Preface. Acknowledgments

Preface

There are numerous controversial topics related to the practice of spine surgery that are routinely discussed and debated at spine conferences without reaching a firm consensus. At the same time there is a growing trend supporting the use of evidence-based medicine. This entails basing clinical decisions on well documented, peer-reviewed literature results and reflecting on the values of the patient and the experience of the treating physician. While this approach has been very suc-cessful in other fields of medicine, there is often a paucity of data related to many issues regarding disorders of the spine. This had made the routine use of evidence-based medicine difficult or impossible in spinal surgery.

The impetus for Controversies in Spine Surgery was to help fill this void between clinical and basic science research and the clinical practice of spine surgery. In many situations there is no Level I evidence to dictate the ideal approach for spine surgeons. In these cases the best available evidence should be well understood to help guide the most appropriate treatment options.

This text provides a thorough review of the literature for some of the most debated topics in spine surgery. The literature is graded according to levels of evidence, and then recommendations are provided in a best evidence approach to spine surgery. Topics are arranged according to trauma, degenerative, emerging technology, and infection.

The authors of each chapter were chosen from a field of internationally well-respected orthopaedic and neurological spine surgeons in an attempt to provide a comprehensive, yet clear understanding of each controversy. The available peer-reviewed literature is summarized in table format, and Pearls boxes summarize the key points in each chapter.

While this text does not profess to hold all of the answers to these controversial topics, we foresee it will provide spine surgeons with an improved understanding of the issues and allow them to provide a best evidence approach for their patients.

Acknowledgments

We would like to acknowledge Lauren Henry, Kay Conerly, and the rest of the editorial staff at Thieme for their hard work and dedication that made this book possible.

Contributors

Todd J. Albert, MD

Professor and Chair

Department of Orthopaedic Surgery Jefferson Medical College

Thomas Jefferson University Rothman Institute

Philadelphia, Pennsylvania

R. Todd Allen, MD, PhD

Assistant Clinical Professor

Department of Orthopaedic Surgery University of California–San Diego San Diego, California

Howard S. An, MD

Professor and Chair

Department of Orthopaedic Surgery Rush Medical College

Rush University Medical Center Chicago, Illinois

E. Ratcliffe Anderson III, MD

University of Alabama School of Medicine Birmingham, Alabama

Christopher M. Bono, MD

Associate Professor

Department of Orthopaedic Surgery Harvard Medical School

Chief

Orthopaedic Spine Service Brigham and Women’s Hospital Boston, Massachusetts David W. Cadotte, MD, MSc Resident Division of Neurosurgery University of Toronto Toronto, Ontario Colin G. Crosby, MD Resident

Department of Orthopaedics and Rehabilitation Vanderbilt University School of Medicine Nashville, Tennessee

Bruce V. Darden II, MD

Fellowship Director Orthopaedic Spine Center Charlotte, North Carolina

Rick A. Davis, MD

Assistant Professor

Department of Orthopaedics and Rehabilitation Vanderbilt University School of Medicine Chief

Division of Spine Surgery

Vanderbilt University Medical Center Nashville, Tennessee

Igor DeCastro, MD

Chief Resident

Department of Neurosurgery

University of Arkansas for Medical Services Little Rock, Arkansas

Clinton J. Devin, MD

Assistant Professor

Department of Orthopaedics and Rehabilitation Vanderbilt University Medical Center

Nashville, Tennessee

Marcel F. Dvorak, MD, FRCSC

Professor and Head Division of Spine

Department of Orthopaedics University of British Columbia Vancouver General Hospital Vancouver, British Columbia

Jason C. Eck, DO, MS

Assistant Professor

Department of Orthopaedics and Physical Rehabilitation University of Massachusetts Medical School

Division of Orthopaedic Spine Surgery UMass Memorial Medical Center Worcester, Massachusetts

Nancy E. Epstein, MD

Clinical Professor

Department of Neurological Surgery Albert Einstein College of Medicine Bronx, New York

Chief

Neurosurgical Spine and Education Winthrop University Hospital Mineola, New York

Long Island Neurosurgical Associates New Hyde Park, New York

Mark S. Eskander, MD

Resident

Department of Orthopedics and Physical Rehabilitation University of Massachusetts Medical School

UMass Memorial Medical Center Worcester, Massachusetts

Michael G. Fehlings, MD, PhD, FRCSC, FACS

Professor

Department of Surgery, Division of Neurosurgery University of Toronto

Medical Director

Krembil Neuroscience Centre University Health Network Toronto, Ontario

Richard G. Fessler, MD, PhD

Professor

Department of Neurological Surgery Feinberg School of Medicine

Northwestern University Chicago, Illinois

Jeffrey S. Fischgrund, MD

Clinical Professor

Department of Orthopaedics

William Beaumont School of Medicine Oakland University

Department of Orthopaedic Surgery William Beaumont Hospital

Royal Oak, Illinois

Michigan Orthopaedic Institute Southfield, Michigan

John C. France, MD

Professor

Departments of Orthopaedics and Neurosurgery Robert C. Byrd Health Sciences Center

West Virginia University Chief

Spine Service

Ruby Memorial Hospital Morgantown, West Virginia

Bruce E. Fredrickson, MD

Professor Emeritus

Departments of Orthopedics and Neurosurgery SUNY Upstate Medical Center

Syracuse, New York Director

Orthopedic Spine Service VA Medical Center Syracuse, New York

Steven R. Garfin, MD

Professor and Chair

Department of Orthopaedics University of California–San Diego

University of California–San Diego Medical Center San Diego, California

Cristian Gragnaniello, MD

Chief Resident

Department of Neurosurgery Second University of Naples Naples, Italy

Alexander G. Hadjipavlou, MD

Professor and Chair

Department of Orthopaedic Surgery and Traumatology University of Crete

Heraklion, Greece

James S. Harrop, MD, FACS

Associate Professor

Department of Neurological Surgery Jefferson Medical College

Thomas Jefferson University Philadelphia, Pennsylvania

Alan S. Hilibrand, MD

Professor

Department of Orthopaedic Surgery Jefferson Medical College

Thomas Jefferson University Rothman Institute

Philadelphia, Pennsylvania

Justin B. Hohl, MD

Resident

Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania

Forrest D. Hsu

Department of Clinical Neurosciences University of Calgary

Division of Neurosurgery

Foothills Hospital and Medical Centre Calgary, Alberta

R. John Hurlbert, MD, PhD, FRCSC, FACS

Associate Professor

Department of Clinical Neurosciences University of Calgary

Division of Neurosurgery

Foothills Hospital and Medical Centre Calgary, Alberta

Louis G. Jenis, MD

Clinical Associate Professor

Department of Orthopaedic Surgery Tufts University School of Medicine Boston, Massachusetts

Boston Spine Group Newton, Massachusetts

KyriakosN. Kakavelakis

Department of Orthopaedic Surgery and Traumatology University of Crete

Heraklion, Greece

Youssef R. Karam, MD

Spine Fellow

Department of Neurological Surgery Feinberg School of Medicine Northwestern University Northwestern Memorial Hospital Chicago, Illinois

Panagiotis G. Korovessis, MD, PhD

Chief

Department of Orthopaedics General Hospital Agios Andreas Patras, Greece

Paul E. Kraemer, MD

Assistant Professor

Department of Orthopaedics

Indiana University School of Medicine Indiana Spine Group

Indianapolis, Indiana

Ivan E. LaMotta, MD

Towson Orthopaedic Associates Towson, Maryland

Anthony S. Lapinsky, MD

Assistant Professor

Department of Orthopedics and Physical Rehabilitation University of Massachusetts Medical School

UMass Memorial Medical Center Worcester, Massachusetts

Darren R. Lebl, MD

Chief Resident

Department of Orthopaedic Surgery Harvard Medical School

Massachusetts General Hospital Boston, Massachusetts

Joon Y. Lee, MD

Assistant Professor

Department of Orthopaedic Surgery University of Pittsburgh School of Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania

WeishiLi, MD

Associate Professor, Research Fellow Department of Orthopaedic Surgery Harvard Medical School

Massachusetts General Hospital Boston, Massachusetts

Amir A. Mehbod

Clinical Instructor University of Minnesota Staff Surgeon

Twin Cities Spine Center Minneapolis, Minnesota

Remi Nader, MD, CM, FRCSC, FACS

Assistant Professor

Department of Neurosurgery

University of Arkansas for Medical Sciences Little Rock, Arkansas

Ahmad Nassr, MD

Assistant Professor

Department of Orthopedic Surgery Division of Spine Mayo Clinic Rochester, Minnesota Sergey Neckrysh, MD Assistant Professor Department of Neurosurgery SUNY Upstate Medical University Syracuse, New York

John R. Orphanos

Chief Resident

Department of Neurosurgery

Robert C. Byrd Health Sciences Center West Virginia University

Morgantown, West Virginia

Farhang Raaii

Twin Cities Spine Center Minneapolis, Minnesota

Daniel K. Resnick, MD, MS

Associate Professor

Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health

University of Wisconsin Hospital and Clinics Madison, Wisconsin

Brandon G. Rocque, MD

Resident

Department of Neurological Surgery University of Wisconsin School of Medicine and Public Health

Madison, Wisconsin

DavorSaravanja, BMed, FRACS (Ortho)

Department of Orthopaedic Surgery Sydney Children’s Hospital

Randwick, Australia

Rick C. Sasso, MD

Professor

Department of Orthopaedic Surgery Indiana University School of Medicine Chief of Spine Surgery

Indiana Spine Group Indianapolis, Indiana

Andrew J. Schoenfeld, MD

Clinical Fellow

Department of Orthopaedic Surgery Harvard Medical School

Brigham and Women’s Hospital Boston, Massachusetts

John C. Sefter, DO

Towson Orthopaedic Associates Towson, Maryland

Harvey E. Smith, MD

Methodist Center for Orthopaedic Surgery The Methodist Hospital

Houston, Texas

Brian W. Su, MD

Mt. Tam Spine Center Larkspur, California

Ishaq Y. Syed, MD, MS

Chief Resident

Department of Orthopaedic Surgery Rush Medical College

Rush University Medical Center Chicago, Illinois

Cyrus E. Taghavi, BS

Department of Orthopaedic Surgery David Geffen School of Medicine University of California–Los Angeles Los Angeles, California

Ensor E. Transfeldt, MD

Staff Surgeon

Twin Cities Spine Center Minneapolis, Minnesota

Alexander R. Vaccaro, MD, PhD, FACS

Professor

Departments of Orthopaedic Surgery and Neurosurgery Jefferson Medical College

Thomas Jefferson University

Thomas Jefferson University Hospital Rothman Institute

Co-Director and Co-Chief of Spine Surgery Delaware Valley Spinal Cord Injury Center Philadelphia, Pennsylvania

Jeffrey C. Wang, MD

Professor

Departments of Orthopaedic Surgery and Neurosurgery David Geffen School of Medicine

University of California–Los Angeles Los Angeles, California

UCLA Comprehensive Spine Center UCLA Medical Center

Santa Monica, California

Kirkham B. Wood, MD

Associate Professor

Department of Orthopaedic Surgery Harvard Medical School

Chief

Orthopaedic Spine Service Massachusetts General Hospital Boston, Massachusetts

Sanjay Yadla

Resident

Department of Neurological Surgery Jefferson Medical College

Thomas Jefferson University Philadelphia, Pennsylvania

Elizabeth M. Yu, MD

Resident

Department of Orthopedic Surgery Mayo Clinic

Rochester, Minnesota

Igor R. Yusupov, MD

Resident

Department of Neurosurgery SUNY Upstate Medical University Syracuse, New York