Trastornos y tratamientos de la columna vertebral

Section 1: Basic Science and Spinal Assessment
1. Basic Science of Degenerative Disk Disease 3
Anthony Petrizzo, Kristina Bianco
• Morphology of the Normal IVD 3
• Morphologic Changes in the Degenerative IVD 4
• Etiology of IVD Degeneration 5
• Inflammatory Mediators 7
• Novel Management Techniques 8
2. Biomechanics of the Spine 11
Antonio Valdevit
• The Spinal Column 11
• Intervertebral Disk 12
• The Facet Joint and Uncovertebral Joint 12
• Spinal Motion 13
• Spinal Loading 13
• Spinal Arthroplasty 15
• Mechanical Evaluation and Clinical Implications of Spinal Instrumentation 16
3. Balance, Posture and Stability in Spinal Disorders 18
Virginie Lafage, Barthelemy Liabaud, Frank Schwab, Jean-Pierre Farcy
• Balance, Stability and Posture 18
4. Differential Diagnosis of Spinal Disorders 23
Michael Gerling, Vadim Goz
• Risk Factors 23
• Prognosis 23
• Types of Pain 24
• Chronic Pain Syndromes and Threshold Modulation 24
• Differential Diagnosis 24
5. Neurological Differential Diagnosis of Spinal Disorders 30
Devon Ryan, Thomas Cheriyan, Ludmilla Bronfin
• Conditions that Mimic Radiculopathy 30
• Conditions that Mimic Cervical Myelopathy 33
6. Examination and Evaluation of Neck Pain 36
Jonathan R Stieber, Robert J Ames
• Prevalence and Natural History 36
• Anatomy 36
• Pathophysiology 37
• History, Physical Examination and Grading 39
• Imaging and Diagnostic Studies 41
7. Examination and Evaluation of Low Back Pain 44
Devon Ryan, Jeffery Perry
• Institutional Guidelines 44
• Examination and Evaluation of Acute Low Back Pain 45
• Examination and Evaluation of Chronic Low Back Pain 48
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8. Clinical Examination and Evaluation of Radiculopathy: A Neurological Perspective 49
Kiril Kiprovski
• History and Physical Examination 49
• Somatic Referred Pain from the Neck and Lower Back 54
• Red Flags 57
9. Evaluation of Adolescent Scoliosis 60
Stephen P Maier II, Thomas Cheriyan, Baron S Lonner
• Evaluation of Scoliosis 62
• Classification 67
10. Evaluation of Adult Spinal Deformity 69
Jeffrey H Weinreb, Pierre Devos, Frank Schwab
• Evaluation 69
• Spine Related Measurements in the Setting of Adult Spinal Deformity 71
• Classification 71
11. Measurement of Adult Spinal Deformity 75
Jeffrey H Weinreb, Thomas Cheriyan, Virginie Lafage, Frank Schwab
• Imaging 75
• Coronal Plane Measurements 75
• Sagittal Plane Measurements 77
• Spinopelvic Radiographic Parameters 77
• Global Alignment 78
• Criticism of 2D Measurements 78
• 3D Analysis 78
12. Assessment of Disability 81
Juan Carlos Robles
• Functional Assessment Instruments 81
• Objective Tools 81
• Subjective Tools 83
13. Non-MRI Evaluation of the Cervical and Lumbar Spine 85
Tony Wong, Gina Ciavarra, Leon Rybak
• Radiographs 85
• Computed Tomography 88
• Nuclear Medicine 95
• Ultrasound 100
14. MRI Evaluation of Cervical and Lumbar Spine Disorders 102
Michael B Mechlin
• Cervical Spine 102
• Lumbar Spine 108
15. Interventional Diagnostic Procedures: Nerve Blocks and Discography 120
Steven Calvino, Jessie Ng
• Diagnostic Nerve Blocks 120
• Discography 121
• Anatomy and Function of the Intervertebral Disk 121
• Disk Degeneration and Pain 123
• Procedure 123
• Complications 123
• Evidence 124
Contents xv
16. Rheumatic Diseases and Myofascial Pain 126
Brian D Golden
• How to tell the Difference between ‘‘-ITIS’’ and ‘‘-ALGIA’’ 126
• Ankylosing Spondylitis as the Prototypical Inflammatory, Rheumatologic Disease Affecting the Spine 126
• Fibromyalgia as the Prototypical Noninflammatory Pain Syndrome 128
17. Diagnosis of Osteopenia and Osteoporosis 130
Stephen Honig, Stephen P Maier II
• Pathogenesis of Postmenopausal Osteoporosis 132
• Diagnosing Osteopenia and Osteoporosis 132
Section 2: Non-Invasive Therapeutic Intervention
18. Multidisciplinary Approach to Spinal Pain 139
Kseniya Slobodyanyuk, Thomas Cheriyan, Christopher Gharibo
• Spinal Pain Pathophysiology 139
• Pharmacologic Treatment 139
• Nonpharmacologic Treatment 141
• Functional Rehabilitation 141
19. Pharmacological Management of Spinal Pain: Narcotics 144
Christopher Gharibo
20. Pharmacological Management of Spinal Pain: Non-narcotics 147
Juan Carlos Robles, Thomas Cheriyan
• Acetaminophen 147
• Nonsteroidal Anti-Inflammatory Drugs 147
• Steroids 147
• Anticonvulsants 148
• Tricyclic Antidepressants 149
• Muscle Relaxants 149
• Nonopioid Combination Medication 149
• Topical Medications 150
21. Prevention and Management of Addiction 151
Marianne T Guschwan
• The Scope of the Problem with Opioids 151
• Addiction Management 152
• Prevention of Addiction 152
22. Therapeutic Management of Osteoporosis 155
Stephen Honig
• Aging, Falling, and the Concept of Frailty 155
• Calcium and Vitamin D Supplementation 156
• Bone Strengthening Prescription Medications 156
23. Nonoperative Treatment of Cervical Myelopathy and Radiculopathy 159
Kristina Bianco, Faruk Razzak, Gerard Varlotta
• Task Force for Neck Pain 159
• Pathophysiology 160
• Nonoperative Treatment for Cervical Myelopathy and Cervical Radiculopathy 161
• Other Nonoperative Treatment Methods 164
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• Nonoperative versus Operative Treatment of Cervical Myelopathy 164
• Nonoperative versus Operative Treatment of Cervical Radiculopathy 165
24. Alternative Medicine Treatment in Spinal Disorders: Application of Acupuncture 168
Alex Moroz, Brian Freed
• Applications of Acupuncture 169
25. Psychosocial Aspects and Management of Chronic Low Back Pain 171
Matthew B Smith
• Aversion 171
• Central Sensitization 172
• Psychiatric Comorbidity 172
• Personality Factors 173
• Interpersonal and Social Factors 173
• Chronic Illness 174
• Psychiatric and Psychological Treatment Considerations 174
• Countertransference 175
26. A Conservative Care Approach to the Rehabilitation of Patients with Spine Pain 178
Angela Lis, Sherri Weiser
• Triage Criterion 1: Duration of SP 180
• Triage Criterion 2: The Presence of Yellow Flags 180
• Triage Criterion 3: Is the Patient a Candidate for an Intensive Interdisciplinary Conditioning Program? 182
Section 3: Spinal Injection
27. Introduction to Spinal Injections 187
Jamie R Terran, Rachel N Rattenni, Faruk Razzak, Gerard P Varlotta
• History 187
• Trigger Point Injections 187
• Sacroiliac Injections 188
• Peripheral Joint Injections 189
• Sympathetic Nerve Blocks 189
• Epidural Injections 189
• Intra-articular Facet Injections 190
• Median Branch Blocks and Rhizotomy 190
• Intradiscal Electrothermal Therapy, Nucleoplasty, and Biacuplasty 190
• Spinal Cord Stimulators 191
• Complications and Risks 191
28. Diagnostic and Therapeutic Value of Spinal Injections 193
Juan Carlos Robles, Vadim Goz
• Discograms 193
• Epidural Steroid Injections 194
• Selective Nerve Root Blocks, Facet Joint Blocks, and Medial Branch Blocks 195
29. Trigger Point Injections 200
Benjamin Bieber, Devon Ryan
• Diagnosis 200
• Indications 201
• Technique 202
Contents xvii
• Preinjection Block 203
• Evidence 203
30. Sacroiliac Injections 205
Jackson Liu, Jeffrey Weinreb, Wayne Stokes
• Anatomy 205
• Diagnosis 205
• Injection 208
• Injection Technique 209
• Complications 210
• Newer Techniques 210
31. Peripheral Joint and Soft Tissue Injections 212
Warren Young
• Injectables 212
• Injection Techniques 216
32. Sympathetic Blocks: Utility in Complex Regional Pain Syndrome 221
Kseniya Slobodyanyuk, Christopher Gharibo
• Nociceptive and Neuropathic Pain 221
• Complex Regional Pain Syndrome 221
• CRPS Management 223
33. Epidural Steroid Injections 228
Kseniya Slobodyanyuk, Christopher Gharibo
• Epidural Steroid Injections 228
• Interlaminar, Transforaminal, and Caudal ESIs 229
• Complications 231
34. Intra-articular Facet Injections 233
Kristina L Bianco, Jeffrey H Weinreb, Gerard P Varlotta
• Facet Joint Anatomy 233
• Etiology and Pathophysiology 233
• Grading Scales for Facet Joint Arthropathy 235
• Diagnosis 235
• Imaging 236
• Treatment 236
• Indications for Injections 237
• Intra-Articular Facet Joint Injections 237
• CYST Intervention Results 238
• Complications 238
• Differential Diagnosis 238
35. Complications of Spinal Injections 240
Brian Forzani, Stephen P Maier II, Kseniya Slobodyanyuk, Thomas J Errico, Thomas Cheriyan, Christopher Gharibo
• Regional/Mechanical Injury 240
• Needle/Injectate-Related Injuries 241
• Pressure-Related Injuries 243
• Infections 244
• Vascular Injury 244
• Neural Complications 248
• Chemical Injury 249
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36. Medial Branch Block and Rhizotomy 253
Devon Ryan, Jamie Terran, Mohammed Khan
• Medial Branch Block 254
• Rhizotomy (Medial Branch Neurotomy, Radiofrequency Neurotomy) 256
37. Intradiscal Electrothermal Therapy, Nucleoplasty and Biacuplasty 259
Steven Calvino, Rohan Bannis, Sachin Shah
• Intradiscal Electrothermal Therapy 260
• Nucleoplasty 260
• Biacuplasty 261
38. Spinal Cord Stimulators 264
Brian Park, Yong H Kim
• What are Spinal Cord Stimulators? 264
• Indications 265
• Ischemic/Visceral Pain 265
• Neurogenic Pain 265
• Spine-Related Conditions 265
• Technique 266
• Trial/Screening 266
• Permanent Implantation 267
• Complications 268
Section 4: Surgical Management
39. History of Surgical Management of Spinal Disorders 273
Justin Paul, Thomas Cheriyan, Thomas J Errico
• Decompression of Spinal Elements 274
• Stabilization of the Spine 276
• Antibiotics and Orthopedic Instrumentation 277
• Posterior Thoracolumbar Instrumentation 278
• Anterior Thoracolumbar Instrumentation 278
• Posterior Cervical Instrumentation 280
• Anterior Cervical Instrumentation 280
• Interbody Fusion 280
• Alternatives to Fusion—Total Disk Replacement 282
• Deformity Correction 282
• Rods for Distraction and Compression 282
• Segmental Fixation for Increased Rigidity 283
• Multiple Hook Rod for Rotation 283
40. Surgical Management of Lumbar Degenerative Spondylolisthesis 286
Qasim M Husain, Robert P Norton, Jeffrey M Spivak
• Pathogenesis 286
• Incidence 286
• Presentation 287
• Nonoperative Measures 287
• Surgical Options 287
• Case Example 292
Contents xix
41. Differentiating Cervical Radiculopathy and Peripheral Compressive Neuropathy 294
Themistocles S Protopsaltis, John A Bendo
• Epidemiology 294
• Clinical Presentation and Relevant Anatomy 294
• C8 Radiculopathy vs Cubital Tunnel Syndrome vs T1 Radiculopathy 296
• Physical Examination 297
• Electrodiagnostic Studies 299
• Peripheral Entrapment Neuropathies and NCS 299
• Treatment 299
• Surgical Results 300
42. Surgical Management of Cervical Disk Herniation 301
Kseniya Slobodyanyuk, Jonathan Stieber
• Epidemiology 301
• Signs and Symptoms 301
• Treatment 302
• Surgical Options 302
• Anterior Approach 302
• Posterior Approach 303
• Selection of Approach 304
• Complications 306
43. Surgical Treatment of Cervical Stenosis 310
Jane S Hoashi, Stephen P Maier II, Jeffrey D Klein
• Cervical Spondylotic Radiculopathy 310
• Cervical Spondylotic Myelopathy 311
• Pathogenesis 311
• Treatment Options 313
• Anterior Approach 314
• Posterior Approach 317
• Laminoplasty 318
• Posterior Laminoforaminotomy 320
44. Operative Management of Degenerative Cervical Disorders 324
Hiroyuki Yoshihara, John A Bendo
• Surgical Indications 324
• Surgical Options 325
• Surgical Outcomes 328
• Complications 329
45. Newer Motion Preservation Technologies 332
Kseniya Slobodyanyuk, Rachel N Rattenni, Thomas Cheriyan, Thomas J Errico
• Nucleus Replacement 332
• Synthetic Nucleus Replacement 332
• Interspinous Distraction 334
• Dynamic Stabilization 334
• Facet Replacement 335
• Annulus Repair 336
46. Minimally Invasive Lumbar Spine Fusion 337
Noel I Perin
• Indications 337
• Anterior Approaches (ALIF) 337
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• Posterior Approaches 340
• Discussion 343
47. Cervical Total Disk Replacement 345
Robert P Norton, Jeffrey A Goldstein
• Evolution of Implants 345
• Technical Considerations 346
• Indications and Contraindications 347
• Analysis of the FDA IDE Trials 347
• Further Literature Analysis 347
• Complications 349
• Case Example 350
48. Lumbar Total Disk Replacement Surgery 354
Hiroyuki Yoshihara, John A Bendo
• Indications for Lumbar Total Disk Replacement 354
• Surgical Approach and Technique 355
• Prostheses 355
• SB Charité III 355
• Complications 358
49. Conventional, Microscopic and Endoscopic Surgical Treatment of Lumbar Disk Herniations 361
Bartosz Grobelny, Michael L Smith
• History 361
• Modern Techniques 361
• Comparative Trials 365
50. Surgical Treatment of Lumbar Spinal Stenosis 369
Stephen P Maier II, Jane S Hoashi, Jeffrey D Klein
• Clinical Features 369
• Physical Examination and Differential Diagnosis 370
• Diagnostic Imaging 370
• Electrodiagnostic Studies 371
• Indications for Surgery 371
• Surgical Treatment 371
• Surgical Outcomes 373
• Interspinous Spacer Technology 374
51. Overview of Spinal Deformity Surgery 378
Justin Paul, Thomas Cheriyan, Anthony Petrizzo, Thomas J Errico
• Anatomy and Biomechanics 379
• Clinical Evaluation 381
• Radiologic Evaluation 381
• Classification 382
• Treatment 383
52. Operative Management of Pediatric Deformities 388
Justin C Paul, Baron S Lonner, Courtney S Toombs
• Scoliosis 388
• Anatomy/Biomechanics 388
• Clinical Evaluation 389
• Radiologic Evaluation 392
• Classification 393
• Nonoperative Treatment 394
Contents xxi
• Operative Treatment 395
• Surgical Technique 395
• Outcomes/Complications 397
• Kyphosis 399
• Spondylolisthesis 400
53. Surgical Treatment of Adult Degenerative Deformity 406
Jeffrey B Knox, Justin Paul, Frank Schwab
• Surgical Indications 406
• Presurgical Considerations 407
• Surgical Planning 407
• Surgical Techniques 407
• Staged Operations 410
• Complications 410
54. Surgical Interventions in Osteoporosis and Compression Fracture 414
Peter G Passias, Andy Chang
• Osteoporotic Compression Fractures 414
• Conservative Management 414
• Surgical Treatment 415
• Adverse Events for Vertebroplasty and Kyphoplasty 417
55. Surgical Management of the Rheumatoid Spine 420
Ronald Moskovich, Jeffrey Knox
• Spine Manifestations 420
• Clinical Evaluation 421
• Natural History 421
• Grading 421
• Imaging 421
• Treatment 423
• Surgical Options 425
56. Traumatic Cervical Spinal Fracture Surgery 429
Justin C Paul, Robert Norton, Themistocles Protopsaltis
• Cervical Spine 429
• Classification 434
• Nonoperative Treatment 437
• Operative Treatment 438
• Classification 444
• Operative Care to Optimize Function 445
57. Thoracolumbar and Sacral Fracture Surgery 448
Robert Norton, Justin C Paul, Themistocles Protopsaltis
• Anatomy and Mechanism of Injury 448
• Clinical Evaluation 448
• Radiologic Evaluation 448
• Classification 449
• Compression Fractures 449
• Burst Fractures 450
• Flexion-Distraction Injuries 451
• Fracture-Dislocation Injuries 451
• Low Lumbar Injuries 452
• Treatment Goals 452
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58. Tumors of the Spine 456
Donato Pacione, Irene Kim, Dimitris Placantonakis, Anthony Frempong-Boadu
• Primary Extradural Spinal Tumors 456
• Intradural Extramedullary Spinal Tumors 461
• Intradural Intramedullary Spinal Tumors 463
• Spinal Metastases 468
59. Intraoperative Monitoring in Spine Surgery 482
Thomas Cheriyan, Rachel N Rattenni, Jerry Cheriyan, Athena M Lolis, Thomas J Errico
• Stagnara Wake-Up Test 482
• Somatosensory Evoked Potential 482
• Motor Evoked Potentials 483
• Spontaneous EMG 484
• Triggered EMG 485
• Multimodal Intraoperative Monitoring 486
Index 489