P

Paget's disease, 454, 454f Pain acute, defined, 112 back complementary and alternative medicine treatments, 146-150

as indication for spinal surgery, 153 pediatric, 249-255 centralization of, 107-108 cervical causes, 104 treatment plan for, 104 chronic defined, 112

muscle relaxants for, 118 opioids for, 115, 116t patient types with, 112-113 pharmacologic management of, 112-119 sedatives-hypnotics for, 118 types, 112 defined, 112

discogenic, 120, 124, 126 leg, 417 low back assessment and management, 329-331 cardiovascular conditioning, role of, 108-109 common causes of lumbar pain, 106 complementary and alternative medicine treatments for, 146-150 discogenic, 337-341 lumbar spine exam, 41-44 in lumbar spine injuries in athletes, 417 orthosis for, 144

probability of recovery, changes in, 106 treatment plan for, 106 trunk strength deficits and, 110 lumbar causes of, 106 treatment plan for, 106 neurogenic, 113

Pain (Continued) neuropathic, 113, 118 nociceptive, 113 perception of axial, 315

pharmacologic management of chronic, 112-119 red flags in evaluation of, 102 thoracic causes of, 105-106 treatment plan for, 106 Pain clinic, 104 Pain diagram, 42 Pain generators, 120

Pain management, after spinal fusion, 235 Palpation in cervical disorder evaluation, 34-35 lumbar spine evaluation, 42 thoracic disorder evaluation, 40 Paramedian retroperitoneal approach to lumbar spine, 186, 186f Paraparesis, 404 Paraplegia, 404, 407

Paraspinal approach to lumbar spine, 192, 192f Paraspinal muscles, 178 Parathyroid hormone, for osteoporosis, 453 Parental hyperalimentation, in adults with scoliosis, 352 Pars interarticularis, 11, 26, 197 Pars repair, 263-264, 264f Pars stress reaction, 418 Patient positioning careful to minimize injury, 228 considerations for spinal procedure kneeling or tuck position, 228 lateral decubitus position, 228 prone position, 228 sitting position, 229 neurologic injury secondary to, 227 Patrick's test, 44 Pax genes, 256 Peak bone mass, 452 Pediatric patients back pain in, 249-255 cervical disorders, 256-260 congenital spinal deformities, 291-297 discitis, 254

sagittal plane deformities in, 278-283 spinal infections in, 254 spinal trauma, 304-310

spondylolysis and spondylolisthesis in, 261-267 surgical techniques for growing spine, 298-303 Pedicle screws, 201, 209, 209f, 215, 287 percutaneous lumbar, 492, 492f for thoracolumbar burst fractures, 393 Pedicle subtraction osteotomy, 349-350, 349f, 357, 464 Pelvic compression test, 44 Pelvic incidence, 78, 78f Pelvic tilt, 78, 78f

Pelvis, instrumentation for fusion of spine to sacrum and, 214-219

Periodontal rheumatoid pannus, 478

PET. See Positron emission tomography

Pharmacologic management of chronic pain, 112-119

Philadelphia collar, 135, 135f

Physical therapy, 103

Pilates, 148

Plates anterior cervical, 202, 202f, 203f, 323 anterior plate systems, 211 buttress (junctional), 204, 204f dynamic, 202, 204 static, 202, 204 Platysma muscle, 181 Pneumothorax, 232

Polymethylmethacrylate (PMMA), 459, 461, 464-465

as spacer, 213 Ponte osteotomies, 280, 280f Ponticulus posticus, 197

Positioning frames for posterior spinal procedures, 190 Positron emission tomography (PET) described, 98

for metastatic spinal lesions, 444 normal, 100f performance of scan, 99-100 useful applications of, 100 Posterior atlantodental interval, 476 Posterior closing wedge osteotomy, 464 Posterior column injuries, 381-384 Posterior cord syndrome, 49

Posterior foraminotomy, for cervical disc herniation, 317, 318f

Posterior fusion, for odontoid fracture, 373 Posterior laminoforaminotomy, 167 Posterior longitudinal ligament, 13 Posterior lumbar interbody fusion, 192, 193f Posterior segmental spinal fixation, 208, 208f Posterior spinal instrumentation, 206-210 for adolescent idiopathic scoliosis, 274, 274f, 275f for neuromuscular scoliosis, 286 for Scheuermann's kyphosis, 280, 280f for spinal infection, 468 Posterior superior iliac spine, 216 Posterior surgical approaches to cervical spine, 177-178, 177f, 178f, 495 to lumbar spine, 190-194, 491 minimally invasive spine surgery cervical, 495 lumbar, 491 thoracic, 494-495 to thoracic spine, 190-194, 494-495 Postoperative management and complications, 231-236 Postural syndrome, 107-108 Powers ratio, 306, 307f, 369 Preoperative assessment and planning, 160-164 Pressure ulcers, 407

Prevertebral soft tissue shadow distance, 71 Primary care, 104

Primary spine tumors. See Tumors, primary spine Progressive curves, 268 Prolotherapy, 103, 149

Protrusion, of discs, 29, 84, 85-86f, 85f, 333, 333f Pseudarthrosis, 239, 318, 318t Pseudosubluxation, 306 Psoas muscle, 185-186 Psoriatic spondyloarthritis, 474 Psychiatrist, referral to, 104 Psychologist, referral to, 104 Pulmonary complications, after spinal surgery, 232, 287, 352

Pulmonary consultation, preoperative, 162

Pulmonary embolism, 233 Pulse generators, 243-245 Pulse sequence, 80-81 Pyogenic infections, 466-470

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