Spinal Degenerative Disease (eBook)

Front Cover 1
Spinal Degenerative Disease 4
Copyright Page 5
Table of Contents 12
Preface 6
Acknowledgements 10
Foreword 14
Chapter 1. Historical Review 16
1.1. Introduction 16
1.2. Lumbar Disc Protrusions 16
1.3. Cervical Spondylosis 19
1.4. Lumbar Canal Stenosis 20
Chapter 2. Spinal Anatomy and Physiology 22
2.1. Introduction 22
2.2. The Spinal Column 22
2.3. Joints and Ligaments Uniting the Vertebral Bodies 27
2.4. Joints and Ligaments Uniting the Laminal Arches 28
2.5 . Sacral Joints 30
2.6.The Spinal Curvatures 30
2.7.Spinal Movements 30
2.8. The Spinal Cord and its Coverings 32
2.9.The Spinal Nerve Roots 32
2.10. The Innervation of Spinal Tissues 36
2.12. The Blood Supply of the Spinal Cord and Nerve Roots 42
Chapter 3. The Intervertebral Disc 47
3.1. Introduction 47
3.2. The Annulus Fibrosus 47
3.3. The Nucleus Pulposus 49
3.4. The Changes o f Normal Ageing 49
3.5. Physiology of the Normal Disc 51
3.6. Forces Acting on the Disc 51
3.7.Nutrition and Blood Supply: The Cartilage End Plates 54
3.8. Disc Degeneration 55
Chapter 4. The Cervical Spine: Pathology 62
4.1.Introduction 62
4.2. Cervical Spondylosis: Pathological Changes 64
4.3.The Pathogenesis of Cervical Spondylotic Radiculopathy (CSR) 71
4.4.The Pathogenesis of the Myelopathy Associated with Cervical Spondylosis (CSM) 72
4.5.Spondylotic Myelopathy:Precipitation or Worsening by Trauma 79
4.6.Spondylosis and Myelopathy: A Coincidental Association? 81
4.7.Other Cervical Degenerative Conditions 83
Chapter 5. The Cervical Spine: Clinical Aspects 84
5.1.Cervical Spondylosis: Incidence 84
5.2.Cervical Spondylosis: Natural History 85
5.3. Cervical Spondylosis: Clinical Manifestations 87
5.4. Cervical Disc Protrusions 94
5.5. Spondylotic Vertebral Artery Insufficiency 97
5.6. The Whiplash Syndrome 99
5.7. Investigations 101
5.8. Differential Diagnosis 104
Chapter 6. The Cervical Spine: Treatment 110
6.1. Introduction 110
6.2. Medical Methods of Treatment 112
6.3. Surgical Methods of Treatment 116
Chapter 7. The Dorsal Spine 129
7.1. Introduction 129
7.2. Dorsal Disc Protrusions 129
7.3. Other Conditionsattributedto Dorsal Degenerative Disease 142
Chapter 8. LOW Back Pain and Sciatica: The Differential Diagnosis 146
8.1. Introduction 146
8.2. Non-specific Low Back Pain 147
8.3. Structural/ Degenerative Causesof Low Back Pain 153
8.4. Congenital and Developmental Disorders 154
8.5. Abdominal Causesof Low Back Pain 158
8.6. Vascular Back Pain 159
8.7. Spinal Tumours 160
8.8. Spinal Inflammatory Disease 166
8.9. Bone Disease 169
8.10. Trauma 170
8.11. Psychological Causes of Low Back Pain 170
8.12. Causesof Leg Painand Sciatica 171
Chapter 9. Low Back Pain and Sciatica: Practical Assessment and Investigation 173
9.1. Introduction 173
9.2. The History 173
9.3. The Examination 174
9.4. Investigations 180
9.5. Major Radiological Investigations 181
9.6. The Technique of Myelography 182
9.7. Contrast Media for Myelography 183
9.8. Discography 187
9.9. Lumbar Venography[167, 404] 191
9.10. Epidurography 191
Chapter 10. Lumbar Disc Protrusions: Pathological and Clinical Aspects 193
10.1. Pathological Features 193
10.2. The Level of Lumbar Disc Protrusions 198
10.3. Double Disc Protrusions 199
10.4. Incidence 199
10.5. Sex and Age 201
10.6. Aetiological Factors 201
10.7. Natural History 203
10.8. Symptomsand Signs 204
10.9. Upper Lumbar Disc Protrusions 212
10.10. Extreme Lateral Disc Protrusions 213
10.11. Disc Protrusionsin Pregnancy 214
10.12. Acute Compression of the Cauda Equina 214
10.13. The Explanation of Root Tension and Spinal Signs 218
10.14. The Mechanism of Remission 221
10.15. Symptomless Disc Protrusions 221
10.16. Investigations in Lumbar Disc Protrusions 223
10.17. Spinal Arachnoiditis and Disc Protrusions 227
Chapter 11. Lumbar Disc Protrusions: Surgical Treatment chapter 231
11.1. The Indications for Surgery 231
11.2. Contraindications to Surgery 232
11.3. Surgical Technique 234
11.4. Surgical Difficulties 237
11.5. Postoperative Management 238
11.6. Differences in Surgical Management 239
11.7. Complications of Lumbar Disc Surgery 240
11.8. The Results of Lumbar Disc Surgery 243
11.9. Negative Operations 247
11.10. The Failed Disc Operation 248
11.11. Fusionofthe Lumbar Spine 250
Chapter 12. Low Back Pain and Sciatica: Non-surgical Treatment 257
12.1. Introduction 257
12.2. Simple Empirical Methods of Treatment 258
12.3. Steroids in Lumbar Disc Protrusions 260
12.4. Chemonucleolysis 262
12.5. Denervation of the Facet Joints 265
12.6. Manipulation 267
12.7. Heterodox Methods of Treatment 272
Chapter 13. Lumbar Canal Stenosis 278
13.1. Introduction 278
13.2. Causes 278
13.3. Primary Lumbar Canal Stenosis 279
13.4. Secondary Lumbar Canal Stenosis 279
13.5. Degenerative Lumbar Canal Stenosis 280
13.6. The Lateral Recess Syndrome and" Occult Lumbar Canal Stenosis" 294
13.7. Lumbar Canal Stenosis and Disc Protrusions 296
13.8. Unilateral Claudication from a Soft Lumbar Disc Protrusion 297
13.9. The Role of the Yellow Ligament 298
13.10. Degenerative Spondylolisthesis 299
Chapter 14. Low Back Pain: Psychological Aspects 303
14.1. Introduction 303
14.2. The Incidence of Spinal Symptoms 305
14.3. How Commonare Psychogenic Factors? 306
14.4. The Evidence for Psychogenic Factors 307
14.5. The Clinical Detection of Psychological Overlay 309
14.6. Types of Psychological Overlay 315
14.7. Treatment 323
References 329
INDEX 350