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Category Neurosurgery
Disc Herniation (Primary, Recurrent, Residual)
Introduction Lumbar intervertebral discs are complex structures subjected to significant axial compressive forces. Because of biomechanical demands and the inability to remodel as a result of an avascular nature, lumbar disc herniation (LDH) is a relatively common cause of back…
Decompression
Introduction Lumbar spine disorders and the disabling pain associated with these conditions are associated with significant healthcare resource use and costs in the United States. Of these patients, an estimated 3% with back pain will require surgical intervention. Spine surgery…
Dural Scarring and Repair Issues
Background A vast majority (up to 80%) of the US population are estimated to experience an episode of low back pain (LBP) during their lifetime. A subset of these individuals will go on to develop chronic LBP, which can limit…
Imaging Considerations (Magnetic Resonance, Computed Tomography, Myelography, Plain)
Introduction Regardless of the presence of lumbar instrumentation, recurrent symptoms after a lumbar decompressive surgery are not uncommon; for example, after undergoing microlumbar discectomy up to 12% of patients may have a recurrent disc herniation within the first year. The…
Indications
Background Revision lumbar spine surgery is predominantly associated with several distinct pathological processes resulting from an initial index surgery. For example, in the treatment of disc herniations, residual stenosis and recurrent disc herniations are well described in the literature. There…
Medical Fitness Evaluation
Introduction One major issue when considering reconstructive spinal surgery is medical fitness for surgery. This is defined as an individual’s ability to sustain the physiological stress of surgery and recovery. Medical fitness is related to the overall wellness of the…
The Role of Osteoporosis and Bone Diseases in Revision Spine Surgery
Introduction Poor bone health can lead to failure of the primary spinal procedure and precipitate the need for a revision spine surgery. Postoperative complications related to poor bone health include failure of fixation, fracture, kyphosis, implant subsidence, pseudarthrosis, and worsening…
Anatomy and Physiology/Biology of Bone
Anatomy Lumbar Spine Make-Up The typical vertebral column is composed of 33 vertebrae. The lumbar spine usually has five mobile lumbar vertebrae, denoted as L1–L5. As a group, the lumbar vertebrae create a lordotic curve. The vertebral bodies increase in…
Use of a Physical Education and Nutrition Program to Improve Outcomes
Introduction Placing the needs of the patient above one's own needs has long been the call of duty badge worn by the physician. Indeed, emergent patient care needs trump immediate personal needs such as sleep, fatigue, hunger, and family commitments.…