Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 2 potx

Interspinous Process Distraction Technique
83
Recapitulation 84
KeyArticles 85
References 86
4 Age-Related Changes of the Spine
Atul Sukthankar, Andreas G. Nerlich,
Günther Paesold
CoreMessages 91
Epidemiology 91
CaseIntroduction 92
GeneralAge-RelatedChanges 92
FunctionalSpineUnit 93
The Intervertebral Disc and Cartilage Endplate 95
IntervertebralDisc 95
TheCartilageEndplate 107
TheFacetJoints 109
NormalAnatomy 109
Age-Related Changes . 109
VertebralBodies 110
NormalAnatomyandComposition 110
Age-Related Changes . 110
SpinalLigaments 111
NormalAnatomyandComposition 111
Age-Related Changes . 111
SpinalMuscles 112
NormalAnatomyandStructure 112
Age-Related Changes . 112
Recapitulation 114
KeyArticles 115
References 116

5 Pathways of Spinal Pain
HeikeE.Künzel,NorbertBoos
CoreMessages 123
HistoricalBackground 123
PrecartesianTheories 123
CartesianTheory 124
GateControlTheory 124
ModernPainTheories 124
EpidemiologyofChronicPain 125
Definition and Classification . . 125
TemporalCourse 126
ContemporaryPainClassification 126
PathwaysofPain 128
Transduction 129
Conduction 130
TransmissionandModulation 130
PainProjection 133
PainPerception 134
Neuroplasticity 135
PeripheralSensitization 135
TranscriptionalDRGChanges 136
CentralSensitization 136
Disinhibition 137
Endogenous and Environmental Influences
onPainPerception 137
ClinicalAssessmentofPain 138
Differentiating Inflammatory and Neuropathic
Pain
138
GeneralConceptsofPainTreatment 141

PharmacologicalTreatment 141
Non-pharmacological Treatment of Spinal
Pain 143
BiopsychosocialInterventions 143
SurgicalTreatment 144
Recapitulation 144
KeyArticles 145
References 146
6 Epidemiology and Risk Factors of Spinal
Disorders
Achim Elfering, Anne F. Mannion
CoreMessages 153
GeneralScope 153
ObjectivesinSpinalDisorders 154
ClassificationofSpinalDisorders 155
Etiology 155
TimeCourse 155
LowBackPain 156
NeckPain 157
Pain,ImpairmentandDisability 157
BurdenofSpinalDisorders 159
EconomicCosts 159
RiskFactors 161
IndividualRiskFactors 161
MorphologicalRiskFactors 162
PsychosocialFactors 162
OccupationalPhysicalRiskFactors 163
OccupationalPsychologicalRiskFactors 163
Absence of Evidence for Certain Risk Factors 164
GeographicalVariation 164

FlagSystemfortheRiskFactors 165
RedFlags 165
YellowFlags 166
BlueFlags 166
BlackFlags 166
Direction for Future Epidemiological Research 167
Recapitulation 167
KeyArticles 168
References 169
7 Predictors of Surgical Outcome
Anne F. Mannion, Achim Elfering
CoreMessages 175
Epidemiology 175
OutcomeMeasures 179
What Constitutes a “Successful Outcome” . . . 180
XIV Contents
The Outcome of Common Spine Surgical
Procedures 182
PredictorsofOutcomeofSpinalSurgery 183
MedicalFactors 184
BiologicalandDemographicVariables 186
HealthBehavioralandLifestyleFactors 187
PsychologicalFactors 187
SociologicalFactors 189
Work-RelatedFactors 189
Risk Factor Assessment in Clinical Practice . . . 190
Recapitulation 192
KeyArticles 193
References 194
Patient Assessment

8 History and Physical Examination
Cl´ement M.L. Werner, Norbert Boos
CoreMessages 201
Epidemiology 201
CaseIntroduction 202
History 203
Pain 204
Function 210
SpinalDeformity 210
PhysicalExamination 211
Walking 211
Standing 211
Sitting 216
LyingSupine 220
LyingonLeft/RightSide 220
LyingProne 221
AbnormalIllnessBehavior 221
Reproducibility 221
Differential Diagnosis of Spinal Pain Syndromes
222
Recapitulation 222
KeyArticles 223
References 224
9 Imaging Studies
Marius R. Schmid, Jürg Hodler
CoreMessages 227
ImagingMethods 227
StandardRadiographs 227
MagneticResonanceImaging 229
ComputedTomography 241

AdditionalImagingMethods 244
Indications for Spinal Imaging 247
Acute Low Back Pain Without Radicular
Symptoms,WithoutTrauma 247
Acute Low Back Pain With Radicular
Symptoms 248
Spinal Cord and Cauda Compression
Syndromes 249
AcuteTrauma 249
ChronicLowBackPain 251
PostoperativeImaging 251
Whiplash-AssociatedDisorders 252
PainRelatingtotheSacroiliacJoint 253
DiseaseoftheSpinalCord 255
Recapitulation 255
KeyArticles 256
References 257
10 Spinal Injections
Massimo Leonardi, Christian W. Pfirrmann
CoreMessages 261
RationaleforSpinalInjections 261
LumbarandCervicalNerveRootBlocks 262
Indications 262
Technique 263
Complications 265
DiagnosticandTherapeuticEfficacy 265
EpiduralandCaudalBlocks 267
Indications 267
Technique 268
Complications 268

TherapeuticEfficacy 268
ProvocativeDiscography 271
Indications 271
Technique 272
Complications 273
DiagnosticEfficacy 273
FacetJointBlocks 275
Indications 275
Technique 276
Complications 277
DiagnosticandTherapeuticEfficacy 278
SacroiliacJointBlocks 280
Indications 280
Technique 280
Complications 280
DiagnosticEfficacy 281
ContraindicationsforSpinalInjections 281
AlgorithmforSpinalInjections 282
Recapitulation 283
KeyArticles 284
References 285
11 Neurological Assessment in Spinal Disorders
Ut a Kliesch, Armin Curt
CoreMessages 291
Epidemiology 291
CaseIntroduction 292
AnatomyandSomatotopicBackground 294
Classification 295
NeurologicalAssessment 298
Pain 298

Contents XV
SensoryDeficits 298
MotorDeficits 299
ReflexDeficits 299
GaitDisorders 301
BowelandBladderDysfunction 303
DisordersoftheAutonomicSystem 303
SpinalCordInjury 304
SpinalCordSyndrome 304
DifferentialDiagnosis 306
Differentiation of Central and Peripheral
Paresis 306
Differentiation of Radicular and Peripheral
NerveLesions 306
Differential Diagnosis of Spinal Cord
CompressionSyndromes 311
MiscellaneousDifferentialDiagnoses 311
Recapitulation 312
KeyArticles 313
References 314
12 Neurophysiological Investigations
Armin Curt, Uta Kliesch
CoreMessages 319
HistoricalBackground 319
Neuroanatomy 320
NeurophysiologicalModalities 321
Electromyography 321
NerveConductionStudies 322
F-WaveRecordings 324
H-Reflex 325

SomatosensoryEvokedPotentials 326
Motor Evoked Potentials (Transcranial
MagneticStimulation) 328
IntraoperativeNeuromonitoring 329
Role of Neurophysiology in Specific Disorders
330
SpinalCordInjury 330
Cervical/LumbarRadiculopathy 330
CervicalMyelopathy 331
LumbarSpinalCanalStenosis 331
NeurophysiologyinDifferentialDiagnosis 332
Peripheral Nerve Lesion Versus Radiculopathy
332
Neuropathy Versus Spinal Canal Stenosis . . . 332
MyopathyandMyotonicDisorders 333
Hereditary and Neurodegenerative Disease . 333
Recapitulation 334
KeyArticles 334
References 335
13 Surgical Approaches
Norbert Boos, Claudio Affolter,
Martin Merkle, Frank J. Ruehli
CoreMessages 337
Surgery and Planning . . . 337
Anterior Medial Approach to Cervical Spine . . . 337
Indications 338
Patient Positioning . . . 338
SurgicalExposure 339
PitfallsandComplications 341
PosteriorApproachtotheCervicalSpine 342

Indications 342
Patient Positioning . . . 342
SurgicalExposure 343
PitfallsandComplications 345
Right-SidedThoracotomy 345
Indications 346
Patient Positioning . . . 346
SurgicalExposure 346
PitfallsandComplications 349
Left-SidedThoraco-Phrenico-Lumbotomy 350
Indications 350
Patient Positioning . . . 350
SurgicalExposure 350
PitfallsandComplications 353
Anterior-Lateral Retroperitoneal Approach
toL2–L5 353
Indications 353
Patient Positioning . . . 353
SurgicalExposure 353
PitfallsandComplications 355
Anterior Lumbar Retroperitoneal Approach . . . 355
Indications 355
Patient Positioning . . . 355
SurgicalExposure 356
PitfallsandComplications 358
Posterior Approach to the Thoracolumbar Spine
358
Indications 358
Patient Positioning . . . 358
SurgicalExposure 359

PitfallsandComplications 361
LandmarksforScrewInsertion 361
Cervico-occipitalSpine 361
Recapitulation 368
KeyArticles 369
References 369
Peri- and Postoperative Management
14 Preoperative Assessment
Stephan Blumenthal, Youri Reil and,
Alain Borgeat
CoreMessages 373
AimofPreanestheticEvaluation 373
InformationandInstructions 374
PatientAssessment 374
History 374
PhysicalExamination 375
LaboratoryStudies 375
XVI Contents
Organ-SpecificAssessment 376
AirwayAssessment 376
RespiratorySystem 376
CardiovascularAssessment 378
NeurologicalAssessment 379
PerioperativeDrugTherapy 379
WhattoStop,toContinueandtoAdd? 379
Premedication 380
ThromboembolicProphylaxis 380
Special Conditions Requiring Spinal Surgery . . 382
SpinalDeformity 382
NeuromuscularDisease 383

CerebralPalsy 383
Malignancy 384
SpinalCordInjury 384
Recapitulation 385
KeyArticles 386
References 387
15 Intraoperative Anesthesia Management
Juan Francisco Asenjo
CoreMessages 389
HistoricalBackground 389
GoalsofAnesthesiainSpinalSurgery 389
PreoperativePatientAssessment 390
InductionofAnesthesia 390
Airway Control and Endotracheal Intubation 391
AntibioticProphylaxis 393
Patient Positioning . . . 394
MaintenanceofAnesthesia 396
IntraoperativeMonitoringTechniques 397
AdvancedMonitoringofVitalFunctions 397
Monitoring Depth of Anesthesia
(Consciousness) 400
Intraoperative Blood Preserving Techniques . . . 400
ControlledHypotensiveAnesthesia 401
IntrathecalOpiates 402
Blood Predeposit and Erythropoietin
Injection 402
CellSalvage 402
PharmacologicalMeasures 403
Blood Transfusion and Coagulation Factor
Substitution 403

IntraoperativeSpinalCordMonitoring 405
AnestheticEffectsonSSEPs 406
AnestheticEffectsonMEPs 407
NerveRootMonitoring 408
Wake-upTest 408
EndofAnesthesia 409
PostoperativePainManagement 409
Recapitulation 411
KeyArticles 411
References 412
16 Postoperative Care and Pain Management
Stephan Blumenthal, Alain Borgeat
CoreMessages 417
PostoperativeCare 417
PostoperativeVentilationorExtubation 418
HemodynamicAssessment 419
NeurologicalAssessment 419
GastrointestinalFunction 420
ThromboembolicProphylaxis 420
PostoperativePainManagement 420
ConsequencesofPain 420
Non-narcotics 421
Non-steroidalDrugs 421
Opioids 421
LocalAnesthetics 422
N-Methyl-
D-aspartateAntagonists 422
Recapitulation 423
KeyArticles 423
References 424

Degenerative Disorders
17 Degenerative Disorders of the Cervical Spine
Massimo Leonardi, Norbert Boos
CoreMessages 429
CaseIntroduction 430
Epidemiology 430
Pathogenesis 432
NeckPain 432
CervicalDiscHerniation 432
CervicalSpondyloticRadiculopathy 433
CervicalSpondyloticMyelopathy 433
ClinicalPresentation 435
History 436
PhysicalFindings 437
FunctionalAssessment 439
DiagnosticWork-up 439
ImagingStudies 439
NeurophysiologicalAssessment 444
DifferentialDiagnosis 444
Non-operativeTreatment 444
NaturalHistory 445
ConservativeTreatmentModalities 446
OperativeTreatment 448
GeneralPrinciples 448
SurgicalTechniques 449
CaseStudy1 451
CaseStudy2 454
CaseStudy3 456
SurgicalDecision-Making 459
Complications 463

Recapitulation 464
KeyArticles 466
References 468
Contents XVII
18 Disc Herniation and Radiculopathy
Massimo Leonardi, Norbert Boos
CoreMessages 481
Epidemiology 481
CaseIntroduction 482
Pathogenesis 483
RiskFactors 483
Radiculopathy 484
ClinicalPresentation 486
History 486
PhysicalFindings 487
DiagnosticWork-up 488
ImagingStudies 488
NeurophysiologicAssessment 490
UrologicAssessment 490
DifferentialDiagnosis 491
Classification 491
Non-operativeTreatment 493
NaturalHistory 494
ConservativeMeasures 494
OperativeTreatment 496
GeneralPrinciples 496
CaseStudy1 497
SurgicalTechniques 497
CaseStudy2 499
Conservative Versus Operative Treatment . . . 503

Complications 504
Recapitulation 505
KeyArticles 506
References 507
19 Lumbar Spinal Stenosis
Patrick O. Zingg, Norbert Boos
CoreMessages 513
Epidemiology 513
CaseIntroduction 514
Pathogenesis 515
Anatomy 515
Pathogenesis 515
SpinalClaudicationSyndrome 517
Classification 517
ClinicalPresentation 519
History 519
PhysicalFindings 520
DiagnosticWork-up 520
ImagingStudies 520
NeurophysiologicStudies 523
DifferentialDiagnosis 524
Non-operativeTreatment 524
NaturalHistory 525
Non-operativeOptions 525
OperativeTreatment 526
GeneralPrinciples 526
SurgicalTechniques 526
CaseStudy1 527
CaseStudy2 529
OperativeRisksandComplications 530

Recapitulation 531
KeyArticles 532
References 533
20 Degenerative Lumbar Spondylosis
Martin Merkle, Beat Wälchli,
Norbert Boos
CoreMessages 539
Epidemiology 539
CaseIntroduction 540
Pathogenesis 541
Disc Degeneration and Discogenic Back Pain 542
FacetJointOsteoarthritis 543
SegmentalInstability 544
ClinicalPresentation 545
History 546
CaseStudy1 547
PhysicalFindings 548
DiagnosticWork-up 548
ImagingStudies 549
CaseStudy2 550
InjectionStudies 551
TemporaryStabilization 552
PatientSelectionforTreatment 552
Non-operativeTreatment 553
OperativeTreatment 554
GeneralPrinciples 554
BiologyofSpinalFusion 555
SurgicalTechniques 558
ComparisonofTreatmentModalities 568
Complications 569

Recapitulation 570
KeyArticles 571
References 573
21 Non-specific Low Back Pain
Florian Brunner, Sherri Weiser,
Annina Schmid, Margareta Nordin
CoreMessages 585
Epidemiology 585
CaseIntroduction 586
ClassificationofBackPain 587
PathogenesisofNSLBP 587
Patient Assessment and Triage for Non-operative
Treatment 588
ManagementofNSLBP 590
Management of Acute NSLBP (<4 weeks) . . . 590
Management of Subacute NSLBP (4–12 weeks)
592
Management of Chronic Non-specific LBP
(>12weeks) 595
Recapitulation 596
XVIII Contents
KeyArticles 596
References 598
22 Postoperative Rehabilitation
Florian Brunner, Shira Schecter-Weiner,
Annina Schmid, Rudolf Kissling
CoreMessages 603
Epidemiology 603
ConceptionalBackground 604
TheoreticalConsiderations 604

AnatomicalandSurgicalConsiderations 605
IndividualandSocietalConsiderations 606
Indications for Postoperative Spinal
Rehabilitation 606
GeneralGoals 607
SpecificGoals 607
PrinciplesofPostoperativeRehabilitation 607
PreoperativeAssessment 607
PostoperativeRehabilitation 608
ObstaclesforRehabilitation 616
Morphological Obstacles and General Medical
Obstacles 616
PsychosocialObstacles 617
Work-RelatedObstacles 617
Recapitulation 617
KeyArticles 618
References 619
Spinal Deformities and Malformations
23 Idiopathic Scoliosis
Mathias Haefeli, Kan Min
CoreMessages 623
Epidemiology 623
CaseIntroduction 624
Pathogenesis 625
GeneticFactors 625
Connective Tissue and Skeletal Muscle
Abnormalities 625
Thrombocyte Abnormalities, Calmodulin
andMelatonin 626
Classification 626

Age-RelatedClassification 626
RadiologicalClassification 627
ClinicalPresentation 627
History 627
PhysicalExamination 629
DiagnosticWork-up 632
ImagingStudies 632
NeurophysiologicEvaluation 637
Treatment 637
GeneralConsiderations 637
NaturalHistory 637
Non-operativeOptions 639
OperativeTreatment 641
IndicationsforSurgery 641
GeneralPrinciples 642
CaseStudy1 646
SurgicalDecisionMaking 647
CaseStudy2 651
Complications 651
Recapitulation 652
KeyArticles 653
References 654
24 Neuromuscular Scoliosis
Jean A. Ouellet , Vincent Arlet
CoreMessages 663
Epidemiology 663
CaseIntroduction 664
DiseaseSpecificSpinalDeformity 666
Pathogenesis 667
Classification 667

ClinicalPresentation 669
History 669
PhysicalExamination 670
CaseStudy1 671
DiagnosticWork-up 673
MedicalAssessment 673
CaseStudy2 674
ImagingStudies 675
Non-operativeTreatment 677
NaturalHistory 677
Non-operativeTreatmentOptions 678
OperativeTreatment 678
SurgicalIndications 678
GeneralPrinciples 679
SurgicalTechniques 680
CaseStudy3 680
CaseStudy4 686
Recapitulation 689
KeyArticles 690
References 691
25 Congenital Scoliosis
Francis H. Shen, Vincent Arlet
CoreMessages 693
Epidemiology 693
CaseIntroduction 694
Pathogenesis 694
Classification 695
ClinicalPresentation 696
History 696
PhysicalFindings 697

DiagnosticWork-up 698
ImagingStudies 698
SpecificInvestigations 700
Non-operativeTreatment 700
Contents XIX
NaturalHistoryandProgression 700
OperativeTreatment 701
GeneralPrinciples 701
SurgicalTechniques 702
CorrectiveSurgeryProcedures 702
CaseStudy1 703
CaseStudy2 704
MiscellaneousSurgicalTechniques 707
Recapitulation 708
KeyArticles 709
References 710
26 Degenerative Scoliosis
Max Aebi
CoreMessages 713
Epidemiology 713
CaseIntroduction 714
Pathogenesis 715
Classification 716
ClinicalPresentation 717
History 717
PhysicalFindings 719
DiagnosticWorkup 720
ImagingStudies 720
InterventionalRadiologicalProcedure 721
AdditionalDiagnosticTools 722

Non-operativeTreatment 722
OperativeTreatment 723
DecompressionProcedure 724
CorrectionProcedures 724
SurgicalTechniques 725
CaseStudy1 728
CaseStudy2 729
Recapitulation 729
KeyArticles 730
References 731
27 Spondylolisthesis
ClaytonN.Kraft,RüdigerKrauspe
CoreMessages 733
Epidemiology 733
CaseIntroduction 734
Pathogenesis 735
Classification 735
ClinicalPresentation 736
History 736
PhysicalFindings 738
DifferentialDiagnosis 738
DiagnosticWork-up 739
Imaging 739
CaseStudy1 742
InvasiveImagingStudies 743
Non-operativeTreatment 745
NaturalHistory 745
ConservativeTreatmentOptions 745
OperativeTreatment 747
GeneralPrinciples 747

SurgicalTechniques 748
CaseStudy2 751
Complications 756
Recapitulation 757
KeyArticles 758
References 759
28 Juvenile Kyphosis (Scheuermann’s Disease)
Dietrich Schlenzka, Vincent Arlet
CoreMessages 765
Epidemiology 765
CaseIntroduction 766
Pathogenesis 767
NormalSagittalProfile 768
Definition and Classification . . 771
ClinicalPresentation 773
History 773
PhysicalFindings 774
DiagnosticWork-up 775
ImagingStudies 775
NeurophysiologicalTests 777
LungFunctionTest 777
DifferentialDiagnosis 777
Non-operativeTreatment 779
NaturalHistory 779
BracingandCasting 780
CaseStudy1 780
OperativeTreatment 782
PreoperativeAssessment 782
GeneralPrinciples 783
OperativeTechnique 784

CaseStudy2 786
ResultsofOperativeTreatment 788
Complications 790
Recapitulation 791
KeyArticles 792
References 793
29 Malformations of the Spinal Cord
Dilek Könü-Leblebicioglu, Yasuhiro
Yo n e k awa
CoreMessages 797
Epidemiology 797
CaseIntroduction 798
Pathogenesis 799
EmbryologicalAspects 799
RelevantEmbryogeneticSteps 800
RiskFactors 801
Pathophysiology of Tethered Cord Syndrome 802
TerminologyandClassification 802
ClassificationofSpinalMalformation 803
XX Contents
CaseStudy1 805
ClassificationofTetheredSpinalCord 811
ClinicalPresentation 812
History 812
PhysicalFindings 813
DiagnosticWork-up 814
PrenatalDiagnosis 814
PostnatalDiagnosticTests 815
Treatment 815
InUteroTreatment 816

PostnatalSurgery 816
Recapitulation 818
KeyArticles 819
References 819
Fractures
30 Cervical Spine Injuries
Michael Heinzelmann, Karim Eid,
Norbert Boos
CoreMessages 825
CaseIntroduction 826
Epidemiology 827
Pathomechanisms 828
NormalAnatomy 828
BiomechanicsofCervicalSpineTrauma 830
SpinalCordInjury 832
Pathomechanism of Whiplash-Associated
Disorders 833
ClinicalPresentation 834
History 834
PhysicalFindings 835
Classification of Whiplash-Associated
Disorders 836
DiagnosticWork-up 836
ImagingStudies 836
Neurophysiology 842
VascularAssessment 842
Synopsis of Assessment Recommendations
842
GeneralTreatmentPrinciples 844
Whiplash-AssociatedDisorders 844

Non-operativeTreatmentModalities 845
SpinalCordInjuries 848
Specific Treatment of Upper Cervical Spine
Injuries 850
FracturesoftheOccipitalCondyle 850
Atlanto-occipitalDislocation 851
FracturesoftheAtlas 852
AtlantoaxialInstabilities 853
DensFractures 854
CaseStudy1 858
TraumaticSpondylolisthesisoftheAxis 860
CaseStudy2 862
CombinedAtlas/AxisFractures 863
Classification and Treatment of Subaxial Injuries
863
Classification 864
Treatment 866
CaseStudy3 870
Complications 871
Recapitulation 871
KeyArticles 873
References 874
31 Thoracolumbar Spinal Injuries
Michael Heinzelmann, Guido A. Wanner
CoreMessages 883
Epidemiology 883
CaseIntroduction 884
Pathomechanisms 885
AxialCompression 885
Flexion/Distraction 886

Hyperextension 886
RotationalInjuries 886
Shear 887
Classification 887
DenisClassification 888
AOClassification 888
ClinicalPresentation 892
SpinalInjuries 892
NeurologicalDeficit 892
ConcomitantNon-spinalInjuries 893
History 893
PhysicalFindings 894
DiagnosticWork-up 895
ImagingStudies 895
Non-operativeTreatment 898
SteroidTreatmentofSpinalCordInjury 899
Non-operativeTreatmentModalities 899
CaseStudy1 900
OperativeTreatment 903
GeneralPrinciples 903
SurgicalTechniques 905
CaseStudy2 906
CaseStudy3 911
Outcome of Operative Versus Non-operative
Treatment 914
Recapitulation 918
KeyArticles 919
References 920
32 Osteoporotic Spine Fractures
Paul F. Heini, Albrecht Popp

CoreMessages 925
Epidemiology 925
CaseIntroduction 926
Pathogenesis and Definition . . 926
Classification of Vertebral Body Compression
Fractures 929
Contents XXI
ClinicalPresentation 930
History 930
PhysicalFindings 933
DiagnosticWork-up 933
ImagingStudies 933
RadionuclideStudies 934
Densitometry 934
BoneBiopsy 935
LaboratoryInvestigations 935
Non-operativeTreatment 936
ConservativeFractureManagement 936
MedicalTreatment 936
OperativeTreatment 937
GeneralPrinciples 937
SurgicalPrinciples 937
Recapitulation 942
KeyArticles 943
References 944
Tumors and Inflammation
33 Primary Tumors of the Spine
Bruno Fuchs, Norbert Boos
CoreMessages 951
Epidemiology 951

CaseIntroduction 952
TumorBiology 953
MolecularTumorBiology 953
PathwaysofMetastasis 954
HistologyandBiologyofSpinalTumors 956
ClinicalPresentation 957
History 957
PhysicalFindings 957
DiagnosticWork-up 958
ImagingStudies 958
CaseStudy1 960
CaseStudy2 961
Biopsy 964
LaboratoryInvestigations 964
TumorStaging 964
BenignTumors 965
MalignantTumors 966
Non-operativeTreatment 967
Non-steroidal Anti-inflammatory Drugs . . . 967
AdjuvantTherapy 967
OperativeTreatment 968
GeneralPrinciples 968
SurgicalTechniques 969
CaseStudy3 971
Recapitulation 973
KeyArticles 974
References 974
34 Spinal Metastasis
Dante G. Marchesi
CoreMessages 977

Epidemiology 977
CaseIntroduction 978
Pathogenesis 978
ClinicalPresentation 980
History 980
PhysicalFindings 980
DiagnosticWork-up 981
ImagingStudies 981
Biopsy 983
LaboratoryInvestigation 983
Classification 984
Non-operativeTreatment 985
Steroids 985
Radiotherapy 985
OperativeTreatment 986
GeneralPrinciples 986
GeneralSurgicalTechniques 987
SpecificSurgicalTechniques 988
CaseStudy1 989
CaseStudy2 992
CaseStudy3 993
PostoperativePatientManagement 993
Recapitulation 994
KeyArticles 995
References 995
35 Intradural Tumors
Yashuhiro Yonekawa, Richard Marugg
CoreMessages 997
Epidemiology 997
CaseIntroduction 998

EtiologyandPathogenesis 998
ClassificationofIntraduralTumors 999
Intradural-ExtramedullaryTumors 999
DifferentialDiagnosis 1000
CaseStudy1 1001
Intradural-IntramedullaryTumors 1002
CaseStudy2 1004
ClinicalPresentation 1005
History 1005
PhysicalFindings 1006
DiagnosticWork-up 1006
ImagingStudies 1007
LumbarPuncture 1008
Treatment 1009
Non-surgicalTreatment 1009
SurgicalTreatment 1009
SurgicalTechniques 1010
Intrinsic Spinal Cord Tumor Resection . . . . 1012
CaseStudy3 1013
Recapitulation 1016
XXII Contents
KeyArticles 1017
References 1018
36 Infections of the Spine
Norbert Boos
CoreMessages 1021
Epidemiology 1021
CaseIntroduction 1022
Pathogenesis 1023
Classification 1023

ClinicalPresentation 1024
History 1024
PhysicalFindings 1025
DiagnosticWork-up 1025
LabaratoryInvestigations 1025
ImagingStudies 1026
Biopsy 1028
NonoperativeTreatment 1029
CaseStudy1 1030
OperativeTreatment 1031
GeneralPrinciples 1031
SurgicalTechniques 1031
CaseStudy2 1035
Recapitulation 1036
KeyArticles 1037
References 1037
37 Rheumatoid Arthritis
Dieter Grob
CoreMessages 1041
Epidemiology 1041
Pathogenesis 1041
CaseIntroduction 1042
Classification 1044
ClinicalPresentation 1045
History 1045
PhysicalFindings 1045
DiagnosticWork-up 1045
ImagingStudies 1045
CaseStudy1 1047
InjectionStudies 1048

NeurophysiologicalInvestigations 1048
Non-operativeTreatment 1048
OperativeTreatment 1048
GeneralPrinciples 1048
Indications 1049
SurgicalTechniques 1050
CaseStudy2 1053
Recapitulation 1054
KeyArticles 1054
References 1055
38 Ankylosing Spondylitis
Thomas Liebscher, Kan Min, Norbert Boos
CoreMessages 1057
Epidemiology 1057
CaseIntroduction 1058
Pathogenesis 1060
ClinicalPresentation 1061
History 1061
PhysicalFindings 1062
DiagnosticWork-up 1063
LaboratoryInvestigations 1063
ImagingStudies 1063
DiagnosticCriteria 1066
Non-operativeTreatment 1067
NaturalHistory 1067
Non-operativeManagement 1068
Physiotherapy 1069
TreatmentRecommendations 1069
OperativeTreatment 1070
GeneralPrinciples 1070

Planning of Osteotomies . . . 1071
SurgicalTechniques 1072
CaseStudy1 1076
CaseStudy2 1078
Complications 1080
Recapitulation 1080
KeyArticles 1081
References 1082
39 Treatment of Postoperative
Complications
Martin Krismer, Norber t Boos
CoreMessages 1087
FrequencyofComplications 1087
CervicalSpineSurgery 1087
CaseIntroduction 1088
AnteriorSpinalSurgery 1089
Disc Herniation and Spinal Stenosis . . . . . . 1089
LumbarSpinalFusion 1090
ComparisonofComplications 1090
PreventiveMeasures 1090
ScreeningofRiskFactors 1091
Preoperative Planning 1093
ProfoundKnowledgeofAnatomy 1094
Patient Positioning . . . 1094
Neuromonitoring 1095
Approach-RelatedComplications 1095
AnteromedialCervicalApproach 1096
CaseStudy1 1097
Anterior Approach to the Cervicothoracic
Junction 1098

Thoracotomy 1098
ThoracolumbarApproach 1100
Contents XXIII