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Diffuse mets to spine with lumbar stenosis

Introduction The skeleton is the third most common site of metastatic disease, with the spinal column being the most common location. Metastatic spinal disease can be found in 20% to 30% of patients with primary malignancies and leads to significant morbidity secondary to compression of the spinal cord, pain related to spinal instability, or neural compression. Concomitant degenerative spinal disease will be found in a significant…

Spine metastasis

Introduction Metastatic spine disease occurs in approximately 20% of cancer patients, with an estimated 20,000 new cases each year. Most malignancies have the ability to spread to the spine, but the most common primary sites are lung, breast, prostate, and kidney. Chemotherapy and immunotherapies have become more efficacious; thus cancer patients are living longer, leading to an ever-growing number of patients with spinal metastasis. Historically, surgical…

Broken rod after scoliosis correction with back pain

Introduction Rod fracture following complex spinal deformity correction is a common problem occurring in up to 15% of cases. Following deformity correction, the rods act as struts that allow the bony fusion to occur. The rods during this time period undergo stress, which may ultimately lead to metal fatigue resulting in rod fracture before solid bony fusion has occurred. While this may be identified during routine…

Iatrogenic kyphoscoliosis

Introduction Kyphoscoliosis is the loss of the normal thoracolumbar curvature resulting in increased kyphosis as a result of either increased thoracic kyphosis or thoracolumbar kyphosis. This can result in significant amount of disability due to pain drastically altering the patient’s quality of life. Many present with back pain, inability to stand erect, and leg pain. The pain is the result of loss of normal posture requiring…

Iatrogenic deformity after Harrington rod

Introduction Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, affecting 2% to 4% of adolescents with an occurrence rate of 0.5 to 5.2%. Although the pathophysiology is unclear, there are some studies that suggest a genetic component. While the presence of smaller curvature is similar in males and female at similar rates, there is a higher prevalence of larger curvatures seen in women.…

Degenerative scoliosis with radiculopathy

Introduction Adult degenerative scoliosis (ADS), or de novo degenerative lumbar scoliosis, is a form of spinal deformity diagnosed in individuals with a coronal curve of >10 degrees, beginning after the age of 50, and without a prior history of scoliosis. Unlike adult idiopathic scoliosis (see Chapter 41 ), which results from unrecognized/untreated adolescent idiopathic scoliosis, ADS results from degeneration over an individual’s lifetime. This condition typically…

Cervical kyphosis

Introduction The cervical spine, which was first described as lordotic by Borden et al. in 1960, is tasked with the responsibility of maintaining a wide range of motion, and allowing proper gaze that is essential for upright gait. The cervical spine also absorbs the torsional, axial, and shear loads exerted by the cranium and more rigid thoracic spine, which serves a crucial role in maintaining normal…

Flat back after fusion

Introduction Flat back syndrome is described as loss of lumbar lordosis, which alters the center of gravity, thereby shifting the head anterior to the sacrum causing sagittal imbalance. This is typically seen following multiple lumbar fusions with distraction of the lumbar spine that ultimately lead to loss of lumbar lordosis. It was first described in patients undergoing scoliosis repair with placement of Harrington distraction by Doherty.…

Adolescent idiopathic deformity

Introduction Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, affecting 2% to 4% of adolescents with an occurrence rate of 0.5 to 5.2%. Although the pathophysiology is unclear, there are some studies that suggest a genetic component. While smaller curvature is seen in males and females at similar rates, there is a higher prevalence of larger curvature in women. Additionally, around the time…

Coronal and sagittal deformity with back pain (adult idiopathic)

Introduction Adult degenerative scoliosis (ADS), or de novo degenerative lumbar scoliosis, is a spinal deformity diagnosed in individuals with a coronal curve of >10 degrees, beginning after the age of 50, and without a prior history of scoliosis. It differs from adult idiopathic scoliosis in that the latter is a result of unrecognized/untreated adolescent idiopathic scoliosis. ADS develops secondary to degenerative changes occurring over an individual’s…

Coronal deformity

Introduction Adult spinal deformities may be caused by progressive degenerative disease, iatrogenic changes, or progression of adolescent curves. It is most commonly seen in patients older than 65 years, which is also the fastest growing population in the United States. The management of adult deformity hinges upon the etiology of the condition. The most common symptom in the adult population is pain. The chief complaints of…

Proximal junctional kyphosis after deformity surgery

Introduction Adult spinal deformity is a prevalent pathology with increasing incidence in the aging population. The correction of this pathology requires multilevel fusion, which unfortunately results in frequent revision. Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common and serious complications following long constructs for spinal deformity. It has been reported to occur in up to 39% of adult spinal deformity cases. PJK is…

Cervical jumped facets

Introduction Fractures of the subaxial spine are typically caused by high-velocity injuries such as motor vehicle collisions, falls, and high-impact sports. The subaxial spine consists of the cervical vertebra numbered three to seven and is more mobile than the upper cervical and upper thoracic spine. The incidence of traumatic spinal cord injuries is about 40 per million persons per year with fractures of the subaxial spine…

Chronic L5 pars fractures with back pain and spondylolisthesis

Introduction The pars interarticularis represents a small piece of bone that connects the facet to the pedicle. Given its small size and location, the pars is prone to fracture from multiple sources. Pars fractures can lead to back pain and leg pain with foraminal stenosis, and it can also lead to lumbar spondylolisthesis, which is described as ventral subluxation of one vertebrae body on the other.…

Acute spinal cord injury

Introduction The estimated global incidence of spinal cord injury (SCI) is difficult to specify as there is wide variation between regions and discrepancies in reporting. It has been reported, however, that there are around 68 cases of SCI per million population and a prevalence as high as 116 per million in people ages 65 and older. The economic burden of SCI is an estimated 4 billion…

C1 fracture

Introduction Cervical spinal cord injury is a devastating complication most commonly caused by motor vehicle collisions and falls from heights. Upper cervical spinal cord injuries may result in neurogenic shock, respiratory failure, and loss of motor in the upper and lower extremities, often leaving patients bed bound and connected to a ventilator for life. For this reason, injuries of the upper cervical spine must be managed…

Penetrating spine trauma

Introduction Penetrating injuries to the spine are often caused by gunshot wounds (GSWs). Most of the literature supporting the management guidelines of GSWs to the spine stem from military and combat medicine. The overall incidence of civilian GSWs has increased and causes 13% to 17% of all traumatic spine injuries, but this varies depending on the country. Civilian GSWs typically occur with low-caliber weapons but still…

Central cord syndrome without instability

Introduction Central cord syndrome was first described by Schneider et al. in 1954 as a syndrome of disproportionate motor weakness of the upper limbs compared with the lower limbs, bladder dysfunction (urinary retention), and variable sensory changes. It is the result of injury to the spinal cord and falls within the spectrum of acute spinal cord injuries. It is the most common form of incomplete spinal…

Pure bone thoracolumbar chance fracture

Introduction The thoracolumbar junction is a region of biomechanical transition from the relatively stiff thoracic spine to the more flexible lumbar spine, which makes it susceptible to injury from high-velocity trauma. Fractures of the thoracolumbar junction are associated with an approximately 25% risk of spinal cord injury. Historically, there has been a general lack of consensus regarding the surgical management of thoracolumbar fractures, primarily driven by…

Fracture after kyphoplasty

Introduction Kyphoplasty is a minimally invasive technique for the treatment of pathological compression fractures and osteoporotic compression fractures of the spine. This procedure represents a valuable treatment option for patients and their families, especially in terms of pain relief and improvement of the quality of life. Kyphoplasty successfully relieves acute pain in the vast majority of patients with pathological and osteoporotic fractures and increases the biomechanical…