Ortho Oracle - orthopaedic operative atlas

Section 18, Chapter 2: Recurrent Disc Herniation – Diagnosis and Management

Paul Licina and Emma Johnston PATHOPHYSIOLOGY The diagnosis of reherniation is often accompanied by the question ‘why did this occur?’ Natural human instinct is to seek an external traumatic cause rather than implicating intrinsic factors within the disc itself. Nevertheless, both causes are relevant, the latter likely more so. Currently, the importance of intrinsic factors … Read more

Section 18, Chapter 4: Pseudarthrosis – Diagnosis and Management

John E. Cunningham INTRODUCTION Pseudarthrosis, or non-union, is an all too common and expensive complication of spinal fusion surgery, with the cost per QALY (quality-adjusted life year) gained estimated to be about US$118,945.1 Rate estimates vary greatly between studies utilizing different surgical techniques and patient populations.2 Pseudarthrosis is usually defined as failure of bony union … Read more

Section 19, Chapter 1: Infections of the Spine

Harold I. Salmons, Jeffrey Ta, Hamadi Murphy, Arjun Sebastian, Kris Radcliff, Alex Vaccaro INTRODUCTION Spinal infections involve pyogenic or granulomatous infections of the vertebral column, intervertebral discs, the dural sac or the epidural space. Infections of the spine can take the form of a primary infection of the spine or a spread of microorganisms originating … Read more

Section 19, Chapter 3: De Novo Pyogenic Spondylodiscitis

Jose Antonio Umali and Ashish Diwan INTRODUCTION De Novo or spontaneous or primary pyogenic spondylodiscitis is an infection affecting both the vertebral body and intervertebral disc of the spine due to bacterial pathogens. Spontaneous pyogenic spondylodiscitis is caused by hematogenous spread secondary to bacteremia from integumentary, respiratory, oral or gastrointestinal infections.1,2 The origin of the … Read more

Section 20, Chapter 1: Primary Spine Tumors

Nicolas Dea and Charles Fisher INTRODUCTION Primary bone neoplasms of the spine are rare; they represent four to thirteen percent of all primary bone tumors. Incidence of primary bone neoplasms is estimated at 2.5–8.5/100,000 people a year.1 Due to the rarity of primary spine tumors, the experience of most surgeons with these tumors is limited, … Read more

Section 20, Chapter 2: Metastatic Spine Tumors

Satoru Demura*, Katsuhito Yoshioka† and Satoshi Kato‡ TREATMENT STRATEGY FOR SPINAL METASTASES* In the past, the indication for surgical management of spinal metastases was based on signs of neurological deficit, presence of intractable pain, and spinal instability. These indications were described by Harrington et al. with a five-category classification for spinal metastases based on the … Read more