Do You Really Need Back Surgery? A Surgeon's Guide to Neck and Back Pain and How to Choose Your Treatment

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Index

Note: Page numbers in bold refer to chapters. Page numbers in italics refer to illustrations or charts.

 

A

abdominal muscles, 47-48

acetaminophen (Tylenol), 10, 28, 29, 30, 39

acetyl salicylic acid (aspirin), 10, 17, 28, 29, 30

Acromed, 218

Actiq (fentanyl oral swabs), 34, 36, 37

activity and exercise. See also specific forms of exercise such as yoga: alternatives, 62; bed rest compared to, 52; benefits, 20; exercise tolerance, 60, 61; in pregnancy, 44; range-of-motion exercises, 20, 53; sports, 47-48; stingers, 113, 147; strengthening the spine, 47-49, 52, 53, 54, 58; stretching, 48-49, 52, 54, 90-91; treatments based on, 18-20, 58-59, 61

acupressure, 18-19, 58

acupuncture, 18-19, 57-58

Adcon-L, 181

adhesions, 27, 140, 158-59, 202

alendronate (fosamax), 93

Aleve (naproxen), 10, 17, 28, 29

Alexander technique, 18-19, 59

alkaloids, 38

allergic reactions, 266, 272, 281

allografts: advantages, 233-34, 254, 282; in cervical fusion surgery, 240; disadvantages, 262; lumbar implants, 254; rejection, 281; sources, 249, 255; vertebrectomies, 195

Ambrose, Jamie, 125

amitripyline (Elavil), 39

analgesics, 31, 39

anatomy, 63-80

anesthesia: allergic reactions, 272; anesthetics, 31-32, 32, 155; fees, 303; multidisciplinary pain management, 54-55; preemptive anesthesia, 175-76; risks, 172, 275-77

anesthetic discogram, 82, 160, 251

aneurysms, 102

anger management, 56

angiograms, 126, 133-34

ankles, 97, 98

ankylosing spondylitis, 115-16

annulus fibrosis: anatomy, 70, 70; annular tears, 82-83, 84, 86, 101, 128, 160; intradiscal electrothermy (IDET), 128, 164-65, 165

anterior-posterior (AP) X-ray, 122

anti-inflammatory drugs, nonsteroidal (NSAIDs): blood clots, 276; categories, names, and risks, 29; combination medications, 35; diagnostic injections, 155; functions, 17, 28-31; for musculoskeletal pain, 10, 100; neuropathic pain, 38; pre-surgical cessation, 174; during surgery, 175-76

antibiotics, 176, 272, 273, 275

antidepressants, 39

antiemetics (anti-nausea medications), 176

antihypertensives, 32

antiseizure medications (anticonvulsants), 38, 39

antispasmodic medicines, 17

anxiety, 56

aorta, 9, 102

aqua therapy, 59

arachnoid, 73, 110

arbitration agreements, 173-74

arms: anatomy, 74, 75; foraminal stenosis, 85; herniation of the cervical spine, 83, 98-99; medical causes for pain, 102; neck pain and, 14; thoracic outlet syndrome, 117

Arnold-Chiari Malformations, 110-11, 111, 202

arteries, blocked, 17

arthritis: artificial disks, 236, 256; bone spurs from, 14; implants and fusion, 232; narrowing of spinal canal, 16, 192; pedicle screws, 216

arthroplasty, 221-22, 256, 259

Arthrotec (Diclofenac with misoprostol), 29

articular processes, 65

articulations, 65

Aspen collar, 183

aspirin (acetyl salicylic acid), 10, 17, 28, 29, 30

assignment of benefits, 174

athletes, 113, 147

Atlas vertebra, 67, 67

auto accidents, 45-47

autografts: advantages, 144; disadvantages, 234, 261-62; discectomy, 233; hip bone, 195, 233, 234, 254; vertebrectomy, 195

autologous blood, 180, 270, 271

autonomic nervous system, 26, 55, 74-75, 77

availability of treatments, 51

Axis vertebra, 67, 67

axon fibers: anatomy, 72, 146, 146; axonal transport, 39, 151; radiofrequency lesions, 163-64; regeneration, 141, 142-43

 

B

back pain: causes, 8-10, 13-14, 16-17, 102, 102-3; symptoms, 100-104; three-month rule, 17-21

back school, 18-19, 54

Baclofen (lioresal), 17, 32

Bagby, George, 220

BAK cages, 220

balance, 90, 103, 115

basal ganglia, 77, 79

baths, 20, 56

bed rest, 20-21, 52

beds, 43

benefits, assignment of, 174

benefits of surgery, 172

Bextra (valdecoxib), 29, 30

biofeedback, 56

biotechnology. See technological advances

bladder, 15, 83, 85, 108

blocked arteries, 17

blood-brain barrier, 150

blood clots, 276

blood loss during surgery, 180, 270-72

blood thinners, 276

blood vessels, 13, 16

board certification of surgeons, 286-87

body weight, 48, 60-61

bone-carving techniques, 212-13

bone growth, 261-65, 264

bone morphogenetic protein (BMPs), 265-67

bone rings, 254

bone spurs (osteophytes): development of, 84-87, 192; diagnosis, 86; imaging, 156; neck pain, 14-15; radiculopathy, 88; removing, 232

bones, 273-74, 279-80

bowel control, 15, 83, 85, 108

braces, 43, 54

brachial plexus, 74, 75, 100, 100

bradykinins (inflammatory chemicals), 140

brain, 23, 79, 150

bruises, 147

butalbital (Fioricet), 39

buttock pain, 11-13

 

C

cable-and-strut assemblies, 240

caffeine, 39

cages, 220-21, 222, 254, 255

calcium, 93-94, 262-63

cancellous bone, 64

cancers, 102

car accidents, 45-47

carbamazepine (Tegretol), 39

carbon-fiber implants, 222-24, 223, 263

cardiovascular risks, 276-77

carisoprodol (Soma), 17, 31, 32

carpal tunnel syndrome, 99, 135

CAT scans. See CT scans (computerized axial tomography)

Catapes TTS (clonidine patch), 32, 37

caudal epidural, 158

causalgia, 26

Celebrex (celcoxib), 29

cell saver devices, 180, 271-72

central canal, 72

central nervous system, 23, 24. See also brain; spinal cord

central pain, 25-26, 27

centrally acting pain medications, 39

cerebellar tonsils, 110-11

cerebellum, 78, 79, 111

cerebral cortex, 76-77

cerebrospinal fluid (CSF), 72, 111, 158, 201-2

cervical collar, 92, 183, 234, 238

cervical spine. See also neck: anatomy, 63, 65, 66, 66-69, 67, 68, 71-72, 74; anterior cervical plating system, 235; artificial disks, 237; foraminotomy, 193, 194; fractures, 219-20, 221; herniation, 83, 87-88, 98-99, 99; laminectomy, 190; number of vertebrae, 117; pain in, 14-16; radiculopathy, 99; recovery from surgery, 295; risks of surgery, 279; slippage in spinal joints, 90; stenosis, 99; subluxation, 89, 92; surgery, 229-41, 231, 279, 295; thoracic outlet, 117; time required for fusion, 294; torn ligaments, 92; traction, 52-53; types of problems, 85; vertebrectomy, 196

chairs, 10, 43

chest, 16-17, 83, 88, 102

children, 192, 213, 214

chiropractic manipulation, 14, 16, 18-19, 59-60, 61

chlorzoxazone (Parafon Forte), 32

chronic pain, 12-13, 25, 27

claudication pain, 13-14

claw devices, 240

cleaning activities, 43-44

Clinoril (sulindac), 29

clonidine patch (Catapes TTS), 32, 37

clonus, 104

Cloward, Ralph, 212

clumsiness, 15

coblation, 167-68

coccyx, 68

codeine and aspirin (Empirin), 34

codeine and Tylenol (Tylenol no. 3), 34, 35

cohort studies, 284

complex regional pain syndrome (CRPS), 26, 169

complications of surgery, 269-82

computer ergonomics, 42

computer image-guidance systems, 224-26, 225, 239, 247, 257

computerized axial tomography. See CT scans

condyle, 65

congenital abnormalities, 13, 202

congenitally narrow spinal canal, 113

Consumer Reports, 46

contrast agents, 126-29, 160

coordination, 15

corsets, 43, 54

cortex, 64, 79

cosmetic issues, 178, 184, 292-93

costovertebral joints, 69

costs of surgery, 299-311

counseling, 56

COX-2 inhibitors, 29, 30

cranium, 63

CT scans (computerized axial tomography): carbon-fiber implants, 223, 223, 263; checking for bone spurs, 86; chronic pain, 101; contrast agents, 126-29; facet blocks, 159; functions, 120, 124, 124-26; identifying slippage, 89; myelography, 126, 127, 203; stenosis, 193

cubital tunnel, 100, 135

curvature and ankylosing spondylitis, 115-16

cyclobenaprene (Flexeril), 17, 31, 32

cysts, 73

 

D

Damadian, Raymond, 131

Danek Corporation, 221

Darvocet (propoxyphene), 34, 35

Darvon (propoxyphene and aspirin), 34, 35

Daypro (oxaprazosin), 29

DEA Schedule II and III narcotics, 34

decompression, 91, 237, 238

deep vein thrombosis (DVT), 276

delays in treatment, 17-18

Demerol (meperidine injection), 34

demineralized bone matrix (DBM), 262

demyelination, 141-42

dens ("tooth"), 68

depression, 56

Dermabond, 182, 182, 293

dermatome, 97, 99

desk work, 42

diagnosis, 52, 119-37. See also imaging

diazepam (Valium), 17, 31, 32

Diclofenac (Voltaren XR), 29, 30

Diclofenac with misoprostol (Arthrotec), 29

diffuse idiopathic spinal hyperostosis (DISH), 116

Dilantin (phenytoin), 39

Dilaudid (hydromorphone), 34, 36

discography: annular tears, 82-83; contrast agents, 126; myelogram compared to, 128; procedures, 128-29, 160-61, 161, 251

disks: anatomy, 70-71; artificial disks, 236-37, 237, 255-56; bulging disks, 81-84, 84, 86, 87, 87-88, 156, 160-61; discitis (infections), 273-74; discogenic pain, 82, 164, 251; discoplasty, 167-69; diskectomies, 186-89, 188, 230-32, 272; replacement technologies, 264; tears, 128, 164-65, 165; thoracic spine, 69

dislodgment, 281-82

distracting stimuli, 27

distribution, 24-25

dorsal root ganglia, 73, 134, 146

double-blind randomized trials, 282-83

drainage, 294

Drug Enforcement Agency (DEA), 35

dual-energy X-ray absorpsiometry (DEXA) scan, 93, 122

dura: anatomy, 73; Arnold-Chiari malformations, 110; epidural injections, 158; myelography, 127, 203; surgery inside dural lining, 201-6; tumor locations, 198, 199

Duragen, 203

Duragesic (Fentanyl patch), 34, 36

 

E

elasticity, 263-64

Elavil (amitripyline), 39

electrical nerve testing, 98

electrical stimulation, 53

electrodiagnosis, 134-37, 136

electromyography (EMG), 135, 136

electroneural interfaces, 151-52

electronic fusion stimulators, 268

electronic pain relief, 163-67

eloquent (neurological quality), 14

embolization, 197-98

emergencies, 8, 172

Empirin (codeine and aspirin), 34

end plates, 64

endorphins, 38

endoscopy, 168-69, 178, 245, 246, 253-54

entubulation, 144-45

epidural abscesses, 274

epidural injections, 13, 156-58, 157

epidural stimulators, 166, 166-67

epiduroscopy, 158-59

epineurium, 73, 141

ergonomics, 20, 41-49

esophagus, 16

evoked potential, 136, 136-37

exercise. See activity and exercise

expectations of patients, 51

expense of treatments, 51

experimental procedures, 171, 310-11

exploratory surgery, 137

extrusions, 83-84, 88

 

F

facet joints: anatomy, 64, 65-66; artificial joints, 259; facet blocks, 157, 159, 164; facetectomy, 194; pain in, 159, 164, 243, 249

fascia, 181, 291-92

fascicles, 140, 141, 145

feet, 15

Feldenkrais, 18-19, 59

fellowship training for surgeons, 287

femoral nerves, 74, 76, 97

fentanyl oral swab (Actiq), 34, 36, 37

Fentanyl patch (Duragesic), 34, 36

fetuses, 129

fibrocytes, 140

fibrosis (scarring): antiscarring agents, 181; of the dura, 202; limiting, 150; lysis of adhesions, 158-59; nerve compression and, 140-41; nerve regeneration and, 143, 150; spinal cord injuries, 145, 147, 148; surgical wound, 293-94

fibula bone, 135

"fight or flight nerves," 75

filum terminale, 109

financial considerations, 299-311

fingers, 14, 15, 87, 99-100, 117

Fioricet (butalbital), 39

fixation, 209-21

"flat back syndrome," 252

Flexeril (cyclobenaprene), 17, 31, 32

flexibility, 58

flexion-extension studies, 92, 123

fluoroscopy, 120, 121, 209, 210, 257-58

Food and Drug Administration (FDA): artificial disks, 236, 256; carbon-fiber spine implants, 224; cervical lateral mass screws, 241; disk replacement technologies, 264; Luque system, 215; oversight authority, 171; pedicle screws, 217-18

foramen: anatomy, 65; foraminotomy, 192-93, 194, 230-32, 237-38; radiculopathy, 87; stenosis, 85, 86

foramen magnum, 110-11, 111, 202

fosamax (alendronate), 93

fractures: cervical spine, 210, 219-20, 221; diagnosis, 131; osteoporotic fractures, 94; risks, surgical, 280; seat belt fractures, 218-19; spontaneous spine fractures, 93; thoracic spine, 244, 248; unlocking, 208-9

fragile bones, 93-94. See also osteoporosis

"funny bone," 100

furniture, 43

fusion: anti-inflammatory agents, 176; benefits, 211-12; blood loss, 180; cervical spine, 232-33, 237, 238; electronic fusion stimulators, 268; failed fusions, 280, 281, 296; grafts, 232-33, 240; implants, 222, 232; lumbar spine, 91, 251-52, 255, 294; posterolateral fusion, 258; proteins and, 265-67, 266; spine carpentry, 209-21; time required, 294-96

 

G

gabapentin (Neurontin), 38, 39

ganglion, 73

gene therapy, 38-39, 265, 267

Glacier Cross, Inc., 53

Gore-Tex, 202-3

grafts. See also implants: advantages, 233-34, 254, 282; disadvantages, 262, 281; dural substitutes, 202-3; fusion, 232-33, 240; lumbar implants, 254; nerve grafts, 144-45; rejection, 281; sources, 249, 255, 261-65; for vertebral disks, 221; vertebrectomies, 195, 249, 249-50

gray matter, 71-72, 72, 146, 146-47

 

H

hamstring muscles, 58

hands, 14-15, 75, 85, 86, 117, 117

hardware for bone repair, 186, 210-11, 212-24. See also implants

Harrington, Paula, 213

Harrington rod, 213-15, 214, 219

headaches, 15, 111, 202

heart problems, 16, 17, 102

heat, 53

Hellerwork, 18-19

helplessness, feelings of, 56

hemilaminectomy, 190-91

herniation: anatomy, 69; cervical spine, 98-99, 99; discectomy, 186-89; imaging, 131; injections, 157; location of, 87-88; lumbar spine, 97; radiculopathy, 88; recovery from, 140; reherniation, 296; results of, 83-84; sciatica, 96-98, 97, 98; thoracic spine, 243, 244; types of, 84

hip joint, 58

hoarseness, 172-73, 230, 275

holistic approaches, 20

holograms, 129-30

home environment, 43-44, 54

hot wires, 189

Hounsfield, Sir Godfrey Newbold, 125

hydrocodone and aspirin (Vicoprofen), 34, 35

hydrocodone and Tylenol (Norco, Lorcet, or Vicodin), 34, 35

hydromorphone (Dilaudid), 34, 36

hypnosis, 18-19

 

I

ibuprofen (Motrin), 17, 28, 29

imaging. See also specific technologies such as X-rays, magnetic resonance imaging (MRI) or CT scans: available technologies, 119-37, 132; bone spurs, 86; carbon-fiber implants, 223, 223, 263; contrast agents, 126-29; diagnosing chronic pain, 101; discography, 82, 160; facet blocks, 159; false positives, 96, 156; flexion and extension, 92, 123; identifying slippage, 89; image-guided surgery, 179, 224-26, 225, 227, 239, 247, 248-49, 257, 257-58; injections and, 82-83, 101, 156-63, 157 (see also discography); myelography, 127, 203; prenatal imaging, 129; risks, 131; spinal cord compression, 104; spinal cord injuries, 148; spine carpentry, 207; stenosis, 193; surgery preparations, 174; torn spinal ligaments, 92, 92

immobilization and healing, 27

Imodium, 33

impingement syndromes, 99

implants. See also grafts: carbon-fiber implants, 222-24, 223, 263; fusion and, 232-33; infections, 274-75; interbody implants, 220-21, 252-56; metal implants, 127, 250; risks of surgery, 280-82; in spine carpentry, 210-11; titanium implants, 234-36, 249, 254, 255, 263, 264; types of, 254

incentive spirometer, 273

incisions, 177-79

Indocin (indomethacin), 29

infections, 9, 102, 172, 272-75

inflammation, 24, 55, 114-15, 157, 281

informed consent, 171-74, 285-86

InFuse, 267

injections: diagnosis and treatment, 156-63; epidurals, 13, 156-58, 157; imaging, 82-83, 101, 156-63, 157 (see also discography); intradiscal injections, 82-83, 164; local anesthetic, 277; locations, 157; outcomes, 51-52

instability in spinal joints, 89-92

insurance, 299-302, 304-11

intention, 76-77

interactive therapies, 56

Interbody Fusion System, 220

intercostal nerves, 74, 243

intradiscal anesthetic injections, 164

intradiscal electrothermy (IDET), 128, 164-65, 165

intraoperative electrodiagnostic monitoring, 136, 136-37

introspective methods, 55-56, 58

intubation, 275-76

iodine, 126

irritation of nerves, 140

isometrics, 61

 

J

joints of the spine: artificial, 259; bone spurs (osteophytes), 85; costovertebral joints, 69; facet joints, 64, 65-66, 159, 164, 243, 259; instability in, 89-92; multiple joint facet syndrome, 159; rehabilitation for, 52-53; risks of surgery, 279-80; slippage in (spondylolisthesis), 89-92, 90, 116; unco-vertebral joint, 192

 

K

Kadian (morphine slow-release), 34

Kaneda, Kiyoshi, 219

Keppra (levitiracetam), 39

Kerrison punch, 193

Kessler, Richard, 217-18

ketoprofen (Orudis), 29

ketorolac intravenous (Toradol), 29, 30, 276

kidneys, 9, 102

knees, 97, 98

Kuslich, Stephen, 220

kyphoplasty, 196, 197

kyphosis, 191

kyphotic deformity, 191

 

L

Lamictal (Lamotrigine), 39

lamina, 64, 65, 185, 189, 258

laminectomy, 113, 115, 189-92, 193

laminoplasty, 115, 189-92, 191

Lamotrigine (Lamictal), 39

lasers, 167, 189, 198

lateral mass, 65

lateral mass screws, 238-40, 239, 241

lateral recess stenosis, 194

lateral X-ray, 122

Lauterbur, Paul, 130-31

legal rights, 173-74. See also litigation

legs: anatomy, 74, 76; claudication pain, 13-14; herniation in the lumbar spine, 83; neck injury and, 15; ossification of the posterior longitudinal ligament, 115; sciatica, 11-13; spinal stenosis, 85, 157; spondylolisthesis, 89

levitiracetam (Keppra), 39

liability litigation, 174, 216-18, 223, 278

lidocaine derivative-oral (Mexilitene), 32, 32

lidocaine (injectable anesthetic), 32

lidocaine patch (Lidoderm), 32, 32

lifting, 42-43, 44, 292

ligaments, 10, 10, 92, 92, 100

ligamentum flavum, 87, 187

lioresal (Baclofen), 17, 32

lipomyelomeningocele, 108-9

litigation, 174, 216-18, 223, 278

loading and lubrication, 52

localization, 95

long tracts of white matter, 71-72, 79, 146, 146-47

Lorcet (hydrocodone and Tylenol), 34

lumbar spine: anatomy, 10, 63, 64, 65, 68, 68, 74; artificial lumbar facet joints, 259; exercise-based treatments, 58; foraminotomy, 193; fusion, 91, 251-52, 255, 294; herniation, 83, 97; imaging, 156; implants, 252-56; lumbar disks, 70; lumbar drain, 202; lumbar support, 43, 45; number of vertebrae, 117-18, 118; pain in, 9-10; pedicle screws, 256-58; recovery from surgery, 295; risks of surgery, 279; sciatica, 12, 98; slippage in spinal joints, 91; stenosis, 87; surgery, 251-59, 279, 295; traction, 53

lumbosacral plexus, 74, 76

lungs, 16, 17

Luque system, 215-16

 

M

magnetic resonance imaging (MRI): carbon-fiber implants, 223, 223; chronic pain, 101; discography, 82, 160; facet blocks, 159; false positives, 96, 156; functions, 130-34; identifying slippage, 89; lumbar spine, 156; MR angiography, 133-34; MR myelogram, 134; MR neurography, 98, 133-34, 134; narrowing of the foramen, 193; osteophytes, 86; surgery within scanners, 226, 227; torn spinal ligaments, 92; types, 132

manipulation, chiropractic, 14, 16, 18-19, 59-60, 61

Mansfield, Sir Peter, 131

manual reduction of fractures, 208-9

Marcaine (injectable anesthetic), 32

marrow, 64

massage, 18-19, 20, 53, 61

median nerves, 74, 99

Medicare, 306-7, 308-9

medications. See also anesthesia; specific drug names: addiction, 37; blood thinners, 276; categories, 25, 28-39, 29, 32, 34, 39; centrally acting pain medications, 39; drug delivery techniques, 39, 40, 150-51; failure to alleviate pain, 27; Medicare, 307; neural protection and regeneration, 150; prophylactic antibiotics, 176; side effects, 29, 34; spinal cord injuries, 149

meditation, 55-56

Medrol Dosepak (methylprednisolone), 31, 32, 150

meningitis, 274

Mensendieck, 18-19

meperidine injection (Demerol), 34

Mercedes, 46

metabolic disorders, 102

metal implants, 127

metaxalone (Skelaxin), 32

methocarbamol (Robaxin), 31, 32

methylprednisolone (Medrol Dosepak), 31, 32, 149, 150

Mexilitene (lidocaine derivative-oral), 32, 32

Miacalcin, 93, 94

microchips, 151

microdiscectomy, 187, 188

microendoscopy, 188-89

mind-body connection, 20, 55

misoprostol with Diclofenac (Arthrotec), 29

morphine pump, 161-63, 162

morphine slow-release (Kadian or MS Contin), 34, 36

motion, neural control of, 75-80

motor circuitry, 78

motor evoked potentials (MEPs), 136-37

motor nerve filaments, 73

motor neurons, 79

motor units, 79

Motrin (ibuprofen), 17, 28, 29

movement, 15, 20, 66-67

MR angiography, 133-34

MR myelogram, 134

MR neurography, 98, 133-34, 134

MS Contin (morphine slow-release), 34, 36

multiple joint facet syndrome, 159

multiple sclerosis, 102

muscles: muscle relaxants, 31, 32; muscle spasms, 17, 31, 181, 292; sensors, 79, 79-80; strained muscles, 100

musculocutaneous nerves, 74

myelin, 141, 148

myelography: discogram compared to, 128; MR myelograms, 134; nerve root pinches, 193; procedure, 126, 127; sealing the dura, 203

myelomeningocele, 108

myelopathy, 87-89, 103-4, 104

 

N

nabumetone (Relafen), 29

Naprosyn (naproxen), 28

naproxen (Aleve), 10, 17, 28, 29

narcotics, 33, 34, 35, 36-37, 38, 277

narrowing. See stenosis

neck. See also cervical spine: causes of pain, 14-16; cervical collars, 14, 92, 183, 234, 238; stiffness, 274; surgery, 101-2; symptoms, 98-99, 99, 100-104; trauma risks, 92

nerves: anatomy, 71-75, 72, 73, 75, 76, 146; broken nerves, 142-43; compression, 140-41, 185-200; conduits, 140, 142-43, 144-45; contrast agents, 126, 127, 145; crunched nerves, 86; grafts, 144-45; nerve compression, 91; nerve conduction velocity (NCV), 135; nerve diseases, 102; neuropathic pain, 24-25, 38; numbering, 74; pain communication, 24; peripheral nerves, 11; pinched nerves, 86, 87, 88, 101, 140; recovery, 139-45; regeneration, 142-43, 150; risks of surgery, 279; root blocks, 157, 159; rootlets, 73, 73; sciatica, 11-13; structure, 141; surgery, 101-2, 185-200, 279; types of nerve damage, 141

nervi nervorum, 25

nervous system, 23, 24. See also brain; spinal cord

neural control of motion, 75-80

neural protection and regeneration, 150

neural tissue risks, 278-79

Neuro Tube products, 145

NeuroGen, 145

neurologic injuries, 92, 216

neurologic symptoms, 86, 108, 111, 113

neuroma, 143

neurons, 71-72

Neurontin (gabapentin), 38, 39

neuropathies, 14

neurosurgeons, 16

nonmedical approaches to treatment, 18-20, 58-59

nonsteroidal anti-inflammatories. See anti-inflammatory drugs

nonsurgical treatments, 51-62

Norco (hydrocodone and Tylenol), 34

notochord, 70-71

novacaine (injectable anesthetic), 32

NSAIDs. See anti-inflammatory drugs

nuclear medicine, 119, 129

nucleoplasty, 168, 189

nucleus pulposus, 70, 70-71, 83-84, 84, 188

numbness: cervical spine origins, 14-15; herniation, 99; nerve entrapments, 98; nerve root blocks, 159; pressure on nerves, 140; sciatica, 12-13; slipped vertebra, 89; subdural empyema, 274; tethered cord syndrome, 108; thoracic outlet compression, 15

Nuquin, 184

 

O

obex, 111

oblique X-ray, 122

obturator nerves, 74

occipital condyle, 65, 67

occipital muscles, 15

older people, 13

operating microscopes, 178

opiates, 36, 38

ordination, 14

Orudis (ketoprofen), 29

ossification of the posterior longitudinal ligament (OPLL), 114, 114-15, 192

osteoblasts, 266, 294

osteoclast cells, 266, 294

osteocytes, 294

osteogenic proteins, 267

osteomyelitis, 273-74

osteopathy, 18-19

osteophytes. See bone spurs

osteoporosis: collapsed vertebra, 248; development and effects of, 93-94, 94; evaluation of, 122; kyphoplasty, 196, 197; as surgical complication, 240

osteoporotic fractures, 94

outcomes, 282-87

oxaprazosin (Daypro), 29

oxycodone and Tylenol (Percocet or Percodan), 34, 36

oxycodone fast-release tablet (Oxy-IR), 34, 36, 37

oxycodone slow-release tablet (Oxycontin), 34, 36

oxygen, 148

 

P

pain: attention to pain, 23; chronic pain, 12-13, 25, 27; claudication pain, 13-14; medications, 25, 28-39 (see also anesthesia); multidisciplinary pain management, 54-55; nature of pain, 23-40; pain fibers, 55; pain generators, 52; positions for pain relief, 10, 15, 98, 100, 276; postoperative pain, 175, 180-81, 277-78; psychological impact of pain, 55-56; referred pain, 95; surgery to block, 204-5; technological advances, 38-39, 40; treatment, 26-27; types, 23-26

pancreas, 9

Parafon Forte (chlorzoxazone), 32

paralysis, 173

parasympathetic nerves, 74-75, 77

parents, 44

Parkinson's disease, 77

pars interarticularis, 116, 123

pedicle screws: functions, 215-16, 217, 219, 221, 222; litigation, 216-18; lumbar spine, 256-58, 257

pedicles, 65, 113, 121

pelvis, 58, 97-98, 98

peptides, 38

Percocet (oxycodone and Tylenol), 34, 36

Percodan (oxycodone and Tylenol), 34, 36

percutaneous procedures, 155-69

perineum, 68, 141

periosteum, 86

peripheral nerves, 11

peroneal nerve, 135

personality, 20

phenytoin (Dilantin), 39

physical therapy, 18-19, 53-54, 296, 297

Pilates, 18-19, 58-59, 61

piriformis muscle, 98

Piriformis Pinch, 96-98

placebo effects, 56-57

plasticity, 25

plate systems, 219-20, 234-35, 235-36, 249-50

pleural lining, 244-45

plus-nerve barrier, 150

pneumonia, 17, 273

point-based treatments, 57-58

polio, 213

polymers, 151, 264

pool therapy, 59

positioning, 10, 15, 98, 100, 276

positron emission tomography (PET), 129

posterior-anterior (PA) X-ray, 122

posterolateral fusion, 258

posterolateral maneuvers, 247-48

postsurgical therapy, 304

posture, 49, 54, 59

pregnancy, 44, 129

preinjury condition, 61-62

pressure, 140-41

Pronex devices, 53

prophylactic antibiotics, 176

propoxyphene and aspirin (Darvon), 34, 35

propoxyphene (Darvocet), 34, 35

prospective cooperative studies, 283-84

proteins, 265, 266, 267

provocative discogram, 82, 160

pseudoarthrosis, 233, 280

psychological aspects of pain management, 42, 54, 55-56

 

R

radial nerves, 74

radiculopathy, 87-89, 103

radiofrequency (RF) treatment, 163-64, 167-68

range-of-motion exercises, 20, 53

Ranitidine, 31

Ray, Charles, 220, 264

Ray Threaded Fusion Cage, 220-21

recovery, 139-52, 291-98

referred pain, 12, 95

reflex sympathetic dystrophy, 26, 169

reflexes, 103, 104

reflexology, 18-19

regeneration of nerves, 141, 142-43, 150

Reiki, 18-19

rejection, 281

Relafen (nabumetone), 29

relaxation, 56

retaining ring, 128

retrospective reviews, 284

ribs, 65, 69, 69, 117, 117

risks of surgery, 172-73, 230, 269-82, 285-86

Robaxin (methocarbamol), 31, 32

robotics, 226, 257, 268

rofecoxib (Vioxx), 29, 30

rolfing, 18, 60

Romberg sign, 104

rootlets, 73, 73

rotator cuff, 99

running, 61, 62

 

S

sacral spine, 10, 63, 68

safety, 19

scalene muscles, 15, 100

scarring. See fibrosis (scarring)

schools of therapy, 51-62

Schwann cell, 141-42, 145

sciatic nerves, 74, 76

sciatic notch, 98

sciatica: aspects of, 96-98; described, 11-13; extrusions and, 83; herniation, 98; lumbar spine, 98; pain distribution, 97; pelvis, 97-98, 98

scoliosis, 91, 106, 106-7, 213, 214, 214, 248

screw-and-plate systems, 219-20

screw-rod systems, 249

screws, 224, 234-35, 238-40, 239, 241, 256-57. See also pedicle screws

seat belt fractures, 218-19

second opinions, 288

secondary injury, 150

segmentation, 105

self-care, 20-21

sensors, microchip, 151

sensors, muscle, 79, 79-80

Seprafilm, 181

shiatsu, 18-19, 58, 61

shortness of breath, 16

shoulders: bone spurs, 99; brachial plexus nerves, 75; cervical spine and, 14, 15, 85; disk herniation, 98-99, 99

shunt (tube), 112

side effects of medications, 29, 34

single-photon emission-computed tomography (SPECT), 129

sitting, 12, 98, 101

Skelaxin (metaxalone), 32

slippage in spinal joints (spondylolisthesis), 89-92, 90, 116

Soma (carisoprodol), 17, 31, 32

somatic pain, 24

somatosensory evoked potential (SSEP), 136, 136-37

spa therapy, 56

spicules, 64

spina bifida, 107-13, 109

spinal canal, 64-65, 72-73, 83, 131, 192

spinal cord: anatomy, 11, 11-12, 64, 71-75, 146; blood flow, 148; compression (myelopathy), 87-89, 103-4, 104; injuries, 92, 145-49, 149, 149-52; neck pain and, 15, 16; nerves, 76; neural routing, 72; recoveries, 147-48; risks of surgery, 279; technological advances, 149-52

spine. See also specific vertebral regions, including cervical spine, thoracic spine, and lumbar spine: anatomy, 68; brain's interaction with, 79; spinal joints (see joints of the spine); spinal manipulation, 14, 16, 18-19, 59-60, 61; spine carpentry, 207-27; spine protectors, 43; spine series of X-rays, 122; technological advances in spinal repair, 221-26

spinous processes, 64, 65, 189-91, 240

spondylolisthesis (slippage), 89-92, 90, 116

spondylolysis, 116, 116, 123, 258-59

spontaneous spine fractures, 93

sports, 47-48

stabilization, 18-19, 90-91

standing, 98

staples, 181-82, 293

Steffee, Arthur, 216, 218, 222

stem cells, 267-68

stenosis: cervical spine, 99; congenitally narrow spinal canals, 113; development of, 192; effects of, 85; epidural steroids, 157; foraminal stenosis, 85; imaging, 131, 156, 193; laminectomies, 189-91, 193; lateral recess stenosis, 194; lumbar stenosis, 87; osteophyte formation, 86-87

sternotomy, 247

steroids: discograms, 160; disk herniation, 157; functions, 31; names and risks, 32; nerve root blocks, 159; postoperative pain control, 180; spinal cord injuries, 148-49, 150

stingers, 113, 147

stomach ulcers, 9, 102

strengthening the spine, 47-49, 52, 53, 54, 58. See also activity and exercise

stress, 42, 56

stretching, 48-49, 52, 54, 90-91

struts, 240

subdural empyema, 274

sublaminar wires, 240

subluxation, 89-90, 91, 92

successful outcomes, 282-87

sulindac (Clinoril), 29

sural nerves, 144

surgeons: choosing, 286-89; experience of, 287-88; fees, 302; surgeon-patient relationship, 278, 289, 314

surgery, 171-84; biotechnology, 261-68; braces, 184; cervical spine, 229-41, 231; cosmetic issues, 178, 184, 292-93; drains, 181; dressings, 183-84; exploratory surgery, 137; image-guided surgery, 179, 224-26, 225, 227, 239, 247, 248-49, 257, 257-58; inside dural lining, 201-6; lumbar spine, 251-59; nerves, 101-2, 185-200; outcomes, 51-52; postoperative pain, 180-81, 277-78; preparations for, 174-75; recovery, 291-98; retroperitoneal technique, 253; risks of surgery, 172, 269-82, 285-86; robotics, 226, 257, 268; skin closure methods, 181-83, 182; spinal cord symptoms, 103-4; spine carpentry, 207-27; surgical series, 284-85; surgical techniques, 179-80; surgical wound, 291-94; sympathectomy surgery, 169, 246; terminology, 185-86; thoracic spine, 243-50, 279; tools, 186, 210-11, 212-24; transabdominal approach, 253

sutures, 292-93

swimming, 20, 61, 62

sympathectomy surgery, 169, 246

sympathetic ganglia, 75, 169

sympathetic nerves, 74-75, 77

symptoms, 19, 95-104

synthetic vectors, 267

syringomyelia, 73, 111-13, 112

syrinx, 112

 

T

Tagamet, 31

tai chi, 18-19, 59

tailbone (coccyx), 68

tarsal tunnel, 98, 135

technological advances: in pain management, 38-39, 40; in spinal cord injuries, 149-52; in spinal repair, 221-26; in synthetics for bone growth, 261-65, 264

Tegaderm, 183

Tegretol (carbamazepine), 39

tension, 42, 56

terminology, 63, 185-86

tethered cord syndrome, 108-9, 109

thighs, 97

thoracic outlet syndrome, 14-16, 99, 100, 117, 247

thoracic spine: anatomy, 63, 65, 68, 68, 69, 69, 74; facets, 243, 249; fixation, 218-19; herniation, 83; number of vertebrae, 117; pain in, 16-17; pedicle screws, 248-49, 250; surgery, 196, 243-50, 249, 279; thoracotomy, 196, 244-46, 249; transaxillary and cervical access, 247; vertebrectomy, 196, 249

threaded dowels, 221

three-month rule, 17-21

tibial nerve, 98

tingling, 99, 140

titanium implants: advantages, 263; cages, 254, 255; plates, 234-35, 235-36, 249; types, 264

toes, 12, 97, 314

tools for bone repair, 186, 210-11, 212-24

Topamax (topiramate), 39

Toradol (ketorolac intravenous), 29, 30, 276

torques (rotating forces), 47

traction: benefits, 52-53, 53; cervical fracture reduction, 210; correcting subluxation, 90; Harrington Rod, 213-15; limitations, 209; for scoliosis, 91; spinal cord injuries, 149

Trager, 18-19

tramadol (Ultram), 39

transarticular screws, 224

transcutaneous electroneural stimulators (TENS), 166

transforaminal epidural, 158

transfusions, 271-72

transpedicular kyphoplasty, 248

transpedicular tunneling, 247

transverse processes, 65

travel ergonomics, 44-45

triplicate prescriptions, 35-36

trophins, 145

tubular retractors, 178

tumors: diagnosis, 131; locations, 199; pain associated with, 9; removing, 196-98; spinal cord, 205-6; thoracic spine, 244

turning, 66-67

20/20, 217

twisting, 101

Tylenol (acetaminophen), 10, 28, 29, 30, 39

Tylenol no. 3 (codeine and Tylenol), 34, 35

 

U

ulcers, 102

ulnar nerves, 74

Ultram (tramadol), 39

ultrasound, 53, 119, 129

unco-vertebral joint, 192

urinary tract infections, 102, 273

Urist, Marshall, 265

 

V

valdecoxib (Bextra), 29, 30

Valium (diazepam), 17, 31, 32

vehicle accidents, 45-47

ventral rami, 75

ventricle system, 72, 111

vertebra. See also specific vertebral regions, including cervical spine, thoracic spine, and lumbar spine: anatomy, 63-69, 64, 70; collapsed vertebra, 249; number of, 116-18, 118; rescue or removal, 248-50, 249; vertebral bodies, 64, 65, 66; vertebrectomies, 194-96, 195, 249-50

vertebral artery, 65

vibration, 43

Vicodin (hydrocodone and Tylenol), 34, 35

Vicoprofen (hydrocodone and aspirin), 34, 35

Vioxx (rofecoxib), 29, 30

vitamin D supplements, 93, 94

vocal cords, risks to, 172-73, 230, 275

Voltaren XR (Diclofenac), 29, 30

 

W

walking, 13, 20, 61, 90, 98, 157

weakness: nerve entrapments, 98; pressure on nerves, 140; sciatica, 12-13; spinal cord injuries, 148; subdural empyema, 274; tethered cord syndrome, 108; thoracic outlet compression, 15

wedge collapses, 93

weight (body), 48, 60-61

whiplash, 14-16, 100

white matter, 71-72, 79, 146, 146-47

wire wraps, 212

workplace, 42-43, 54

 

X

X-rays. See also CT scans: anterior-posterior (AP) X-ray, 122; for bone spurs, 86; carbon-fiber implants, 263; categories, 119; chronic pain, 101; computer image-guidance systems, 224, 225; contrast agents, 126-29; dual-energy X-ray absorpsiometry (DEXA) scan, 93, 122; facet blocks, 159; flexion and extension, 92, 123; fluoroscopy, 120, 121, 209, 210, 257-58; functions, 119-23; identifying slippage, 89; lateral X-ray, 122; lumbar spine, 156; myelography, 126, 127, 203; oblique X-ray, 122; posterior-anterior (PA) X-ray, 122; risks associated with, 131; spine carpentry, 207; spine series of X-rays, 122; surgery preparations, 174

Xanax, 37

xenografts, 202-3

 

Y

yoga, 2, 18-19, 58, 61, 62

 

Z

Z-plates, 219

Zanaflex (muscle relaxant), 31