Advanced Concepts in Lumbar Degenerative Disk Disease João Luiz Pinheiro-Franco Alexander R. Vaccaro Edward C. Benzel H. Michael Mayer Editors 123 Advanced Concepts in Lumbar Degenerative Disk Disease João Luiz Pinheiro-Franco Alexander R . Vaccaro Edward C. Benzel H. Michael Mayer Editors Advanced Concepts in Lumbar Degenerative Disk Disease Editors João Luiz Pinheiro-Franco Edward C. Benzel Neurosurgery and Spine Surgery Cleveland Clinic Neurological Surgery Hospital Samaritano – São Paulo Cleveland , OH Brazil USA Alexander R. Vaccaro H. Michael Mayer Rothman Institute Schön Klinik München Harlaching Thomas Jefferson University FG Wirbelsäulenchirurgie Medical Center München Philadelphia, PA Germany USA The Work was fi rst published in 2010 by Dilivros Editora Ltda., Rua Dr. Satamini 55, Tijuca, Rio de Janeiro, RJ, Brazil with the following title: Conceitos Avançados em Doença Degenerativa Discal Lombar. ISBN 978-3-662-47755-7 ISBN 978-3-662-47756-4 (eBook) DOI 10.1007/978-3-662-47756-4 Library of Congress Control Number: 2015952115 Springer Heidelberg New York Dordrecht London © Springer-Verlag Berlin Heidelberg 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper S pringer-Verlag GmbH Berlin Heidelberg is part of Springer Science+Business Media (www.springer.com) This book is dedicated to the neurosurgeon who inspired my career: my father, Luiz Fernando Pinheiro-Franco, who is fond of saying Natura non facit saltus (Latin for “Nature (Life) makes no leap”). João Luiz Pinheiro-Franco We also dedicate this book to our patients and our colleagues. Without all of them, this book would not have been possible . João Luiz Pinheiro-Franco Alexander R. Vaccaro Edward C. Benzel H. Michael Mayer Pref ace A fter my graduation in neurosurgery, I had the unexpected privilege to immerse myself in 4 years of clinical and research fellowships, working with or simply observing the clinical and surgical techniques of several world- renowned experts in treating spinal diseases. Being far from my native coun- try, I had at times longed for family, friends, and colleagues, yet at the same time, the experience thrust me into the emerging fi eld of globalized spinal surgery. It was during this time that I fi rst came in direct contact with incred- ibly interesting people, all of us breaking the barriers of language to make sense of many different concepts, with different ideas bubbling forth from so many gifted minds. Although there was tremendous diversity in our avenues of thought, everyone was driven by the common pursuit of great results. These were my earliest impressions as a “global spinal surgeon.” Refl ecting on that time, I can say undoubtedly that the single unifying element of that great diversity in talent and ideas was an underlying modus operandi dedicated to the common goal of serving the well-being of patients suffering from lower back ailments. It was during this period when I conceived the notion of a “puzzle theory” of knowledge: different pieces of a puzzle falling into place. At fi rst, only a few scattered pieces seemed to make sense, others less so or not at all. However, gradually, as more pieces came together, a clear image steadily emerged, more tangible, more solid, and more understandable. I share this experience with you to offer insight into the origin of this book. In some respects, it is a tribute to the people from around the world who con- tributed with total mind and dedication to what had once seemed the seren- dipity of solving the “puzzle” of what today we call l umbar degenerative disk disease . This is the wellspring we present to you as A dvanced Concepts in Lumbar Degenerative Disk Disease . It is a great honor to share with you the insights and rigor of my coeditors, Dr. Alexander R. Vaccaro, Dr. Edward C. Benzel, and Dr. H. Michael Mayer. They are perhaps the three greatest minds I have ever had the opportunity to work with. Above all, they each possess a particular magnetism and charisma that electrify audiences with their knowledge in a way that infl uences people to make a difference in the world. They themselves have made many great differences, yet they are modest and sincere in their relationships with both colleagues and patients. I thank them dearly for the time invested and the enormous knowledge shared in the chapters of this book. Similarly, I extend my thanks to everyone who participated in the produc- tion of the various chapters in this book. This dedicated group of men and vii viii Preface women from all over the world helped gather a variety of concepts into an extensive knowledge base for our fi eld. These contributors include interna- tionally recognized thinkers of new concepts, creators of innovative tech- niques and novel instruments, and courageous voices of provocative new philosophies—all at the vanguard of lumbar degenerative disk disease. Advanced Concepts in Lumbar Degenerative Disk Disease was written and designed for spinal surgeons, neurosurgeons, and orthopedic surgeons: those who are new to the fi eld as well as those who are more seasoned professionals. P art I of the book begins by laying out the foundations of bipedalism and the importance of the verticalization of the spine, that is, the alignment of the intervertebral disks to bear the weight and function of the upper body. The opening chapter was written by the internationally award-winning French paleoanthropologist Yves Coppens, who also gave his name to the asteroid. Then, Gusmão et al., in fi ne detail, take the reader through the evolution of the concept of sciatica to what is known today as lumbar disk degeneration. Part I continues with an award-winning German scientist’s discussion of the pathophysiologic fundamentals of disk degeneration and the degenerative cascade. Epidemiology is treated by the late Pierre Kehrli, with the section on genetics perhaps deserving the most attention. This subject is examined fur- ther in the chapter by Cheung et al. Part II opens with contemporary advancements in spinal imaging, with a subsequent chapter by Dr. Michael Modic. An experienced team of experts then takes on the controversial theme of diskography. Part III examines the day-to-day issues faced by surgeons in practice: psy- chosocial aspects in patient care, work-related issues, costs, outcome mea- sures, and conservative treatments. This section also includes a comprehensive chapter dedicated to facet pain. P art IV deals with lumbar disk herniation, once disregarded by many sur- geons as “just an herniated disk.” Here, the subject receives the attention it deserves. This section closes with chapters on scientifi c considerations, tech- nical operation, and revision surgeries. Part V focuses on the surgeon’s decision-making process in providing individualized care. In detail, it examines when to operate, when to fuse or not to fuse, adjacent disease, biomechanics, techniques to increase lordosis, bone substitutes, the osteoporotic spine, and the advantages of different accesses: frontal, posterior, lateral, transpsoas, and oblique. Part VI consists of several engaging discussions regarding studies on mini- mally invasive techniques: intradiscal therapy, endoscopy, spinal injections, use of tubes, disk cell transplantation, and robotic spinal surgery, as well as a comprehensive chapter on the use of spinal injections after spine surgery. P art VII addresses nonfusion technologies such as disk arthroplasty and dynamic techniques based on pedicle screws and interspinous devices. Part VIII includes discussions on degenerative scoliosis, the modern con- cept of sagittal balance of the spine, compensatory mechanisms of sagittal imbalance, and osteotomy techniques. Preface ix Finally, in part IX, “Lessons from a Life,” some of the most experienced spine surgeons today share their personal clinical experiences. This is a valu- able resource for all surgeons. T his is just a glimpse of what we have included in A dvanced Concepts in Lumbar Degenerative Disk Disease. I hope you enjoy reading it as much as I have enjoyed bringing it together for you. São Paulo, Brazil João Luiz Pinheiro-Franco Spine Committee – World Federation of Neurosurgical Societies (WFNS) Assistant Editorial Board – Spine (Phila Pa – 1976) Editorial Board – European Spine Journal Spine Section Editor – World Neurosurgery (Offi cial Journal of the WFNS) Member of the centenary Academia de Medicina de São Paulo Member of the Elected Board of the Brazilian Spine Society