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Spondylolisthesis

General Information Spondylolisthesis is a descriptive term derived from the Greek spondylo (spine) and olisthesis (slip) and was first described by Herbinaux, an obstetrician, in 1782. The varied etiologies of spondylolisthesis were first classified by Wiltse, with other classifications of subtypes of spondylolisthesis added over the years. The common feature of the various types is anterior translation of the cephalad vertebra relative to the adjacent caudal…

Degenerative Disorders of the Thoracic and Lumbar Spine

Overview of Lumbar and Thoracic Disc Degeneration and Herniation Despite an improving understanding of degenerative disc disease on the basis of its natural history and basic science, treatment results of this entity vary greatly. There is no lack of treatment options for degenerative discs; what we tend to lack is understanding of the specific cause(s) of the patient’s chief complaint. Despite the fact that William Kirkaldy-Willis…

Degenerative Disorders of the Cervical Spine

Overview of Disc Degeneration and Herniation in the Cervical Spine Cervical degenerative disc disease (DDD) is not a specific diagnosis but a pathophysiologic process that incorporates a spectrum of disease states. Manifestations of cervical DDD can range from neck pain and headache to cervical radiculopathy and/or myelopathy. Fortunately, most of these pathologies can be managed nonoperatively; they may require surgical intervention if the symptoms and signs…

Anatomic Approaches to the Spine

Anatomy of Vertebral Column The vertebral column comprises 33 vertebrae divided into five sections (7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal) ( Fig. 37.1 ). The sacral and coccygeal vertebrae are fused, which typically allows for 24 mobile segments. Congenital anomalies and variations in segmentation are common. The cervical and lumbar segments develop lordosis as an erect posture is acquired. The thoracic…

Fractures and Dislocations in Children

General Principles Fractures are common in children, occurring at a rate of 12 to 30 per 1000 children every year. The risk of sustaining a fracture between birth and 16 years of age has been reported to be 42% to 64% for boys and 27% to 40% for girls. Children and adolescents, because of their unique physiologic features, such as the presence of physes, increased elasticity…

Neuromuscular Disorders

Neuromuscular disease in children includes conditions that affect the spinal cord, peripheral nerves, neuromuscular junctions, and muscles. Accurate diagnosis is essential because the procedures commonly used to treat deformities in patients with neuromuscular disease such as poliomyelitis or cerebral palsy may not be appropriate for hereditary neuromuscular conditions. The diagnosis is made on the basis of clinical history, detailed family history, physical examination, laboratory testing (including…

Paralytic Disorders

Poliomyelitis Acute anterior poliomyelitis is a viral infection localized in the anterior horn cells of the spinal cord and certain brainstem motor nuclei. One of three types of poliomyelitis viruses is usually the cause of infection, but other members of the enteroviral group can cause a condition clinically and pathologically indistinguishable from poliomyelitis. Viral transmission is primarily fecal-oral, and initial invasion by the virus occurs through…

Cerebral Palsy

Etiology Cerebral palsy is a heterogeneous disorder of movement and posture that has a wide variety of presentations, ranging from mild motor disturbance to severe total body involvement. Because of this variability in clinical presentation and the absence of a definitive diagnostic test, defining exactly what cerebral palsy is has been difficult and controversial. It is generally agreed that there are three distinctive features common to…

Osteochondrosis or Epiphysitis and Other Miscellaneous Affections

Legg-Calvé-Perthes Disease The cause of Legg-Calvé-Perthes disease is unknown but has provoked considerable controversy. Previously, some authors thought that an inherited thrombophilia promoted thrombotic venous occlusion in the femoral vein, causing bone death in the femoral head and ultimately leading to Legg-Calvé-Perthes disease. More recent studies have not found an inherited hypercoagulability or a deficiency in protein C activity, however, indicating that inherited thrombophilia is not…

Congenital Anomalies of the Trunk and Upper Extremity

This chapter discusses congenital elevation of the scapula, congenital torticollis, and congenital pseudarthrosis of the clavicle, radius, and ulna. Congenital anomalies of the hand and certain other anomalies of the forearm are discussed in Chapter 81 . Congenital conditions of the spine are discussed in Chapter 43, Chapter 44 . Congenital Elevation of the Scapula (Sprengel Deformity) First described by Eulenberg in 1863, Sprengel deformity is…

Congenital and Developmental Abnormalities of the hip and Pelvis

Developmental Dysplasia of the hip Developmental dysplasia of the hip (DDH) generally includes subluxation (partial dislocation) of the femoral head or complete dislocation of the femoral head from the true acetabulum and acetabular dysplasia. In a newborn with true congenital dislocation of the hip, the femoral head can often be dislocated and reduced into and out of the true acetabulum. In an older child, the femoral…

Congenital Anomalies of the Lower Extremity

This chapter describes congenital anomalies of the foot and lower extremity. Congenital anomalies of the hip and pelvis are described in Chapter 30 , and congenital anomalies of the trunk and upper extremities are described in Chapter 31 . Congenital anomalies of the spine are discussed in Chapters 43 and 44 , and congenital anomalies of the hand are discussed in Chapter 80 . Many of…

Soft-Tissue Tumors

The evaluation of patients with musculoskeletal neoplasms was discussed in detail in Chapter 24 , but certain points warrant repetition and elaboration. In contrast to bone tumors, the presence or absence of pain does not help to distinguish benign from malignant soft-tissue tumors because most patients with soft-tissue malignancies have minimal pain and consult a physician because of the presence of a mass. The mass, typically,…

Malignant Tumors of Bone

Osteosarcoma Osteosarcoma is a tumor characterized by the production of osteoid by malignant cells. It is the most common nonhematologic primary malignancy of bone. The incidence is 1:3 per 1 million per year. Onset can occur at any age; however, primary high-grade osteosarcoma occurs most commonly in the second decade of life. Parosteal osteosarcoma has a peak incidence in the third and fourth decades, and secondary…

Benign/Aggressive Tumors of Bone

The aggressiveness of the lesions described in this chapter ranges between purely benign and frankly malignant. Although these lesions frequently are treated satisfactorily with intralesional procedures, such as curettage, they are sometimes very aggressive locally and require marginal or wide resection. Systemic involvement, although rare, must be evaluated and treated. Giant cell tumors and chondroblastomas can develop pulmonary metastases and in rare cases can be fatal.…

Benign Bone Tumors and Nonneoplastic Conditions Simulating Bone Tumors

This chapter discusses bony lesions that do not usually behave aggressively locally and that have never been shown to metastasize. Most are either asymptomatic or minimally symptomatic except when complications, such as a pathologic fracture, occur. Many are discovered incidentally ( Table 25.1 ). TABLE 25.1 Lesions of Bone Tumor Age Demographics Site Presentation Imaging Histology Treatment Comments Bone-Forming Osteoid osteoma 2nd-3rd decades Male:female 3:1 Lower…

General Principles of Tumors

A team comprising an orthopaedic surgeon, radiologist, pathologist, radiation oncologist, and medical oncologist is necessary to treat the spectrum of musculoskeletal tumors. Other surgical specialists frequently are required, such as a vascular surgeon, thoracic surgeon, or plastic surgeon. The orthopaedic surgeon must be well versed in the principles of oncologic surgery, and the radiologist and pathologist should have a special interest in bone and soft-tissue tumors.…

Tuberculosis and other Unusual Infections

Tuberculosis Tuberculosis is transmitted primarily through inhalation or ingestion of Mycobacterium tuberculosis or Mycobacterium bovis. After exposure, the infection may be cleared by the host, lead to a primary infection, or can later be reactivated from a latent infection. Thereafter, lymphogenous, hematogenous, or contiguous extension to other tissues and organ systems may occur. The clinical presentation depends on the presence of isolated musculoskeletal involvement or miliary…

Infectious Arthritis

Acute septic arthritis results from bacterial invasion of a joint space, which can occur through hematogenous spread, direct inoculation from trauma or surgery, or contiguous spread from an adjacent site of osteomyelitis or cellulitis. Despite in-depth research into the pathophysiology and treatment of acute septic arthritis, the morbidity and mortality are still significant, especially in patients at the extremes of age. The bacterial strain and the…

Osteomyelitis

Osteomyelitis has long been one of the most difficult and challenging problems confronted by orthopaedic surgeons. Currently, morbidity and mortality from osteomyelitis are relatively low because of modern treatment methods, including the use of antibiotics and aggressive surgical treatment. The key to successful management is early diagnosis and appropriate surgical and antimicrobial treatment. A multidisciplinary approach is required, involving an orthopaedic surgeon, an infectious disease specialist,…