Table Of ContentThe Adolescent Spine
The Adolescent Spine
Second Edition
Hugo A. Keirn
Associate Professor
Clinical Orthopaedic Surgery
College of Physicians and Surgeons
Columbia University
With Contributions by
John R. Denton
Harold M. Dick
James G. McMurtry III
David P. Roye, Jr.
With 366 Illustrations
Springer-Verlag
New York Heidelberg Berlin
Hugo A. Keirn, M.D., F.A.C.S.
Associate Professor
Clinical Orthopaedic Surgery
College of Physicians and Surgeons
Columbia University
161 Fort Washington Avenue
New York, New York 10032, U.S.A.
Sponsoring Editor: Larry W. Carter
Production: William J. Gabello
The illustration on the front cover was adapted from an illustration by Robert 1. Demarest,
who also rendered the frontispiece.
The first edition of The Adolescelll Spine was published in 1976 by Grune & Stratton, Inc.,
New York.
Library of Congress Cataloging in Publication Data
Keirn, Hugo A.
The adolescent spine.
Includes bibliographies and index.
I. Spine--Diseases. 2. Spine--Abnormalities.
3. Youth-Diseases. I. Denton, John R. II. Title.
[DNLM: 1. Spinal diseases-In adolescence. 2. Spinal
injuries-In adolescence. WE 725 K27aJ
RJ482.S64K44 1982 617'.375 81-9356
@ 1976, 1982 by Springer-Verlag New York, Inc.
Softcover reprint of the hardcover 2nd edition 1982
All rights reserved. No part of this book may be translated or reproduced in any form without
written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010,
U.S.A.
The use of general descriptive names, trade names, trademarks, etc. in this publication, even
if the former are not especially identified, is not to be taken as a sign that such names, as
understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely
by anyone.
987654321
ISBN-13,978-1-4612-5662-5 e-ISBN-J3:978-J-4612-5660-1
DOl: 10.1007/978-1-4612-5660-1
To the wonderful and loving women in my life:
Thank you for helping me survive.
Contents
Foreword to the First Edition ix
Frank E. Stinchfield
Preface to the Second Edition xi
Acknowledgments xiii
Contributors xv
Chapter 1
Embryology and Anatomy of the Human Spine 1
Chapter 2
Neurology of the Spine 11
Chapter 3
Biomechanics of the Adolescent Spine 17
David P. Roye, Jr.
Chapter 4
Congenital Problems in the Adolescent Spine 25
Chapter 5
Tumors in the Adolescent Spine 43
Harold M. Dick
viii Contents
Chapter 6
Trauma and the Adolescent Spine 63
John· R. Denton
Chapter 7
The Cervical Adolescent Spine 77
James G. McMurtry III
Chapter 8
Infections and Inflammatory Lesions of the
Adolescent Spine 97
Chapter 9
Scoliosis 107
Chapter 10
Clinical and Roentgenographic Evaluation of the
Scoliosis Patient 137
Chapter 11
Nonoperative Treatment for Scoliosis 151
Chapter 12
The Operative Management of Scoliosis 181
Chapter 13
Kyphosis and Lordosis 225
Index 245
Foreword to the First Edition
It is my great privilege to contribute a foreword to this excellent book, The Adolescent
Spine. The book, which is a comprehensive work on adolescent spinal problems,
clearly reflects the author's wide clinical experience.
Dr. Keirn, at a young age, has limited his work to the study and treatment of
the human spine-not only in the clinical field but in research as well. He has immersed
himself thoroughly in all aspects of this subject. The material is clearly and authorita
tively presented. It is a scholarly text, carefully organized, with each chapter containing
valuable information on the area covered. I believe that medical students, residents,
and experienced orthopaedic surgeons all will derive benefits and valuable assistance
from this book.
Among the outstanding features are the photographs, x-ray reproductions, and
excellent art work of Mr. Robert Demarest.
The New York Orthopaedic Hospital, of the Columbia-Presbyterian Medical Center,
in which Dr. Keirn is doing his work, has always been recognized for its orthopaedic
surgeons who have made the spine their particular specialty. The author has been a
worthy successor to such men as Doctors Russell Hibbs, Joseph Risser, William H.
Von Lackum, and Theodore Waugh, all of whom preceded him in this specialized
field.
Dr. Keirn has always been an enthusiastic teacher of orthopaedic surgery, especially
in the field of scoliosis. He has done a remarkable job in writing this book, which I
believe will stand the test of time. I recommend the book to the physician who is
looking for advice on how to diagnose and treat the adolescent patient with a spinal
problem. I found the text interesting, informative, instructive, and highly readable.
Dr. Keirn is to be complimented.
Frank E. Stinchfield, M.D., F.A.C.S.
Professor Emeritus
College of Physicians and Surgeons
Columbia-Presbyterian Medical Center
New York, New York, U.S.A.
January, 1976
Preface to the Second Edition
As modern science and medical technology increase the life span of man, the human
skeleton is required to function for longer periods of time. Many skeletal problems
that besiege the adult stem from abnormalities that exist during infancy and adoles
cence. These may be congenital problems or acquired problems due either to a child's
environment or to some injury sustained during the growth years. Adolescents today
are extremely active; many sports and hobbies subject them to an infinite array of
traumatizing episodes that may result in injuries and diseases.
When I wrote the first edition of The Adolescent Spine in 1976, I felt it pertinent
to produce a work which would help medical students and practitioners alike. That
edition was extremely successful, not only in this country, but also in many foreign
countries. For a medical text, the number of copies purchased was overwhelming
certifying that the adolescent spine is of serious interest to pediatricians, orthopaedists,
physical therapists, physiatrists, medical students, and other allied health practitioners.
This new edition has been revised and considerably expanded with this audience
in mind. Four chapters have been contributed by authorities with special expertise.
John R. Denton has redone the chapter "Trauma and the Adolescent Spine" and
Harold M. Dick has reworked the chapter "Tumors in the Adolescent Spine." The
addition of two completely new chapters fills out areas of weakness in the first edition
and should strengthen the text in general: James G. McMurtry Ill's "The Cervical
Adolescent Spine" and David P. Roye, Jr.'s "Biomechanics of the Adolescent Spine."
Knowledge of the human spine is increasing at a rather rapid pace. However,
new knowledge either extends or outmodes the old-it forces us to relearn today
what we thought we knew yesterday. To quote Dr. Robert Hilliard of the Federal
Communications Commission: "At the rate at which knowledge is growing, by the
time a child born today graduates from college, the amount of knowledge in the
world will be four times as great. By the time that same child is fifty years old, it
will be thirty-two times as great, and ninety-five percent of everything known in
the world will have been learned since the time he was born."!
This overwhelming amount of new information that we must absorb every day is
forcing us to make changes. We must apply in our daily lives the discoveries of
modern technology and science. Even though our basic anatomy doesn't change,
our ability to treat pathologic disturbances of this anatomy has been in constant
change since the time of Hippocrates.
1 Tomer A: Future Shock, 1st Edn. Pan Books, London, 1973, p. 149.
xii Preface to the Second Edition
In this edition, as in the first, I have endeavored to describe the living anatomy
of the adolescent spine, especially because so little anatomy is taught today in medical
schools. The chapters on anatomy, embryology, neurology, and biomechanics provide
a logical context for the chapters that follow, discussing the maladies that affect
the adolescent spine. For each problem, the pathology, diagnosis, and treatment as
they pertain to the cervical, thoracic, and lumbar regions of the spine are covered
in detail, both as separate problems and in light of their effects on the spine as a
whole.
I have been most happy to have this new edition published by Springer-Verlag
New York, who have been most helpful in a very thorough and concise expansion
of the original work. Mr. Larry Carter and Mr. William Gabello have given their
attention to detail to see that the book is accorded its proper presentation and format.
I would again like to express my thanks to the many educators and former teachers
who have helped me to formulate some of the basic facts as I understand them.
Particularly, to Dr. Frank E. Stinchfield, my colleague and Chief, Emeritus, at the
New York Orthopaedic Hospital of the Columbia-Presbyterian Medical Center, for
his unselfish devotion and dedication in helping residents and young staff members.
Also, to Dr. Alexander Garcia, the present chairman of the Orthopaedic Department
here at the Columbia-Presbyterian Medical Center, for his encouragement to produce
the second edition.
I would like very much to thank my secretary, Ms. Gloria Curry, for her tremendous
encouragement to help the second edition to spring forward. I would also like to
thank my family, and the many other physicians, teachers, and friends who have
been a great source of help to me and are too numerous to mention individually.
Many of the people, especially my children, who have been close to me have suffered
to some extent because of my absence when they needed me, but they have been
most understanding during the long hours I have been unable to share with them.
Hugo A. Keirn, MD., F.A.CS.
January, 1982
Description:As modern science and medical technology increase the life span of man, the human skeleton is required to function for longer periods of time. Many skeletal problems that besiege the adult stem from abnormalities that exist during infancy and adoles cence. These may be congenital problems or acqui
