Multidisciplinary Spine Care

Introduction References Contents Contributors 1: Lifestyle Management of Spine Patient Introduction How Posture Affects the Spine The Impact of Exercise on the Spine The Effects from Nutrition on the Spine The Effects of Sleep on the Spine The Effects of Stress on the Spine The Effects of Overuse of Technology on the Spine Conclusions References 2: Evaluation of a New Spine Patient Introduction Patient History Red Flag Symptoms Physical Examination Inspection Palpation Range of Motion Neurological Testing Functional Testing Special Maneuvers and Provocative Tests Cervical Region Spurling Distraction Bakody Upper Limb Tension Test Valsalva Lumbosacral Region Straight Leg Raise Seated Slump Test Gaenslen’s Facet Loading FABER Test Posterior Superior Iliac Spine (PSIS) Joint Distraction SI Compression/Distraction Thigh Thrust General Overview of Clinical Decision Making Nonspecific Spine Pain Radiculopathy and Spinal Stenosis Red Flags and/or Specific Conditions Common Clinical Syndromes Myotendinous Pain Strains and Sprains Myofascial Pain Syndrome and Trigger Points Arthropathy Facet Arthropathy Sacroiliac Joint Dysfunction Discogenic Pain Radiculopathy Myelopathy Spinal Stenosis Vertebral Compression Fractures References 3: Electromyography in the Spine Patient Overview of the Study Utility of EMG in Identifying Radiculopathy Limitations of EMG in Radiculopathy Timing of Findings in Radiculopathy Role of EMG in Lumbar Spinal Stenosis When EMG Is Not Helpful Significance of EMG in Predicting Clinical Outcomes Conclusions References 4: Conventional and Advanced Imaging Evaluation of Spine History of Spine Imaging Morbidity Related to Spine Imaging Evaluation Radiographic Evaluation of Spine Radiography in Scoliosis Digital Video Fluoroscopy Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Special MRI Sequences and Applications in Spine Imaging Future Directions References 5: Spondyloarthritis Introduction Classification Epidemiology Clinical Manifestations Physical Exam Diagnosis Lab Testing Imaging Studies Algorithm Differential Diagnosis Treatment Options Nonpharmacologic Treatment Pharmacologic Treatment References 6: Soft Tissue Pain Introduction Differential Diagnosis of Acute Pain Posterior Neck Pain Interscapular and Scapular Pain Midline Thoracolumbar Pain Lumbosacral Pain Unilateral Buttock Pain Bilateral Buttocks Pain Myofascial Pain Etiologies Treatments Fibromyalgia Cervical Whiplash Cervical Dystonia and Torticollis Notalgia Paresthetica Paraspinal Muscles Quadratus Lumborum Thoracolumbar Fascia Greater Trochanteric Pain Syndrome Gluteal Bursitis Ischial Bursitis Neuropathic Back Pain Shingles Nerve Entrapment Piriformis Syndrome Referred Pain Treatment Guidelines References 7: Non Pharmacological Treatments Introduction Active Component: Therapeutic Exercise Exercise and Acute Low Back Pain Exercise and Acute Neck Pain Exercise and Chronic Spine Pain Exercise and Prevention of Spine Pain Exercise Based Exercises for Spine Pain Walking Aerobic Exercise Stretching Exercise Pilates Yoga Tai Chi Qigong Physical Therapy Physical Therapist Lead Exercise Programs Types of PT Programs McKenzie Therapy Movement Control Williams Flexion Back School Passive Component: Manipulation and Modalities Mobilization and Manipulation Massage Passive Therapeutics Thermal Modalities Transcutaneous Electrical Nerve Stimulation Spinal Traction Low Level Laser Therapy Therapeutic Ultrasound Bracing Acupuncture Psychological Treatments and Therapies References 8: Pharmacology Overview Learning Objectives Acetaminophen Mechanism of Action Evidence in Spine Adverse Effects Dosing COX-Inhibitors Mechanism of Action Evidence in Spine Adverse Effects Dosing Antidepressants Mechanism of Action Evidence in Spine Adverse Effects Dosing Anticonvulsants Mechanism of Action Evidence in Spine Adverse Effects Dosing Muscle Relaxers Mechanism of Action Evidence in Spine Adverse Effects Dosing Corticosteroids Mechanism of Action Evidence in Spine Adverse Effects Dosing Local Anesthetics Mechanism of Action Evidence in Spine Adverse Effects Dosing Opioids Mechanism of Action Evidence in Spine Adverse Effects Dosing Capsaicin Mechanism of Action Evidence in Spine Adverse Effects N-Methyl-D-Aspartate (NMDA) Receptor Antagonists Mechanism of Action Evidence in Spine Adverse Effects Tumor Necrosis Factor (TNF) Inhibitors (Anti-TNF) Mechanism of Action Evidence in Spine Adverse Effects Prostaglandin E1 (PGE1) Derivatives Mechanism of Action Use in Spine Adverse Effects Other Conclusion References 9: Interdisciplinary Pain Management Introduction Biopsychosocial Neuroscience of Pain Psychological Impact of Pain Psychological Treatment of Pain Interdisciplinary Care Conclusion References 10: Spine Injections in the Management of Painful Spinal Conditions Introduction Epidural Steroid Injections Background Mechanism of Action Lumbar Interlaminar Epidural Steroid Injections Evidence Caudal Epidural Steroid Injections Evidence Lumbar Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks Cervical Epidural Steroid Injections Cervical Interlaminar Epidural Steroid Injections Cervical Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks Evidence Facet Joint injections and Medial Branch Nerve Blocks Background Facet Joint Injections Medial Branch Nerve Blocks Evidence Sacroiliac Joint Injections Evidence Conclusion References 11: Vertebral Compression Fractures Introduction Epidemiology and Risk Factors Global Effects of VCF Evaluation Management Medications for Pain Control Spinal Bracing Physical Therapy and Exercise Preventative Medicine & Bone Health Spinal Injections Vertebral Augmentation Conclusion References 12: Epidural Lysis of Adhesions Introduction Recent Modifications Lysis of Epidural Adhesions Applied Anatomy Indications Techniques Lysis of Epidural Adhesions via Caudal Approach Advanced Catheter Fastening Technique Steps 1 Day Lumbar Lysis Catheter Tape Down Technique Lumbar Transforaminal Catheter Placement Sacral Foraminal Catheter Placement S1 Catheter Injections Cervical Interlaminar Epidural Catheter Placement Enlarging of Neural Foramina by Flexion Rotation and Chin to Shoulder Maneuver Cervical Interlaminar Epidural RX-2™ Coude® Needle and Catheter Placement Catheter Tape Down Technique Cervical Injections Neural Flossing Exercises Dural Flossing Exercises Medicolegal Concerns Informed Consent Complications Trainees Prevention of Complications Outcome Studies and Conclusions References 13: Pre-surgical Psychological Evaluation of Spine Surgery Candidates Introduction Guidelines for Presurgical Psychological Evaluations Domains of the Presurgical Psychological Evaluation Medical Chart Review Structured Clinical Interview Psychometric Testing Integration of Evaluation Data Psychological Clearance/Recommendations Feedback Session Summary References 14: Pre and Postoperative Spine Rehabilitation Epidemiological Considerations Preoperative Spine Patient What Is Prehabilitation? Education Reducing Fall Risk Cardiovascular Conditioning Smoking Cessation Alcohol Cessation Nutrition Centralization of Pain and Psychologic Intervention Enhanced Recovery After Surgery Program An Approach and Potential Model Postoperative Rehabilitation Early Mobilization (Day 0–2 Weeks) Timing and Frequency of Postoperative Rehabilitation Postoperative Cardiovascular Exercise Aquatic Exercises Strength Training Neural Mobilization Soft-Tissue Mobilization/Manual Therapy Psychosocial Considerations Mind Body Exercises Bibliography and Further Reading 15: Preoperative Optimization and Intraoperative Enhanced Recovery Principles for Patients Undergoing Spine Surgery Preoperative Assessment for Primary Care Providers Cardiovascular Risk Assessment and Recommendations Procedure-Specific Risks Patient-Specific Risks Risk Calculators Cardiovascular Clinical Risk Factors Coronary Artery Disease Valvular Heart Disease Heart Failure Pulmonary Risk Assessment and Recommendations Pulmonary Risk Reduction Hematologic Risk Assessment and Recommendations Preoperative Anemia Causes of Preoperative Anemia and Management Iron Deficiency Anemia Anemia of Chronic Disease Endocrine Risk Assessment and Recommendations Introduction to the Anesthesia Preoperative Evaluation System-Based Approach to the Preoperative Anesthesia Evaluation Airway Pulmonary Cardiovascular Neuromuscular Positioning Considerations Blood Bank Coordination Pain Assessment Preoperative Testing Informed Consent and Discussion of Anesthetic Risks Preoperative Introduction to Enhanced Recovery After Surgery Tenets of Anesthetic Intraoperative Management and Spine ERAS Pathways Background Anesthetic Technique Fluid Management Perioperative Vision Loss Analgesia Multimodal Analgesia Opioid-Free Analgesia Bleeding During Spine Surgery Monitoring for Blood Loss Pharmacologic Agents to Mitigate Blood Loss Hypotensive Anesthesia for Reducing Blood Loss Bleeding and Temperature Management Positioning Strategies for Minimization of Blood Loss Examples of Published Spine ERAS Protocols Conclusion References 16: ICU Care for the Spine Patient Neurological System Neurological Exam Pain Management Mobility, Therapy, and Rehabilitation Delirium Cardiovascular System Postoperative Cardiac Considerations After Spine Surgery Cardiac Considerations After Spinal Cord Injury Respiratory System Airway Compromise After Spine Surgery Lower Respiratory Tract Complications After Spine Surgery Respiratory Care in Spinal Cord Injury Renal System Acute Kidney Injury Electrolyte Disorders Urinary Retention Gastrointestinal System Dysphagia Postoperative Ileus Neurogenic Bowel Dysfunction Glycemic Control and Nutrition Hematologic System Hematologic Considerations After Spine Surgery Hematologic Considerations in Spinal Cord Injury Infectious Disease Considerations Infectious Disease Evaluation Infectious Disease Treatment Principles Conclusion References 17: Postoperative Care of the Spine Surgery Patient Preparation for Surgery and Postoperative Care Expectations Education Aftercare General Care Instructions Inpatient Nursing DVT Prophylaxis Bracing Discharge Activity After Discharge Pain Management and Poly Pharmacy Complications and Emergencies After Discharge References 18: The Neurosurgical Management of Pain Introduction Spinal Ablative Procedures Anterolateral Cordotomy Overview Percutaneous Versus Open Surgery Complications Dorsal Root Entry Zone (DREZ) Lesioning Spinal DREZ Nucleus Caudalis DREZ Punctate Midline Myelotomy Neurotomy Dorsal Root Ganglionectomy Intracranial Ablative Procedures Bilateral Anterior Cingulotomy Medial Thalamotomy Mesencephalotomy Hypophysectomy Deep Brain Stimulation/Motor Cortex Stimulation Overview Procedure Outcomes Complications Spinal Cord Stimulation Overview Patient Selection Outcome Complications Direct Drug Administration Into CNS Overview Procedure Medication Options Classic Examples of Pain Conditions Treated by Surgery Trigeminal Neuralgia Microvascular Decompression Percutaneous Treatments Stereotactic Radiosurgery Occipital Neuralgia Occipital Nerve Decompression Occipital Nerve Stimulation Conclusions References 19: Endoscopic Spine Surgery Introduction History Endoscopic Lumbar Spine Percutaneous Transforaminal Endoscopic Discectomy Anatomy Technique Outcomes Re-herniation PTED Versus Microdiscectomy Other Percutaneous Endoscopic Interlaminar Discectomy Outcomes Re-herniation Interlaminar Versus Microdiscectomy Interlaminar Versus Transforaminal Approach Lumbar Five – Sacral One Disc Herniation Endoscopic Transforaminal Lumbar Interbody Fusion Outcome Endoscopic Posterior Cervical Foraminotomy Indications Outcomes Endoscopic Posterior Cervical Foraminotomy Versus Anterior Cervical Discectomy and Fusion (ACDF) Endoscopic Thoracic Discectomy Endoscopic Treatment of Spinal Infections Conclusion References 20: Minimally Invasive Spine Surgery Minimally Invasive Thoracolumbar Spine Surgery Minimally Invasive Thoracic Spine Surgery Minimally Invasive Cervical Spine Surgery Miscellaneous Technological Advances in Minimally Invasive Spine Surgery Conclusion References 21: Cervical Spine Problems References 22: Thoracic Degenerative Conditions Introduction Anatomy and Biomechanics of Thoracic Spine General Surgical Approaches to the Thoracic Spine Dorsal Approaches Ventral Approaches Dorsolateral Approaches Minimally Invasive Surgery Degenerative Diseases of the Thoracic Spine Disc Degeneration and Herniation Pathophysiology Epidemiology Physical Exam Findings Imaging Findings Initial Management Surgical Management Osseous Degenerative Changes Pathophysiology Epidemiology Physical Exam Findings Imaging Findings Management Ligament Ossification Pathophysiology Epidemiology Physical Exam Findings Imaging Findings Initial Management Surgical Management Conclusion References 23: Lumbar Spinal Stenosis Definition, Classification, and Grading Relevant Anatomy and Pathophysiology Epidemiology Clinical Presentation Management Options Summary References 24: Spine Vascular Lesions of the Bone and the Epidural Space Vertebtal Hemangiomas Aneurysmal Bone Cysts Spinal Arteriovenous Lesions with Extradural Involvement Case Presentation References 25: Trauma Cervical Spine Anatomy Evaluation Surgical Indications Thoracolumbar Spine Injuries References 26: Post Surgical Spinal Deformities Introduction Decompression-Related Postoperative Spinal Deformities Posterior Decompression Clinical Presentation Instrumentation-Related Postoperative Deformities Adjacent Segment Disease Proximal Junctional Failures Surgical Correction of Postsurgical Deformity Conclusion References 27: Patient Reported Outcomes in Spine Surgery Introduction History General Health Measures European Quality of Life Five-Dimension (EuroQoL-5D) Short Form Questionnaire Numeric Rating Scale Visual Analog Scale McGill Pain Questionnaire Disease-Specific Measures Cervical Spine Thoracolumbar Spine Discussion References 28: Scoliosis in Children Definition Classification of Scoliotic Curves Idiopathic Scoliosis Adolescent Idiopathic Scoliosis Prevalence Natural History After Skeletal Maturity Natural History Before Skeletal Maturity Gender Remaining Growth Curve Magnitude Scoliosis Screening Etiology Neurologic Factors Connective Tissue Abnormalities Genetic Factors Clinical Features Presenting Signs and Symptoms Physical Examination Patient Maturity Radiographic Findings Plain Radiography Measurement of Curve Magnitude Measurement of Vertebral Rotation Diagnosis of Exclusion Magnetic Resonance Imaging Treatment Observation Orthotic (Brace) Treatment Evidence Supporting Bracing Effectiveness Indications for Brace Treatment Brace Treatment Protocols Physical Therapy and Biofeedback Electrical Stimulation Surgical Treatment Indications for Surgery Preoperative Planning Curve Flexibility Lenke Classification System Fusion Levels Transfusion Requirements Bone Grafting Spinal Cord Monitoring Technique for Posterior Spinal Fusion with Instrumentation Spine Mobilization Techniques for Deformity Correction Postoperative Pain Management Complications of Posterior Instrumentation and Fusion in AIS Antibiotic Prophylaxis for Dental Procedures Anterior Spinal Surgery Instrumented Anterior Fusion for AIS Anterior Spinal Fusion for Crankshaft Anterior Release and Fusion to Increase Deformity Correction Fusionless Surgery: Tethering Juvenile Idiopathic Scoliosis Infantile Idiopathic Scoliosis Congenital Spinal Deformities Etiology Associated Abnormalities Congenital Scoliosis Classification Defects of Formation Defects of Segmentation Natural History Radiographic Findings Nonoperative Treatment Operative Treatment Anterior and Posterior Fusion Posterior Spinal Fusion Hemivertebra Excision Vertebral Column Resection Congenital Kyphosis Classification Defects of Formation (Type I) Defects of Segmentation (Type II) Natural History Clinical Features Radiographic Findings Treatment Type I Kyphosis Type II Kyphosis Type III Kyphosis Segmental Spinal Dysgenesis, Congenital Vertebral Displacement, and Congenital Dislocation of the Spine Scoliosis in Cerebral Palsy Nonoperative Treatment Surgical Treatment Preoperative Evaluation Intra-operative Neuromonitoring Surgical Technique Complications Results Spinal Deformity in Myelomeningocele Scoliosis Kyphosis Scoliosis in Duchene Muscular Dystrophy Scoliosis in Spinal Muscular Atrophy Scoliosis in Neurofibromatosis Nondystrophic Scoliosis Dystrophic Scoliosis Scoliosis in Marfan Syndrome Early-Onset Scoliosis Scoliosis Effect on Respiratory Function Lung Volume Impaired Chest Wall Function Treatment Non-operative/“Delaying Tactics” Bracing Casting Traction Operative Treatment Instrumentation Without Fusion: Growing Rod Instrumentation (GRI) Magnetic Controlled Growing Rod (MCGR) Expansion Thoracoplasty with VEPTR Growth Guidance Constructs Psychological Effects Summary References 29: Anesthesia for Pediatric Spinal Deformity Natural History Classification Idiopathic Scoliosis Early Onset Scoliosis Neuromuscular Scoliosis Cerebral Palsy Myelodysplasia Duchenne’s Muscular Dystrophy Syndromic Scoliosis Marfan Syndrome Down Syndrome Additional Spinal Pathologies Kyphosis Spondylolysis and Spondylolisthesis Preoperative Evaluation for Spinal Deformity Surgery Respiratory Evaluation Cardiac Evaluation Non-Surgical Treatment Serial Casting Operative Approaches Posterior Fusion Anterior Procedures Anesthetic Intraoperative Management Monitoring Positioning Blood Loss Strategies to Limit Blood Loss and Allogenic Blood Transfusion Induced Hypotension Antifibrinolytic Agents Intraoperative Cell Salvage Preoperative Autologous Blood Donation Acute Normovolemic Hemodilution Normothermia Transfusion Threshold Iron Therapy and Anemia Spinal Cord Monitoring Somatosensory Evoked Potentials Selecting Anesthetic Agents Motor Evoked Potentials Electromyography Incidence, Cause, and Response to IONM Changes Response to Intraoperative Neuromonitoring Changes Multi-Modal Pain Management Postoperative Recovery Recovery in Intensive Care Unit Versus General Floor Summary References 30: Regenerative Therapies Introduction Regulatory Landscape Blood-Derived Products Platelet-Rich Plasma Autologous Conditioned Serum Cellular Products Embryonic Stem Cells Non-Embryonic Stem Cells Other Regenerative Therapy in Spinal Disease References 31: Epidural Catheter Infusion for Post-operative Analgesia for Major Spine Surgery Why Use an Epidural Catheter Benefits Risks Surgical Procedures and Patient Populations Infusion Solutions and Techniques Integration of Perioperative Epidural Analgesia into Enhanced Recovery Protocols References 32: Telemedicine Physical Examination for Spine Introduction Vital Signs General Appearance Inspection of Painful Area Range of Motion Cranial Nerve (CN) Exam Sensorimotor Exam Coordination Gait and Station Tests for Specific Conditions Low Cerebrospinal Fluid (CSF) Pressure Headache Temporomandibular Joint Dysfunction (TMD) Cervical Myelopathy Cervical Instability Cervical Pain Brachial Plexopathy Cervical Radiculitis Thoracic Outlet Syndrome Shoulder Pain Rotator Cuff Subscapularis Muscle Tear Subacromial Impingement Acromioclavicular Joint Pathology Cubital Tunnel Syndrome Lateral Epicondylitis Carpal Tunnel Syndrome Neuropathy Thoracic Spine Pathology First Thoracic Nerve Root Pain Lumbar Spine Instability Lumbar Radiculitis Lumbar Spondylosis Lumbar Stenosis Compression Fracture Sacroiliac Pain Hip Pain Gluteus Medius Tear Greater Trochanter Pain Syndrome Piriformis Syndrome Knee Meniscus Tear Patellofemoral Syndrome Discussion References 33: The Future of Spine Care Technology and Technique Injections Multimodal Postoperative Analgesia Surgical Innovation Neuroaugmentation Big Data Electronic Medical Records and Registries Guidelines Outcome Documentation Team Medicine Interdisciplinary Spine Rehabilitation Programs Prevention and Self Management ERAS Programs Healthcare System Changes New Models of Care Medical Training The Opioid Epidemic Lack of Efficacy of Opioids for Long Term Use Opioids and Surgical Outcomes Regulatory and Medicolegal Environment Patient Satisfaction COVID-19 Conclusions References Index Introduction References Contents Contributors 1: Lifestyle Management of Spine Patient Introduction How Posture Affects the Spine The Impact of Exercise on the Spine The Effects from Nutrition on the Spine The Effects of Sleep on the Spine The Effects of Stress on the Spine The Effects of Overuse of Technology on the Spine Conclusions References 2: Evaluation of a New Spine Patient Introduction Patient History Red Flag Symptoms Physical Examination Inspection Palpation Range of Motion Neurological Testing Functional Testing Special Maneuvers and Provocative Tests Cervical Region Spurling Distraction Bakody Upper Limb Tension Test Valsalva Lumbosacral Region Straight Leg Raise Seated Slump Test Gaenslen’s Facet Loading FABER Test Posterior Superior Iliac Spine (PSIS) Joint Distraction SI Compression/Distraction Thigh Thrust General Overview of Clinical Decision Making Nonspecific Spine Pain Radiculopathy and Spinal Stenosis Red Flags and/or Specific Conditions Common Clinical Syndromes Myotendinous Pain Strains and Sprains Myofascial Pain Syndrome and Trigger Points Arthropathy Facet Arthropathy Sacroiliac Joint Dysfunction Discogenic Pain Radiculopathy Myelopathy Spinal Stenosis Vertebral Compression Fractures References 3: Electromyography in the Spine Patient Overview of the Study Utility of EMG in Identifying Radiculopathy Limitations of EMG in Radiculopathy Timing of Findings in Radiculopathy Role of EMG in Lumbar Spinal Stenosis When EMG Is Not Helpful Significance of EMG in Predicting Clinical Outcomes Conclusions References 4: Conventional and Advanced Imaging Evaluation of Spine History of Spine Imaging Morbidity Related to Spine Imaging Evaluation Radiographic Evaluation of Spine Radiography in Scoliosis Digital Video Fluoroscopy Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Special MRI Sequences and Applications in Spine Imaging Future Directions References 5: Spondyloarthritis Introduction Classification Epidemiology Clinical Manifestations Physical Exam Diagnosis Lab Testing Imaging Studies Algorithm Differential Diagnosis Treatment Options Nonpharmacologic Treatment Pharmacologic Treatment References 6: Soft Tissue Pain Introduction Differential Diagnosis of Acute Pain Posterior Neck Pain Interscapular and Scapular Pain Midline Thoracolumbar Pain Lumbosacral Pain Unilateral Buttock Pain Bilateral Buttocks Pain Myofascial Pain Etiologies Treatments Fibromyalgia Cervical Whiplash Cervical Dystonia and Torticollis Notalgia Paresthetica Paraspinal Muscles Quadratus Lumborum Thoracolumbar Fascia Greater Trochanteric Pain Syndrome Gluteal Bursitis Ischial Bursitis Neuropathic Back Pain Shingles Nerve Entrapment Piriformis Syndrome Referred Pain Treatment Guidelines References 7: Non Pharmacological Treatments Introduction Active Component: Therapeutic Exercise Exercise and Acute Low Back Pain Exercise and Acute Neck Pain Exercise and Chronic Spine Pain Exercise and Prevention of Spine Pain Exercise Based Exercises for Spine Pain Walking Aerobic Exercise Stretching Exercise Pilates Yoga Tai Chi Qigong Physical Therapy Physical Therapist Lead Exercise Programs Types of PT Programs McKenzie Therapy Movement Control Williams Flexion Back School Passive Component: Manipulation and Modalities Mobilization and Manipulation Massage Passive Therapeutics Thermal Modalities Transcutaneous Electrical Nerve Stimulation Spinal Traction Low Level Laser Therapy Therapeutic Ultrasound Bracing Acupuncture Psychological Treatments and Therapies References 8: Pharmacology Overview Learning Objectives Acetaminophen Mechanism of Action Evidence in Spine Adverse Effects Dosing COX-Inhibitors Mechanism of Action Evidence in Spine Adverse Effects Dosing Antidepressants Mechanism of Action Evidence in Spine Adverse Effects Dosing Anticonvulsants Mechanism of Action Evidence in Spine Adverse Effects Dosing Muscle Relaxers Mechanism of Action Evidence in Spine Adverse Effects Dosing Corticosteroids Mechanism of Action Evidence in Spine Adverse Effects Dosing Local Anesthetics Mechanism of Action Evidence in Spine Adverse Effects Dosing Opioids Mechanism of Action Evidence in Spine Adverse Effects Dosing Capsaicin Mechanism of Action Evidence in Spine Adverse Effects N-Methyl-D-Aspartate (NMDA) Receptor Antagonists Mechanism of Action Evidence in Spine Adverse Effects Tumor Necrosis Factor (TNF) Inhibitors (Anti-TNF) Mechanism of Action Evidence in Spine Adverse Effects Prostaglandin E1 (PGE1) Derivatives Mechanism of Action Use in Spine Adverse Effects Other Conclusion References 9: Interdisciplinary Pain Management Introduction Biopsychosocial Neuroscience of Pain Psychological Impact of Pain Psychological Treatment of Pain Interdisciplinary Care Conclusion References 10: Spine Injections in the Management of Painful Spinal Conditions Introduction Epidural Steroid Injections Background Mechanism of Action Lumbar Interlaminar Epidural Steroid Injections Evidence Caudal Epidural Steroid Injections Evidence Lumbar Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks Cervical Epidural Steroid Injections Cervical Interlaminar Epidural Steroid Injections Cervical Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks Evidence Facet Joint injections and Medial Branch Nerve Blocks Background Facet Joint Injections Medial Branch Nerve Blocks Evidence Sacroiliac Joint Injections Evidence Conclusion References 11: Vertebral Compression Fractures Introduction Epidemiology and Risk Factors Global Effects of VCF Evaluation Management Medications for Pain Control Spinal Bracing Physical Therapy and Exercise Preventative Medicine & Bone Health Spinal Injections Vertebral Augmentation Conclusion References 12: Epidural Lysis of Adhesions Introduction Recent Modifications Lysis of Epidural Adhesions Applied Anatomy Indications Techniques Lysis of Epidural Adhesions via Caudal Approach Advanced Catheter Fastening Technique Steps 1 Day Lumbar Lysis Catheter Tape Down Technique Lumbar Transforaminal Catheter Placement Sacral Foraminal Catheter Placement S1 Catheter Injections Cervical Interlaminar Epidural Catheter Placement Enlarging of Neural Foramina by Flexion Rotation and Chin to Shoulder Maneuver Cervical Interlaminar Epidural RX-2TM Coude® Needle and Catheter Placement Catheter Tape Down Technique Cervical Injections Neural Flossing Exercises Dural Flossing Exercises Medicolegal Concerns Informed Consent Complications Trainees Prevention of Complications Outcome Studies and Conclusions References 13: Pre-surgical Psychological Evaluation of Spine Surgery Candidates Introduction Guidelines for Presurgical Psychological Evaluations Domains of the Presurgical Psychological Evaluation Medical Chart Review Structured Clinical Interview Psychometric Testing Integration of Evaluation Data Psychological Clearance/Recommendations Feedback Session Summary References 14: Pre and Postoperative Spine Rehabilitation Epidemiological Considerations Preoperative Spine Patient What Is Prehabilitation? Education Reducing Fall Risk Cardiovascular Conditioning Smoking Cessation Alcohol Cessation Nutrition Centralization of Pain and Psychologic Intervention Enhanced Recovery After Surgery Program An Approach and Potential Model Postoperative Rehabilitation Early Mobilization (Day 0–2 Weeks) Timing and Frequency of Postoperative Rehabilitation Postoperative Cardiovascular Exercise Aquatic Exercises Strength Training Neural Mobilization Soft-Tissue Mobilization/Manual Therapy Psychosocial Considerations Mind Body Exercises Bibliography and Further Reading 15: Preoperative Optimization and Intraoperative Enhanced Recovery Principles for Patients Undergoing Spine Surgery Preoperative Assessment for Primary Care Providers Cardiovascular Risk Assessment and Recommendations Procedure-Specific Risks Patient-Specific Risks Risk Calculators Cardiovascular Clinical Risk Factors Coronary Artery Disease Valvular Heart Disease Heart Failure Pulmonary Risk Assessment and Recommendations Pulmonary Risk Reduction Hematologic Risk Assessment and Recommendations Preoperative Anemia Causes of Preoperative Anemia and Management Iron Deficiency Anemia Anemia of Chronic Disease Endocrine Risk Assessment and Recommendations Introduction to the Anesthesia Preoperative Evaluation System-Based Approach to the Preoperative Anesthesia Evaluation Airway Pulmonary Cardiovascular Neuromuscular Positioning Considerations Blood Bank Coordination Pain Assessment Preoperative Testing Informed Consent and Discussion of Anesthetic Risks Preoperative Introduction to Enhanced Recovery After Surgery Tenets of Anesthetic Intraoperative Management and Spine ERAS Pathways Background Anesthetic Technique Fluid Management Perioperative Vision Loss Analgesia Multimodal Analgesia Opioid-Free Analgesia Bleeding During Spine Surgery Monitoring for Blood Loss Pharmacologic Agents to Mitigate Blood Loss Hypotensive Anesthesia for Reducing Blood Loss Bleeding and Temperature Management Positioning Strategies for Minimization of Blood Loss Examples of Published Spine ERAS Protocols Conclusion References 16: ICU Care for the Spine Patient Neurological System Neurological Exam Pain Management Mobility, Therapy, and Rehabilitation Delirium Cardiovascular System Postoperative Cardiac Considerations After Spine Surgery Cardiac Considerations After Spinal Cord Injury Respiratory System Airway Compromise After Spine Surgery Lower Respiratory Tract Complications After Spine Surgery Respiratory Care in Spinal Cord Injury Renal System Acute Kidney Injury Electrolyte Disorders Urinary Retention Gastrointestinal System Dysphagia Postoperative Ileus Neurogenic Bowel Dysfunction Glycemic Control and Nutrition Hematologic System Hematologic Considerations After Spine Surgery Hematologic Considerations in Spinal Cord Injury Infectious Disease Considerations Infectious Disease Evaluation Infectious Disease Treatment Principles Conclusion References 17: Postoperative Care of the Spine Surgery Patient Preparation for Surgery and Postoperative Care Expectations Education Aftercare General Care Instructions Inpatient Nursing DVT Prophylaxis Bracing Discharge Activity After Discharge Pain Management and Poly Pharmacy Complications and Emergencies After Discharge References 18: The Neurosurgical Management of Pain Introduction Spinal Ablative Procedures Anterolateral Cordotomy Overview Percutaneous Versus Open Surgery Complications Dorsal Root Entry Zone (DREZ) Lesioning Spinal DREZ Nucleus Caudalis DREZ Punctate Midline Myelotomy Neurotomy Dorsal Root Ganglionectomy Intracranial Ablative Procedures Bilateral Anterior Cingulotomy Medial Thalamotomy Mesencephalotomy Hypophysectomy Deep Brain Stimulation/Motor Cortex Stimulation Overview Procedure Outcomes Complications Spinal Cord Stimulation Overview Patient Selection Outcome Complications Direct Drug Administration Into CNS Overview Procedure Medication Options Classic Examples of Pain Conditions Treated by Surgery Trigeminal Neuralgia Microvascular Decompression Percutaneous Treatments Stereotactic Radiosurgery Occipital Neuralgia Occipital Nerve Decompression Occipital Nerve Stimulation Conclusions References 19: Endoscopic Spine Surgery Introduction History Endoscopic Lumbar Spine Percutaneous Transforaminal Endoscopic Discectomy Anatomy Technique Outcomes Re-herniation PTED Versus Microdiscectomy Other Percutaneous Endoscopic Interlaminar Discectomy Outcomes Re-herniation Interlaminar Versus Microdiscectomy Interlaminar Versus Transforaminal Approach Lumbar Five – Sacral One Disc Herniation Endoscopic Transforaminal Lumbar Interbody Fusion Outcome Endoscopic Posterior Cervical Foraminotomy Indications Outcomes Endoscopic Posterior Cervical Foraminotomy Versus Anterior Cervical Discectomy and Fusion (ACDF) Endoscopic Thoracic Discectomy Endoscopic Treatment of Spinal Infections Conclusion References 20: Minimally Invasive Spine Surgery Minimally Invasive Thoracolumbar Spine Surgery Minimally Invasive Thoracic Spine Surgery Minimally Invasive Cervical Spine Surgery Miscellaneous Technological Advances in Minimally Invasive Spine Surgery Conclusion References 21: Cervical Spine Problems References 22: Thoracic Degenerative Conditions Introduction Anatomy and Biomechanics of Thoracic Spine General Surgical Approaches to the Thoracic Spine Dorsal Approaches Ventral Approaches Dorsolateral Approaches Minimally Invasive Surgery Degenerative Diseases of the Thoracic Spine Disc Degeneration and Herniation Pathophysiology Epidemiology Physical Exam Findings Imaging Findings Initial Management Surgical Management Osseous Degenerative Changes Pathophysiology Epidemiology Physical Exam Findings Imaging Findings Management Ligament Ossification Pathophysiology Epidemiology Physical Exam Findings Imaging Findings Initial Management Surgical Management Conclusion References 23: Lumbar Spinal Stenosis Definition, Classification, and Grading Relevant Anatomy and Pathophysiology Epidemiology Clinical Presentation Management Options Summary References 24: Spine Vascular Lesions of the Bone and the Epidural Space Vertebtal Hemangiomas Aneurysmal Bone Cysts Spinal Arteriovenous Lesions with Extradural Involvement Case Presentation References 25: Trauma Cervical Spine Anatomy Evaluation Surgical Indications Thoracolumbar Spine Injuries References 26: Post Surgical Spinal Deformities Introduction Decompression-Related Postoperative Spinal Deformities Posterior Decompression Clinical Presentation Instrumentation-Related Postoperative Deformities Adjacent Segment Disease Proximal Junctional Failures Surgical Correction of Postsurgical Deformity Conclusion References 27: Patient Reported Outcomes in Spine Surgery Introduction History General Health Measures European Quality of Life Five-Dimension (EuroQoL-5D) Short Form Questionnaire Numeric Rating Scale Visual Analog Scale McGill Pain Questionnaire Disease-Specific Measures Cervical Spine Thoracolumbar Spine Discussion References 28: Scoliosis in Children Definition Classification of Scoliotic Curves Idiopathic Scoliosis Adolescent Idiopathic Scoliosis Prevalence Natural History After Skeletal Maturity Natural History Before Skeletal Maturity Gender Remaining Growth Curve Magnitude Scoliosis Screening Etiology Neurologic Factors Connective Tissue Abnormalities Genetic Factors Clinical Features Presenting Signs and Symptoms Physical Examination Patient Maturity Radiographic Findings Plain Radiography Measurement of Curve Magnitude Measurement of Vertebral Rotation Diagnosis of Exclusion Magnetic Resonance Imaging Treatment Observation Orthotic (Brace) Treatment Evidence Supporting Bracing Effectiveness Indications for Brace Treatment Brace Treatment Protocols Physical Therapy and Biofeedback Electrical Stimulation Surgical Treatment Indications for Surgery Preoperative Planning Curve Flexibility Lenke Classification System Fusion Levels Transfusion Requirements Bone Grafting Spinal Cord Monitoring Technique for Posterior Spinal Fusion with Instrumentation Spine Mobilization Techniques for Deformity Correction Postoperative Pain Management Complications of Posterior Instrumentation and Fusion in AIS Antibiotic Prophylaxis for Dental Procedures Anterior Spinal Surgery Instrumented Anterior Fusion for AIS Anterior Spinal Fusion for Crankshaft Anterior Release and Fusion to Increase Deformity Correction Fusionless Surgery: Tethering Juvenile Idiopathic Scoliosis Infantile Idiopathic Scoliosis Congenital Spinal Deformities Etiology Associated Abnormalities Congenital Scoliosis Classification Defects of Formation Defects of Segmentation Natural History Radiographic Findings Nonoperative Treatment Operative Treatment Anterior and Posterior Fusion Posterior Spinal Fusion Hemivertebra Excision Vertebral Column Resection Congenital Kyphosis Classification Defects of Formation (Type I) Defects of Segmentation (Type II) Natural History Clinical Features Radiographic Findings Treatment Type I Kyphosis Type II Kyphosis Type III Kyphosis Segmental Spinal Dysgenesis, Congenital Vertebral Displacement, and Congenital Dislocation of the Spine Scoliosis in Cerebral Palsy Nonoperative Treatment Surgical Treatment Preoperative Evaluation Intra-operative Neuromonitoring Surgical Technique Complications Results Spinal Deformity in Myelomeningocele Scoliosis Kyphosis Scoliosis in Duchene Muscular Dystrophy Scoliosis in Spinal Muscular Atrophy Scoliosis in Neurofibromatosis Nondystrophic Scoliosis Dystrophic Scoliosis Scoliosis in Marfan Syndrome Early-Onset Scoliosis Scoliosis Effect on Respiratory Function Lung Volume Impaired Chest Wall Function Treatment Non-operative/“Delaying Tactics” Bracing Casting Traction Operative Treatment Instrumentation Without Fusion: Growing Rod Instrumentation (GRI) Magnetic Controlled Growing Rod (MCGR) Expansion Thoracoplasty with VEPTR Growth Guidance Constructs Psychological Effects Summary References 29: Anesthesia for Pediatric Spinal Deformity Natural History Classification Idiopathic Scoliosis Early Onset Scoliosis Neuromuscular Scoliosis Cerebral Palsy Myelodysplasia Duchenne’s Muscular Dystrophy Syndromic Scoliosis Marfan Syndrome Down Syndrome Additional Spinal Pathologies Kyphosis Spondylolysis and Spondylolisthesis Preoperative Evaluation for Spinal Deformity Surgery Respiratory Evaluation Cardiac Evaluation Non-Surgical Treatment Serial Casting Operative Approaches Posterior Fusion Anterior Procedures Anesthetic Intraoperative Management Monitoring Positioning Blood Loss Strategies to Limit Blood Loss and Allogenic Blood Transfusion Induced Hypotension Antifibrinolytic Agents Intraoperative Cell Salvage Preoperative Autologous Blood Donation Acute Normovolemic Hemodilution Normothermia Transfusion Threshold Iron Therapy and Anemia Spinal Cord Monitoring Somatosensory Evoked Potentials Selecting Anesthetic Agents Motor Evoked Potentials Electromyography Incidence, Cause, and Response to IONM Changes Response to Intraoperative Neuromonitoring Changes Multi-Modal Pain Management Postoperative Recovery Recovery in Intensive Care Unit Versus General Floor Summary References 30: Regenerative Therapies Introduction Regulatory Landscape Blood-Derived Products Platelet-Rich Plasma Autologous Conditioned Serum Cellular Products Embryonic Stem Cells Non-Embryonic Stem Cells Other Regenerative Therapy in Spinal Disease References 31: Epidural Catheter Infusion for Post-operative Analgesia for Major Spine Surgery Why Use an Epidural Catheter Benefits Risks Surgical Procedures and Patient Populations Infusion Solutions and Techniques Integration of Perioperative Epidural Analgesia into Enhanced Recovery Protocols References 32: Telemedicine Physical Examination for Spine Introduction Vital Signs General Appearance Inspection of Painful Area Range of Motion Cranial Nerve (CN) Exam Sensorimotor Exam Coordination Gait and Station Tests for Specific Conditions Low Cerebrospinal Fluid (CSF) Pressure Headache Temporomandibular Joint Dysfunction (TMD) Cervical Myelopathy Cervical Instability Cervical Pain Brachial Plexopathy Cervical Radiculitis Thoracic Outlet Syndrome Shoulder Pain Rotator Cuff Subscapularis Muscle Tear Subacromial Impingement Acromioclavicular Joint Pathology Cubital Tunnel Syndrome Lateral Epicondylitis Carpal Tunnel Syndrome Neuropathy Thoracic Spine Pathology First Thoracic Nerve Root Pain Lumbar Spine Instability Lumbar Radiculitis Lumbar Spondylosis Lumbar Stenosis Compression Fracture Sacroiliac Pain Hip Pain Gluteus Medius Tear Greater Trochanter Pain Syndrome Piriformis Syndrome Knee Meniscus Tear Patellofemoral Syndrome Discussion References 33: The Future of Spine Care Technology and Technique Injections Multimodal Postoperative Analgesia Surgical Innovation Neuroaugmentation Big Data Electronic Medical Records and Registries Guidelines Outcome Documentation Team Medicine Interdisciplinary Spine Rehabilitation Programs Prevention and Self Management ERAS Programs Healthcare System Changes New Models of Care Medical Training The Opioid Epidemic Lack of Efficacy of Opioids for Long Term Use Opioids and Surgical Outcomes Regulatory and Medicolegal Environment Patient Satisfaction COVID-19 Conclusions References Index