerative disease
– surgical management
(continued)
–– intradiskal electrothermal
therapy, 180t
–– lateral lumbar interbody fusion
(LLIF), 189t , 191, 194
–– microscopically assisted
diskectomy, 180t
–– open diskectomy, 180t
–– percutaneous diskectomy, 180t
–– posterior lumbar interbody
fusion (PLIF), 1 89t , 190–191f
–– posterolateral (intertransverse
process) fusion (PLF), 188–190
–– total disk arthroplasty,
–– surgical options, 219f
–– treatment, 217–219
– epidemiology, 210
– hereditary factors, 210
– isthmic, 212–214
–– radiographic m easurements,
213–214
–– roentgenographic ndings, 213
–– surgical techniques
––– direct pars repair, 215
––– interbody fusion, 215, 216f
––– posterolateral fusion with or
without decompression, 215
–– treatment, 214–215
– pathological, 220
– traumatic, 219
McAfee anterior retropharyngeal
exposure of the upper cervical,
29–30
McGregor’s line, 86t, 300f, 300t
McRae’s line, 299f, 300f, 300t
medical history, 47–49
measurements
– atlantodens interval (ADI), 86t,
125, 252, 253f, 297–298, 301f,
303
– biomechanical, 86t
– central sacral vertical line
(CSVL), 230
– Chamberlain line, 299f
– Cobb angle, 221f, 231–232
– McGregor’s line, 86t, 300f, 300t
194–195
–– transforaminal lumbar
interbody fusion (TLIF), 189t ,
191, 192f
–– Wiltse paraspinal approach,
181f
– total disk replacement (TDR), 195
lum bar fusion , 205– 207
lum bar in dex, 214
lum bar in terbody fusion. See
anterior lumbar interbody
fusion (ALIF); axial lu m bar
interbody fusion (AxiaLIF);
lateral lu m bar interbody
fusion (LLIF); p oste rior
lum bar in terbody fusion
lum bosacral sp ine st abilit y,
98–100
lym ph om a , 269t
M
Magerl lateral m ass screw
orientation, 90f, 303
magnetic resonance imaging
(MRI), 58, 59f, 67, 68t, 70–74,
76f, 77f
– burst fracture, 138f
– cervical degenerative disease,
156–157, 159f
– cervical kyphosis, 263f
– disk degeneration, 73, 151f
– facet dislocation, 131f
– McRae’s line, 299f, 300f, 300t
– Power’s ratio, 84f, 86t, 260
– radiographic, 299–301
– Ranawat’s index, 86t, 299f, 300f,
300t, 302, 303t
– Redlund–Johnell index, 86t,
300f, 300t
– slip angle, 214, 214f
– space available for cord (SAC),
86t, 252, 253f, 254f
– Wackenheim line, 299f
meningioma, 270t
mesenchymal stem cells (MSCs),
114–115
methotrexate, 302, 311, 315
methylprednisolone, 120–121
(PLIF); tran sforam inal lum bar
interbody fusion (TLIF)
lum bar plexus, nerve str uctu res
of, 3f
lum bar spinal stenosis, 197–209
– classi cation, 197–198
–– acquired, 198
–– congenital, 197–198
– clinical ndings, 202–204
– di erential diagnosis, 204
– dim ensions, 201, 202f
– pathogenesis, 198–202
– surgical techniques
–– decompression, 204, 205f
–– lumbar fusion, 205–207
– treatment, 204–209
– fracture-dislocation of the
thoracolumbar spine, 139f
– giant cell tumor, 276f
– herniated disk, 167, 167f, 175f
– Klippel-Feil syndrome, 256f
– lumbar degenerative disease,
178, 184
– neoplastic disease, 267t
– osteogenesis imperfecta, 255f
– osteoporotic compression
fract ure, 267t
– rheumatoid arthritis, 297, 298,
301, 305f
– spinal cord injury, 72–73, 119
– spinal infections, 285t
– spinal stenosis, 64f, 65f, 164f
Meyerding classi cation of
spondylolisthesis, 213
Modic end plate changes, 73,
76f, 77f
Morquio’s syndrom e, 259
motor evoked potentials (MEPs),
78
motor evoked potentials, myogenic
(mMEPs), 81
motor evoked potentials,
transcranial (tcMEPs), 80, 81
motor strength testing, 55t
MRI. See magnetic resonance
im aging (MRI)
muscle strength, 53–54
muscular anatomy, 14f–15f, 18
lum bar spine pain. See lu m bar
degenerative disease
lum bar spine stabilit y, 98–100
lum bar sp on dylolisth esis, 210–220
– biomechanics, 210
– classi cations, 210
– degenerative, 215, 217–219
–– clinical ndings, 215, 217
–– epidemiology, 215
–– radiographic ndings, 217
– spondylolisthesis, 66f, 218f
– spondylosis, 61f, 62f
– subdural abscess, 288f
– tuberculosis of the spine, 292f
– tumors, 266t
– vertebral body collapse, 63f
– vertebral osteomyelitis, 267t,
288f, 289f
Marchetti-Bartolozzi classi cation
of spondylolisthesis, 210, 212
muscular dystrophy, 246
myelography, 67, 266t
– neuro broma, 275f
myelomeningocele, 241, 247
myelopathic signs, 51t, 156
myelopathy, 47, 155
myofascial syndromes, 177
myogenic motor evoked potentials
(mMEPs), 81
myotome distribution, 12t
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