(BQ) Part 2 book “50 landmark papers every spine surgeon should know” has contents: Surgical versus nonsurgical treatment for lumbar - degenerative spondylolisthesis, ervical spine fusion in rheumatoid arthritis, classification of spondylolysis and spondylolisthesis, the impact of positive sagittal balance in adult spinal deformity,… and other contents.
Sec t ion T hre e • D e ge nerat ive Chapter 21 Lumbar Disc Herniation: A Controlled, Prospective Study with 10 Years of Observation Weber H, et al Spine 1983 Reviewed by Raj Gala and Peter G Whang Research Question/Objective The type and timing of treatment for lumbar disc herniation remains controversial The shortcomings of prior studies included concern for information and selection bias, the often retrospective nature of the research, and a lack of diagnostic imaging in the conservatively treated groups Prior to this study, there was a paucity of randomized controlled trials comparing operative to nonoperative management Throughout previous nonrandomized comparative studies, the reported outcomes were inconsistent, and there was additional uncertainty surrounding the longevity of treatment effects observed with operative versus nonoperative treatment The current study aimed to produce more reliable data surrounding the question of operative versus nonoperative treatment for lumbar disc herniation Study Design The main research focus (Group 1) was a prospective, randomized, controlled trial comparing surgery and continued physiotherapy for patients with sciatica secondary to an associated lumbar disc herniation for whom the authors believed there was true equipoise between the two treatments The study also included two prospective nonrandomized observational arms: a group of patients who were thought to have definitive indications for surgery (Group 2) and a group of patients who were selected for conservative management (Group 3) because they demonstrated continued improvement with initial nonoperative treatment Sample Size The study included 280 consecutive patients with sciatica secondary to a disc herniation One hundred twenty-six patients were allocated to Group (age range 25 to 55 years) and randomized to either operative treatment (60 patients) or continued physiotherapy (66 patients) Group consisted of 67 patients who were felt to have definitive indications for surgery, and Group included 87 patients who showed continuous improvement during the initial enrollment period and were selected for conservative treatment 109 110 Section Three • Degenerative Follow-Up All patients were sent a questionnaire at 3, 6, and 9 months, as well as and 3 years after enrollment Patients presented for reexamination at the 1-year and 4-year marks At 10 years of follow-up, only patients in Group 1 presented for repeat assessment The study included 280 consecutive patients who presented with sciatica with clinical symptoms of L5 or S1 radiculopathy and with corresponding positive findings on radiological investigation (radiculography) Patients were excluded if they had spondylolisthesis or prior operations on the spine Patients were assigned to definitive surgery (Group 2) if they exhibited any of the following findings: severe and immobile scoliosis, intolerable pain, suddenly occurring and/or progressive muscle weakness, and bladder/rectum paresis Patients who demonstrated satisfactory progression during the 2-week observational period were allocated into Group to continue nonsurgical treatment The remaining patients (Group 1) were randomized to either operative or nonoperative management Inclusion/Exclusion Criteria Intervention or Treatment Received All patients were initially admitted to the hospital under the Department of Neurology Patients who did not require immediate surgery underwent a 14-day observation period of bed rest, medication, and progressive physiotherapy After this regimen, patients in Group 1 were randomized to either surgery or conservative management The nonoperative patients were transferred to a rehabilitation hospital for an average of 6 weeks of physiotherapy Operative patients were placed prone in the knee-elbow position Ligamentum flavum was excised with resection of the edges of the vertebral arch above and below the exposed interspace, with subsequent nerve root decompression and disc removal Surgical patients were discharged seven to nine days postoperatively, without further treatment Baseline patient characteristics showed a male to female ratio of 1.4:1, similar to prior studies Twenty-nine percent of the patients were found to have psychosocial problems, a comparable rate to the U.S general population Results Of the 66 patients who were randomized to conservative treatment, 17 crossed over to operative treatment during the first year (range 1–11 months), with one patient randomized to the surgical group having refused operation At followup, patients were assigned an outcome—good, fair, poor, and bad— according to subjective reports made by the patients Within the intention-to-treat analysis and as-treated analyses, the 1-year results showed statistically better outcomes in the operated group By the 4-year mark, the difference was no longer statistically significant, although there remained a trend toward favorable outcomes in the operated group At final follow-up at 10 years, there was no observable difference between the two groups “Good” outcomes were reports in 56% of patients initially assigned to conservative treatment compared to 63.6% of patients initially randomized to surgery, but this was not a statistically Chapter 21 Table 21.1 • 111 Lumbar Disc Herniation Conservative Treatment Group 1-Year Results 10-Year Results Result Remained in Original Group Operated Total Remained in Original Group Operated Total Good Fair Poor Bad Total 16 24 49 4 17 24 28 13 66 27 18 49 10 0 17 37 25 66 Adapted from Weber, H., Spine, 1983 Table 21.2 Operative Treatment Group 1-Year Results 10-Year Results Result Operated as Planned Not Operated Total Operated as Planned Not Operated Total Good Fair Poor Bad Total 39 15 59 0 39 16 60 34 16 54 0 35 16 55 Adapted from Weber, H., Spine, 1983 significant difference Tables 21.1 and 21.2 summarize the data for the groups undergoing conservative and operative treatments, respectively Muscle weakness was evident in 64 patients prior to randomization At 10-year follow-up, patients had persistent muscle paresis, which appeared to be unrelated to their treatment group More than 35% of patients still had sensory deficits at 10 years, equally distributed between the two groups Otherwise there were no differences in pain and spinal mobility between the two groups at the 10-year follow-up There was a relatively small number of patients who underwent randomization, an issue that is further complicated by the relatively high percentage of crossover (26%) into the operative group This problem did not appear to significantly affect the statistics because surgical treatment resulted in better outcomes at year on both an intention-totreat and on an as-treated basis The research and follow-up were performed by a nonsurgeon, which at least theoretically limited bias toward surgical treatment, but the study was not blinded to patient or researcher In addition, the researchers used outcome measures that were unique to this study, and they have not been validated in prior or subsequent trials Another minor weakness relates to the use of radiculography in this study, which is a modality that is now rarely employed to diagnose lumbar disc herniations Study Limitations 112 Section Three • Degenerative A lumbar disc herniation resulting in sciatica is a common cause of discomfort and disability in patients The natural history of lumbar disc prolapse is typically resolution over time,1 but there remains debate over the short- and long-term outcomes of surgical treatment In 2005, Atlas et al.2 published the long-term results of a prospective cohort series of 400 patients comparing surgical and nonsurgical management of sciatica secondary to lumbar disc herniation At 10-year follow-up, 69% of patients who underwent discectomy and 61% of patients initially treated nonsurgically (p = 0.2) exhibited improvement in their symptoms There was no difference in work and disability status between the two groups Nevertheless, there was a statistically higher proportion of surgical patients who reported more complete relief of pain as well as greater satisfaction with their treatment Relevant Studies The Spine Patient Outcomes Research Trial (SPORT)3 included 501 patients randomized to either surgical or nonsurgical treatment for symptomatic lumbar disc herniations While there was significant crossover between groups, according to an intention to treat analysis, patients in both groups demonstrated significant improvements in primary and secondary outcomes over the first 2 years; however, the differences between the two groups were small and not statistically significant A separate as-treated analysis was also performed because of the high rates of crossover, which showed that the surgical patients did statistically better than nonsurgical patients at all time points during the first 2 years of follow-up As a continuation of the astreated analysis, a 4-year follow-up of these same cohorts4 demonstrated that surgical patients still showed greater improvements in all primary and secondary outcomes except work status compared to those treated nonoperatively The SPORT study also included a nonrandomized cohort of 743 patients,5 with 528 electing to proceed with surgery and 191 choosing nonoperative care; as with the randomized subjects, selfreported outcomes were statistically better in the surgical group at 2 years REFERENCES Bush K, Cowan N, Katz DE, Gishen P The natural history of sciatica associated with disc pathology: A prospective study with clinical and independent radiologic follow-up Spine 1992; 17(10): 1205–1212 Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the Maine lumbar spine study Spine 2005; 30(8): 927–935 Weinstein JN, Tosteson TD, Lurie JD, et al Surgical versus nonoperative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT): A randomized trial JAMA 2006; 296(20): 2441–2450 Weinstein JN, Lurie JD, Tosteson TD, et al Surgical versus non-operative treatment for lumbar disc herniation: Four-year results for the Spine Patient Outcomes Research Trial (SPORT) Spine 2008; 33(25): 2789 Weinstein JN, Tosteson TD, Lurie JD, et al Surgical versus nonoperative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT) observational cohort JAMA 2006; 296(20): 2451–2459 Chapter 22 Radiculopathy and Myelopathy at Segments Adjacent to the Site of a Previous Anterior Cervical Arthrodesis* Hilibrand AS, Carlson GD, Palumbo MA, et al J Bone Joint Surg Am 81:519–528, 1999 Reviewed by Godefroy Hardy St-Pierre and Ken Thomas Anterior cervical arthrodesis is believed to lead to an accelerated progression of adjacent segment degeneration While providing excellent short-term results, the longevity of the procedure is brought into question via additional biomechanical stress at the unfused levels above and below Further ambiguity arises with the lack of clear association between radiological degeneration postoperatively and symptomatic clinical disease attributable to the adjacent segment Contrary to prior studies, Hilibrand et al focused on symptomatic adjacent segment disease (ASD), rather than radiological, up to 10 years post–cervical arthrodesis They determined the incidence and prevalence of this disease and explored potential causative factors Research Question/Objective Study Design A cohort study of patients who underwent anterior cervical arthrodesis by a single surgeon at a single institution Sample Size Three hundred seventy-four patients undergoing 409 procedures over 19 years (1972–1992) Follow-Up One to 10 years Median 4 years Inclusion criteria are not explicitly cited in the article Excluded were 9 patients that died within 6 months of the index procedure as well as patients with acute fracture or dislocation, or malignant neoplasm, or those scheduled for a concomitant posterior arthrodesis Inclusion/Exclusion Criteria Anterior cervical arthrodesis via a modified SmithRobinson technique The procedure was performed at all levels with Intervention * Hilibrand AS, Carlson GD, Palumbo MA, et al Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis J Bone Joint Surg 1999; 81: 519–528 113 114 Section Three • Degenerative attributable symptoms of either radiculopathy or myelopathy in 338 procedures In another 71 procedures, a subtotal vertebrectomy and arthrodesis with strut grafting was performed for advanced spondylosis or congenital stenosis with spinal cord compression Clinical ASD presented in 58 of the 409 procedures, representing an overall prevalence of 14.2% New symptomatic ASD presented at a constant rate over the 10-year postoperative period at an average annual incidence of 2.9% per year Kaplan-Meier analysis predicted a prevalence of 13.6% at 5 years and 25.6% at 10 years Of the 55 patients with clinical ASD, 27 underwent reoperation at the adjacent segment There were significant differences between the cervical levels with C5-C6 and C6-C7 being at highest risk of reoperation, while C2-C3 and T1-T2 were at the lowest risk Those results seemed to correlate location of clinical ASD with the amount of motion in flexion/extension Contrary to the authors` initial hypothesis, multilevel arthrodesis was found to be associated with a significantly lower prevalence of clinical ASD (OR 0.64 p < 0.001) Finally, preoperative radiological degeneration, not addressed at the time of the index surgery, was correlated with an earlier onset of clinical ASD Results The prevalence of clinical ASD in this study was much higher than previously reported, most likely secondary to the long duration of follow-up and the inclusion of both operative and nonoperative patients in the new clinical ASD group The finding that multilevel arthrodesis imparted a lower risk of clinical ASD supports the hypothesis that clinical ASD is due to progression of existing cervical spondylosis, as opposed to excessive motion at unfused segments This was consistent with their radiological analysis of initial degeneration and, if not addressed surgically, its correlation with earlier onset of clinical ASD The authors finally advocated incorporating all degenerated segments in the construct to minimize reoperation Despite being accounted for through sound statistical methodology, 10%–20% of patients were lost to follow-up each year, with the potential to greatly alter the results, including the steady rate of clinical ASD postoperatively With the exception of multilevel versus single level, no further stratification or subgroup analysis was provided despite the heterogeneity of the procedures performed Likewise, no information was provided as to which procedure was performed at which specific level The radiological analysis was again similarly weakened by the use of three different modalities to assess the presence of degenerative changes with widely different sensitivities for such findings Finally, the outcomes of patients without clinical ASD were not provided, thus preventing an answer as to whether the occurrence of clinical ASD influences overall outcome Study Limitations Chapter 22 • Radiculopathy and Myelopathy 115 The authors opened an entirely new field of study by bringing the notion of adjacent segment disease to the forefront of the literature Numerous reports1,2 have confirmed their findings, the most important being that cervical clinical ASD was much more common than previously thought; despite initial skepticism,3 the concept has been firmly established.4–6 Relevant Studies Even with more widespread recognition of clinical ASD, the exact cause of adjacent segment disease remains unclear.7 The initial report established that the natural history of cervical spondylolysis was the determining factor in the appearance of clinical ASD Further studies suggested that the fusion itself might be a factor through increased biomechanical stress,1–6 although this commonly held belief has at most indirect evidence.7–9 Matsumoto et al.9 compared the natural history of radiological changes over 10 years between asymptomatic volunteers to patients treated with cervical arthrodesis Progression of degeneration was more rapid in the cervical arthrodesis group To draw a conclusion that the arthrodesis caused accelerated degenerative changes is inherently flawed by selection bias, bias in that the cervical arthrodesis group may not have been the same at inception as they started out with symptomatic disease—this possibly being a surrogate for a propensity toward degenerative changes The recognition of clinical ASD has led to a search for preventative strategies such as the use of cervical total disk replacement (cTDR) This led to numerous randomized controlled trials comparing cTDR to cervical arthrodesis.10–14 This new literature confirmed Hilibrand et al findings with remarkably similar rate of ASD for cervical arthrodesis, with no reduction of clinical ASD for cTDR.15–19 This failure to demonstrate any significant prevention of clinical ASD lends credence to the notion that this entity was linked to the progression of cervical spondylosis, as initially postulated by Hilibrand et al REFERENCES Ishihara H, Kanamori M, Kawaguchi Y, et al Adjacent segment disease after anterior cervical interbody fusion Spine J 2004; 4(6): 624–628 Yue WM, Brodner W, Highland TR Long-term results after anterior cervical discectomy and fusion with allograft and plating Spine 2005; 30(19): 2138–2144 Moonsang S, Choi D Adjacent segment disease after fusion for cervical spondylosis: Myth or reality? Br J Neurosurg 2008; 22(2): 195–199 Hilibrand AS, Robbins M Adjacent segment degeneration and adjacent segment disease: The consequence of spinal fusion? Spine J 2004; 4(6): S190–S194 Lawrence BD, Hilibrand AS, Brodt ED, et al Predicting the risk of adjacent pathology in the cervical spine: A systematic review Spine 2012; 22S: S52–S64 Chung JY, Kim SK, Jung ST, et al Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: Results after a minimum of 10 years follow-up Spine J 2014; 14(10): 2290–2298 116 Section Three • Degenerative Hegelson MD, Bevenino AJ, Hilibrand AS Update on the evidence for adjacent segment degeneration and disease Spine J 2013; 13(3): 342–351 Harrod CC, Hilibrand AS, Fischer DJ, et al Adjacent segment pathology following cervical motion-sparing procedures or devices compared with fusion surgery: A systematic review Spine 2012; 37(22S): S96–S112 Matsumoto M, Okada E, Watanabe K, et al Anterior cervical decompression and fusion accelerates adjacent segment degeneration: Comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study Spine 2010; 35(1): 36–43 10 Mummaneni PV, Burkus JK, Haid RW, et al Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: A randomized controlled clinical trial J Neurosurg Spine 2007; 6: 198–209 11 Sasso RC, Smucker JD, Hacker RJ, et al Artificial disc versus fusion: A prospective, randomized study with 2-year follow-up on 99 patients Spine 2007; 32: 2933–2940 12 Coric D, Nunley PD, Guyer RD, et al Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex C artificial disc investigational device exemption study with a minimum 2-year follow-up J Neurosurg Spine 2011; 15: 348–358 13 Delamarter RB, Zigler J Five-year reoperation rates, cervical total disc replacement versus fusion, results of a prospective randomized clinical trial Spine 2013; 38: 711–717 14 Bae HW, Kim KD, Nunley PD, et al Comparison of clinical outcomes of 1- and 2-level total disc replacement: Four-year results from a prospective, randomized, controlled, multicenter IDE clinical trial Spine 2015; 40(11): 759–766 15 Jawahar A, Cavanaugh DA, Kerr EJ, et al Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: Results of 93 patients in 3 prospective randomized clinical trials Spine J 2010; 10(12): 1043–1048 16 Nunley PD, Jawahar A, Kerr EJ, et al Factors affecting the incidence of symptomatic adjacent-level disease in cervical spine after total disc arthroplasty Spine 2012; 37(6): 445–451 17 Verma K, Gandhi SD, Maltenfort M, et al Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion Spine 2013; 38(26): 2253–2257 18 Boselie TFM, Willems PC, van Mameren H, et al Arthroplasty versus fusion in single-level cervical degenerative disc disease Spine 2013; 38(17): E1096–E1107 19 Nunley PD, Jawahar A, Cavanaugh DA, et al Symptomatic adjacent segment disease after cervical total disc replacement: Re-examining the clinical and radiological evidence with established criteria Spine J 2013; 13: 5–12 Chapter 23 Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis Weinstein JN, Lurie JD, Tosteson TD, et al N Engl J Med 356:2257–2270, 2007 Reviewed by Akshay A Gupte and Ann M Parr The optimal management strategy for patients with lumbar spinal stenosis and degenerative spondylolisthesis remains a challenge to the spinal neurosurgical community The goal of the published study was to report 2-year outcomes in patients with degenerative spondylolisthesis who were treated either surgically or with nonsurgical conservative management Research Question/Objective The three components of the Spine Patient Outcomes Research Trial (SPORT)1–4 sought to comprehensively examine different and common treatment options used to manage patients with intervertebral disc herniation, lumbar spinal stenosis, and lumbar degenerative spondylolisthesis SPORT was a 5-year multicenter (11 states, 13 medical centers), multispecialty (neurosurgery, orthopedic surgery) prospective study with one arm randomized and the other observational that allowed patients to choose their preferred therapy Both arms had identical selection criteria and outcomes assessments Study Design Sample Size Of 892 eligible patients, 607 were enrolled in the current study Of the 304 patients enrolled in the randomization group, 252 patients had follow-up data at 2 years Similarly, of the 303 in the observational group, 269 patients had follow-up data at 2 years Follow-Up Primary and secondary outcome measures were collected at 6 weeks as well as at 3, 6, 12, and 24 (listed only in detail in Table 23.1) months after enrollment Scores were adjusted for age, sex, work status, depression, osteoporosis, joint problems, duration of current 117 118 Section Three • Degenerative Table 23.1 Change Scores and Treatment Effects for Primary Outcomes at 2 Years Postoperatively in the Randomized and Observational Cohorts Combined, According to Treatment Received Primary Outcomes Nonsurgical Treatment (n = 187) Surgery (n = 324) Treatment Effect of Surgery (95% CI)c SF-36 Bodily paina SF-36 Physical functiona Oswestry Disability Indexb 11.7 + 1.5 8.3 + 1.5 −7.5 + 1.2 29.9 + 1.2 26.6 + 1.3 −24.2 + 1.0 18.1 (14.5 to 21.7) 18.3 (14.6 to 21.9) −16.7 (−19.5 to −13.9) Source: Modified from Table of Weinstein JN, et al N Engl J Med 2007; 356, 2257–2270 a The SF-36 scores range from 0 to 100, with lower scores indicating severe symptoms b The Oswestry Disability Index ranges from 0 to 100, with higher scores indicating severe symptoms c Global p-value based on a Wald test assessing all time points simultaneously is less than 0.001 for all measures symptoms, reflex deficit, number of moderate or severe stenotic levels, baseline scores (for the SF-36, Oswestry Disability Index, and Stenosis Bothersomeness Index), and the treatment center Inclusion Criteria Symptoms Signs Imaging Exclusion Criteria Neurogenic claudication or radicular leg pain >12 weeks Neurologic signs Spinal stenosis on cross-sectional scans Degenerative spondylolisthesis on lateral standing radiographs Spondylolysis and isthmic spondylolisthesis The surgical intervention consisted of posterior decompressive laminectomy with or without single-level fusion (iliac crest bone grafting ± pedicle screw placement posteriorly) Nonsurgical treatment could include physical therapy, epidural steroid injections, nonsteroidal medications and opioid drugs, or a combination of any of these Intervention or Treatment Received After adjusting for baseline confounding factors and eliminating the crossover effect (as-treated analysis), the authors concluded that symptomatic patients (>12 weeks) with degenerative spondylolisthesis improved significantly after surgical intervention in terms of their pain, function, and satisfaction for up to 2 years (Table 23.1) Results The study design allowed for crossover of patients from one group (nonsurgical) to the other (surgical treatment) Forty-nine percent of the nonsurgical treatment group in the randomization arm and 25% of the nonsurgical treatment group in the observational arm underwent surgery by the end of 2 years The authors postulate that this nonadherence to treatment was the main reason they were not able to find any statistical difference in the intention-to-treat analysis in the primary outcomes between the treatment groups across all follow-up time Index Note: Page numbers followed by f and t refer to figures and tables, respectively A AANS See American Association of Neurological Surgeons Abdominal approach, 18 Abdominal injury, 22, 247 Acetabulum, 178 Acrylic surgical cement, 11–14 Acute disc protrusion, 225 Acute paralysis, 104, 106f Acute spinal cord injury methylprednisolone for, 53–56 MPSS in, 47–51, 49t STASCIS in, 97–100 Acute thoracolumbar spine injury, 43–45 Adjacent segment disease, 115 Adjuvant therapy, 17–18, 35 Adolescent idiopathic scoliosis (AIS), 173–176, 187, 205–208 Adult Deformity Classification, 186–187 Adult spinal deformity (ASD) anterior cervical arthrodesis in, 113–115 classification of, 185–188, 186f operative and nonoperative outcomes in, 211–215 positive sagittal balance in, 191–196, 193f–194f AIS See Adolescent idiopathic scoliosis ALL See Anterior longitudinal ligament Allen classification, 95 American Academy of Orthopaedic Surgeons, 89 American Association of Neurological Surgeons (AANS), 50–51 American College of Surgeons, 120 American Rheumatism Association, 139 American Society of Anesthesiologists (ASA), 162 American Spinal Injury Association (ASIA), 1, 3, 83–85, 97–99 Ames, C P., 199 Analgesics, 1, 3, 12–13, 133 Anderson, P A., 89 Anesthesia, 41, 66 Ankylosing spondylitis (AS), 43, 73, 149, 152, 233 ANOVA test, 50 Anterior annulus, 80 Anterior cervical arthrodesis, 113–115 Anterior cervical discectomy, 199, 228 Anterior cervical fusion, 140, 228 Anterior column collapse, 44 Anterior cord syndrome, 88 Anterior interbody fusion, 212 Anterior longitudinal ligament (ALL), 79, 92, 150–152, 226–227 Antibiotics, 231, 238 Anti-inflammatory mechanisms, 53 AO Fracture classification, 78 AO Spine cervical spondylotic myelopathy, 145–148 AO Spine Classification System, 45 AOSpine guideline, 50–51 AOSpine Thoracolumbar Spine Injury Classification System, 45 Apophyseal joint, 151 Arachnoiditis, 238 Arthrodesis, 63, 169 AIS in, 173–176 of cervical vertebrae, 113–115 decompressive laminectomy comparison with, 155–158 Articular facet, 226 253 254 Index Articular mass, 80 AS See Ankylosing spondylitis ASA See American Society of Anesthesiologists ASD See Adult spinal deformity ASIA See American Spinal Injury Association Aspiration pneumonia, 141 As-treated analysis in lumbar disc herniation, 110–112 in spondylolisthesis, 118–119, 124–126, 125t in SPORT, 129–130 Atlantoaxial instability, 229–231 Atlantoaxial subluxation, 140–141 Atlas, S J., 112 Axial loading, 44 Axial torque, 79 Axis See also Sagittal vertical axis fractures of ring of, 65–69, 66f, 68f odontoid process of, 59–63 B Barthel index, 24 Bartolozzi, P., 183 Bauer scoring system, 24, 30 Benign neoplasm, 16f, 17 Bilateral pedicle fracture, 92 Bilateral posterior foraminotomy, 227 Bilateral sensory data, 54 Bilsky classification, 36 Bilsky, M H., 36 Bivalve body jacket, 246 Bladder, 35, 110 Bladder cancer, 22, 23t Block vertebra, 202 Blondel, B., 195–196 Boa, H., 219 Bodily pain (BP) scale, 124–125 Bone-graft extender, 164 Bone grafting, 157 in lumbar spine, 221–222, 222f Bone metastases, 27–29 Bone-on-bone contact, 235 Bone scintigraphy, 16, 22, 27 Bone tumor, 15–19, 16f–17f, 19t, 43 Bony hook, fracture of, 182 Bony resection, 197–198 Boriani, S., 18 Boston brace, 208 Bowel function, 35 BP See Bodily pain scale Brachial neuralgia, 238 Bracing, 205–208, 242–243 See also Halo-vest immobilization Bracken, M B., 54 Breast cancer, 22, 23t, 28, 35 Bridwell, K H., 169, 214–215, 234 Brooks, A L., 231 Brown-Séquard syndrome, 242 Brox, J I., 136 Buchbinder, R., 88 Burst fracture, 44–45, 72, 74, 79 Burst spinal cord stimulation, 137 C C1-C7 See Cervical vertebrae Cadaveric study, 149–150, 232, 248 CAFE See Cancer Patient Fracture Evaluation Calcification, 150–152 Canadian Cervical-Spine Rule (CCR), 103–106, 106f Canal stenosis, 44 Cancer See Metastatic cancer Cancer Patient Fracture Evaluation (CAFE), 13 Carcinoid tumor, 22, 23t Cardiovascular disorders, 147 Carotid artery, 226 Carreon, Y L., 247 CAT See Computerized axial tomography scan Cauda equina, 44, 48, 72, 72t Cauda equina syndrome, 128 Caudal vertebra, 235 CCR See Canadian Cervical-Spine Rule Cement delivery, 88–89 Cerebral contusions, 60 Cerebrospinal fluid, 36 Cervical arthrodesis, 113–115 Cervical collar, 68 Index Cervical nerve root compression, 226–228 Cervical spinal cord compression of, 97–100 rheumatoid arthritis in, 139–143, 140f, 140t Cervical-spine disorder, 225–228 Cervical spondylosis, 114–115 Cervical spondylotic myelopathy (CSM), 145–148 Cervical total disk replacement (cTDR), 115 Cervical traction, 226 Cervical tumor, 28 Cervical vertebrae C1, 139–142, 140f C1-C2 posterior fusion of, 229–232, 230f C1-C2 wiring and fusion, 61 C1 laminectomy, 142 C2, 60, 139–142, 140f, 230, 230f, 232 See also Axis C2-C3 fusion, 66–69 C2-C3 pediatric spine injury, 246–247 C3-C4, 230 C7 plumb line, 178, 192–195, 193f, 233 rheumatoid arthritis of, 139–142, 140f Charlson comorbidity index, 29, 98, 212 Children, 60–61, 99–100, 241–244 Chi-square test, 245 Chondrosarcoma, 41 Chordoma, 41 Chou, R., 119 Chronic low back pain, 133–137 Circumferential fusion, 134, 237–238 Classification of acute thoracolumbar spine injury, 43–45 of ASD, 185–188, 186f Delphi technique in, Denis three-column system, 74 of disco-ligamentous complex, 91–95, 95t of fractures of axis, 65–69, 66f, 68f of ISNCSCI, 83–85 of lumbar injury, 77–80 of primary bone tumors, 15–19, 16f–17f, 19t SINS in, 6–8, 19, 19t of spinal arthrodesis, 173–176 of spinal osteotomy, 197–200 255 of spondylolisthesis, 181–184, 217–219 of spondylolysis, 181–184 of subaxial cervical spine injury, 91–95, 95t of thoracic injury, 77–80 of thoracolumbar injury, 71–74, 72t–73t Clavicle, 226 Clements, D H., 176 Cloward, R B., 228 CNS See Congress of Neurological Surgeons Cobb angle, 187 in AIS, 206–207 in ASD, 213 in sagittal balance measurement, 193–195 Cobb method, 178 Cochrane analysis, 56 Cochrane systematic review, 33, 35, 170 Coflex system, 158 Colon tumor, 28 Comorbidity, 99–100 Charlson index of, 29, 98 Complex flap closure, 40 Compression fracture, 44 Compressive injury, 92 Computed tomography (CT), 229 of acute thoracolumbar spine, 43–45 of chest, 22 in congenital scoliosis, 202–203 in DISH, 151–152, 152f in low back pain, 134 in metastatic spine tumors, 22 of odontoid fracture, 61–62 in primary bone tumor, 16 in SCIWORA, 241–244 in spinal metastases, 27 in spinal stenosis, 156 Computerized axial tomography (CAT) scan, 65, 67 Congenital malformation, 229 Congenital scoliosis, 201–204 Congenital stenosis, 114 Congenital vertebral column anomaly, 245–248 256 Index Congress of Neurological Surgeons (CNS), 50–51 Contralateral hemivertebrae, 201–202 Conus injury, 72, 72t Conus medullaris, 44, 249 Conventional radiotherapy (CRT), 33–36 Coronal imbalance, 191 Corpectomy, 199 Corticosteroids, 1, Cost-utility analysis, 100 Cox’s regression model analysis, 28 Cranial vertebra, 235 Crossover patients, 129–130, 147 CRT See Conventional radiotherapy Crutchfield tongs, 60 Cryotherapy, 17 CSM See Cervical spondylotic myelopathy CT See Computed tomography cTDR See Cervical total disk replacement Curettage, 15 Diabetes mellitus, 147 Diffuse idiopathic skeletal hyperostosis (DISH), 149–152, 152f Discectomy, 112, 127–128 Disc herniation, 117 of lumbar region, 109–112 SPORT and, 127–130 Disco-ligamentous complex (DLC), 91–95, 95t Disco-ligamentous injury, 44, 78–80 Disc removal, 110 DISH See Diffuse idiopathic skeletal hyperostosis Distractive injury, 92 DLC See Disco-ligamentous complex Dorsal root ganglion, 230, 230f Duane, T M., 106 Dural tear, 128–129, 239 Dvorak, M., 95 Dynesys system, 158 Dysphagia, 146, 151 Dysplastic spondylolisthesis, 181–184 D E Decision-making process, 158, 219 Decompression surgery CSM in, 145–148 laminectomy in, 155–158 Decompression-with-fusion, 165–166 Decubitus ulcers, 141 Deep wound infection, 146, 231 Degenerative spondylolisthesis, 117–120, 118t, 155–158, 238 fusion surgery and, 165–170, 167f–168f in lumbar canal stenosis, 123–126, 124t–125t Delitto, A., 126 Delphi technique, Denis classification system, 74, 80 Denis, F., 73, 80 De novo deformity, Dens, 62, 140–141 Depression, 117–118 Dermatomes, 47 Dermoid tumor, 249 Dexamethasone regime, 2–3 ECOG, 35 Edinburgh Scoliosis Clinic, 201–202 Edwards, C C., 68–69 Effendi classification, 68–69 Eggshell curettage, 28 Elderly patient, 148 halo-vest treatment in, 62 nonunion comorbidity in, 59 odontoid fractures in, 59–63 thoracolumbar injury in, 73 Elliot, R E., 232 Emans, J B., 208 Embase database, 33 Embolization, 17 Employment status, 134 En bloc excision, 15–18 En bloc resection, 28, 36, 39–41 Enneking classification, 40–41 Enneking, W., 15, 17–18 Epidural cord compression, 34 Epidural hematoma, 88 Epidural steroid injection, 118–119, 212 Esophageal diverticula, 228 Index 257 Esophagus cancer, 22, 23t European Quality of Life–5 Dimensions, 165 External orthosis, 63 Extradural spinal cord compression, 35 Extralesional procedure, 15–16 Extraspinal bone, 19, 21 Fritzell, P., 135 Functional Independence Measure (FIM), 55 Furlan, J C., 100 Fusion surgery circumferential fusion in, 237–238 lumbar spinal stenosis, 165–170, 167f–168f TLIF in, 237–239 F G Facet, 7, 80, 89, 103–104 Facet capsule, 92 Facetectomy, 198, 239 Facet resection, 199 Facial bone fracture, 60 Farrokhi, M R., 89 Fat emboli, 141 Ferguson and Allen system, 94–95 Filum terminale, 249–250 FIM See Functional Independence Measure Fixed sagittal imbalance, 233–235 Fleiss’s kappa coefficient, 185–186 Flexion-distraction fracture, 44 Flexion rotation fracture, 44 Fluoroscopic guidance, 68 Foramen, 139, 199, 225–226 Forestier’s disease, 149 Försth, P., 120, 170 Fourth column, of spine, 45 Fractionation schedules, 34 Fracture, 43–44 avulsion-type, 60 of bony hook, 182 burst fracture, 44–45, 72, 74, 79 CAFE in, 13 of odontoid process, 61–62 osteoporotic compression type, 87–89 of ribs, 73 of ring of axis, 65–69, 66f, 68f of spinous process, 78 VCF in, 36 Francis, W R., 67 Frankel classification system, 1, 84, 245–246 of metastatic spine tumor, 22, 23t Gait dysfunction, 147 Gallbladder tumor, 22, 23t Gallie fusion, 140–141 Garfin, S R., 88 Gastrointestinal carcinoma, 35 Gastrointestinal disorder, 50, 147 General Function Score (GFS), 134–135 Ghogawala, Z., 120, 170 Glascow Coma Scale, 98, 106f Glassman, S D., 187, 191–196, 193f–194f Goel, A., 231 Goel-Harms technique, 142 Golinvaux, N S., 120 GRADE methodology, 33 Graf system, 158 Graft delivery arm systems, 239 Graft malposition, 146 Graft resorption, 61 Guilford cervical brace, 242–243 Gunshot wound, 48 Guyatt, G., 33 H Hadley, M N., 245–248 Hairline fracture, 66 Halo-thoracic brace therapy, 67, 69 Halo-vest immobilization, 62, 142, 231, 246 Hamilton, M G., 247–248 Hangman’s fracture, 67, 68f, 69 Harms, J., 231, 238 Harms Study Group, 176 Harrington fusion, 250 Harrington instrumentation, 203 Harris system, 94–95 258 Index Health-related quality of life (HRQOL) in ASD, 185–188, 211–215 in low back pain, 179 in metastatic spine disease, 34–35 Hemivertebrae, 201–202 Hemorrhage, 40 Hemothoraces, 247 Herkowitz, H N., 157, 169 Herniated disc, 118–119, 166 Herniation, 109–112, 117, 127–130 Hilibrand, A S., 113, 115 Histology-specific setting, Hoffman, J R., 105 Horner’s syndrome, 227 Hresko, M T., 219 HRQOL See Health-related quality of life Hurlbert, R J., 53, 56 Hyperkyphosis, 174 Hyperostotica, 149–152 Hypokyphosis, 174 Hypoxia, 88 I Iatrogenic deformity, 191, 232 ICC See Intrarater intraclass correlation Idiopathic scoliosis in adolescents, 173–176 AIS in, 205–208 Idiopathic skeletal hyperostosis, 149–152, 152f Iliac crest, 134, 162, 221 Immobilization, 59–63, 66–67, 227 See also Halo-vest immobilization in SCIWORA, 242–244 Infection, 40, 50, 60 in CSM, 146 in fusion, 134–135, 231 in SPORT, 128 in TLIF, 237–239 Inferior facet, 198 Inflammatory spondylarthropathy, 128 In situs inversus, 152 InSTeP See International Standards Training e-Learning Program Intention-to-treat analysis in lumbar disc herniation, 112 in spondylolisthesis, 118–119, 124–125, 124t in SPORT, 129–130 Interbody fusion, 225–228 International Spinal Cord Society (ISCoS), 84 International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), 83–85 International Standards Training e-Learning Program (InSTeP), 84 Interobserver reliability, 7, 44–45, 62, 73, 79 of CCR, 105 in osteotomy classification, 198–200 in spinal arthrodesis, 173–175 in spondylolisthesis, 184, 217, 219 Interspinous ligament, 80, 92 Intervertebral disc, 92, 151 anterior removal of, 225–228 herniation of, 117, 127 Intervertebral foramina, 226 Intrafilar cyst, 250 Intralesional resection, 15–16, 28–29, 39–41 Intranasal intubation, 226 Intraobserver reliability See Interobserver reliability Intrarater intraclass correlation (ICC), 94–95 Intravertebral acrylic cement injection, 11–14 ISCoS See International Spinal Cord Society ISNCSCI See International Standards for Neurological Classification of Spinal Cord Injury Isthmic spondylolisthesis, 118 J Jagannathan, J., 239 Japanese Orthopaedic Association (JOA) score, 145–148 Jenkins, E B., 231 JOA See Japanese Orthopaedic Association score Johns Hopkins Hospital, 226 Journal of Spinal Cord Medicine, 84 Juxta-articular ossification, 151 Index K Kaisy, A., 137 Kallmes, D., 88 Kaplan-Meier analysis, 114 Karnofsky’s performance status, 22 Katagiri system, 30 Kidney tumor, 22, 23t, 28 King classification, 173–175 Kornblum, M B., 157 Kurz, L T., 157, 169 Kyphoplasty, 13–14, 24, 87–89 Kyphosis, 19t, 73 Kyphotic deformity, 192–195 L L1-L5 See Lumbar vertebrae Labelle, H., 183, 219 Lafage, V., 195 Laheri, V., 231 Lamina, 103–104 Laminectomy, 3–4, 22–23, 119, 249–250 for lumbar spondylolisthesis, 161–164, 163f Laufer, I., 25 Legaye’s presentation, 179 LEMS See Lower extremity motor scores Lenke classification, 173–176, 187 Leukemia, Level trauma center, 106 Leventhal, H R., 248 Levine, A M., 68–69 Lewis, S J., 235 Life expectancy, 24, 34 Ligamentum flavum, 80, 92, 110, 198 Linear tomography, 241 Lipoma, 249–250 Lipomyelomeningocele, 249–250 Listhesis See Spondylolisthesis Liver cancer, 22, 23t, 28 LL See Lumbar lordosis Location of disease, Mechanical instability, Neurologic status, Oncological history, and Physical status (LMNOP), 7, 24 Lonstein, J E., 208 259 Louis, R., 80 Low back pain, 133–137 radiographic analysis of, 177–179 in TLIF, 238–239 Lower extremity motor scores (LEMS), 85 Lower limb spasticity, 147 Lumbar degenerative spondylolisthesis, 117–120, 118t Lumbar disc herniation, 109–112 SPORT and, 127–130 Lumbar disc prolapse, 112 Lumbar lordosis (LL), 234 in ASD, 185–188, 186f in low back pain, 178–179 PI-LL in, 179, 196, 213 Lumbar radiculopathy, 162 Lumbar spinal stenosis, 117–120, 118t fusion surgery in, 165–170, 167f–168f SF-36 in, 123–126, 124t–125t Lumbar spine, 43 injury classification of, 77–80 paraspinal sacrospinalis-splitting approach to, 221–223, 222f tumor of, 28 Lumbar spondylolisthesis, 161–164, 163t Lumbar vertebrae fusion of, 133–137 L1-S1 lordosis, 195 L2 fusion surgery, 166 L3 end plate obliquity, 195 L3-L4 stenosis in, 156 L4-L5 levels, 135–136, 156 L5, 110, 181–182, 238 L5-S1 isthmic spondylolisthesis, 221–223, 222f L5-S1 levels, 135–136, 156, 217–219, 233 Lumbosacral deformity, 219 See also Spondylolisthesis Lumbosacral joint, 182 Lumbosacral kyphosis, 183–184 Lumbosacral spine disease, 237–238 Lung tumor, 22, 23t, 28 Lymphoma, 2, 22, 35 M McMaster, M J., 204 Mac-Thiong, J M., 183, 219 260 Index Magerl classification, 73–74 Magerl, F., 45, 231 Magerl transarticular screws, 142 Magnetic resonance imaging (MRI), 67 in low back pain, 134 of odontoid fracture, 61–62 of primary bone tumor, 16 of SCC, 145–146 in SCIWORA, 242–244 in spinal metastases, 27 in spinal stenosis, 156 Maine Lumbar Spine Study (MLSS), 119, 125–126, 130 Major osteotomy, 200 Malignant neoplasm, 17, 113 Malmivaara, A., 125–126 Marchetti, P C., 183 Mardjetko, S M., 157 Matsumoto, M., 115 MCID See Minimal clinically important difference Medical Outcomes Study (MOS), 192, 194f See also Short-Form General Health Survey Melanoma, 35 Melcher, R P., 231 Menezes, A H., 248 Metabolic bone disease, 43 Metastases, 27–30 acrylic surgical cement in, 11–14 Metastatic cancer, 1–4, 22, 23t, 28, 35 See also Tumor Metastatic foci, 19 Metastatic fracture, 43 Metastatic spine disease preoperative evaluation of, 21–25, 23t radiotherapy in, 33–36 Methylprednisolone (MPSS), 47–51, 49t, 53–56 Middle column, of spine, 43–45 Million Visual Analogue Score (MVAS), 134–137 Minerva cast, 61, 63 Minimal clinically important difference (MCID), 213 Minimally invasive surgery, 24 Minor osteotomy, 200 Misterska, E., 207 Mixter, S J., 231 mJOA See Modified Japanese Orthopaedic Association score MLSS See Maine Lumbar Spine Study Mobile spine, 6, 19t, 40–41 Modified Japanese Orthopaedic Association (MJOA) score, 145–148 Morbidity, 48 in en bloc resection, 36, 39 in pediatric spinal injury, 246–247 in PSO, 235 Morphine, Mortality, 47–48 cervical spine injury and, 99 in en bloc resection, 39 MPSS and, 56 in pediatric spinal injury, 246–247 in ring of axis fracture, 65 MOS See Medical Outcomes Study Motor function, 54–56 Motor vehicle collision (MVC), 60–61, 104 axis fracture from, 66 in pediatric spinal trauma, 246 in SCIWORA, 242 MPSS See Methylprednisolone MRI See Magnetic resonance imaging Multilevel arthrodesis, 114 Multiple herniations, 128 Multiple myeloma, 2, 7, 22 Multiple rib fractures, 73 MVAS See Million Visual Analogue Score MVC See Motor vehicle collision Myeloma, 35 Myelomeningocele, 249–250 Myelopathy, 60, 241 anterior cervical arthrodesis and, 113–115 in cervical spine fusion, 142–143 Myles, S T., 247–248 Myocardial infarction, 141 Myotomes, 47, 50 N Nachemson, A L., 207 Naloxone hydrochloride, 47–51, 49t Narcotics, 12, 48, 128 National Acute Spinal Cord Injury Study (NASCIS), 47, 50, 53–56 Index National Emergency X-Radiography Utilization Study (NEXUS), 103–106, 106f National SCI Statistical Center Database, 84 National Surgical Quality Improvement Program (NSQIP) database, 120 Neck Disability Index (NDI), 145–148 Neck hematoma, 146 NEJM See New England Journal of Medicine Neonatal spinal column, 248 Neoplasm, 5–8, 16f, 17 See also Tumor Nerve-root compression, 110, 128, 225–226 Nerve-root injury, 48, 124 Neural arch, 80 Neurenteric cysts, 249 Neurogenic claudication, 118, 123 Neurologic, oncologic, mechanical, and systemic (NOMS) decisional framework, 7, 25 New England Journal of Medicine (NEJM), 88, 169 NEXUS See National Emergency X-Radiography Utilization Study NOMS See Neurologic, oncologic, mechanical, and systemic decisional framework Noncontiguous spinal cord trauma, 67 Non-small cell lung cancer (NSCLC), 35 Nonsteroidal anti-inflammatory drug (NSAID), 118, 124, 128 NSCLC See Non-small cell lung cancer NSQIP See National Surgical Quality Improvement Program database Numerical motor score, 54 Nurick grade, 145–148 O Oblique avulsion-type fracture, 60 Oblique lateral approach, 18 ODI See Oswestry Disability Index Odontoid process, 59–63 Older patient See Elderly patient Omnibus test, 50 Oncological staging, 15 Oncologist, 261 Open biopsy, 39 Open fracture, 73 Open-label randomized trial, 88 Opiate-receptor antagonist, 47 Opioid drugs, 1, 3, 118 OPLL See Ossification of posterior longitudinal ligament Oppenheimer, A., 151 Oral narcotics, 238 Osenbach, R K., 248 Osgood, R B., 231 Os odontonium, 229 Osseous injury, 78–79 Ossification of posterior longitudinal ligament (OPLL), 147 Osteophyte, 103, 225–226 Osteoporosis, 43, 117–118 Osteoporotic compression fracture, 87–89 Osteosarcoma, 22, 23t Osteotomy, 197–200, 233–235 Oswestry Disability Index (ODI), 118, 118t in ASD, 188 in chronic low back pain, 134–137 in fusion surgery, 165–170, 167f–168f in laminectomy, 161–163, 163f in positive sagittal balance, 192–193, 194f in PSO, 233–234 in spondylolisthesis, 123–126, 124t–125t in SPORT, 127, 129 Oswestry Functional Capacity, 239 Otani, K., 50, 55 Overweight body habitus, 207 P Pachymeningitis, 12 Palliation, 15–17 Palsy, 21–22, 23t Pancreas, cancer of, 22, 23t Pang, D., 243, 248 Panjabi, M M., 67 Paraplegic, 48 Paraspinal muscles, 223 Paraspinal sacrospinalis-splitting approach, 221–223, 222f Paratracheal fascia medial, 226 Pars interarticularis, 182 Pediatric isthmic spondylolisthesis, 221 262 Index Pediatric Quality of Life Inventory (PedsQL), 206–207 Pediatric spinal trauma, 245–248 Pedicle, 7, 92, 198, 200 in C1-C2 fusion, 229–232 polyaxial screws of, 229 screw fixation of, 155, 157, 162, 237–239 Pedicle subtraction osteotomy (PSO), 212, 233–235 PedsQL See Pediatric Quality of Life Inventory Pelvic incidence (PI), 185–188, 186f, 218 Pelvic incidence and lumbar lordosis (PI-LL), 179, 196, 213 Pelvic tilt (PT), 196, 212–213 in ASD, 185–188, 186f in PSO, 234 Penetrating neck trauma, 104 Percutaneous injection, 11–14 Periosteum, 89 Peterson, L E., 207 Petitjean, M., 55 PF See Physical function scale Philadelphia collar, 242 Physical function (PF) scale, 124–125 Physiotherapy, 109–112, 126, 133 PI See Pelvic incidence PI-LL See Pelvic incidence and lumbar lordosis Pinprick measure, 48, 49t Pituitary rongeurs, 226 Platysma, 226 PLC See Posterior ligamentous complex PLF See Posterolateral fusion PLL See Posterior longitudinal ligament Pneumonia, 141 Pneumothoraces, 247 Point-tenderness, 89 Pollack, I F., 243 Polyaxial screw, 229–232, 230f Poncet, P., 175 Positive sagittal balance, 191–196, 193f–194f Posterior annulus, 44, 80 Posterior arch, 18, 181, 231 Posterior arthrodesis, 113 Posterior atlantoaxial spinal fusion, 62 Posterior cervical vertebrae, 69, 229–232, 230f Posterior decompressive laminectomy, 118, 124 Posterior facet capsule resection, 199 Posterior ligamentous complex (PLC), 72–73, 72t, 80 Posterior longitudinal ligament (PLL), 79, 92, 151–152 Posterior lumbar interbody fusion, 237–239 Posterior osteophytes, 225 Posterior superior iliac spine, 221 Posterolateral fusion (PLF), 134, 136, 155, 239 Postoperative sagittal imbalance, 191 Posttraumatic kyphosis, 233 Pregnancy, 48, 98, 128 Prevertebral fascia, 226 Primary bone tumor, 15–19, 16f–17f, 19t Primary spine tumor, 39–41 Prognosis-based scoring system, 27 Prolo score, 239 Propensity-matched analysis, 213–214 Prostate cancer, 22, 23t, 28, 35 Proximal filum, 250 Proxy Outcome Assessment Tool, 103–105 Pseudarthrosis, 141–142, 156–157, 232, 234–235 Pseudo-claudication, 166 Pseudosubluxation, 247 PSO See Pedicle subtraction osteotomy PT See Pelvic tilt Pullout strength, 232 Pulsating thoracic aorta, 152 Puno, R M., 176 p-values, 55 Q Quadriparesis, 141 Quality-of-life measures, 166, 167f–168f, 206–207 See also Health-related quality of life R Rades system, 24, 30 Radiation myelopathy, 35 Radicular pain, 13, 118, 123, 128 Radiculopathy, 119 anterior cervical arthrodesis and, 113–115 in TLIF, 238–239 Index Radiography, 7–8 in acute thoracolumbar spine injury, 43–45 in anterior cervical arthrodesis, 114 in classification of neoplastic disease, Cobb angles in, 187 of DISH, 149–152, 152f NEXUS in, 103–106, 106f in primary bone tumor, 16 of sagittal plane alignment, 177–179 in SCIWORA, 241–244 Radiosurgery, 24, 33–36 Radiotherapy See also Conventional radiotherapy in en bloc resection, 40 in metastatic cancer, 1–4 in sagittal balance, 192–195 Ramsey Medical Center, 43 Ranawat Classification of Pain and Neurologic Status, 140t Ranawat technique, 140f Randomized-controlled trial (RCT), 89 acrylic surgical cement and, 11–14 in ASD, 115 of extradural spinal cord compression, 35–36 of fusion surgery, 165–170, 167f–168f for lumbar spinal stenosis, 165–170, 167f–168f of MLSS, 125–126 of SCC, 1–4 of SPORT, 127–130 Rectum paresis, 110 Rectum tumor, 22, 23t Regression-to-mean bias, 130 Renal cell carcinoma, 35 Resnick, D., 149, 151 Retroperitoneal approach, 18 Rheumatoid arthritis, 73, 229 in cervical spine fusion, 139–143, 140f, 140t Richards, B S., 175 Rigid pedicle fixation, 157 Risser score, 205–206 Robinson, R A., 225, 228 Rod fixation, 229–232, 230f Roland-Morris Disability Questionnaire, 13 Rolinger, H., 238 Rotatory subluxation, 229 263 S S1 See Sacral segment Sacral ala, 221 Sacral segment (S1), 110, 183 Sacroiliac ankylosis, 150 Sacroiliac joint, 150–151 Sacrum, 41, 166 Sagittal balance, 191–196, 193f–194f pedicle subtraction osteotomy in, 233–235 of spino-pelvis, 217–219 Sagittal malalignment, 234–235 Sagittal plane deformity, 203 Sagittal thoracic spine modifier, 173 Sagittal vertical axis (SVA), 196, 218 in ASD, 185–188, 186f, 212–213 Salehi, S A., 239 Sanders digital hand score, 206, 208 Sarcoma, 35 SBRS See Stereotactic body radiosurgery SCC See Spinal cord compression Schwab classification system, 179, 185–188, 186f, 199 in ASD, 212–213 Schwab, F J., 195–196, 199 SCI See Spinal cord injury Sciatica, 109–112 Sciatica Bothersomeness Index, 128–129 Scintigraphy, 16, 22, 27 SCIWORA See Spinal cord injury without radiographic abnormality Scoliosis, 19t, 128 in adults, 191–196, 193f–194f natural history of, 201–204 Scoliosis Research Society (SRS), 173–174, 179, 187–188, 192, 212–214 SDSG See Spinal Deformity Study Group database Seat-belt type fracture, 44 Seemann, P S., 231 Seminoma, 35 Sepsis, 141 Sequelae, 88 SF-36 See Short-Form General Health Survey Shared decision-making process, 129 Shau, D N., 239 264 Index Shear fracture, 44, 79 Short-Form General Health Survey (SF-36), 13, 35, 187–188, 192, 194f in degenerative spondylolisthesis, 118, 118t Health Status Questionnaire of, 127 in laminectomy, 161–163, 163f in lumbar spinal stenosis, 123–126, 124t–125t mental component of, 213 version of, 145–148 Simple tethered cord, 250 SINS See Spine Instability Neoplastic Score SLIC See Subaxial Cervical Spine Injury Classification SLIP See Spinal Laminectomy versus Instrumented Pedicle Screw trial Smith, G W., 225, 228 Smith-Petersen osteotomy, 234–235 Smith-Robinson technique, 113, 228 Smoking status, 146–147, 212–213 Soft cervical collar, 230 Soft tissue attachment, 79 Soft tissue dissection, 239 SOSG See Spine Oncology Study Group Southwick, W O., 228 Spina bifida, 182, 249 Spinal arthrodesis, 173–176 Spinal cord compression (SCC), 97–100 by metastatic cancer, 1–4 neoplastic disease in, 5–8 Spinal cord injury (SCI) acute, 47–51, 49t ISNCSCI and, 83–85 methylprednisolone for, 53–56 Spinal cord injury without radiographic abnormality (SCIWORA), 241–244 Spinal Deformity Study Group (SDSG) database, 217–219 Spinal Laminectomy versus Instrumented Pedicle Screw (SLIP) trial, 120 Spinal metastases, 11–14, 27–30 Spinal neoplasm, 15, 18 See also Tumor Spinal osteotomy, 197–200 Spinal stability arthrodesis in, 155–158 sternal-rib complex in, 45 Spinal stenosis, 155–158 See also Lumbar spinal stenosis Spine Instability Neoplastic Score (SINS), 6–8, 19, 19t Spine magazine, 195 Spine Oncology Study Group (SOSG), 5–8, 19, 33–36 en bloc resection review by, 39–41 Spine Patient Outcomes Research Trial (SPORT), 112, 127–130, 169 in lumbar spinal stenosis, 117–120, 118t, 123–126, 124t–125t Spine Trauma Study Group (STSG), 71, 91, 100 Spino-pelvis alignment of, 177–179 in low back pain, 178–179 sagittal balance in, 217–219 Spinous process fracture, 78 Spondylectomy, 16, 18 Spondylitis hyperostotica, 151 Spondylolisthesis, 117–120, 118t absence of, 177 of axis, 67 classification of, 181–184 spino-pelvic sagittal balance of, 217–219 Spondylolysis, 115, 118, 166, 181–184 Spondylosis, 114–115 SPORT See Spine Patient Outcomes Research Trial SRS See Scoliosis Research Society Standard of care status, 53 Starr, J K., 68, 68f STASCIS See Surgical Timing in Acute Spinal Cord Injury Study Stenosis Bothersomeness Index, 118, 118t Stereotactic body radiosurgery (SBRS), 33–36 Stereotactic radiation, Sternal-rib complex, 45 Sternocleidomastoid muscle, 226 Steroids, 13, 48, 99–100, 118–119, 212 Stomach cancer, 22, 23t, 28 Straight delivery arm system, 239 Strut grafting, 114 STSG See Spine Trauma Study Group Subaxial articulations, 139–142 Subaxial cervical spine injury, 91–95, 95t Index Subaxial Cervical Spine Injury Classification (SLIC), 93 Sublaminar wires, 231 Subluxation injury, 246–247 Superior facet, 198 Supraspinous ligament, 92 Surgical Timing in Acute Spinal Cord Injury Study (STASCIS), 97–100 SVA See Sagittal vertical axis Swedish Lumbar Spine Study Group, 133–137 Synovial cavity, 62 T T1-T12 See Thoracic vertebrae Terran, J., 215 Tethered cord syndrome, 249–251 Thoracic apex, 178 Thoracic injury classification, 77–80 Thoracic kyphosis, 178, 212 Thoracic tumor, 28 Thoracic vertebrae, 43 T1 superior endplate of, 178 T10 level, 78 T12 inferior endplate of, 178 Thoracolumbar Injury Classification and Severity Score (TLICS), 45, 71–74, 72t–73t Thoracolumbar junction, 78 Thoracolumbar spine fusion of, 223 injury classification of, 43–45, 71–74, 72t–73t tumors of, 15–19, 16f–17f, 18t Thoracolumbosacral orthosis (TLSO), 206 Three-column spine, 43–45 Thyroid surgery, 227 Thyroid tumor, 22, 23t, 28 Titanium alloy rod, 162 TLICS See Thoracolumbar Injury Classification and Severity Score TLIF See Transforaminal lumbar interbody fusion TLSO See Thoracolumbosacral orthosis Tokuhashi scoring system, 21–25, 23t, 30 Tokuhashi, Y., 18 Tomita, K., 18 Tomita scoring system, 24, 29–30 Tomogram, 65 265 Trabecular bone, 62 Tracheitis, 227 Tracheostomy, 141 Transarticular screw, 229 Transforaminal lumbar interbody fusion (TLIF), 237–239 Transient radiculopathy, 239 Transpedicular instrumentation, 156 Transthoracic approach, 18 Transverse foramen, 199 Transverse fracture, 78 Transverse process, 103–104 Trauma CCR and, 103–106, 106f cervical spine injury and, 97–100 NEXUS Low-Risk Criteria in, 103–106, 106f t-test, 50 Tumor, 28, 249 en bloc resection in, 39–41 life expectancy in, 24 in metastatic spine, 21–25, 23t in metastatic spine disease, 35 of primary bone, 15–19, 16f–17f, 19t Two-column concept, 80 Two-column model, 43 U UEMS See Upper extremity motor score Ultrasonography, 22 Uncinate process, 243, 247 Uncovertebral joint resection, 199 Unilateral laminotomy, 164 Univariate analysis, 147 Upper endplate, 183 Upper extremity motor score (UEMS), 85 Upper sacrum, 181 Urinary continence, 1, Uterus tumor, 22, 23t, 28 V VA See Vertebral artery Vaccaro, A R., 80 van der Linden system, 24, 30 VAP See Vertebral augmentation procedure 266 Index Variable screw placement (VSP), 134–136 VAS See Visual Analogue Scale VCF See Vertebral compression fracture Vena cava, 13 Vertebral artery (VA), 67, 229, 231 Vertebral augmentation procedure (VAP), 13–14, 88 Vertebral body, 6–7, 12–13, 44, 80 metastases in, 3, 21–22, 23t in osteotomy classification, 198–200 in primary bone tumor, 17f, 18–19, 19t Vertebral column injury, 245–248 Vertebral compression fracture (VCF), 36 Vertebral disease, 104 Vertebrectomy, 16, 18 Vertebroplasty, 11–14, 87–89 Visceral metastases, 18, 24 Visual Analogue Scale (VAS), 134, 137, 165–166 in PSO, 233–234 VSP See Variable screw placement White, A A., 67, 139 Whitesides, T E., 80 Wilberger, J E., 248 Wilmington brace, 208 Wiltse approach, 221–223, 222f Wiltse, L L., 181, 183 Winter, R B., 201, 203, 208 X X-ray flexion-extension plain film in, 229 NEXUS criteria in, 103–106, 106f in spinal osteotomy, 197 in TLIF, 239 Y Yoshida, G., 214 Younger patient See Children Z W Weber study, 130 Weinstein, Boriani, Biagini (WBB) staging system, 15, 40–41 Weinstein, S L., 207–208 Zaina, F., 119 Zoccali, C., 24 Zung Self-Rating Depression Scale, 134–135 Zurich Claudication Questionnaire, 165 ... Lumbar Spine Study Group Spine Dec 20 01; 26 (23 ): 25 21 25 32; discussion 25 32 25 24 133 134 Section Three • Degenerative Two hundred twenty-two were randomized to the surgical group, and 72 were... treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial JAMA 20 06 Nov 22 ; 29 6 (20 ): 24 41 2 450 127 128 Section Three • Degenerative satisfaction... criteria Spine J 20 13; 13: 5– 12 Chapter 23 Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis Weinstein JN, Lurie JD, Tosteson TD, et al N Engl J Med 356 :22 57 22 70, 20 07