The Hip - book

Section 4, Chapter 1: Measuring Spine Safety

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

Spine: in Paget’s Disease

– 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

Spine in Achondroplasia

– 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

MRI of the Spine

– 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

Lumbar Scoliosis

– 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

Herniated Disc in the Child

– 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

Double Major Curves

– 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

Adult Degenerative Spondylolisthesis

– 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