Teaching Atlas of Spine Imaging (Teaching Atlas Series)

874 Pages·1999·51.1 MB·English

by  Ruth Ramsey

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ofS pinIem a in
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RuthG .R amsey
ProfessoofRr a diology
Head,S ectioofnN euroradiology
TheU niversoiftC yh icago
ChicagIol,l inois
1999
Yor.k Stuttgart
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trantsnilga,p reparaotfmi iocnr ofialnmde, l ectrdoantipacr o cesasnidnsg t orage.
Importannott eM:e dickanlo wledigse ev er-ncghianAgs.n ewr eseaarncdhc ilnciaelx periebnrcoead oeunrk nowledge, icnh anges
trletlmeanntdd rutghe rapmya yb er equiTrheeda .u thoarnsde ditoorfts h em aterhieaerli hna vceo nsulstoeudr cbeesl ietvoeb de
reliea ibntl heeifrf otrotp sr oviidnefm oartoint haiIsc ompleatnedi na ccowrdih t thse tandaarcdcse ptaettd h e toifpm ueb lication.
Howeveirnv, i eowf t hep osbsliiotfhy u maenr robryt haeu thoerdsi,t ors, oro fpt uhbwelo irskhh eerre oirnc .h angiensm edical
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warratnhtast itnhfeo rmactonitoanid n heereiisin n e verrye septa ccuroartc eo mpleatnedt, eh y arcn otr esponsfiobarln eye rroorrs
omissioor(n ostr h er esuolbttsna eidf romu seo fs ucihn forimoanRt.e adearrsee ncouratgoec do nfirtmh ien formactonitoiann ed
herewiint oht hesro urcFeosre. x amprleea,d earrsea dvisteocd h ectkh per oduct infsohremeiatctn liuodnie ndt hpea ckaogfee ach
drutgh ey pla1n0 a dministtobe erc ertathiantt h ei nformaciontatonine di nt hipsu hlicaitsai cocnu raantdet haCth angheasv neo t
been miandt eh er ecommenddoesdoe r i n tchoneta rindatiicofnosar d miinstraTthiiorsne .c ommendant iisoo fp articular importance
inc onnectwiiotnnhe wo ri nrfequentulsyed dr ugs.
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Some ofp rtohdeu ncatm esp,t entsa,n dr egistdeerseidgr nesf ertroei dnt hibso oka rei nf acrte gistterraedde maorrpk rso prietary
nameesv etnh ough specifict ort dheifrsae cintsnc oeta lwamyasd ei nt het etxT.h erefotrheea, p pearaonfac nea mew ithout
designaatspi roonp rieitsna orttyo b ec onstrausae rde presenbtyat thiepo unb listhheaitrti si nt bep ubilcd omain.
Printientd h eU niteSdt atoefsA merica
5 4 2 3 1
0-86577-778-0
TNY ISBN
3-13-115791-7
GTV ISBN
ForM ichaTehlo,m aasn,dT imolhy­
thanfkosar l ylo uurn derstanding
Contents
Perfeac. . xv
Ackneodgwmlents xivi
I.N ormaAln atomy
A.C ercvilas npie
Eaxmep 1l.S atgtail 5
Exaem 2p.l Midsagittal 9
B.T horacic spine
Eaxmpel I. SagisthtoTarlRti m ea g 20
Eaxmep 2l.S agiltotnTagRli mea g. 22
Eaxmlpe3 .S agisthtoTarRlti meai gnap ediatrpiaectnt i 24
Exaem 4p.lS agiltotnTagRli meai gnap ediraiptcae tnti 25
C.L umbsaperi n
Exaem p1.l Midstataglsih oTrRti measg 30
Exam2p.l Meid statgasilh oTrRti measg 34
Exaem 3p.lC orosnhaolTr Rti mag.e s 35
Exaem pl4P.ra asagsihtoTtrRuat nl ae gs 37
Exaem 5p.lN romapled tiiarlcu mbsaperi n 40
Eaxmpel 6S.a gihtotrTatlRi m easg 42
Eaxmep 7l.A xisahloT riRt ma egs. 45
Exaem pl8P.er nifusainopdno i sfntusaixoinsa htlo T rRi measg 51
Exaem 9p.lL onTgR i amegs. . 52
.
Exaem p1.0lA xialT Ril omaenggs 54
Exaem 1pl1Axi.ac lo mepudtt omogiramaepghsy 56
Exaem p1.l2M ultei Tprallcosyvt s 58
O. Congenital
Casle. C hiIam raiol r[matwiihotf no csaylr cianvxi ty 67
Caes 2.C hi[am raiol rfmatwiitohln oe wrcer viacnadl thsoiyrnrxac caivci ty 71
Cas3e. C hiIamr ail foramnatdtohi roanc uilXc . syr 74
Cas4e. C ihratiey pIm[al ofrtminao withal raegm enngioemolyclee,s caraaeglen iss. 77
Cas5e. C hi1amr1ai l forwmitahtme inoning oemolyecel.dy srasppehi,icnerc ebe llatnro sillar
herniatteteihroednc ,o rduef,o erdmv eerbrtea,a dne pxanufeoure anmm agnum 80
Caes 6.C hiIam raifl orimnoaw titshynr xci aviptosyet,aro tepi cvheanswgi tshh unt
teu bpleamecnt. 83
Caes 7. Chitaeyr piI ImIa olrfmation 86
Caes 8.A netirosra cmreyaollem ningeoelc 88
Caes 9.T eteherdc ormden.i ngeolemoeycl,a ncdo cecalya eggeniss 90
Caes 1.0S acreanels iwaistg hfi lutemr mien lailpoamnladoe w-rthan-snipoanrlcm oarld 93
Caes 1I .C audreagelrss isoynn der woimttetheh erdco radn mdu let viereptlbraaln oemas.l i 97
Caes 12.P artsaicaarldna c lo cecalya eggnesissi,sn t urascpti,dn yaslir masp,teh teherd
sipncaolr d 100
Caes 1.3T eheterdc orsda,c aregaenlis ,sh oerhsseo,p elvkiiced yn. . 102
Caes 14T.et eherdco rwdi tfihl utemr mien lailposmyar,oi ftne hx d isctoareldpx .a endd
lumbvearetrb rcaaln al 104
Caes 1.5T eteherdco rsdi,nt ruasc t 107
Caes 1.6T teeherdco ,r ldipomeaol,em inmnoygcele 109
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1EACHINGA TLASO fS'P IEN IMAGING
Cas1e7 K.lip pe-lFeialon malayso sctieawdi tthhC ehi raIim aolmrfati,ot netehdce orrd,
lipaos,ma careganle sis 112
Cas1e.8D isateommaeytliscao,l vieorstibesob,dr .ya l 115
Cas1e9D .i satemato.m ye.l ia 191
Cas2e0 D.ai stemyaetlwoiimata ht rhoispcp icnoarwldi tthws ol hitgalsyy mmehtermiicc ords
anadn asssoycriciaantvxefi dort myfe,ur sotfe C ha iiIa m ralforwmiatthi on
deforomfti htey pofsotsesrai or 122
Case Ne2ru1o.l lbrotmyap1te,mo uslitnsiu eprloefi braolmoatnthgsae p ianl ea,rp gleeo xrimf
neurofiablrootnmhgae cooftu hrbesr ea cphlieaoxlnut shr ei tga hrm 125
Cas2e2N .e urofibrotmypaetw ois2tm,ihUt s li ple nsocmshap,wo asntopcehraantsgipnevisae,l
cortde thering 128
Cas2e3. B ialtearcaolu sshctwiacn noamnmdau sl teis pplisncahlw annsommaralislg; h t
inetrnaauildt ocrnayal li po.m a 130
Case Do2w4n.s' ysrn odme Cwl2i-d tihcs alto,ic ooennngihteatadl ri esaswei tahta rli
sepdteafle ct 133
10.S pinCaolr dT umors
A.I ntramedullary
Cas1e. Ependymoma 137
Cas2e.A strocynteooumfiraobsmrs;ao ft hdeo rlrs oaogtag nliboinl ateraUy 114
Cas3e. P iloacsyttriocc .y toma 145
Cas4e.G lioomfta h cee rvsipciacnloa raldn cde rebeclolnufimra,mts e udr gery 194
Cas5e. S pilcn oarldeo snai,m etasftraotsmhip esa tntik'enso wlne iomyoscaorncfiormmae,d
ats urg.e ry 151
Cas6e.P liocaysttirco ccyotnofimraam,tse udr gery 154
Cas7e.P ostopcehraatniignavep esai tewnhtoh apdr evsiuorugsri ecmaolov faas lp inal
coredp endym.o ma 161
CaseP io8lc.y atsitcr occyotnofimrbamy,be ido psy 164
CaseA s9t.r occyotnofimraam,tse udr gteurmryao ;r ofsreow mi tnt hhiseip nlca oradn d
greiwna ne xophfyahtosiinsc;o tfsits sucewh annomas 176
B.I ntradural
Cas1e. S hcwaonmna. 175
Case Ios2l.ea dst hcwannoma 178
Cas3e.S chwnaomnam ;u ltmiypelleo ma 108
Cas4e.S chwanantLo 3mo;as teoppoorsotsoipsce;hr aantgievse 182
Cas5e. M ennigiocmoan,fi ramtse udr gery 184
Cas6e.M enigniom.a 168
Case My7ox.p aiplleapreyn dymoma 189
Case My8x.o papeipUeanrdyy wmiotamhra e oafhs e morrhage 192
Cas9e.E pendoymmad;ia tleVdi rchows-pRaoicbneti shnb e r aoifn
unkonwns ignifi.c ance 195
Cas1e0D .ro pm etasftraorsmei csu rrentf opseospsaet nedryimoorm a 189
Cas1e.1 M etasctoaltcoiranccn iom.a 201
C.N eurollbromatosis
Cas1e.N eurofibrtoympa1we ti otmshui lst pilpelxein feuorrormfo imbas 211
Cas2e. N euorfibromtaytp1owe si itmshu ltpilpelxei afnoddru mmb be-lslhatpuemdo rs 217
Cas3e.N eurofibrotympa1wet i otmshiul st ipplleoexr imnf eufirboormsaa t all levels on
thsep ine 225
Cas4e.N eurofibrtoymp2awe ti otpshlie sox rimnf eurofibirnto hmiean st ervertebral
foramdieneapt, h tseot ernoclemiudsocamlnaeids,nt t hoieitn dr adsupraaiclne the
cevricaantldh orraecgiico n 230
Cas5e.P roabbenl onheanncliongwgr aadset rocoyftt hodesmi tasa pli cnoarld 233
Caes6 .N eufirboromattyop2sw eii stm hu ltsipnpialslec hnwnaoamsm,en nigmiaso, and
epeynmdomaassw ,e llc earsem berinanlmg aiason adc ousshctwiacn nso m.a 235
Cas7e.N eurofibrwoimtabthiao ltseaircsao lu sscthiwca nnmoemnaisn,sg a,i nosdmp ainal
coredp endymomas 241
CONTENTS
D.M iscellaneous
Cas1e. Ch ordwoimtap,ho stopecrhgaasetni.v e 249
Case M2e.t ascthaotrid:co p moasgstcsiauclrh gaens 253
Cas3e. C hordwoimtath hivene rtebbordoayfLl , 3c nofirmeadtb iopsy 256
Cas4e. M ulitphleem gaoinblasitnoap m aatsi weintvtho H ni ppniedla-udL isease 258
Cas5e. Sacral. teratoma 206
Cas6e. D ermotiudm olros,wp icnoar(ldp roavtse udr ge.r y.) . 263
IV.T rauma
Cas1e. Ta ruamtciocm psrieofsnra cwtiutsrhpea i lcno redd em.a 269
Cas2e. C omprefsrsaicootnfL u r1aen ddi stroafc titinhloteiane c jeton ittstit he
L1-2l ev.e l 272
Cas3e. Fracdtiusrleo ocfTa t-6i7wo intc ho rcdo ntuasnipdoa nr ashpeiamnmtaoal
fromati. on 276
Cas4e. F elxiiojnunr wyi tfhr acdtiusrleo ocfat thei- o2snL p linporu.oss c eewsi tthe art hien
duara nlde gakeoaf c erebirnoflasiulpda nbdl oiondtt hoe tsiosfastnu mdeu scolf es
thbea ck 282
Cas5e. C omprefsrsaicootnfLu rlwei tshp icnoarhlde mat.o ma 284
Caes 6.T arumiacat ntehreosloiifCss 4o t nC 5w itath r auamlahlteiyrc nidaitosenctd h lee ft
sidaett hCe4 -5 l. evel 286
Cas7e. P robaoblfldry a cture odfCi 4so lnCo 5ca astsaitooecwdini tash co lsiiaosn d
fromatioofanp osuttmraatsiyrcci anvxai tCt 4;yp resucmheiadlu bds e 289
Cas8e. F racdtiusrleo ocfa C2 toinCo 3ni n a " ahgnma'n"st ypoef furerwa icttah
trauiamclahlteyr nidaitsecd Ca2t- l3et vhee l 292
Cas9e. O lodd ontforiar;dce ttyup2oe d ontforiadc ture 298
Cas1e.0 B ialteprearlc fhaecde .t s 300
Cas1e1. A netrior diofsC l5oo ncC a6wt iitdohin s ruopftt hineou ncL gailma enatn d
traumatic heirnnrtiveaetritdoeinbas rcttoa hflCe 5 t-lhoee v .e l 302
Casle.2 S maelpli dhuermaoalmt a 306
Cas]e.3 E pidhuermaalt bolmoaio;ntd h teh esc:aa cla itrh veie nr tecbarniaanll ltohwee r
thoircag coirne 308
Cas1e.4 S pontaenpeioduhuser maalt .o ma. 331
Ca]se5. S pontaenpeioduhuser maalt iontm hame di t horragecoiinsc e contdoa ry
cotulmiunt reatment 3]7
Cas1e.6 B egnnico mprefsarscitouonrfT e 4as n Td1 2s econtdooa srtye ospiosr o 302
Cas1e.7 M ultciopmlper efsrsaicotnu res 322
Cas1e.8 M ultbienpgilnceo mprefsrsaicotsnueo rcnedsat rooy s teoporosis 324
V. Metastases
Cas1e. Io slamteetda statciacr cbirtneotoa hmLsea3t v ertebbordpayrl,o vaetbd i opsy 331
Cas2e. P sotradcihagatesni o.n 3R3
Cas3e. M etasotsatteiocbp lraosscttaianctcw eei rtt hhibeno nmea r;r mouwltpiaprlae- aortic
lymnpohd aelsss hoo sgwin so fm etasdtiastei.ac s e 304
Cas4e. P osgticsauclrh gasenw itphl aceomfe mnaet t aplllaaitncemd u ilptslcer eiwnts h e
vertebbordaialetC s 56 ,,a n 7d;d iffusmee tastmasuletsiv petlroet ebbordaile s and
spinporuosc esses 344
Cas5e. V ertebmreatla satnamdsU elst ippaltegh coilalloeynag lrdel ymnpohd seesc ontdoa ry
noHno-dgk'insl ymphoma 347
Cas6e. D fifuem etaessst eacsontdoia nrmnyeu raobsltee oblleassirtoeinlcsa ttehde to
prosctaantce.e r 305
Cas7e. M etasatdaetniocc arwciitbnhoo ndmeseat rucatdni sopni cnoarcldo mpressio3n5 3
Cas8e. M etatsibtcra ecaasntcw eirtv he rtebbordiaynvl o lveamnedn t
patghcoia ldoenopathy 357
Cas9e. M ettatasibcr easti vcnoalgnv cmieunrl tvieprltee braaldn t bhboerd aicephsli eaxlu 3s06
Cas1e0. M etasltgua nctaincc beoirp,sp yr ovmeuldt;i apdldei tliguo nnnoadlu wleerpser esent
ont hceh eCTs ts ca.n 362
TEAHCINAGT LAOSF S PlNIE MAGING
CasIeI M.te astcaotlcioacnrn coimtaoT 1w2i tbhon e exapnacdno srcidoo mnp ressio37n6
Cas1e.2 M etasEtwagit'snis ca rcwoimtcaho r cdo mpreasts iT2to hlnee v.e l 369
Cas1e.3 M etasrteantcaielcl l tcota hnrgecih etlrg u nantdh vee rteibnr attehh oer aancdi c
lmubargre oina nidvn ovlgi tnhpea trraa clhyemanploh d .e s 371
Ca1se4. C hlorsoemcao,n tdoaa cruymt yeeg lneooulse ukemia 377
Cas1e.5 M etasrteantcaielccl a lrn coimian vgot lehvC i3nv ertebbordwayil t h
corcdo mpression 308
Cas1e.6 B eracsatn cmeert.a sttota htCei2 vc e rtebbordwyai ltc ho rcdo mpression 383
Cas1e.7 M etasltgua nctainccw eirtb ho nayn edp idmuertaals atnacdso ercsdo mpressi3o8n6
Casle.8 M utlipmlyee lowmiativ hno lveomfte hnsetp iannebd o ncya lva.r iam 389
Cas1e.9 M ultmiypoellmeaw itdfhif umsarer oiwn volvaenmmdeu lnttip pahtloegli oc
comprefsrsaicot.nu res 392
Cas20e. M uilptmlyee lo.m a 395
Cas2e.1 D iffusmee tasitvnaoslgev msi ulntivpelret ebbordaiwlei sta p ha tghcoif lroacture
atT6 379
Cas22e. M ulitlpemy elowmiatr ha ppirgdro eosns.i 399
Cas2e3 M.u tlipmlyee loimnavg o ltvhei nsbtornuye cst ufarondrig mn sao rt mtaissss ue
dortsoat lhs ep icnoarrlde sgu ilntc oirncdo mpression 402
Cas2e4 M.u ltimpyleel owmiatdr hif uifisntel ratoifto hbneo nmea rroowr vtehret ebral
bodies aas nfodtt iwsimstauhse s 404
Cas2e5 M.u lptlmiey el;o mmulalteivel heepmiadtuporrmaealdi onmanptolstye rbiuaotlr sloy ,
presaentnetr iboirllaybt;le oropadllye uerfaflu s.i ons 407
Cas2e6 M.e tashteraatcsiatcn cweirtd hi ffousstee obmleatsatsit.ca ses 401
Cas2e7. B eracsatn cweirto hs teobmleattsaatssiwecis ts hot fits espuied cuormaplo anenndt
spicnoarcldo mpres. sion 4J2
Cas2.e8 Metasotsatteiocbp lraosscttaiarnctco eim a 441
Cas2e9 D.fi fusoes teobmleatsatsditicas tewiaicstm ehli ds otfits csoumep oinnet nhlteo wer
cervrigecoianal n mdu ltpiaptlghecoi fr lcaotrues 471
Cas30e. D iffusoes teobmleatasastseiftscr o tmh pea tikennotwp'nrs i mary
osgteneoisca rcoma 42l
VI. Carcinomatosis
Csael .S piannacdle remberngailaen lca rcinosmeactoontsdoibasr r eyca asntc weirt,h
involvoefm eltnehtpe t ogmsee( npiainnaad r achonfto hisedp )i annebd r ain;
presummeetda sdteaptoiisnct i hte e riienonfrpd l aotfte h Le4 v ertebrae 429
Cas2e. R ecurcreernegtb ilroabtllo ammsau lotrimwfei tdhr ompe tasatnardse essgu ltin
meingnealca rcinomatosis 433
Cas3e. D iffusbeo nmee tasatnasdsip ensma elng iaenlca rcino.m atosis 439
as4e. D fifuslee ukeimnlifitcrt ahtgreho ouutthv ei slzuideam arrrosewu,gl tin idfniufse
decresgaisanewldi tthhimena rroowf vtehret ebramli nbiopmdaaitlgeh csoi ;l o
fracotftu hrLeel v ertebbo;rd mayelt aessit nta hsdei setnaodlf t hteh esca;ac l
mengiaenlc arcinopmoaltyocsdyiissst;eoi aftcs h eke i dn(eiyn cifidndeginnt)a l 443
Cas5e. M etasctoaltoinc icnta hnsecu ebra rascphan.co eid 474
Cas6e. R ecurproesnttef roismosedrau olblsltaowmiatm hu letd irpomlpe tastases
fromme dulloblastoma 449
Ca7se. G reminowimtadh r ompe tasatnardsse eusgl stnpiainlm engiaenlca rcinomat4o5s1i s
Cas8e. L uekemifiintclr aitnte h mea rrooftw h vee rtebbordaialen msde ngiaenl
carcinowmiatethno hscaiensm eonftt h nee rrvoeo otft sh cea uedquai n.a 455
Cas9e. M etasbtraetcaiascnt ct eotr hv ee rtebbordmayal r raonwtd h sepn ial
epidsupraacle 458
Ca1s0e. D iffusoes teoblaossttiecom leaytntadisd cte aptoitschi grtoshou utth beo ny
stru;cc teurreembserngailaen cla rcinomatosis 416
VII.I nflammatory
CasIe. Dsiciwtiitssho t fit scsoumep oandend nets truofct thvieeo rnt ebbordayl
enpdl ate 467
CONTENTS
Cas2e. D is,c filotlioswtirnaguw miata hnu nusournagilas amst heet giioaclge onbti;tl earal
psoaabss ceasnsaden as sb cessusor urndtihnaegb domaionra.tl a 407
Cas3e. D isciitvniosl,vt ihinetng e rverdtiewsbicrt pahal r asepxitnoeannles; nhi anceomfe nt
the verterberflaetclht pesbre oencdseyo f v erteobsrtaelo myelitis 477
Cas4e. P sotopewroautniidvne ecf twiiotnd hr aiinng tsrianacuntpsd o ospetratdiivsec
ientc[ioiflnna;m matporroyce eexstndss i nott hseo tfits soufte hbse a cakn idn tthoe
intervefrroatmeebbnriaalela t.e r. al.l y . . 408
Cas5e. D iscaintedip si daunrpdaa lr asapbisncsaeelsnc sdo atroy
Mycobacttuebreiruc.mu losis 483
Cas6e. D is,c vietritseobsrtaeloi m;sy beilliapttseoraasl abespuciredasabsles sce;ex stse nding
formt hleu mbraerg tihoognru ht hteh orsapicnitebci; c k-ritmhmoerpdar caainscap li
muscalbeess sc . . . . 487
Cas7e. M lulteivaenlt earnipdoo rs teerpiiodarus brecaslms e,n iitnaignsmd lu itep dlorsal
anpda rpaisnaanlpd,s omauss cle ab.s c.e sses 419
Cas8e. L oculmautlletediv,ae tnle rainopdro steerpiiodarub resasclsso e ncdatroy
retrophaarbsy;cn eegtseisaololg ronagiiscm wcausl tnuo.rt e d 498
Cas9e. C hemimceanglii ntisa rwaicthahnde ohisiodn .s 503
Cas1e0. P robapbnleyu miosan nimdte nngiitwiistM hy cobacttuebreirucmu losis 507
Cas11e. M ycobacttuehcrueilruowmsi itshe oveuintdc oefs arcoidosis 509
Ca1se2. M ycobacttuebcrueilruoimsn i istne htref ajeoesiot nf tt hteh oraancdi c
lumbraerg io.n s 512
Ca1se.3 C ervsipcLia cnloa ridvnL oevmewnitts ha rcoidosis 516
Ca1se4. C ytomegarlaocdvuiilriutsi s 591
Vlll.C ervicSapli ne
Cas1e. Lag rehe rneidad tiastc thele evClo5n - 6rt ihegs hitd e 527
Cas2e. R giht-shiedrendii tanetrevde rdtieasbttcr haCel5 -l6e vel 532
Cas3e. L eflta therneriaalt eddi asctt hCe4- 5l ev.e l . 535
Cas4e. H reniamtieddla inLndfee pt a racecnetrrvailc atle hC d4i-lse5vc e la t 538
Cas5e. D geeneracthiavnewg ietoshs teofpohrymtaeat nitdor na urmeas gu ltin
inm yeolmaclia.a 504
Cas6e. R heuimadatr otihtwriistC h1 -d2i slno;chae tiraintodeids c Ca34t- anthde
C4-l5e vels 544
Cas7e. A tlantfosuai:xo Kinilaplp ela-nFoem;i arlil gyhth-esrindiedadit asetctd h e
C4-5 .l ev.e l . . . . 549
Case H8re.n iadtieasdctC 3-l4e vpeols;t elroinogri tluidgianomasfelsicn iatt i.o n 553
Cas9e.P ostelroinognria tllguia dmiecnaftllci ctliiosnsc/ifiaoti.o n . 557
Cas10e. R ecengter yFs ruod rirsecm Lo avtta hCe4- 5a nCd5 -l6e vweiltbsho nfyu sion
pglusinp l ace 516
Cas1e1 L.ag remi dlhienraent ieddi astcC 3 ;- p4ostopecrhagatenwsii vtfehu saitto hnCe 5 -6
anCd6 -l7e ve.l s. . 563
Ca1se.2 P sotopecrhaateinswvg iet h fuCs4;i- bo5onno ysa tte oeap th ytthel evCe4l- 5 with
comproomfi steah ear cshunsbopi;ad ac reeoafm yelomaatlt ahCce4i -a5 leve5l6 7
Cas1e.3 D geeneracthigavenien t hcee rvsipciawnlie ts hu4 bsueenptoo spteracthigavene.s 507
Ca1se4. R ight-sidendu chlpeeuruolnsspi uaastt eCda5 n-rd6e sumlyteilnogm alacia 574
Cas1e.5 P ostopecrhaae;tns cigervvei scpailn asly rcionrxd 579
Cas1e6 D.fiu fesi diopsaLktetehahilyc rp oest.o sis 581
IX.T horacSipci ne
Ca1se. H reniaittneerdv reLar dtiesabtc Tt6h-le7 e vel 587
Cas2e.C aliceihdfe,r niiantteedr vedritasettcb hTre6a -ll7 e vel 519
Cas3e. H reniactafieldedc,i it nervreLar tdeibscT 8a-lt9e vtehle 593
Case C4afi.le c,di herniiantteedr vedritasetctb hTre6a l-l7ve ewli tcho mproomfi steh e
vertebrianl mtcihadenl aainlnod en t hLefe ts id.e . 595
Cas5e. v oHni ppel-dLisieena wdsiatmuLhu itpcleer ebheelmlaanrg tioombaalnsasd sp inal
corhde maonbgliast.o m.a s . . . . 599
�I
I
TEACHINAGT LAOSF S PIINMEA GING
Cas6e.T horascpiiccno arld c miisaacnh pdr esuimnefda rction 602
Cas7e. P robasbpliceno arilds e cmhiwai taehrsa o f ennceheamnt 607
Cas8e. Spicnoaraledr tireovnoumsa olrfmatwiiotsnhu barahcchmnroorihdaa gnsedp li na
corids chemia 610
X. LumbarD isc
Caes I.Lu geh erendid saicta tte h L4-Sl evdeelg;e nedriasatcttes hd L e3 -4 and
LS1- lSevels . . . 691
.
Caes 2.H erinadle,e xtruddeids. c 622
Cas3e. L atlelrhyae rnidaitasetcd LtShl-c lS eevl 62S
Cas4e. L arlgetep f aracheenrtnriadalit asetctd h LeS1 - aSnadm Oderasteiezdldyi sct haet
L4-lSe v.e l . 629
CasSe. H erneid,as tequesdtiewsrice tndhe rrvoeoe tn heamnecn.t 632
Caes 6 .Lar gree curhreerenntdid ai ctfs rmaegnwti tphe ripehnehraanlc .e ment 637
Cas7e. R ecurhreernentdid ai twshc ihcahms i grahetheidnt dhLe vSee rbtrablo dy 604
Caes S. Hereniddai tspcr,o baabrliysfr imon tgh Le2 -l3e; v seulrgliypcr eaoldv 64S
CasYe. Leflta tehreranliladyti casdtct hLe4 -leSv ewli ethnc roachomnee n tth
itnerverftoerebanrm al 647
Cas1e.0 M dilei hrneniatdcidas ttce h L2-lev3el ;l aer egxterduhedr niadtiewsdic t ah
sequrClee sftreagmaetten h Lt4 -.S 615
Casl.e1 Gard1es pondtyhlsesios leicsontdobai lrayt seproanly disysl oallAt 5-lt evhecl 6S5
.
Cas1e.2 B ilraastlpe ondyysailnsogd lr a1d sep onUdtsyhleos.i s 6S9
Cas1e. 3G ard4es ponUdtsyehlisos 662
Cas1e.4 S ynocvyisa.tl . 666
Caes I.SS ynocvyiasatrl i sfirontmgh lee ifentfrt acjeotia ntt thle evLe3l-4 607
Cas1e.6 S pisntaeln aotts hies lLve3el-s ec4o ndtaohr yyp ertorfo Upt\\hghyeme ntuf1mv aum
anedn croacuhpmotenhn deto rassaploe fct thv ee rtecbarniaanllec ;nti adPla 'g�c t
deisasc tohlfcm u basrpe i ntaeht L 5,S, 1 anSd2 le velassw, e alslt hsea carlaale
antdeh iialcc res.t s .. 673
Cas1e. 7D iffusbeulglyi ndigs lrcaeg,ts tonhl ee sfi;td l eatreercaselts es noontse hi s
rigshitd. e . 677
Caes 1.8S pisnetanols isv awciutduhem ge earntivee soc fht ahienen gvtrcrtcdbirs.ac l 697
Caes 1.9S pisnntaseoli ast te h L4-5L 3a-ln4ed v weiltbshu lgdisincagstL 3-L44,- 5,
and LS-S1 618
Xl.M iscellaneous
Caes I.M lutispcllee orfo sbtirhsae ai nnsd p icnoarld 689
Cas2e. M luti�plcleer oosftei h bsr aainnsd p inal cord 694
Cas3e. P orbabmlueilpe tl scler.o sis 699
Caes 4.M lutliesp cleorfot shsiep si cnoarl.d . 703
CasSe. M luitpslcel eorfot shsieps i cnoarl.d 707
Cas6e .Tr vanressmeey lsi otfui nknocwanu s.e 709
Caes 7.P sotihmzmiitauno tarnsvmeyresleo p(ametyilhtyi s) 712
Cas8e. Psotvcaiocniaentnc ephalomy(ealcodupiteasemtis hneyaed tnc ephaeloolpmaythy)
secondtaovra ycn caiti.o n 716
Cas9e. T ranes mvyeertslimiso,slk tiel yse contdoma urlyt siecprlloes is 719
Ca1s0e.T raensrsemv yelitiusn,kw nnco. a use 722
Cas1c1 P.o stiraatcdihoeanns ignt e h spicnoaraldn tdh vee rtebbordaile s 725
Ca1se2. P orsatdiacthiea onwngie thnha ncemoefn tst phien al. cord 728
Ca1se3. P sotradcihaatni.go en . 713
Cas1e.4 R etaipnaendt o:p hrnaejqauteeddi astIAc, S . 733
CasIe. SE xtenpsoisvteo pccrhaeatnswigi vtschc anrgar niadd hesoifto hnneesr vreo ootfs
thcea uedquian a 736
Cas1e. 6P sotopee ardaehtiseiv avrachno.i .d i.t i.s 739
Cas1e.7 E pidhuemraatlo ma 742
CasIeS .M lueteviellpi rdulah cmationtm hale u mbreagiro n 744