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Decision Making in
Spinal Care
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Decision Making in
Spinal Care
D. Greg Anderson, M.D.
Associate Professor
Department of Orthopaedic Surgery
Thomas Jefferson University
Jefferson Medical College
Thomas Jefferson University Hospital
The Rothman Institute
Philadelphia, Pennsylvania
Alexander R. Vaccaro, M.D.
Professor
Department of Orthopaedic Surgery
Thomas Jefferson University
Jefferson Medical College
Thomas Jefferson University Hospital
The Rothman Institute
Philadelphia, Pennsylvania
Thieme
New York • Stuttgart
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Thieme Medical Publishers, Inc.
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New York, NY 10001
Consulting Medical Editor: Esther Gumpert
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Library ofCongress Cataloging-in-Publication Data
Decision making in spinal care / [edited by] D. Greg Anderson, Alexander R. Vaccaro.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58890-415-6 (US-SC) — ISBN 3-13-140481-7 (GTV-SC)
1. Spine—Diseases. 2. Decision making. 3. Medical care—Decision making. I.
Anderson, D. Greg. II. Vaccaro, Alexander R.
[DNLM: 1. Spinal Diseases—therapy. 2. Decision Making. 3. Orthopedic Procedures.
WE 725 D294 2006]
RD768.D43 2006
616.7’3—dc22
2006045564
Copyright ©2007 by Thieme Medical Publishers, Inc. This book, including all parts thereof,
is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow
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Important note:Medical knowledge is ever-changing. As new research and clinical experience
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Printed in the United States.
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The Americas ISBN 1-58890-415-6
978-1-58890-415-7
Rest ofWorld ISBN 3-13-140481-7
978-3-13-140481-7
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I dedicate this book to my loving wife, Sandra, for supporting me and giving me a
reason to pursue excellence.
D. Greg Anderson, M.D.
I dedicate this book to the wonderful physicians at Johns Hopkins Medical Center,
especially Ziya Gokaslan, M.D., for their care of my son Alex during our time of
need.
Alexander R. Vaccaro, M.D.
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Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Acknowledgment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
I. Cervical Trauma
1. Occipitoatlantal Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Christopher M. Bono and Edward Carreras
2. C1 Ring Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Michael A. Pahl, Chadi Tannoury, and D. Greg Anderson
3. Atlantoaxial Instability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Christopher M. Bono and William Min
4. Odontoid Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Tony Y. Tannoury and Douglas G. Orndorff
5. Traumatic Spondylolisthesis ofthe Axis (Hangman’s Fracture). . 31
Matthew H. Walker, Thomas F. Day, and D. Greg Anderson
6. Flexion-Compression Injuries of the Cervical Spine . . . . . . . . . . 37
John M. Beiner
7. Cervical Distraction-Extension Injuries. . . . . . . . . . . . . . . . . . . . . . 43
John B. Thaller
8. Cervical Facet Dislocation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Brett A. Taylor
9. Cervicothoracic Fractures and Dislocations. . . . . . . . . . . . . . . . . . 55
Norman B. Chutkan
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viii Contents
II. Thoracolumbar Trauma
10. Thoracic and Lumbar Vertebral Compression Fractures . . . . 61
James S. Harrop, Sumeet Vadera, and Deshdeepak Sahni
11. Thoracolumbar Burst Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . 67
James S. Harrop, Sumeet Vadera, and Deshdeepak Sahni
12. Thoracolumbar Flexion-Distraction Injuries . . . . . . . . . . . . . . 73
Qusai M. Hammouri and Jonathan N. Grauer
13. Thoracolumbar Fracture Dislocations . . . . . . . . . . . . . . . . . . . . 79
Qusai M. Hammouri and Jonathan N. Grauer
14. Sacral Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Douglas G. Orndorff and D. Greg Anderson
15. Thoracolumbar Distraction-Extension Injuries . . . . . . . . . . . . 91
Y. Raja Rampersaud
III. Cervical Degenerative/Metabolic Disease
16. Cervical Disk Degeneration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Kanit Chamroontaneskul
17. Cervical Radiculopathy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Wahid M. Baqaie
18. Cervical Myelopathy: Anterior Approach . . . . . . . . . . . . . . . . . 109
Maurice L. Goins, Corey A. Pacek, and Alan S. Hilibrand
19. Cervical Myelopathy: Posterior Approach. . . . . . . . . . . . . . . . . 115
Jonathan G. Roper, Kenneth J. H. Lee, and Jeffrey C. Wang
20. Cervical Kyphosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Todd J. Albert and Michael A. Pahl
21. Ossification of the Posterior Longitudinal Ligament. . . . . . . 129
Maurice L. Goins, Corey A. Pacek, and Alan S. Hilibrand
22. Cervical Whiplash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Aaron S. Covey and Jonathan N. Grauer
23. Cervical Diagnostic and Therapeutic Interventional
Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Richard Derby and Kwan Sik Seo
24. Cervical Rehabilitation and Physical Therapy Techniques . . 151
James R. Beazell
IV. Thoracic Degenerative/Metabolic Disease
25. Ankylosing Spondylitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Kornelis A. Poelstra
26. Diffuse Idiopathic Skeletal Hyperostosis. . . . . . . . . . . . . . . . . . 165
Kornelis A. Poelstra
27. Thoracic Disk Herniation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
William Sukovich
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Contents ix
V. Lumbar Degenerative/Metabolic Disease
28. Lumbar Disk Disease and Low Back Pain . . . . . . . . . . . . . . . . . 179
Jeff Scott Silber
29. Lumbar Radiculopathy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Jeff Scott Silber
30. Lumbar Spinal Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Wahid M. Baqaie
31. Lumbar Degenerative Spondylolisthesis. . . . . . . . . . . . . . . . . . 199
Vincent J. Devlin and Matthew Eager
32. Degenerative Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Rocco R. Calderone and Louise E. Toutant
33. Adult Isthmic Spondylolisthesis. . . . . . . . . . . . . . . . . . . . . . . . . . 213
Jim A. Youssef
34. Failed Back Syndromes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Adam C. Crowl
35. Lumbar Rehabilitation and Physical Therapy Techniques . . 225
James R. Beazell
36. Lumbar Injections and Procedures. . . . . . . . . . . . . . . . . . . . . . . 231
Maged Hamza
37. Cauda Equina Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Leo R. Spector and David H. Kim
VI. Scoliosis
38. Congenital Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
John P. Lubicky
39. Infantile Scoliosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Samuel R. Rosenfeld
40. Juvenile Idiopathic Scoliosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Peter G. Gabos
41. Adolescent Idiopathic Scoliosis. . . . . . . . . . . . . . . . . . . . . . . . . . 263
Ronald A. Lehman Jr. and Timothy R. Kuklo
42. Neuromuscular Scoliosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Francis H. Shen, Peter W. Thompson, and Vincent Arlet
43. Adult Scoliosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Moe R. Lim, Joon Yung Lee, and Todd J. Albert
VII. Kyphosis
44. Scheuermann’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Timothy R. Kuklo and Ronald A. Lehman Jr.
45. Posttraumatic Thoracolumbar Kyphosis. . . . . . . . . . . . . . . . . . 295
Jeff Scott Silber and Dimitry G. Kondrashov
46. Corrective Osteotomies for Kyphosis. . . . . . . . . . . . . . . . . . . . . 303
Keith H. Bridwell
