Rothman Simeone The Spine: Expert Consult: Online and PRint, 2-Volume Set, 6th Edition

Rothman-Simeone The Spine helps you achieve optimal outcomes in the clinical practice of spine surgery in adults and children. Drs. Harry N. Herkowitz, Steven R. Garfin, Frank J. Eismont, Gordon R. Bell, Richard Balderston, and an internationally diverse group of authorities help you keep up with the fast-paced field and get the best results from state-of-the-art treatments and surgical techniques, such as spinal arthroplasty and the latest spinal implants and equipment. An all-new full-color design and surgical videos on DVD and online at www.expertconsult.com make this classic text more invaluable than ever before. • Get the best results from the full range of both surgical and non-surgical treatment approaches with guidance from the world’s most trusted authorities in orthopaedic spine surgery. • Find important information quickly through pearls, pitfalls, and key points that highlight critical points. • Watch experts perform key techniques in real time with videos, on DVD and online, demonstrating minimally invasive surgery: SED procedure; thorascopic techniques; lumbar discectomy; pedicle subtraction osteotomy (PSO); C1, C2 fusion; intradural tumor; cervical laminoforaminoty; and much more. • Apply the newest developments in the field thanks to expert advice on minimally invasive surgery, spinal arthroplasty and the latest spinal implants and equipments. • See procedures clearly through an all new full-color design with 2300 color photographs and illustrations placed in context. • Access the fully searchable contents of text online at www.expertconsult.com. The new edition of the leading spine book in the fast-paced field of spine surgery presents state-of-the-art treatments and surgical techniques for spinal disorders through text and videos and is written by an internationally diverse group of the best specialist surgeons. Cover......Page 1 Front Matter......Page 2 ISBN: 9781416067269......Page 4 Copyright......Page 5 Dedication......Page 6 Contributors......Page 8 Preface......Page 20 Acknowledgments......Page 24 Early Embryologic Spine Precursors: Day 17 to Week 4......Page 26 From Somites to Spinal Column......Page 27 Precartilaginous (Mesenchymal) Stage: Weeks 4 and 5......Page 28 Ossification Stage: Week 8 and Beyond......Page 29 Fate of the Notochord......Page 30 From Neural Tube to Spinal Cord......Page 31 Spinal Ligament Development......Page 32 Atlantoaxial Complex......Page 33 Links Between Fly and Human......Page 35 Caudal Dysplasias......Page 36 References......Page 37 Pars Interarticularis......Page 39 Regional Characteristics......Page 40 Cervical Vertebrae......Page 41 Thoracic Vertebrae......Page 43 Sacral Vertebrae......Page 44 Articulations of the Vertebral Arches......Page 45 Articulations of the Vertebral Bodies......Page 47 Nucleus Pulposus......Page 48 Regional Variations of the Disc......Page 49 Posterior Longitudinal Ligament......Page 50 Relationships of the Roots of the Spinal Nerves......Page 51 Lumbosacral Nerve Root Variations......Page 52 Innervation of the Spine......Page 54 Spinal Motion Segment......Page 56 Blood Supply of the Vertebral Column......Page 57 Atlantoaxial Complex......Page 60 Sacroiliolumbar Arterial System......Page 61 Fourth Lumbar Arteries......Page 62 Iliolumbar Artery......Page 63 Venous System of the Vertebral Column......Page 64 Blood Supply of the Spinal Cord......Page 66 Anterior Spinal Artery......Page 67 Intrinsic Vascularity of the Spinal Cord......Page 69 Vascularization of the Spinal Nerve Roots......Page 70 Functional Anatomy of the Spine......Page 72 Specific Regional Considerations......Page 73 Acknowledgments......Page 74 References......Page 75 Basic Architectural Definitions......Page 78 Experimental Determination of Skeletal Muscle Architecture......Page 79 Comparison of Two Muscles with Different Physiologic Cross-Sectional Areas......Page 80 Interplay of Muscle Architecture and Moment Arms......Page 81 Intrinsic Spinal Muscles Found in the Lumbar, Thoracic, or Cervical Spine......Page 82 Suboccipital Muscles......Page 85 Extrinsic Muscles Linking Vertebrae or Skull to the Shoulder Girdle or Rib Cage......Page 87 Fascicle Length Changes with Posture......Page 88 Moment Arm Changes with Posture......Page 89 Muscle Injury and Implications for Neck and Back Pain......Page 90 Summary......Page 91 References......Page 92 Internal Oblique......Page 94 Rectus Sheath......Page 96 Mechanical Properties of the Abdominal Muscles......Page 97 Mechanical Consequences: Compression Force, Shear Force, and Stability......Page 99 Abdominal Muscles and Low Back Pain......Page 100 References......Page 101 Physiology......Page 104 Anatomy......Page 106 Erector Spinae......Page 108 Quadratus Lumborum......Page 109 Gluteal Muscles......Page 110 Electrophysiology......Page 111 Trunk Muscle Strength......Page 112 Muscle-Sparing Surgery......Page 115 Key References......Page 116 References......Page 117 Anulus Fibrosus......Page 121 Disc Composition......Page 122 Macromolecules......Page 123 Degeneration......Page 124 Matrix Macromolecule Changes......Page 125 Neovascularization and Ingrowth of Sensory Nerves......Page 126 Environmental Factors......Page 127 Disc Herniation......Page 128 References......Page 129 Physical Characteristics of Spine Structures......Page 133 Support Structures......Page 134 Disc......Page 135 Coordinate System and Force and Movement Definitions......Page 136 Mechanical Degeneration—Tissues at Risk......Page 138 Spine Kinematics......Page 139 Axis of Rotation......Page 140 Motion Coupling......Page 142 Neutral Zone Limits......Page 144 Compression......Page 145 Shear......Page 147 Flexion and Extension......Page 148 Summary......Page 149 References......Page 150 Experimental Compression of Nerve Roots......Page 153 Onset Rate of Compression......Page 154 Chronic Experimental Nerve Root Compression......Page 155 Mechanical Nerve Root Deformation and Pain......Page 156 Biologic Effects of Nucleus Pulposus......Page 157 Nucleus Pulposus and Sciatic Pain......Page 158 Chemical Components of Nucleus Pulposus......Page 159 Cytokines as Mediators of Nerve Dysfunction and Pain......Page 160 Summary......Page 162 References......Page 163 Definition......Page 170 Viral Vectors......Page 171 Augmentation of Spinal Fusion with Bone Morphogenetic Proteins......Page 172 Clinical Problem......Page 173 Previous Studies of Intradiscal Gene Therapy......Page 174 Gene Expression Time Frame......Page 176 Summary......Page 178 References......Page 179 Need for Outcomes Research......Page 182 Measuring Outcomes in Spinal Disorders......Page 183 Importance of Study Design in Outcomes Research......Page 184 Chance......Page 185 Confounding......Page 186 Randomized Controlled Trials......Page 187 Observational Cohort Studies......Page 188 Cost-Effectiveness Analysis......Page 189 Future of Outcomes Research: Patient-Specific Recommendations......Page 190 References......Page 191 Differential Diagnosis......Page 194 “Red Flags”—What Not to Miss......Page 196 Axial Versus Radicular Pain......Page 198 Past Medical History......Page 199 “Yellow Flags”—Predictors of Poor Outcome in the Patient’s History......Page 201 Additional Assessment Tools......Page 202 Observation......Page 203 Neurologic Examination......Page 204 Nonorganic Signs......Page 206 Conclusions......Page 207 References......Page 208 Myelography......Page 211 Computed Tomography......Page 212 Spinal Angiography......Page 213 Spinal Angiography Using Magnetic Resonance Imaging and Computed Tomography......Page 214 Degenerative Disc Disease......Page 216 Lumbar Stenosis......Page 217 Cervical Radiculopathy and Myelopathy......Page 218 Ossification of Posterior Longitudinal Ligament......Page 220 Postoperative Issues......Page 221 Epidural Fibrosis and Disc Herniations......Page 225 Infection......Page 227 Intramedullary Lesions......Page 230 Intradural Extramedullary Lesions......Page 233 Cysts......Page 235 Hemorrhage......Page 237 References......Page 239 Pathophysiology......Page 245 Sensory Nerve Conduction Studies......Page 246 Late Responses (H Responses and F Waves)......Page 247 At-Rest Phase......Page 248 Electrodiagnostic Findings in Radiculopathy......Page 249 Routine Studies......Page 250 Needle Electrode Examination......Page 251 Cervical Radiculopathy......Page 255 Thoracic Radiculopathy......Page 256 Differential Diagnoses......Page 257 Myelopathy......Page 258 Key References......Page 259 References......Page 260 Intraoperative Monitoring of the Spinal Cord......Page 261 Motor-Evoked Potential Monitoring......Page 262 Clinical Use of Intraoperative Monitoring......Page 265 Pedicle Screw Stimulation......Page 266 Summary......Page 267 References......Page 268 Targeting Pain Generators......Page 270 Diagnostic Analgesic Injections as Reference Standard......Page 271 Biopsychosocial Factors......Page 272 Pathophysiology of Facet Pain......Page 273 Rationale for Control Blocks in Diagnostic Facet Intra-articular and Medial Branch Blocks......Page 274 History......Page 276 Lumbar Zygapophyseal Joint Pain......Page 277 Predictive Value......Page 278 Cervical Zygapophyseal Joint Pain......Page 280 Thoracic Spine......Page 281 Summary......Page 283 Pathophysiology......Page 284 Diagnostic Accuracy of Clinical History and Physical Examination for Sacroiliac Pain......Page 286 Diagnostic Accuracy of Sacroiliac Joint Injections......Page 287 Summary......Page 288 Diagnostic Accuracy of Selective Nerve Root Blocks......Page 289 Sensitivity......Page 290 History......Page 291 Technical Considerations......Page 293 Summary......Page 294 Key References......Page 296 References......Page 297 Clinical Context......Page 304 Pain Generator Concept and Provocative Discography......Page 305 Depression, Anxiety, and Somatic Distress......Page 307 Evidence for Validity and Usefulness of Provocative Discography......Page 308 Specificity of Positive Discography: Testing on Subjects with No Axial Pain History......Page 309 Discography in Subjects with Minimal Low Back Symptoms......Page 310 Evidence That Discography in Clinical Practice May Improve Outcomes......Page 311 Clinical Outcome as a “Gold Standard” in Provocative Discography......Page 312 Complications......Page 313 Conclusions Regarding Provocative Discography......Page 314 References......Page 315 Osseous Anatomy and Bony Articulation......Page 320 Ligaments......Page 322 Intervertebral Discs......Page 323 Neural Elements......Page 324 Vascular Structures......Page 325 Musculature......Page 326 Anterior Approaches to Upper Cervical Spine......Page 327 Anteromedial Retropharyngeal Technique......Page 328 Anterolateral Retropharyngeal Technique......Page 330 Complications......Page 331 Anteromedial Approach......Page 332 Complications......Page 333 Modified Anterior Approach......Page 334 Transthoracic Approach......Page 335 Posterior Approach to Upper Cervical Spine......Page 336 Posterior Approach to Lower Cervical Spine......Page 337 Complications......Page 338 References......Page 339 Operative Procedure......Page 342 Transthoracic (Third Rib Resection)......Page 344 Operative Procedure......Page 345 Operative Procedure......Page 346 Anatomy of Thoracolumbar Junction......Page 348 Operative Procedure......Page 349 Surgical Procedure......Page 351 Anatomy of Thoracic Spine......Page 352 Posterior Approach for Decompressive Laminectomy......Page 356 Transpedicular Approach......Page 357 Costotransversectomy......Page 358 Lateral Extracavitary Approach......Page 359 Key References......Page 361 References......Page 362 Vascular Anatomy: Variability, Bifurcations, Iliolumbar Vein, Segmental Vessels, and Middle Sacral Vessels......Page 363 General Considerations......Page 364 Retroperitoneal......Page 365 Complications......Page 369 Key References......Page 371 References......Page 372 Technique......Page 373 Posterior Approach to Lumbar Spine......Page 375 Technique......Page 376 Technique......Page 378 References......Page 380 History......Page 382 Bone Scan......Page 383 Disc Herniation......Page 384 Spondylolysis and Spondylolisthesis......Page 385 Scheuermann Kyphosis......Page 386 Lumbar Scheuermann Disease......Page 387 Discitis......Page 388 Aneurysmal Bone Cysts......Page 390 Osteoid Osteoma......Page 391 Leukemia......Page 392 Nonorthopaedic Causes of Pain......Page 393 References......Page 394 Failures of Segmentation......Page 398 Etiology......Page 399 Natural History......Page 400 Radiographs......Page 401 Posterior Spine Fusion......Page 402 Convex Hemiepiphysiodesis......Page 403 Guided Growth Procedures......Page 404 Indications......Page 405 References......Page 406 Genetics......Page 409 Radiographic Evaluation......Page 410 Classification Systems......Page 411 Bracing and Casting......Page 412 Surgical Techniques......Page 413 Selective Fusions......Page 416 Direct Vertebral Rotation......Page 417 Osteotomies......Page 418 Postoperative Care......Page 420 Summary......Page 421 Key References......Page 422 References......Page 423 Natural History and Associated Complications......Page 426 Treatment Principles......Page 427 Genetic and Family Counseling......Page 428 Bracing......Page 429 Operative Treatment......Page 430 Pulmonary......Page 432 Radiographic Assessment......Page 433 History of Instrumentation in Neuromuscular Scoliosis......Page 434 Pelvic and Sacral Fixation......Page 435 Indications......Page 438 Spinal Cord Monitoring......Page 439 Transthoracic Approach......Page 440 Wound Infections......Page 441 Scoliosis in Cerebral Palsy......Page 442 Authors’ Recommendations......Page 443 Scoliosis in Myelodysplasia......Page 444 Posterior Fusion......Page 446 Kyphosis Treatment......Page 448 Spinal Muscular Atrophy Types......Page 450 Bracing......Page 451 Scoliosis in Muscular Dystrophy......Page 452 Surgical Management......Page 453 Rett Syndrome......Page 454 Scoliosis in Rett Syndrome......Page 455 References......Page 456 Scoliosis......Page 461 Contraindications......Page 463 Surgical Technique......Page 464 Outcomes......Page 466 Surgical Technique......Page 467 Outcomes......Page 469 Thoracic Disc Herniation......Page 470 References......Page 471 Scheuermann Disease......Page 475 Clinical Evaluation......Page 476 Natural History......Page 477 Nonsurgical Treatment......Page 478 Surgical Treatment......Page 479 Complications......Page 481 Junctional Kyphosis......Page 482 Classification......Page 483 Clinical Evaluation......Page 484 Surgical Treatment......Page 485 Neurologic Complications......Page 488 References......Page 489 Pathophysiology......Page 493 Epidemiology......Page 494 History and Physical Examination......Page 495 Radiographic Evaluation......Page 496 Conservative Management......Page 497 Surgical Treatment......Page 498 Summary......Page 502 References......Page 503 Developmental Anatomy and Biomechanics......Page 510 Transport and Evaluation......Page 511 Plain Radiography of Cervical Spine......Page 512 Computed Tomography and Magnetic Resonance Imaging of Spine......Page 513 Spinal Cord Injury in Children......Page 514 Atlanto-occipital Dislocation......Page 516 Atlantoaxial Rotatory Subluxation......Page 517 Odontoid Fractures......Page 518 Burst Fractures......Page 519 Pediatric Halo......Page 520 Chance Fractures......Page 521 Limbus Fractures......Page 522 References......Page 523 History......Page 529 Physical Examination......Page 530 Single Photon Emission Computed Tomography......Page 531 Sport-Specific Exercise......Page 532 Education......Page 533 Spondylolysis......Page 534 Treatment......Page 535 Spondylolisthesis......Page 536 Lumbar Scheuermann Disease (Juvenile Disc Disease)......Page 537 Herniated Nucleus Pulposus......Page 538 On-Field Examination......Page 539 Stingers or Burners......Page 540 Sacral Stress Fracture......Page 541 Tumor......Page 542 Key References......Page 543 References......Page 544 Basilar Impression......Page 548 Radiographic Features......Page 549 Clinical Features......Page 550 Treatment......Page 551 Pathomechanics......Page 552 Radiographic Features......Page 553 Treatment......Page 557 Laxity of Transverse Atlantal Ligament......Page 558 Clinical Features......Page 559 Radiographic Features......Page 560 Anomalies of Ring of C1......Page 561 Incidence......Page 563 Development of Odontoid......Page 564 Etiology and Pathogenesis......Page 565 Clinical Features......Page 566 Os Odontoideum......Page 567 Treatment......Page 569 Klippel-Feil Syndrome (Congenital Synostosis of Cervical Vertebrae, Brevicollis)......Page 571 Clinical Features......Page 572 Radiographic Features......Page 575 Patterns of Cervical Motion......Page 579 Scoliosis......Page 580 Renal Abnormalities......Page 581 Treatment......Page 582 Muscular Torticollis (Wry Neck)......Page 583 Etiology......Page 584 Surgery......Page 585 Differential Diagnosis......Page 586 Radiographic Features......Page 588 References......Page 589 Embryology......Page 597 Initial Evaluation......Page 598 Management of an Unrepaired Newborn......Page 599 Closure Before Birth......Page 601 Tethered Cord......Page 602 Hydromyelia......Page 603 Chiari Malformation......Page 604 Occult Spinal Dysraphism and Tethered Cord......Page 605 Cutaneous Syndrome......Page 606 Orthopaedic Syndrome......Page 607 Lipomyelomeningocele......Page 608 Sacral Agenesis and Caudal Regression Malformations......Page 614 Split Cord Anomalies......Page 615 Anterior Sacral Meningocele and Currarino Triad......Page 618 Congenital Dermal Sinus and Dermoid Cysts......Page 620 Filum Terminale Syndrome......Page 621 Neurenteric Cyst......Page 622 Intraoperative Neurophysiologic Monitoring......Page 624 References......Page 625 Achondroplasia......Page 632 Diastrophic Dysplasia......Page 638 Spondyloepiphyseal Dysplasia Tarda......Page 639 Spondyloepiphyseal Dysplasia Congenita......Page 641 Pseudoachondroplasia......Page 643 Hurler Syndrome (Mucopolysaccharidosis Type I)......Page 644 Morquio Syndrome (Mucopolysaccharidosis Type IV)......Page 645 Kniest Syndrome......Page 646 Metatropic Dysplasia......Page 647 Spondyloepimetaphyseal Dysplasia with Joint Laxity......Page 649 Summary......Page 650 Key References......Page 651 References......Page 652 Epidemiology......Page 656 Atlantoaxial Subluxation......Page 657 Physical Examination......Page 658 Radiographic Evaluation......Page 659 Psoriatic Arthritis......Page 660 Reactive Arthritis......Page 662 Diffuse Idiopathic Skeletal Hyperostosis......Page 663 Muscle Relaxants......Page 664 Anti–Tumor Necrosis Factor-α Inhibitors......Page 665 Cervical Subluxation......Page 666 Radiographic Evaluation......Page 667 Nonsteroidal Anti-inflammatory Drugs......Page 669 Cervical Spine Therapy......Page 670 References......Page 671 Historical Perspective......Page 675 Natural History......Page 676 Radiologic Evaluation......Page 677 Indications......Page 679 Perioperative Management of Rheumatoid Medication......Page 680 Wire Techniques......Page 681 Posterior C1-2 Intra-articular Screw Fixation......Page 682 Posterior C1-2 Screw-Rod Constructs......Page 683 Occipitocervical Plating......Page 685 Resection of the Odontoid......Page 686 Wiring Techniques......Page 687 Thoracolumbar Disease......Page 688 Summary......Page 689 References......Page 690 Nonorthopaedic Manifestations......Page 694 Management of Acute Injury......Page 695 Preoperative Assessment......Page 697 Lumbar Osteotomies......Page 698 Thoracic Osteotomies......Page 700 Cervicothoracic Osteotomy......Page 701 Key References......Page 703 References......Page 704 Pathophysiology of Axial Neck Pain......Page 708 Pathophysiology of Radiculopathy......Page 709 Pathophysiology of Myelopathy......Page 711 Axial Neck Pain......Page 712 Axial Neck Pain......Page 713 Cervical Radiculopathy......Page 714 Cervical Myelopathy......Page 715 Summary......Page 717 References......Page 718 Acute Idiopathic Transverse Myelitis and Multiple Sclerosis......Page 721 Adrenomyeloneuropathy......Page 723 Human Immunodeficiency Virus Infection......Page 724 Enteroviruses......Page 725 Tabes Dorsalis......Page 726 Other Forms of Bacterial Myelopathy......Page 728 Arachnoiditis......Page 729 Vascular Disease of the Spinal Cord......Page 730 Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome......Page 731 Vitamin B12 Deficiency......Page 732 Paraneoplastic Myelopathies......Page 733 Toxins......Page 734 Electrical Injury......Page 735 Heredofamilial Degenerations......Page 736 References......Page 737 Natural History......Page 744 Ice, Heat, and Passive Modalities......Page 745 Narcotics......Page 746 Cervical Manipulation......Page 747 Cervical Steroid Injections......Page 748 Summary......Page 749 References......Page 750 Why Understanding the Natural History of a Condition Is Crucial......Page 752 Etiology......Page 753 Physical Examination......Page 754 Advanced Invasive Diagnostics......Page 756 Surgical Outcomes for Axial Neck Pain......Page 757 Summary......Page 759 References......Page 760 Radiographic Evaluation......Page 763 Anterior Cervical Discectomy and Fusion: Surgical Technique......Page 765 Anterior Cervical Plating......Page 769 Results......Page 770 Complications......Page 774 Autograft Versus Allograft......Page 775 Polyetheretherketone......Page 776 Anterior Cervical Foraminotomy......Page 777 Cervical Disc Arthroplasty......Page 778 Key References......Page 780 References......Page 781 Indications for Surgical Intervention......Page 786 Surgical Techniques......Page 788 Anterior Cervical Discectomy and Fusion......Page 791 Anterior Cervical Corpectomy and Fusion......Page 792 Complications......Page 793 Indications for a Posterior Approach......Page 795 Technique......Page 797 Complications......Page 799 Open-Door Laminoplasty......Page 800 Technique......Page 801 Outcomes......Page 802 Complications......Page 803 Comparison of Outcomes......Page 804 Combined Anterior-Posterior Procedures......Page 805 Intraoperative Neurologic Monitoring......Page 806 Key References......Page 807 References......Page 808 Pathology......Page 815 Location......Page 816 Plain Radiography......Page 817 Magnetic Resonance Imaging......Page 818 Authors’ Preferred Choice of Surgical Procedure......Page 819 Surgical Technique......Page 820 Posterior Approaches......Page 822 Surgical Results......Page 823 Ossification of the Posterior Longitudinal Ligament or Ossification of the Ligamentum Flavum of the Thoracic Spine......Page 825 Surgical Treatment......Page 828 References......Page 829 Background......Page 832 History of Disc Arthroplasty and Device Design......Page 833 Indications for Use, Contraindications, and Complications......Page 836 Technique of Implantation......Page 837 PRESTIGE Disc......Page 840 BRYAN Disc......Page 841 PCM Disc......Page 843 Biomechanics......Page 844 Wear Analysis......Page 845 Conclusion......Page 846 References......Page 847 Epidemiology......Page 852 Etiology......Page 853 Clinical Presentation......Page 854 Level and Classification of Herniation......Page 855 Differential Diagnosis......Page 856 Magnetic Resonance Imaging......Page 857 Treatment......Page 860 Video-Assisted Thoracoscopic Surgery......Page 863 Minimally Invasive Techniques......Page 864 Summary......Page 865 References......Page 866 Natural History......Page 870 Changes in Disc Structure with Aging and Degeneration......Page 871 Degenerative Disc Disease......Page 872 Degenerative Disc Disease......Page 873 Magnetic Resonance Imaging......Page 874 High-Intensity Zone......Page 876 Modic Endplate Changes......Page 877 Discography......Page 878 Bed Rest and Advice to Stay Active......Page 880 Physical Therapy......Page 881 Pharmacotherapy......Page 882 Epidural Spinal Injection......Page 883 Thermal Annuloplasty......Page 884 Surgical Treatment......Page 885 Spinal Fusion......Page 886 Circumferential Fusion......Page 887 Posterior and Transforaminal Lumbar Interbody Fusion......Page 889 Minimally Invasive Surgical Approaches......Page 890 Minimally Invasive Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion......Page 891 Extreme Lateral Lumbar Interbody Fusion and Direct Lateral Lumbar Interbody Fusion......Page 892 Percutaneous Axial Lumbar Interbody Fusion......Page 893 Materials and Osteobiologics......Page 894 Dynamic Spinal Stabilization Techniques......Page 895 Disc Arthroplasty......Page 896 Nuclear Replacement......Page 897 Summary......Page 898 Key References......Page 899 References......Page 900 Pathoanatomy......Page 911 Disc Degeneration and Herniation......Page 912 Disc Herniation and Sciatica......Page 913 Timing......Page 914 History and Symptoms......Page 915 Palpation and Percussion......Page 916 Specific Tests......Page 917 Diagnostic Imaging......Page 918 Magnetic Resonance Imaging......Page 919 Computed Tomography......Page 920 Pharmacologic Treatment......Page 921 Operative Versus Nonoperative Treatment......Page 922 Available Techniques......Page 923 Technique......Page 924 Postoperative Care and Rehabilitation......Page 926 Outcomes......Page 927 Recurrent Disc Herniations......Page 929 Discectomy in Elderly Patients......Page 930 Cauda Equina Syndrome......Page 931 Endoscopic Discectomy......Page 932 Chemonucleolysis......Page 933 References......Page 934 Healing of Anulus......Page 939 Surgical Repair......Page 940 References......Page 941 Anatomy and Approach......Page 943 Interbody Implants and Graft Material......Page 944 Circumferential Fusion......Page 948 Complications......Page 949 Key References......Page 950 References......Page 951 Historical Perspective......Page 954 Indications for Interbody Fusion......Page 955 Biomechanics of Interbody Fusion......Page 956 Cage Characteristics......Page 957 Author’s Preferred Technique......Page 959 Optimal Graft Material......Page 961 Outcomes and Complications of Posterior Lumbar Interbody Fusion......Page 965 References......Page 966 Transforaminal Lumbar Interbody Fusion......Page 970 Surgical Procedure......Page 971 Complications......Page 974 Key References......Page 975 References......Page 976 Historical Devices......Page 977 Constrained versus Unconstrained......Page 978 Clinical Indications for Lumbar Total Disc Replacement......Page 979 CHARITÉ Artificial Disc......Page 980 Prodisc-L......Page 981 Other Devices......Page 983 Complications and Revision Strategies......Page 985 Future Considerations......Page 986 Conclusion......Page 987 References......Page 988 Design and Material Options of Nucleus Replacement......Page 992 Clinical Experience of Different Nucleus Replacement Devices......Page 995 Conclusion......Page 996 References......Page 997 Instability......Page 999 Design Rationale for Dynamic Stabilization Devices......Page 1000 Resistance to Fatigue Failure......Page 1001 Dynamic Stabilization Devices......Page 1002 Indications for Interspinous Process Distraction......Page 1003 Pedicle Screw–Based Posterior Dynamic Stabilization Devices......Page 1004 Interspinous Distraction Devices......Page 1005 Summary......Page 1006 Key References......Page 1007 References......Page 1008 Radiologic Diagnosis and Issues......Page 1010 Current Treatment of Posterior Lumbar Degeneration......Page 1012 Clinical Testing......Page 1013 Future of Total Facet Replacement......Page 1015 References......Page 1018 Multifidus Muscle......Page 1022 Interspinales, Intertransversarii, and Short Rotator Muscles......Page 1023 Fiber Type Characteristics of the Paraspinal Muscles......Page 1024 Correlation of Muscle Injury with Clinical Outcomes......Page 1025 Summary......Page 1026 Key References......Page 1027 References......Page 1028 Minimally Invasive Spine Surgical Corridor......Page 1031 Lumbar Decompression......Page 1032 Percutaneous Pedicle Screw Instrumentation......Page 1035 Radiation Exposure......Page 1037 Learning Curve for Minimally Invasive Spinal Surgery......Page 1039 Key References......Page 1041 References......Page 1042 Obesity......Page 1044 Technical Outcomes of Minimally Invasive Fusion Surgery......Page 1045 Percutaneous Pedicle Screws......Page 1046 Technique of Percutaneous Pedicle Screw Placement......Page 1047 Screw Insertion Technique: Fluoroscopic Versus Navigation......Page 1048 References......Page 1051 Principles of Minimally Invasive Spinal Surgery......Page 1052 Setup and Imaging......Page 1053 Surgical Incisions and Approach......Page 1054 Posterior Interbody and Transforaminal Interbody Fusion......Page 1055 Pedicle Screw Instrumentation......Page 1056 Cannulated Pedicle Screw Insertion......Page 1057 Technical Tips......Page 1060 Direct Pedicle Screw Insertion via a Paramedian Approach......Page 1061 Patient Selection......Page 1062 Conclusion......Page 1063 References......Page 1064 History......Page 1065 Endoscopic Lumbar Discectomy......Page 1066 Indications/Contraindications......Page 1067 Evocative Chromo-discography......Page 1069 Performing the Discectomy......Page 1070 Clinical Outcomes......Page 1071 Future Considerations......Page 1072 References......Page 1073 Design Rationale......Page 1075 Surgical Technique......Page 1076 Summary......Page 1077 References......Page 1078 Preparation......Page 1080 Identifying and Tagging the Anatomy......Page 1081 Part II: L4-5 Fibroregeneration......Page 1082 Part III: Chondrogenic Reconstitution......Page 1083 Part V: Posterior Mechanical Environment......Page 1084 Part VI: Final Confirmation......Page 1085 Disc......Page 1088 Intervertebral Foramen......Page 1089 Classification......Page 1090 Natural History......Page 1091 Clinical Presentation......Page 1092 Computed Tomography with and Without Myelography......Page 1093 Magnetic Resonance Imaging......Page 1094 Electromyography, Nerve Condition Studies, and Somatosensory Evoked Potentials......Page 1096 Summary......Page 1097 References......Page 1098 Natural History of Lumbar Spinal Stenosis......Page 1102 Physical Therapy......Page 1103 Lumbar Spinal Stenosis: Evidence-Informed Approach to Management......Page 1104 References......Page 1105 Laminectomy......Page 1107 Outcomes of Laminectomy......Page 1111 Arthrodesis After Laminectomy......Page 1112 Fenestration......Page 1113 Laminoplasty......Page 1114 Microendoscopic Decompressive Laminotomy......Page 1115 Interspinous Devices......Page 1116 Complications......Page 1118 Key References......Page 1120 References......Page 1121 Epidemiology and Biomechanics......Page 1125 Clinical Features......Page 1126 Radiographic Diagnosis......Page 1127 Decompression Without Fusion......Page 1128 Noninstrumented Posterolateral Fusion......Page 1129 Posterior Instrumented Fusion......Page 1131 Posterior Fusion with Anterior Column Support......Page 1133 Alternative Surgical Strategies......Page 1134 Summary......Page 1135 References......Page 1136 Posterior Ilium......Page 1142 Fibula......Page 1144 Rib......Page 1145 Arterial Injury......Page 1146 Lateral Femoral Cutaneous Nerve......Page 1147 Hematoma......Page 1148 Fracture......Page 1149 Damage to Deep Neurovascular Bundles......Page 1150 Rib......Page 1151 References......Page 1152 Fusions Site......Page 1154 Bone Graft......Page 1155 Autologous Cortical Bone......Page 1156 Autologous Bone Marrow......Page 1157 Structural Allografts and Cages......Page 1159 Demineralized Allograft Bone Matrix......Page 1160 Bone Morphogenic Proteins......Page 1161 Collagen......Page 1165 Ceramics......Page 1166 Systemic Factors Influencing Spinal Fusion......Page 1167 Local Factors Influencing Spinal Fusion......Page 1168 Key References......Page 1169 References......Page 1170 Allografts......Page 1183 Demineralized Bone Matrices......Page 1185 Osteoinductive Growth Factors......Page 1186 Gene Therapy......Page 1188 Conclusion......Page 1189 References......Page 1190 Ba