37 T_h e spine

Ankylosing spondylitis Should a patient with ankylosing spondylitis present following trauma, a h...

Arnold–Chiari malformation Arnold–Chiari malformation occurs when the medulla oblongata and the c...

Bone densitometry Bone density and osteoporosis can be measured using dual energy x-ray absorptio...

Bone scintigraphy Isotope bone scans are highly sensitive, but non-specific, tests that are useful...

CLINICAL ANATOMY The normal cervical lordosis measures between 35° and 45°. The normal lumbar lor...

Cauda equina syndrome CES is a very serious and urgent condition that arises from compression of ...

Cervical myelopathy Degenerative change in the cervical spine leading to spinal cord compression ...

Computed tomography This investigation is the best test for assessing bone anatomy . Three-dimens...

Congenital scoliosis This is caused by vertebral anomalies that produce a frontal plane growth as...

Cost implications of modern spinal Cost implications of modern spinal Cost implications of mo...

DEGENERATIVE CONDITIONS OF THE SPINE Cervical radiculopathy Patients present with neck and arm pa...

DEGENERATIVE CONDITIONS OF THE SPINE Cervical radiculopathy Patients present with neck and arm pa...

DEVELOPMENTAL ABNORMALITIES Developmental abnormalities of the spine and spinal cord can be divi...

Discogenic low back pain Discogenic low back pain has been defined as a continuum of diagnostic c...

EPIDEMIOLOGY The lifetime prevalence of low back pain has been reported to be 60–80%. By contras...

Epidural abscess This condition is often a surgical emergency . The majority of cases occur with...

Facet joint injections For patients with facet joint arthropathy , x-ray-guided local anaesthetic...

Foraminal epidural steroid injections For patients with radiculopathy due to a prolapsed inter- v...

GLOBAL ISSUES IN SPINE SURGERY It is important that the information presented in this chapter, wh...

INFECTIONS OF THE SPINE Pyogenic infections Pyogenic vertebral osteomyelitis is primarily a lesio...

INFLAMMATORY SPONDYLOARTHROPATHY Rheumatoid arthritis Disease-modifying anti-rheumatic drugs (DMA...

INFLAMMATORY SPONDYLOARTHROPATHY Rheumatoid arthritis Disease-modifying anti-rheumatic drugs (DMA...

INVESTIGATIONS The most common diagnostic imaging tests used to evaluate spinal disorders include...

Idiopathic scoliosis Idiopathic scoliosis accounts for 70% of presentations. It can be classified...

Intradural tumours These are rare. They may be intramedullary (within the substance of the spinal...

Introduction No content extracted automatically.

Learning objectives To learn: The salient features relating to the history and examination • of t...

Lumbar disc herniation Symptomatic lumbar disc herniation occurs during the lifetime in approxima...

METABOLIC BONE DISEASES AFFECTING THE SPINE Osteoporosis Patients with osteoporosis may present w...

METABOLIC BONE DISEASES AFFECTING THE SPINE Osteoporosis Patients with osteoporosis may present w...

Magnetic resonance imaging This allows detailed visualisation of the spinal cord, thecal sac, ep...

Neuromuscular scoliosis This may be due to neuropathic disorders, such as cerebral palsy , spinoc...

Non-spinal causes of back pain Pain may arise from the spine, but non-spinal causes of pain must...

PATIENT HISTORY The commonest reasons for referral to a spinal clinic include pain and spinal def...

PHYSICAL EXAMINATION The patient should be undressed and posture should be eval uated in both fro...

Plain radiographs It is not appropriate to order spine radiographs for every patient presenting w...

Primary tumours of the spine Primary bone tumours of the spine account for only 2% of all spinal...

Provocative discography This investigation involves the placement of a 24-gauge needle into the ...

Red flags After taking a history and examining the patient it is important to consider ‘red flags’ ...

SPINAL DEFORMITY Spinal deformity may be categorised into a coronal plane deformity (scoliosis) o...

SPONDYLOL YSIS AND SPONDYLOLISTHESIS Spondylolysis This is a unilateral or bilateral defect in th...

Scheuermann’s kyphosis Typically , in this condition, there is wedging of the seventh to 10th th...

Spina bifida Spina bifida is caused by a failure of fusion of the vertebral arches and possibly t...

Spinal biopsy Either CT-guided or open biopsy is often performed to obtain tissue for diagnostic ...

Spinal dysraphism This is a group of disorders arising from abnormal embryo- logical formation o...

Spinal stenosis Spinal stenosis may be defined as any type of narrowing of the spinal canal, nerv...

Spondylolisthesis Spondylolisthesis is a forward slippage of the vertebral body engendered by a ...

Syringomyelia Patients may present with sensory disturbance, weakness of the hands, loss of pain...

TUMOURS OF THE SPINE Metastatic tumours The commonest malignancies that metastasise to the spine ...

The lack of trained spinal surgeons In the last 25 years high-income countries have seen the rap...

Thoracic disc herniation Thoracic disc herniations that require surgical intervention are rare, a...

Tuberculosis This is discussed in Chapters 6 and 43 . Tuberculosis This is discussed in Chapters ...

modern imaging and equipment? The key to good surgery in all disciplines is a surgeon who is dedi...

surgery There have been dramatic advances in spinal surgery owing to modern imaging, modern instr...