Norbert Boos · Max Aebi (Editors) Spinal Disorders Fundamentals of Diagnosis and Treatment Norbert Boos · Max Aebi (Editors) Spinal Disorders Fundamentals of Diagnosis and Treatment With 274 Figures in 1290 Parts and 190 Tables Prof. Dr. Norbert Boos Zentrum für Wirbelsäulen- und Rückenmarkchirurgie Universität Zürich Universitätsklinik Balgrist Forchstraße 340, 8008 Zürich Switzerland Prof. Dr. Max Aebi Institut für Evaluative Forschung in Orthopädischer Chirurgie MEM Forschungszentrum, Universität Bern Stauffacherstraße 78, 3014 Bern Switzerland ISBN 978-3-540-40511-5 Springer-Verlag Berlin Heidelberg New York Library of Congress Control Number: 2006927571 ˇ 2008 Springer-Verlag Berlin Heidelberg This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. 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ToChristine, Eva and Samuel M.A. For their love, understanding, encouragement and tolerance, without which this book would not have been possible VII Foreword Form Follows Function Congratulations to the editors and authors on a truly outstanding book. Most books recapitulate what many already know, and leave one seeking more. This book is unique in its content and format. “Form follows function”, popularized by the great American architect Frank Lloyd Wright, is a principle associated with modern architecture and industrial design in the 20th century. Simply stated, the shape of a building or object should be predicated by or based upon its intended function or purpose. Like this phrase there is often a history that is important to recognize and understand if we are to truly understand its meaning. The origin of the phrase “Form follows function” can be traced back to the American sculptor Horatio Greenough, but it was American architectural giant Louis Sullivan who adopted it and made it famous. Sullivan actually said, “form ever follows function”, but the simpler (and less emphatic) phrase is the one usu- ally remembered. Sullivan’s student and assistant Frank Lloyd Wright adopted this principle in slightly different form – perhaps because shaking off the old styles gave them more freedom and latitude. Drs. Boos and Aebi have adopted a particular form, in this book, in order to give the reader a thorough grounding in the basic knowledge and general princi- ples of spinal disorders. The didactic concept (form) of all the chapters is based on a consistent style and layout, and follows three basic principles of sustainable learning (functions), i.e.: (1) less is more, (2) repetition enhances sustained learning, and (3) case studies are an efficient and complementary means of learn- ing. The book utilizes learning aids to highlight and repeat core messages through- out all chapters, and visual aids facilitate a repetition-based learning approach, starting with the core messages, leading to an in-depth reading of each chapter. Marginal notes allow for effective repetition of material to facilitate the learning process, and outstanding graphics with pictorial and anecdotal learning meth- ods are used to complement the many detailed case studies to exemplify the core messages. Finally, the use of important references and landmark articles makes this a prized book for everyone’s shelf. Congratulations to Norbert and Max on a fantastic contribution. This book will help those most in need, our patients. “Form and function” are the most important outcomes of this work, especially for those of us who work everyday to care for people with these various spinal disorders. Thank you. James N. Weinstein Director, The Dartmouth Institute for Health Policy and Clinical Practice Professor & Chairman, The Department of Orthopaedics Editor-in-Chief – Spine Dartmouth College and Medical School Dartmouth Hitchcock Medical Center Lebanon, New Hampshire, USA IX Foreword Dinosaur or State of the Art? Long ago, medical observations, advances, innovations and reviews were first presented at meetings and published in books. With the introduction of scientific medical journals, two things happened. First publication time was cut down dra- maticallycomparedtobooksanddisseminationofknowledgebecamefaster. Secondly a new approach to scientific publication was introduced in the form of peer review. This again lengthened publication time, yet benefited quality. Some argued that scientific journals would herald the slow death of books. History proved them wrong. The advent of the internet again mixed up all the cards. Would scientific jour- nals survive the internet? Initially the peer review aspect was lost and the quality of available knowledge suffered. Yet, sites like Wikipedia introduced the very concept of peer review online. So, would the internet kill peer review journals let alone books? Well, here again history demonstrates that both journals and books remain alive and well. This book on spinal disorders edited by Norbert Boos and Max Aebi is a typi- cal example of the kind of textbook anybody involved with matters regarding the spine wants on her or his desk. Moreover, this work is unique because it is not a classic multi-author textbook. The editors have approached chapter authors with whom they personally collaborated and share a common philosophy on the diag- nosis and treatment approach to spinal disorders. By an intensive editing pro- cess, the different chapters have been woven into a homogeneous book combin- ing personal experience with evidence based knowledge. Editors of scientific journals know that so-called “review articles” are very popular, more referenced than other articles and thus excellent for boosting a journal’s Impact Factor. Well, this book consists of a succession of reviews bring- ing us a real “state of the art” regarding the spine but put into perspective through personal experience. This work is truly pluri-disciplinary and reflects the com- plex and difficult nature of the human spine. Among the authors we find clini- ciansaswellasscientists. The editors tackle every aspect of the spine in a well balanced way. No topic is superfluous or perceived as more important than another and the book reads as one continuous flow, one topic logically leading to the next. This book can be rec- ommended to anyone involved in clinical or research aspects of the spine. It sim- ply has to lie on the desk of doctors, scientists, physiotherapists and chiroprac- tors, psychologists and health-care specialists interested in the spine. Robert Gunzburg President 2007–2008 EuroSpine, the Spine Society of Europe Cavell Spine Center Brussels, Belgium XI Preface Spinal disorders are among the most common medical conditions, having a sig- nificant impact on health-related quality of life, use of health care resources and socioeconomic costs. As a therapeutic measure, spinal surgery is still one of the most rapidly growing areas in clinical medicine, and is a major contributor to the continuously increasing costs of modern-day medicine. Similarly, the increas- ingly aging population will have a greater need for the treatment of degenerative spinal disorders, particularly secondary spinal deformities and stenosis. How- ever, at the same time limited health care resources will mean difficult choices in the allocation of treatment modalities. Therefore, a basic knowledge of the state of the art of the diagnosis and treatment of spinal disorders is required, not only for spine specialists but also for general orthopedic surgeons, rheumatologists, neurologists, rehabilitation doctors, psychiatrists, chiropractors, physiothera- pists, basic scientists and health care executives, to enable them to choose and/or evaluate appropriate diagnostic and therapeutic approaches. Owing to the rapid development of knowledge of spinal disorders over the past 20 years, a comprehensive new textbook which incorporates all the latest knowledge has become necessary, and we have become aware again and again of innumerable residents, fellows and colleagues searching for a comprehensive introductory learning tool for the study of spinal disorders. Although excellent textbooks on specific issues of the spine and specifically spinal surgery are already available, none fulfills the criterion of being an easily readable teaching tool that focuses systematically on the fundamentals and basic principles in a standardized manner. Strongly encouraged by our residents and fellows, we have designed a textbook on spinal disorders