Spinal Disorders: Fundamentals of Diagnosis and Treatment

1162 Pages·2008·30.527 MB·English

by  Philipp Gruber, Thomas Boeni (auth.), Prof. Dr. Norbert Boos, Prof. Dr. Max Aebi (eds.)

NorbertBoos·MaxAebi(Editors)
SpinalDisorders
FundamentalsofDiagnosisandTreatment
NorbertBoos·MaxAebi(Editors)
Spinal Disorders
Fundamentals of Diagnosis and Treatment
With274Figuresin1290Parts
and190Tables
Prof.Dr.NorbertBoos
ZentrumfürWirbelsäulen-undRückenmarkchirurgie
UniversitätZürich
UniversitätsklinikBalgrist
Forchstraße340,8008Zürich
Switzerland
Prof.Dr.MaxAebi
InstitutfürEvaluativeForschunginOrthopädischerChirurgie
MEMForschungszentrum,UniversitätBern
Stauffacherstraße78,3014Bern
Switzerland
ISBN978-3-540-40511-5 Springer-VerlagBerlinHeidelbergNewYork
LibraryofCongressControlNumber:2006927571
ˇ 2008Springer-VerlagBerlinHeidelberg
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usemustalwaysbeobtainedfromSpringer-Verlag.Violationsareliabletoprosecutionunder
theGermanCopyrightLaw.
PrintedinGermany
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doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom
therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse.
Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformationabout
dosageandapplicationcontainedinthisbook.Ineveryindividualcasetheusermustcheck
suchinformationbyconsultingtherelevantliterature.
Coverdesign:eStudioCalamar,Spain
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Dedication
ToChrista,Anna,LisaandSarah N.B.
ToChristine,EvaandSamuel M.A.
Fortheirlove,understanding,encouragementandtolerance,
withoutwhichthisbookwouldnothavebeenpossible
VII
Foreword
FormFollowsFunction
Congratulations to the editors and authors on a truly outstanding book. Most
booksrecapitulatewhatmanyalreadyknow,andleaveoneseekingmore.This
bookisuniqueinitscontentandformat.“Formfollowsfunction”,popularized
by the great American architect Frank Lloyd Wright, is a principle associated
with modern architecture and industrial design in the 20th century. Simply
stated,theshapeofabuildingorobjectshouldbepredicatedbyorbaseduponits
intended function or purpose. Like this phrase there is often a history that is
importanttorecognizeandunderstandifwearetotrulyunderstanditsmeaning.
The origin of the phrase “Form follows function” can be traced back to the
AmericansculptorHoratioGreenough,butitwasAmericanarchitecturalgiant
LouisSullivanwhoadopteditandmadeitfamous.Sullivanactuallysaid,“form
everfollowsfunction”,butthesimpler(andlessemphatic)phraseistheoneusu-
ally remembered. Sullivan’s student and assistant Frank Lloyd Wright adopted
this principle in slightly different form – perhaps because shaking off the old
stylesgavethemmorefreedomandlatitude.
Drs.BoosandAebihaveadoptedaparticularform,inthisbook,inorderto
givethereaderathoroughgroundinginthebasicknowledgeandgeneralprinci-
plesofspinaldisorders.Thedidacticconcept(form)ofallthechaptersisbased
onaconsistentstyleandlayout,andfollowsthreebasicprinciplesofsustainable
learning (functions), i.e.: (1) less is more, (2) repetition enhances sustained
learning,and(3)casestudiesareanefficientandcomplementarymeansoflearn-
ing.
Thebookutilizeslearningaidstohighlightandrepeatcoremessagesthrough-
outallchapters,andvisualaidsfacilitatearepetition-basedlearningapproach,
startingwiththecoremessages,leadingtoanin-depthreadingofeachchapter.
Marginalnotesallowforeffectiverepetitionofmaterialtofacilitatethelearning
process,andoutstandinggraphicswithpictorialandanecdotallearningmeth-
odsareusedtocomplementthemanydetailedcasestudiestoexemplifythecore
messages.Finally,theuseofimportantreferencesandlandmarkarticlesmakes
thisaprizedbookforeveryone’sshelf.
Congratulations to Norbert and Max on a fantastic contribution. This book
will help those most in need, our patients. “Form and function” are the most
importantoutcomesofthiswork,especiallyforthoseofuswhoworkeverydayto
careforpeoplewiththesevariousspinaldisorders.Thankyou.
JamesN.Weinstein
Director,TheDartmouthInstituteforHealthPolicyandClinicalPractice
Professor&Chairman,TheDepartmentofOrthopaedics
Editor-in-Chief–Spine
DartmouthCollegeandMedicalSchool
DartmouthHitchcockMedicalCenter
Lebanon,NewHampshire,USA
IX
Foreword
DinosaurorStateoftheArt?
Long ago, medical observations, advances, innovations and reviews were first
presentedatmeetingsandpublishedinbooks.Withtheintroductionofscientific
medicaljournals,twothingshappened.Firstpublicationtimewascutdowndra-
matically compared to books and dissemination of knowledge became faster.
Secondlyanewapproachtoscientificpublicationwasintroducedintheformof
peerreview.Thisagainlengthenedpublicationtime,yetbenefitedquality.Some
argued that scientific journals would herald the slow death of books. History
provedthemwrong.
Theadventoftheinternetagainmixedupallthecards.Wouldscientificjour-
nalssurvivetheinternet?Initiallythepeerreviewaspectwaslostandthequality
of available knowledge suffered. Yet, sites like Wikipedia introduced the very
conceptofpeerreviewonline.So,wouldtheinternetkillpeerreviewjournalslet
alonebooks?Well,hereagainhistorydemonstratesthatbothjournalsandbooks
remainaliveandwell.
ThisbookonspinaldisorderseditedbyNorbertBoosandMaxAebiisatypi-
calexampleofthekindoftextbookanybodyinvolvedwithmattersregardingthe
spinewantsonherorhisdesk.Moreover,thisworkisuniquebecauseitisnota
classicmulti-authortextbook.Theeditorshaveapproachedchapterauthorswith
whomtheypersonallycollaboratedandshareacommonphilosophyonthediag-
nosis and treatment approach to spinal disorders. By an intensiveediting pro-
cess,thedifferentchaptershavebeenwovenintoahomogeneousbookcombin-
ingpersonalexperiencewithevidencebasedknowledge.
Editors of scientific journals know that so-called “review articles” are very
popular, more referenced than other articles and thus excellent for boosting a
journal’sImpactFactor.Well,thisbookconsistsofasuccessionofreviewsbring-
ingusareal“stateoftheart”regardingthespinebutputintoperspectivethrough
personalexperience.Thisworkistrulypluri-disciplinaryandreflectsthecom-
plexanddifficultnatureofthehumanspine.Amongtheauthorswefindclini-
ciansaswellasscientists.
Theeditorstackleeveryaspectofthespineinawellbalancedway.Notopicis
superfluousorperceivedasmoreimportantthananotherandthebookreadsas
onecontinuousflow,onetopiclogicallyleadingtothenext.Thisbookcanberec-
ommendedtoanyoneinvolvedinclinicalorresearchaspectsofthespine.Itsim-
plyhastolieonthedeskofdoctors,scientists,physiotherapistsandchiroprac-
tors,psychologistsandhealth-carespecialistsinterestedinthespine.
RobertGunzburg
President2007–2008
EuroSpine,theSpineSocietyofEurope
CavellSpineCenter
Brussels,Belgium
XI
Preface
Spinaldisordersareamongthemostcommonmedicalconditions,havingasig-
nificantimpactonhealth-relatedqualityoflife,useofhealthcareresourcesand
socioeconomiccosts.Asatherapeuticmeasure,spinalsurgeryisstilloneofthe
mostrapidlygrowingareasinclinicalmedicine,andisamajorcontributortothe
continuously increasing costs of modern-day medicine. Similarly, the increas-
inglyagingpopulationwillhaveagreaterneedforthetreatmentofdegenerative
spinal disorders, particularly secondary spinal deformities and stenosis. How-
ever,atthesametimelimitedhealthcareresourceswillmeandifficultchoicesin
theallocationoftreatmentmodalities.Therefore,abasicknowledgeofthestate
oftheartofthediagnosisandtreatmentofspinaldisordersisrequired,notonly
forspinespecialistsbutalsoforgeneralorthopedicsurgeons,rheumatologists,
neurologists, rehabilitation doctors, psychiatrists, chiropractors, physiothera-
pists,basicscientistsandhealthcareexecutives,toenablethemtochooseand/or
evaluateappropriatediagnosticandtherapeuticapproaches.
Owing to the rapid development of knowledge of spinal disorders over the
past 20 years, a comprehensive new textbook which incorporates all the latest
knowledgehasbecomenecessary,andwehavebecomeawareagainandagainof
innumerable residents, fellows and colleagues searching for a comprehensive
introductorylearningtoolforthestudyofspinaldisorders.Althoughexcellent
textbooks on specific issues of the spine and specifically spinal surgery are
alreadyavailable,nonefulfillsthecriterionofbeinganeasilyreadableteaching
tool that focuses systematically on the fundamentals and basic principles in a
standardizedmanner.Stronglyencouragedbyourresidentsandfellows,wehave
designedatextbookonspinaldisorderswhichisanintegrationoftheevidence-
basedknowledgeintheup-to-dateliteratureandourdecade-longpersonalexpe-
rienceatthesourceofresearchandtreatmentofspinaldisorders.
WithSpringer,wefoundadedicatedpublisherwillingtogiveourbookproject
strong support, and with carefully selected chapter authors we have hopefully
succeededin creating a consistentmessagethroughoutthebook.Unlikemany
otherspinaltextbooks,theeditorsdidnotwantsimplytocollectandeditchap-
tersfrommanydifferentauthors,whichoftenleadstoaninhomogeneousbook
withoverlapping,redundantandincoherentchapters.Weratheraimedtopro-
videahomogeneoussyllabuswithaconsistentdidacticstrategytoteachthefun-
damentalsandgeneralprinciples.
Althoughwehavebasedtheinformationinthisbookonanextensivesurvey
ofthepeer-reviewedliterature,wehavemoderatedthisinformationinasynthe-
siswithresearchandclinicalexperience.Wehave,however,refrainedspecifically
fromanin-depthdescriptionofsophisticatedsurgicalprocedures.Forthisfield
of expertise, there are already a number of excellent manuals and textbooks
available.
Althoughwerecognizethedifficultyandchallengeofourtask,wefeelthatwe
havefulfilledourgoalbychoosingauthorswithwhomwehavecollaboratedfor
alongtimeandwhoconcurwithourownphilosophy.Thedidacticconceptis
XII Preface
presentedineverysinglechapterinaconsistentmannerandisbasedonthree
principles:
1. Lessismorewhenconciselywritten
2. Repetitionenhancessustainedlearning
3. Casestudiesareaninvaluablemeansofexemplifyingimportantprinciples
Wehopethatwehavemetourobjectiveinprovidingamodern,up-to-dateand
easytoreadtextbookonspinaldisorderswithanappealinglayout,andthatthe
bookwillinspireandstimulatethereaderinthestudyofspinaldisorders.Itis
ourhopethatthisbookmaybecomethestandardbasictextbookforspinaldisor-
dersifyou,thereader,decidestomakethishappen.
Wewouldliketothankallthecontributingauthorsfortheirmajorcommit-
mentandhardwork.Wewouldalsoliketothankourstudents,fellowsandcol-
leagues for critically proof-reading the chapters and their constructive and
encouraging feedback. We owe many thanks to Doris Stettler and Grit Gagel-
mannfortheirsupportandhelpwiththeeditingprocess.WefurtherthankWil-
liam Shufflebotham in the UK for copy-editing the book. We also want to
acknowledgetheMedicalPictorialDocumentationteamoftheUniversityHospi-
talBalgrist(HeidiWylenmann,HeleneUhlmannandChristianStreng)fortheir
invaluablehelpwiththeeditorialpreparationofthemedicalimagesandfigures.
WeareparticularlyindebtedtoAlainBlank,whocreatedtheuniqueillustra-
tions with his meticulous and careful attention to the anatomical and surgical
details.ThemajorbooksectionsareseparatedbythepaintingsofArnaldoRicci-
ardi,whoperfectlyunderstoodhowtotransformhisinspirationsofspinaldisor-
ders into works of art. We also thank Springer, the publisher, and specifically
GabrieleSchröderformakingthisbookhappen.
ZürichandBern,March2008
NorbertBoos MaxAebi
CentreforSpinalSurgery MEMResearchCentrefor
UniversityHospitalBalgrist OrthopaedicSurgery
UniversityofZürich UniversityofBern
XIII
Contents
1 History ofSpinalDisorders Basic Science
PhilippGruber,ThomasBoeni
CoreMessages ............................. 1 2 BiomechanicsoftheSpine
ABriefEtymology ......................... 1 StephenFerguson
HistoricalCaseIntroduction ................. 2 CoreMessages ............................. 41
SpinalAnatomyandPhysiology .............. 4 TheHumanSpine .......................... 41
AnesthesiaandSupportiveTechniques ........ 6 TheMotionSegment ....................... 42
LaughingGas,ChloroformandCocaine ..... 6 AnteriorStructures....................... 42
AntisepsisandAntibiotics................. 6 PosteriorElements ....................... 46
DiagnosticImaging ...................... 8 LigamentsoftheSpine.................... 47
Scoliosis .................................. 8 MotionSegmentStiffness ................. 48
Pathogenesis ............................ 9 Muscles................................... 48
Assessment ............................. 9 SpinalStabilityThroughMuscularActivity .. 52
Non-operativeTreatment.................. 11 MuscleActivityDuringFlexionandExtension 54
ScoliosisSurgery......................... 13 MuscleActivityDuringLateralFlexionand
JuvenileKyphosis .......................... 13 Rotation ................................ 54
Spondylolisthesis .......................... 14 SpineKinematics........................... 54
AnObstetricalProblem ................... 14 RangeofMotion ......................... 55
Surgery................................. 14 MechanicalResponseoftheSpinalMotion
BackPainandSciatica ...................... 15 Segment ................................ 55
AWrongMixtureofFluids ................ 15 ClinicalInstability ....................... 57
DiscHerniation.......................... 17 Kinetics(SpinalLoading) ................... 58
HistoricalCaseStudy ..................... 19 StaticLoading ........................... 58
TheFacetSyndrome...................... 21 LoadsDuringLifting ..................... 59
SpinalStenosis .......................... 21 DynamicLoading ........................ 60
SpinalInfections ........................... 22 Recapitulation ............................. 61
EgyptianMummiesandSirPercivalPott .... 22 KeyArticles ............................... 62
Treatment............................... 24 References ................................ 63
AnkylosingSpondylitis ..................... 24
DiscoveryofaNewDisease ................ 25 3 SpinalInstrumentation
SpinalInjuries ............................. 27 DanielHaschtmann,StephenJ.Ferguson
FirstReports ............................ 27 CoreMessages ............................. 67
SpinalInjuriesasaSocioeconomicProblem .. 28 GoalsofSpinalInstrumentation .............. 67
TractionTableandLaminectomy ........... 29 BasicBiomechanicsofSpinalInstrumentation .. 69
TheAdventofInternalSpinalFixation ...... 29 LoadingandLoadSharingCharacteristics ... 69
Recapitulation ............................. 30 PosteriorStabilizationPrinciples ........... 71
Appendix:Historyofspinaldisorders ......... 31 AnteriorStabilizationPrinciples............ 74
KeyArticles ............................... 33 AnteriorTensionBandTechnique .......... 78
References ................................ 34 Biomechanicsofthe“AdjacentSegment” ...... 79
Non-FusionPrinciples ...................... 80
DiscArthroplasty ........................ 80
Nucleoplasty ............................ 82
PosteriorDynamicStabilizationTechnique .. 82