Vikas V. Patel Alpesh Patel James S. Harrop Evalina Burger Editors Spine Surgery Basics 123 Spine Surgery Basics Vikas V. Patel (cid:129) Alpesh Patel James S. Harrop (cid:129) Evalina Burger Editors Spine Surgery Basics Editors Vikas V. Patel James S. Harrop Department of Orthopaedics Department of Neurosurgery University of Colorado, Denver Jefferson Medical College Aurora, CO Philadelphia, PA USA USA Alpesh Patel Evalina Burger Department of Orthopaedic Surgery Department of Orthopaedics Northwestern University University of Colorado, Denver Chicago, IL Aurora, CO USA USA ISBN 978-3-642-34125-0 ISBN 978-3-642-34126-7 (eBook) DOI 10.1007/978-3-642-34126-7 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013946428 © Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To our families for all the support and to Heidi Armbruster for all the organization to make this project possible. Preface The stronger the foundation, the grander the possibilities! The purpose of this textbook is to lay the foundation of spine education for medical students, residents, fellows, and junior attendings. It provides a con- cise and accurate methodology to understanding and diagnosing different spine conditions followed by the basics of treatment. This textbook will, thus, provide the link between education, optimized clinical evaluation, and evi- dence-based decision making. This is especially relevant today as with an enlarging and aging popula- tion, spinal diseases will become more prevalent. Already back pain is the second most common complaint for which patients seek care after the com- mon cold. Concurrently, the past two decades have seen an explosion of tech- nology utilization in patient care. This has led to students and naive practioners diagnosing by exclusion-based testing as opposed to using sound clinical judgement. As healthcare funding becomes limited, this current trend in uti- lization of special high-end testing and imaging will be unsustainable. The skills to obtain an accurate, real-time clinical diagnosis and treatment plan will be in high demand. In the ever growing plethora of diagnoses, adhering to basics will provide the knowledge and framework necessary to make the correct decision for the patient. Aurora, CO Vikas V. Patel Chicago, IL Alpesh Patel Philadelphia, PA James S. Harrop Aurora, CO Evalina Burger vii Contents Part I General 1 Anatomy ........................................................................................ 3 Christopher M.J. Cain 2 Physical Examination of the Cervical Spine .............................. 13 Virgilio Matheus and Edward C. Benzel 3 Examination of Back Pain ........................................................... 23 Jennifer Malone, Ravi Madineni, Niti Cooper, Angud Mehdi, and Ashwini Sharan 4 Radiologic Imaging of the Spine ................................................. 37 Angela Valladares-Otero, Brian Christenson, and Brian D. Petersen 5 Diagnostic Evaluations ................................................................ 75 Richard Kendall and Zach Beresford 6 General Considerations for Spine Surgery Including Consent and Preparation. General Surgical Principles, Guidelines for Informed Consent, Patient Positioning for Surgery, Equipment Needed, and Postoperative Considerations .............................................................................. 83 Evalina Burger 7 Surgical Approaches .................................................................... 91 Michael C. Gerling and Sheeraz A. Qureshi 8 Cervical and Cervicothoracic Instrumentation ........................ 99 Adam Pearson and Todd Albert 9 Lumbosacral Instrumentation .................................................... 113 Joanne Elston and Nelson Saldua 10 Bone Graft and Bone Substitute Biology ................................... 147 Harshpal Singh and Allan D. Levi 11 Neurological Monitoring in Orthopedic Spine Surgery ........... 153 Tod B. Sloan, Leslie Jameson, Daniel Janik, and Paul Mongan ix