Wheeless' Textbook of Orthopaedics
Presented by Duke Orthopaedics
Fady Y. Hijji, Ankur S. Narain, Kern Singh and Jonathan N. Grauer INTRODUCTION Patient-centered outcomes and safety are central aspects of health care. Reform will require changes in quality and efficacy of treatment. Surgical treatment for spine disorders is rapidly growing in prevalence and cost – spinal fusion is currently the most expensive procedure performed … Read more
– See: Pagets Disease – Discussion: – Paget’s disease involves spine, esp third and fourth lumbar vertebras, in up to 1/3 of affected patients, & lower thoracic vertebras in 20%; – most patients have symptoms; – localized pain can develop because of pathologic fracture w/ vertebral collapse, spinal-canal stenosis, … Read more
– See: Pseudoachondroplasia – Cervical Spine: – stenosis of foramen magnum: – all patients with achrondroplasty will demonstrate some radiographic stenosis of foramen magnum, and many can be shown to demonstrate either some at least some clinical symptoms or … Read more
– See: – MRI in Cervical Fractures – Role of CT & MRI in Cervical Fractures – MRI of Disc Herniation – MRI diagnosis of Spinal Osteomylitis – Discussion: – most sensitive and accurate method for screening patients with symptoms of a spinal cord lesion; – … Read more
– See: Fusion to Sacrum: – Indications for Rx: – curves > 40-45 deg; – documented progression; – marked imbalance with a shift to one side; – substantial pain; – Operative Considerations: – attempt to increase lordosis compared with that noted … Read more
– Diff Dx: slipped vertebral apophysis – Discussion: – disc herniation is uncommon in children; – herniations are most common at the disc spaces between the fourth and fifth lumbar vertebrae & between 5th lumbar and 1st sacral vertebrae; – Clinical Findings: – children experience little or no back … Read more
– See: Scoliosis Menu: – Discussion: – frequently double curves balance out & do not produce cosmetic deformity; – they do not tend to progress unless > 60 deg at skeletal maturity; – operative indications: – marked progression of curves; – disadvantages … Read more
– Age: – Back Pain in the Child: – Younger Adults: – ankylosing spondylitis (see spondyloarthropathies) – disc disease: – spondylothisthesis – metabolic bone disease – indicated by … Read more
Section 1: Anatomy Section Editor: R. Shane Tubbs Chapter 1: Anatomy of the Lumbar Intervertebral Discs by Erfanul Saker and R. Shane Tubbs Chapter 2: The Ligaments of the Lumbar Vertebrae by Lydia Jones and R. Shane Tubbs Chapter 3: Anatomy of the Lumbar Nerves by Jaspreet Johal and R. Shane Tubbs Section 2: Basic … Read more
– Discussion: – often occurs as a result of degenerative disc disease and facet deficiency; – it is often associated w/ intersegmental instability and w/ central stenosis; – more commonly involves older black females and diabetics (affects females 6 times as much as males); – involves L4-L5 … Read more