R

Radiation therapy, for metastatic spinal disease, 445 Radicular artery of Adamkiewicz, 22 Radiculopathy cervical computed tomography, 93 described, 36 disc replacement, 320 electrodiagnosis, 132 magnetic resonance imaging (MRI), 86, 93 natural history of, 104 nonsurgical treatment plan for, 105 provocative maneuvers for evaluation, 36 electrodiagnosis, 129, 130-131, 130t, 132-133 lumbar electrodiagnosis, 132 nonsurgical treatment plan for, 106 thoracic electrodiagnosis, 132-133 treatment plan for, 106 Radiofrequency neurotomy, 124, 124f Radiography advantages of plain, 67 assessment of the spine, 70-79 cervical, 70-72, 70f, 71f deformities, 75-79, 75f, 76f, 77f, 78f lumbar, 72-75, 73f, 74f thoracic, 72, 72f atlantoaxial impaction, 476 atlantoaxial subluxation, 476 of basilar impression, 258 cervical degenerative disorders, 316 in children with back pain, 251 coned-down views, 74 in degenerative spondylolisthesis, 362, 362f disadvantages of plain, 67 Ferguson view, 74, 74f flexion-extension views cervical spine, 71 lumbar spine, 74 of idiopathic scoliosis, 270, 270f in lumbar degenerative disc disease, 337-341 for metastatic spinal lesions, 444 of occipitocervical instability, 258 of osteoporotic compression fracture, 457-458, 457f for presurgical patient evaluation, 238 for pyogenic vertebral infection, 467

Radiography (Continued) in rheumatoid arthritis, 475-476, 476f for sagittal plane alignment, 355 in Scheuermann's, 279 in spinal cord injury, 304-305 cervical flexion-extension views, 50 lateral cervical, 50 of spondylolisthesis, 262-263, 263f, 264t of spondylolysis, 262-263 in stenosis, 343 subaxial subluxation, 476 of thoracic and lumbar fractures, 386, 386f when to order spinal, 67 Radioisotope/radionuclide studies for metastatic spinal lesions, 444 for pyogenic vertebral infection, 467 Ranawat Class of Neurologic Function, 475 Ranawat index, 476 Range of motion cervical disorder evaluation, 35 cervical spine, 35 lumbar spine evaluation, 42 thoracic disorder evaluation, 40 Reactive arthritis, 474 Recurrent laryngeal nerve, 15 Recurrent meningeal branch (sinuvertebral nerve), 15 Redlund-Johnell measurement, 476 Reflexes, in cervical disorder evaluation absent, significance of, 36 grading, 35t hyperreflexia, significance of, 36 testing function, 35t Reflexive dyssynergia, 235 Reflexology, 148

Reflex sympathetic dystrophy, 113 Rehabilitation medicine, 101-111 cervical spine, 104-105

components of nonoperative treatment program, 102-103 defined, 102

levels of nonsurgical care, 104 pain clinic, 104 physical agents, use of, 103 physical therapy, 103 red flags in evaluation of pain, 102 spinal traction, 103 TENS, use of, 103 therapeutic injections, 103 thoracic and lumbar spine, 105-110 Resolving curves, 268

Respiratory function and spinal injury, 406, 406t Retrograde ejaculation, 188 Retrolisthesis, 75

Retroperitoneal approach to lumbar spine, 186, 186f Retroperitoneal flank approach, 186, 187f Retropharyngeal approach, 180, 180f Reverse Trendelenburg position, 178 Revision surgery. See Surgery, revision RhBMP-2, 235, 507-508 Rheumatoid arthritis, 473-479

spinal compression from, 167 Rib phase, 268, 269f

Rib-vertebral angle difference (RVAD), 268, 269f Risser sign, 270, 270f Rogers wiring, 201

Rotary subluxation, 75

Roy-Camille classification for sacral fractures, 400

S1 screws, 215-216, 215f S2-alar-iliac fixation, 217 Sacral arteries, 190, 191f Sacral fractures, 399-403, 418 Sacral insufficiency fracture, bone scan in, 99, 99f Sacral slope, 78, 78f Sacral sparing, 47 Sacrectomy, 441 Sacroiliac joint anatomy of, 28, 28f assessment, 44 as pain generator, 120 Sacroiliac joint injections, 126, 126f Sacroiliac orthosis, 142, 143f Sacroiliac screws, 402 Sacropelvic fixation, 216f Sacrum anatomy osteology, 26-27, 27f sacroiliac joint, 28, 28f instrumentation for fusion of spine to sacrum and pelvis, 214-219

Sagittal contour, normal adult, 354, 354f Sagittal imbalance syndrome, 56, 57f, 349, 356 Sagittal plane deformities in adults, 354-358 in pediatric patients, 278-283 Sagittal resection, 440, 440f Sagittal vertical axis, 77-78, 354 Scapulohumeral reflex, 38

Scheuermann's disease/kyphosis, 55, 144, 253, 278-283,

278f, 355 Schober's test, 42 Schwannomas, 426 Sciatica, 332 Sciatic scoliosis, 55

SCIWORA (spinal cord injury without radiographic abnormality), 50, 304-305 Scoliometer, 53 Scoliosis adolescent idiopathic orthoses, spinal, 143, 143f, 144f pain associated with, 253 surgery indications, 154 adult idiopathic, 347-353 causes, 53 complications, 350 computed tomography, 92f congenital, 291-292, 294 de novo, 348

early onset (EOS), 298-299, 299f, 300f evaluation of, 54f adolescent patient, 53 adult patient, 55 scoliometer, 53 in growing child, 298 idiopathic, 268-277 adult, 347-353 causes of, 268

Scoliosis (Continued) described, 268 infantile, 268 juvenile, 269

King-Moe classification, 271, 271f Lenke classification, 271-272, 272f neuromuscular distinct from, 284 radiography, 270, 270f risk factors for curve progression, 272-273 leg-length discrepancy, 53 measurement of, 77f myopathic, 284 neuromuscular, 284, 284 neuropathic, 284 orthoses for, 143, 143f, 144f painful, 53

progression in adulthood, 350

risk after pediatric spinal cord injury, 308

sciatic, 55

spinal cord and nerve root compression, 169 surgery for adult scoliosis, 350-351, 352

anterior spinal instrumentation and fusion, 275-276, 276f complications, 276

indications, 154

posterior spinal instrumentation and fusion, 274, 274f, 275f

"Scotty dog" (radiographic feature), 73 Screws anterior vertebral body, 212f C1, posterior placement at, 196-197, 197f C1-C2 transarticular, 198-199, 199f C2 pars screw, 197, 197f C2 pedicle screw, 197, 198f C2 translaminar screw, 198, 198f iliac, 287

lateral mass, 200-201, 201f, 201t occipital connection to rod system, 196, 196f safe placement of, 196, 196f odontoid screw fixation, 200, 200f pedicle, 201, 209-210, 209f, 215, 287, 393, 492, 492f sacral, 215 sacroiliac, 402 Secondary care, 104

Sedatives-hypnotics, for chronic pain, 118 Segmental artery and vein, ligation of, 185 Segmental fixation, 208 Segmental spinal dysgenesis, 296 Segmentation defects, 291

Selective estrogen receptor modulators (SERMs), for osteoporosis, 453

Sensation assessment, in cervical disorder evaluation, 35 SEP testing, 132

Sequestration, of discs, 84, 85-86f, 85f, 333, 333f

SHILLA procedure, 301

Shoulder adduction test, 36, 37f

Shoulder height asymmetry, 55

SIADH (syndrome of inappropriate antidiuretic hormone secretion), 233 Single leg extension test, 418 Single-photon emission computed tomography described, 98 in spondylolysis, 98, 98f

Sinuvertebral nerve, 15 Slip angle, 263, 263f Slipped vertebral apophysis, 254 Smith-Petersen osteotomy, 357, 349, 349f, 357f, 486-487 Smith-Robinson approach, 181, 181f Smoking, interference with spinal fusion, 171 Social Security Administration disability definition, 60 filling out forms for, 62-63 Social Security Disability (SSD), 60 Social Security Disability Insurance (SSDI), 60 Soft collar, 134, 134f Somatic dysfunction, 146 Somatosensory-evoked potentials, 221 SOMI (sternal occipital mandibular immobilizer) cervicothoracic orthosis, 136, 136f Space available for the cord, 476 Spasticity, 409 Spear tackler's spine, 412 Spina bifida clinical features, 430 congenital lumbar kyphosis and, 289 defined, 429-430, 429f Spinal balance, 77 Spinal construct, 208-209 Spinal cord anatomy cervical, 14, 14f thoracic, 21-22, 21f blood supply cervical, 16 critical supply zone, 15 thoracic, 14 watershed region, 15 decompression procedures for, 165-170 monitoring function, 221

stimulation and implantable drug delivery systems, 243-248 Spinal cord disorders, 423-433 amyotrophic lateral sclerosis (ALS), 432-433 Chiari malformation, 428-429, 429f multiple sclerosis, 432 myelopathy, 432

spinal dysraphism, 429-432, 429f syringohydromyelia, 428-429 tumors, 424-427 extradural, 424-425, 425f, 425t intradural-extramedullary, 424, 426, 426f, 426t intramedullary, 424, 427, 427f, 427t location, 424, 424f Spinal cord injury, 404-410 complete, 377, 405 evaluation of, 46-51 ASIA Impairment Scale, 49 bulbocavernosus reflex, significance of, 47 elements of exam, 41f, 47 Frankel classification, 49 imaging studies, initial, 50 MRI, 50

osteoligamentous injury, 47-49

radiograph, cervical flexion-extension views, 50

radiograph, lateral cervical, 50

sacral sparing, 47

spinal shock, 47

tract assessment, 49

Spinal cord injury (Continued) transient neurologic deficit, 47 functional outcomes C1 to C5 injuries, 408t C6 to L1 injuries, 408t hypotension in, 46-47 incidence and causes of, 46 incomplete, 377, 405 pediatric spinal trauma, 304-310 spinal deformity risk with, 288-289 syndromes, 49 anterior cord syndrome, 49 Brown-Sequard syndrome, 49 central cord syndrome, 49 posterior cord syndrome, 49 SCIWORA (spinal cord injury without radiographic abnormality), 50 treatment goals of, 46 steroids, 46 Spinal cord stimulation, 243-248 Spinal decompression. See Decompression Spinal deformities. See also Kyphosis; Scoliosis congenital, 56, 291-297 evaluation of, 52-58 neuromuscular, 284-290 radiographic assessment, 75-79 Cobb method, 76 flatback syndrome, 79 measurement of scoliosis/kyphosis, 77f normal values for sagittal curves, 77 sacral parameters, 78, 78f sagittal curves, 78f specialized radiographs, 76, 76f spinal balance, 77 standard radiographs, 75, 75f when to order, 76 revision surgery for, 241 sagittal plane deformities in adults, 354-358 in pediatric patients, 278-283 secondary to neuromuscular disease, 56-58, 57f Spinal disorders degenerative, pathophysiology and pathoanatomy of,

311-315 electrodiagnosis in, 128-133 imaging strategies for, 65-69 nuclear imaging and, 97-100 rehabilitation medicine approaches to, 101-111 surgery indications for, 151-156 when not to operate, 157-159 tumors metastatic, 443-449 primary, 434-442 Spinal fusion, 171-176. See also Arthrodesis for adolescent idiopathic scoliosis, 274, 274f, 275-276,

275f, 276f for adult scoliosis, 350-351, 352 after thoracic discectomy, 327 anterior cervical discectomy and fusion, 495 anterior technique, 173, 173f, 275-276, 276f in athletes, 420

for cervical disc herniation, 318-319, 319t

Spinal fusion (Continued) for children with spondylolisthesis, 264-265, 265f classification of problems after procedure, 240t computed tomography following, 95, 96f for congenital scoliosis, 294 in degenerative spondylolisthesis, 364, 364f instrumentation for fusion of spine to sacrum and pelvis,

214-219 interbody, 173, 174f for degenerative spondylolisthesis, 364 for lumbar degenerative disc disease, 340, 340f minimally invasive surgery, 492-493, 493f, 494 posterior lumbar interbody fusion, 192, 193f for spondylolisthesis, 266, 266f transforaminal lumbar interbody fusion, 193, 193f trans-sacral, 361 for lumbar spinal stenosis, 345 medications interfering with, 171 for neuromuscular scoliosis, 286 nonunions, 176, 174-175 for odontoid fracture, 373 orthosis use following, 141 posterior lumbar interbody fusion, 192, 193f posterior technique, 172, 172f, 274, 274f, 275f revision surgery after prior, 239-241 for Scheuermann's kyphosis, 280 Spinal impairment, evaluation of, 109-110 Spinal infections. See Infections, spinal Spinal motion segment, 313 Spinal muscular atrophy, scoliosis associated with, 288 Spinal neoplasms. See Tumors Spinal nerves cervical, 15, 15f thoracic, 22 Spinal orthoses, 134-145 Spinal osteotomy, in ankylosing spondylitis, 484 Spinal realignment, indications for, 152 Spinal shock, 47 Spinal stabilization indications for, 152 as two-stage process, 206 Spinal stabilization exercises, 108, 109f Spinal stenosis. See Stenosis Spinal traction, 103 Spinal trauma. See Trauma, spinal SpineCor brace, 143, 144f Spine infections bone scan of, 98 treatment without surgery, 159 Spinopelvic fixation, 441, 442f Spinothalamic tracts, 14, 14f assessment in spinal cord injury, 49 Spondylodiscitis, 482 Spondylolisthesis, 58, 58f in adults, 359 bone scan, 263 causes of, 262

computed tomography, 95, 95f, 263 defined, 75, 253, 261, 418 degenerative, 361-364, 362f, 364f isthmic, 360-361, 361f, 418-419 magnetic resonance imaging (MRI), 263 Marchetti and Bartolozzi classification, 262, 262t in pediatric patients, 261-267

Spondylolisthesis (Continued) prevalence of, 262 radiography of, 262-263, 263f, 264t referrals for, 262 surgery, 264-265, 265f, 266f traumatic cervical, 382 traumatic of the axis, 373-374, 374f treatment, 253

Wiltse classification, 261-262, 261f Spondylolysis in adults, 359 in athletes, 418-419, 419t bone scan, 263 causes of, 262 cervical, 316, 316t computed tomography (CT), 263 defined, 26, 253, 261, 418 diagnosis of, 253 evaluation and treatment of, 419t magnetic resonance imaging (MRI), 263 orthosis for, 144 in pediatric patients, 261-267 prevalence of, 262 radiography of, 262-263 referrals for, 262

"Scotty dog" (radiographic feature), 73, 74f single-photon emission computed tomography, 98, 98f surgery, 263 treatment, 253 for acute traumatic, 309 Spondyloptosis defined, 261

treatment options, 266, 267f Spondylotic cervical myelopathy, 320-321 Sports injuries. See Athletes, injuries in Sports support, 142, 142f Sprain, soft tissue, 120 Stagnara wake-up test, 221, 228, 287 Staircase phenomenon, 476 Steel's rule, 258, 258f Stenosis adult scoliosis an, 348 anatomy of, 94f central, 29, 94 cervical, 94, 94f, 414 anterior surgical approach for decompression, 167 CT-myelography and MRI, 94, 94f laminectomy for, 167-168 laminoplasty for, 167-168 multilevel, 167-168

posterior surgical approach for decompression, 167 surgery indications, 153 computed tomography, 94, 95f, 343 CT-myelography, 94, 94f, 343 degenerative, 342 electrodiagnosis, 133 lateral, 29, 94, 344, 344f lumbar, 88, 88f, 94, 153, 342-346 surgery indications, 153

surgical decompression, 169-170, 343-344, 344f, 345 magnetic resonance imaging, 88, 88f, 343 minimally invasive surgery, 491 radiography, 343 thoracic, 328

Sternocleidomastoid muscle, 180, 180f Steroids. See also Epidural steroid injections dosing after acute spinal cord injury, 235 for metastatic spinal disease, 445 Stinger, 412-413 Straight-leg raise test, 43 contralateral, 43 reverse, 43 seated, 43f supine, 43f Strain, 120, 411 Strain-counterstrain, 147 Stroke, perioperative, 162 Subaxial cervical spine injury, 377, 377t Subaxial Injury Classification (SLIC) scoring system, 378, 379t

Subaxial subluxation, 473, 476-477, 479 Superficial abdominal reflex, 41 Superior gluteal artery, 190, 191f Superior hypogastric plexus, 30, 31f, 188 Superior laryngeal nerve, 180f, 181 Superior mesenteric artery syndrome, 234 Superscan phenomenon, 99 Supplemental Security Income (SSI), 60 Supraspinous ligaments, 13 Surgery. See also specific procedures approach involving anterior spinal column, 155 cardiac risk stratification, 161-162 cervical spine, 177-182 anterior approaches, 178-182, 179f, 180f, 181f posterior approach, 177-178, 177f, 178f complications of, 160, 164 decompression procedures for spinal cord and nerve roots, 165-170 diagnostic imaging tests prior to, 238 equipment/facility requirements, 163 failed back surgery syndrome, 237 indications for, 151-156 intraoperative considerations, 225-230 intraoperative neurophysiology monitoring, 220-224 lumbar spine anterior surgical approaches, 183-189 posterior surgical approaches, 190-194 minimally invasive spine, 489-496 cervical, 495 lumbar, 491-494 thoracic, 494-495 patient education, 163-164 poor outcomes, 237

posterior spinal instrumentation and fusion procedures, 154-155

postoperative management and complications, 231-236 preoperative assessment and planning, 160-164 revision, 154, 237-242 contraindications for, 158 principles of, 238

after prior spinal decompression, 239 after prior spinal fusion, 239-241 for spinal deformity, 241 techniques for growing spine, 298-303 thoracic spine anterior surgical approaches, 183-189 posterior surgical approaches, 190-194 when not to operate, 157-159

Surgical stabilization of sacral fractures, 401, 401t Sympathetic trunk/chain damage to, 182, 189 thoracic portion, 22 Syndrome of inappropriate antidiuretic hormone secretion

(SIADH), 233 Syringohydromyelia, 428-429 Syringomyelia, 288 Systemic lupus erythematosus, 474

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