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CONTRIBUTING AUTHORS / xxi
Paul Pagano, M.D.
Tulane University Health Sciences Center New Orleans, Louisiana
Manohar M. Panjabi, Ph.D.
Professor and Director Department of Orthopaedics and Rehabilitation Biomechanics Research Laboratory Yale University School of Medicine New Haven, Connecticut
Frank M. Phillips, M.D.
Associate Professor and Co-Director Spine
Fellowship Department of Orthopaedic Surgery Rush University Medical Center Chicago, Illinois
Malcolm H. Pope, Dr.Med.Sc., Ph.D., D.Sc.
Department of Environmental and
Occupational Medicine Liberty Worksafe Research Centre University of Aberdeen Aberdeen, Scotland
Franco Postacchini, M.D.
Professor Department of Orthopaedic Surgery University La Sapienza Chairman Department of the Orthopaedics Policlinico Umberto I Rome, Italy
Christopher S. Raffo, M.D.
Instructor Department of Orthopaedics Georgetown University Washington, D.C.
James Rainville, M.D.
Clinical Assistant Professor Department of Physical Medicine and
Rehabilitation Harvard Medical School Chief Department of Physical Medicine and
Rehabilitation New England Baptist Hospital Boston, Massachusetts
S. Rajasekaran, M.S., Ph.D.
Academic Director Department of Orthopaedics Ganga Institute of Orthopaedics Department of Orthopaedics and Spine Surgery Ganga Hospital Coimbatore, India
Ralph F. Rashbaum, M.D.
Texas Health Research Institute Texas Back Institute Musculoskeletal Research
Foundation
Plano, Texas
Donald L. Renfrew, M.D.
Musculoskeletal Radiologist Department of Radiology Center for Diagnostic Imaging Winter Park, Florida
Setti S. Rengachary, M.D.
Prof essor and Associate Academic
Chairman Department of Neurosurgery Wayne State University Attending Neurological Surgeon Department of Neurosurgery Harper Hospital Detroit, Michigan
Peter A. Robertson, M.D., F .R.A.C.S.
Orthopaedic and Spinal Surgeon Department of Orthopaedic Surgery Auckland City Hospital Auckland, New Zealand
Stephen L. Gabriel Rothman, M.D.
Clinical Professor Department of Radiology University of Southern California School of
Medicine Los Angeles, California Spinal Injury Service Rancho Los Amigos Hospital Downey, California
Björn L. Rydevik, M.D., Ph.D.
Professor and Chairman Institute for Surgical Sciences Göteborg University Professor Department of Orthopaedics Sahlgrenska University Hospital Göteborg, Sweden
Jeffre y A. Saal, M.D., F .A.C.P.
Associate Clinical Professor Department of Functional Restoration Stanford University School of
Medicine Stanford, California SOAR, Physiatry Group Redwood City, California
xxii /CONTRIBUTING AUTHORS
Joel S. Saal, M.D.
Associate Clinical Professor Department of Functional Restoration Stanford University School of Medicine Stanford, California SOAR, Physiatry Group Redwood City, California
Srinath Samudrala, M.D.
Assistant Professor Department of Neurological Surgery Keck School of Medicine University of Southern California Los Angeles, California
Steven C. Scherping, Jr., M.D.
Assistant Professor Department of Orthopaedic Surgery Georgetown University Hospital Washington, D.C.
Klaus-Peter Schulitz, M.D.
Professor Emeritus Department of Orthopaedic Surgery Heinrich-Heine Universitaet Duesseldorf, Germany
Dilip K. Sengupta, M.B.B.S., M.S., Dip.
N.B.E., M.Ch.
Staff Spine Surgeon Department of Orthopaedics William Beaumont Hospital Royal Oak, Michigan
William O. Shaffer, M.D.
Associate Professor and Surgery Residency
Program Director Department of Surgery Division of Orthopaedic Surgery University of Kentucky Medical School Attending Orthopaedic Surgeon Department of Surgery Division of Orthopaedic Surgery Chandler Medical Center of the University
of Kentucky Lexington, Kentucky
Osamu Shirado, M.D.
Associate Professor Department of Orthopaedic Surgery Saitama Medical School Saitama, Japan Vice President Department of Orthopaedic Surgery Sapporo Orthopaedic and Cardiovascular
Hospital
Sapporo, Japan
Jeff Scott Silber, M.D.
Assistant Professor Department of Orthopedic Surgery Albert Einstein College of
Medicine Bronx, New Yor k Assistant Professor Department of Orthopedics Chief, Orthopedic Spine Surgery Long Island Jewish Medical Center New Hyde Park, New York
Edward D. Simmons, M.D., C.M., M.Sc.,
F.R.C.S.(C.)
Associate Clinical Professor Department of Orthopaedic Surgery State University of New York at
Buffalo Attending Orthopaedic Surgeon Department of Orthopaedic Surgery Buffalo General Hospital Buffalo, New Yor k
Edward H. Simmons, M.D., B.Sc.(Med.),
F.R.C.S.(C.), M.S.(Tor.), F.A.C.S.
Emeritus Professor Department of Orthopedic Surgery State University of New York at
Buffalo Emeritus Chief Department of Orthopaedic Surgery State University of New York at Buffalo Buffalo, New Yor k
Francis H. Shen, M.D., F.A.C.S.
Assistant Professor Department of Orthopaedic Surgery University of Virginia School of Medicine Assistant Professor Department of Orthopaedic Surgery Health Sciences Center University of V irginia Charlottesville, V irginia
Kevin P. Singer, Ph.D., P.T.
Associate Professor and Director The Centre for Musculoskeletal
Studies School of Surgery and Pathology The University of Western Australia Royal Perth Hospital Perth, W estern A ustr alia
CONTRIBUTING AUTHORS / xxiii
Kevin F. Spratt, Ph.D.
Adjunct Assistant Professor Department of Psychological and Quantitative
Foundations College of Education University of Iowa Senior Project Leader Department of Orthopaedic Surgery University of Iowa Hospitals and
Clinics Iowa City, Iowa
Thomas Steffen, M.D., Ph.D., M.B.A.
Associate Professor and Research
Director Division of Orthopaedic Surgery Orthopaedic Research Laboratory McGill University Montreal, Quebec, Canada
Björn Strömqvist, M.D., Ph.D.
Associate Professor Department of Orthopedics Head of Spine Unit Lund University Hospital Lund, Sweden
Marek Szpalski, M.D.
Associate Professor School of Medicine Free University of Brussels Chairman Department of Orthopedic and Trauma
Surgery IRIS South Teaching Hospitals Brussels, Belgium
Jayesh M.Trivedi, F.R.C.S.(Orth.)
Consultant Spinal Surgeon Department of Orthopaedics Robert Jones and Agnes Hunt
Hospital
Oswestry, United Kingdom
George M.Tsoukas, M.D.
Department of Endocrinology McGill University Montreal, Quebec, Canada
Michael N.Tzermiadianos, M.D.
Department of Orthopaedic Surgery and
Traumatology University of Crete at Heraklion Crete, Greece
Alexander R.Vaccaro, M.D.
Professor and Co-Director Delaware Valley Regional Spinal Cord Injury Center Co-Chief Spine Service Co-Director Spine Fellowship Program Thomas Jefferson University and the Rothman
Institute Philadelphia, Pennsylvania
Tapio Videman, M.D., Dr .Med.Sc.
Alberta Heritage Foundation for Medical
Research Scientist and Professor Faculty of Rehabilitation Medicine University of Alberta Edmonton, Canada
Tetsuya Tamaki, M.D., Ph.D.
Professor Emeritus Department of Orthopaedic Surgery, Wakayama Medical University Medical Director Aitoku Medical Welfare Center Wakayama, Japan
Naoki T ak eda, M.D.
Professor Department of Health Sciences Hokkaido University School of Medicine Sapporo, Hokkaido, Japan
Ensor E. Transfeldt, M.D.
Associate Professor University of Minnesota Twin Cities Spine Center Minneapolis, Minnesota
Robert G. Watkins IV, M.D.
Los Angeles Spine Surgery Institute Los Angeles, California
Robert W atkins III, M.D.
Los Angeles Spine Surgery Institute Los Angeles, California
Thomas S. Whitecloud III, M.D.
Ray J. Haddad Professor and Chairman Tulane University of Health Sciences
Center New Orleans, Louisiana
Sam W.Wiesel, M.D.
Professor and Chair Department of Orthopedics Georgetown University Washington, D.C.
xxiv /CONTRIBUTING AUTHORS
Alexander Wild, M.D.
Orthopaedic University Hospital Duesseldorf, Germany
Leon L. Wiltse, M.D.
Wiltse Spine Institute Carmel Valley, California
Douglas S. Won, M.D.
Fellow, Spinal Surgery Department of Orthopaedic Surgery William Beaumont Hospital Royal Oak, Michigan
Hansen A.Y uan, M.D.
Professor Department of Orthopaedic and Neurological
Surgery State University of New York, Upstate Medical
University Syracuse, New Yor k
Yinggang Zheng, M.D.
Research Fellow Department of Orthopaedic Surgery State University of New York at Buffalo Research Fellow Simmons Orthopaedic and Spine Associates Buffalo, New Yor k

Preface

This third edition of the International Society for the Study of the Lumbar Spine textbook represents a complete revision of the prior edition. A significant amount of new information is included— from the basic science of spine disease to surgical management of lumbar disorders. The members of this soci­ety who have contributed their excellent work are also the ones whose research has led to the many advances in the care and management of spinal disorders. This is an inclusive textbook emphasizing the basic science behind the clinical problems we face on a daily basis; it is comprehensive and covers all facets of the diseases that affect the lumbar spine. We are grateful to all the members of this society who have contributed chapters in order to make this the authoritative textbook on the lumbar spine.
This book is intended for all physicians and allied personnel who care for patients with low-back dis­orders. Hopefully, it will answer all the questions that the reader has to better understand the etiology, pathophysiology, clinical diagnosis, and management of lumbar disease.
Harry N. Herkowitz, M.D.
Jiri Dvorak, M.D.
Gordon R. Bell, M.D.
Margareta Nordin, Dr.Sci., P.T., C.I.E.
Dieter Grob, M.D.
xxv

Acknowledgments

No textbook makes it to press without the dedication of those behind the scenes. The International Soci­ety for the Study of the Lumbar Spine (ISSLS) textbook is no different.
First, I would like to acknowledge Shirley Fitzgerald, our administrator, friend, and the one person who keeps ISSLS on track making sure the business of the society is dealt with in a timely fashion. Many of us have “grown up with her” over the years and her dedication to the well-being of the soci­ety cannot be overstated. She is a unique individual who we are lucky to have in ISSLS.
Second, each Editorial Board member has his/her administrative assistant who helps organize the paperwork, correspondence, and chapter reviews. We would like to thank Christine Musich, Susana Kuster, Katrin Knecht, Elisabeth Weiss, and Katherine Habler.
Without their dedication and organization, the fruition of this textbook would have been significantly delayed. We wish to thank each of you for your outstanding effort.
Finally, we are grateful to Robert Hurley, Kerry Barrett, and Karina Mikhli at Lippincott Williams & Wilkins and Ted Huff, the illustrator, for supporting our organization, for being so professional in putting this textbook together, and for seeing it through to publication.
xxvii
SECTION I
Basic Science