Summary of Key Points Psychological distress and psychiatric disease have been shown to be predictors for poor surgical outcomes. The presence of a workers’ compensation claim is also a predictor for poor surgical outcomes. Preoperative evaluation should include identification of…
Summary of Key Points Age-related structural changes occur in the disc and facet joints. Older patients present with multilevel disease with complex pathology. Osteoporosis is common in the older population and commonly identified in patients undergoing spinal procedures; osteoporosis remains…
Summary of Key Points Patients who are medically optimized before major spine surgery demonstrate improvements in self-reported satisfaction scores, decreased postoperative complications, and decreased hospital length of stay. There are several patient-specific, modifiable risk factors that could be targets for…
Summary of Key Points The differential diagnosis for the patient with spine-related symptoms and/or signs can be extensive. An appropriate history and physical examination are the foundations for developing a differential diagnosis. The practitioner evaluating and treating patients with potential…
Summary of Key Points Components of the electrodiagnostic (EDX) examination include (1) nerve conduction studies, (2) needle electrode examination (or electromyogram), and (3) special studies (e.g., H reflexes, F waves). Diagnosis is best facilitated when these components are used in…
Summary of Key Points Imaging plays an important role in establishing spinal diagnosis by building upon the information gleaned from history and physical examination. Computed tomography offers superior resolution and has largely supplanted conventional radiography as the primary imaging modality…
Summary of Key Points Adult spinal deformity with sagittal plane imbalance is associated with poor health-related quality of life (HRQOL) scores. A correlation exists between certain radiographic parameters and disability. Reestablishing harmonious spinopelvic alignment is associated with significant improvement in…
Summary of Key Points The upright sagittal posture in bipedal humans is a unique evolutionary development that has allowed humans to free up their hands, carry their young, exploit food sources, increase their cognitive function, and travel efficiently across great…
Summary of Key Points The history and physical examination are best used to assess the function of the spine and nervous system, complementing the anatomic information from spine imaging. The physical and neurological examinations should include the following: Assessment of…
Summary of Key Points The proximal and distal extents of long posterior fusions in adults with spinal deformity are considered “at risk” for failure because of increased loads and motion at the last instrumented vertebra and the unfused adjacent segment.…