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Index
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Note: Page numbers in bold refer to chapters. Page numbers in italics refer to illustrations or charts.
A
abdominal muscles, 47-48
acetaminophen (Tylenol), 10, 28, 29, 30, 39
acetyl salicylic acid (aspirin), 10, 17, 28, 29, 30
Acromed, 218
Actiq (fentanyl oral swabs), 34, 36, 37
activity and exercise. See also specific forms of exercise such as yoga: alternatives, 62; bed rest compared to, 52; benefits, 20; exercise tolerance, 60, 61; in pregnancy, 44; range-of-motion exercises, 20, 53; sports, 47-48; stingers, 113, 147; strengthening the spine, 47-49, 52, 53, 54, 58; stretching, 48-49, 52, 54, 90-91; treatments based on, 18-20, 58-59, 61
acupressure, 18-19, 58
acupuncture, 18-19, 57-58
Adcon-L, 181
adhesions, 27, 140, 158-59, 202
alendronate (fosamax), 93
Aleve (naproxen), 10, 17, 28, 29
Alexander technique, 18-19, 59
alkaloids, 38
allergic reactions, 266, 272, 281
allografts: advantages, 233-34, 254, 282; in cervical fusion surgery, 240; disadvantages, 262; lumbar implants, 254; rejection, 281; sources, 249, 255; vertebrectomies, 195
Ambrose, Jamie, 125
amitripyline (Elavil), 39
analgesics, 31, 39
anatomy, 63-80
anesthesia: allergic reactions, 272; anesthetics, 31-32, 32, 155; fees, 303; multidisciplinary pain management, 54-55; preemptive anesthesia, 175-76; risks, 172, 275-77
anesthetic discogram, 82, 160, 251
aneurysms, 102
anger management, 56
angiograms, 126, 133-34
ankles, 97, 98
ankylosing spondylitis, 115-16
annulus fibrosis: anatomy, 70, 70; annular tears, 82-83, 84, 86, 101, 128, 160; intradiscal electrothermy (IDET), 128, 164-65, 165
anterior-posterior (AP) X-ray, 122
anti-inflammatory drugs, nonsteroidal (NSAIDs): blood clots, 276; categories, names, and risks, 29; combination medications, 35; diagnostic injections, 155; functions, 17, 28-31; for musculoskeletal pain, 10, 100; neuropathic pain, 38; pre-surgical cessation, 174; during surgery, 175-76
antibiotics, 176, 272, 273, 275
antidepressants, 39
antiemetics (anti-nausea medications), 176
antihypertensives, 32
antiseizure medications (anticonvulsants), 38, 39
antispasmodic medicines, 17
anxiety, 56
aorta, 9, 102
aqua therapy, 59
arachnoid, 73, 110
arbitration agreements, 173-74
arms: anatomy, 74, 75; foraminal stenosis, 85; herniation of the cervical spine, 83, 98-99; medical causes for pain, 102; neck pain and, 14; thoracic outlet syndrome, 117
Arnold-Chiari Malformations, 110-11, 111, 202
arteries, blocked, 17
arthritis: artificial disks, 236, 256; bone spurs from, 14; implants and fusion, 232; narrowing of spinal canal, 16, 192; pedicle screws, 216
arthroplasty, 221-22, 256, 259
Arthrotec (Diclofenac with misoprostol), 29
articular processes, 65
articulations, 65
Aspen collar, 183
aspirin (acetyl salicylic acid), 10, 17, 28, 29, 30
assignment of benefits, 174
athletes, 113, 147
Atlas vertebra, 67, 67
auto accidents, 45-47
autografts: advantages, 144; disadvantages, 234, 261-62; discectomy, 233; hip bone, 195, 233, 234, 254; vertebrectomy, 195
autologous blood, 180, 270, 271
autonomic nervous system, 26, 55, 74-75, 77
availability of treatments, 51
Axis vertebra, 67, 67
axon fibers: anatomy, 72, 146, 146; axonal transport, 39, 151; radiofrequency lesions, 163-64; regeneration, 141, 142-43
B
back pain: causes, 8-10, 13-14, 16-17, 102, 102-3; symptoms, 100-104; three-month rule, 17-21
back school, 18-19, 54
Baclofen (lioresal), 17, 32
Bagby, George, 220
BAK cages, 220
balance, 90, 103, 115
basal ganglia, 77, 79
baths, 20, 56
bed rest, 20-21, 52
beds, 43
benefits, assignment of, 174
benefits of surgery, 172
Bextra (valdecoxib), 29, 30
biofeedback, 56
biotechnology. See technological advances
bladder, 15, 83, 85, 108
blocked arteries, 17
blood-brain barrier, 150
blood clots, 276
blood loss during surgery, 180, 270-72
blood thinners, 276
blood vessels, 13, 16
board certification of surgeons, 286-87
body weight, 48, 60-61
bone-carving techniques, 212-13
bone growth, 261-65, 264
bone morphogenetic protein (BMPs), 265-67
bone rings, 254
bone spurs (osteophytes): development of, 84-87, 192; diagnosis, 86; imaging, 156; neck pain, 14-15; radiculopathy, 88; removing, 232
bones, 273-74, 279-80
bowel control, 15, 83, 85, 108
braces, 43, 54
brachial plexus, 74, 75, 100, 100
bradykinins (inflammatory chemicals), 140
brain, 23, 79, 150
bruises, 147
butalbital (Fioricet), 39
buttock pain, 11-13
C
cable-and-strut assemblies, 240
caffeine, 39
cages, 220-21, 222, 254, 255
calcium, 93-94, 262-63
cancellous bone, 64
cancers, 102
car accidents, 45-47
carbamazepine (Tegretol), 39
carbon-fiber implants, 222-24, 223, 263
cardiovascular risks, 276-77
carisoprodol (Soma), 17, 31, 32
carpal tunnel syndrome, 99, 135
CAT scans. See CT scans (computerized axial tomography)
Catapes TTS (clonidine patch), 32, 37
caudal epidural, 158
causalgia, 26
Celebrex (celcoxib), 29
cell saver devices, 180, 271-72
central canal, 72
central nervous system, 23, 24. See also brain; spinal cord
central pain, 25-26, 27
centrally acting pain medications, 39
cerebellar tonsils, 110-11
cerebellum, 78, 79, 111
cerebral cortex, 76-77
cerebrospinal fluid (CSF), 72, 111, 158, 201-2
cervical collar, 92, 183, 234, 238
cervical spine. See also neck: anatomy, 63, 65, 66, 66-69, 67, 68, 71-72, 74; anterior cervical plating system, 235; artificial disks, 237; foraminotomy, 193, 194; fractures, 219-20, 221; herniation, 83, 87-88, 98-99, 99; laminectomy, 190; number of vertebrae, 117; pain in, 14-16; radiculopathy, 99; recovery from surgery, 295; risks of surgery, 279; slippage in spinal joints, 90; stenosis, 99; subluxation, 89, 92; surgery, 229-41, 231, 279, 295; thoracic outlet, 117; time required for fusion, 294; torn ligaments, 92; traction, 52-53; types of problems, 85; vertebrectomy, 196
chairs, 10, 43
chest, 16-17, 83, 88, 102
children, 192, 213, 214
chiropractic manipulation, 14, 16, 18-19, 59-60, 61
chlorzoxazone (Parafon Forte), 32
chronic pain, 12-13, 25, 27
claudication pain, 13-14
claw devices, 240
cleaning activities, 43-44
Clinoril (sulindac), 29
clonidine patch (Catapes TTS), 32, 37
clonus, 104
Cloward, Ralph, 212
clumsiness, 15
coblation, 167-68
coccyx, 68
codeine and aspirin (Empirin), 34
codeine and Tylenol (Tylenol no. 3), 34, 35
cohort studies, 284
complex regional pain syndrome (CRPS), 26, 169
complications of surgery, 269-82
computer ergonomics, 42
computer image-guidance systems, 224-26, 225, 239, 247, 257
computerized axial tomography. See CT scans
condyle, 65
congenital abnormalities, 13, 202
congenitally narrow spinal canal, 113
Consumer Reports, 46
contrast agents, 126-29, 160
coordination, 15
corsets, 43, 54
cortex, 64, 79
cosmetic issues, 178, 184, 292-93
costovertebral joints, 69
costs of surgery, 299-311
counseling, 56
COX-2 inhibitors, 29, 30
cranium, 63
CT scans (computerized axial tomography): carbon-fiber implants, 223, 223, 263; checking for bone spurs, 86; chronic pain, 101; contrast agents, 126-29; facet blocks, 159; functions, 120, 124, 124-26; identifying slippage, 89; myelography, 126, 127, 203; stenosis, 193
cubital tunnel, 100, 135
curvature and ankylosing spondylitis, 115-16
cyclobenaprene (Flexeril), 17, 31, 32
cysts, 73
D
Damadian, Raymond, 131
Danek Corporation, 221
Darvocet (propoxyphene), 34, 35
Darvon (propoxyphene and aspirin), 34, 35
Daypro (oxaprazosin), 29
DEA Schedule II and III narcotics, 34
decompression, 91, 237, 238
deep vein thrombosis (DVT), 276
delays in treatment, 17-18
Demerol (meperidine injection), 34
demineralized bone matrix (DBM), 262
demyelination, 141-42
dens ("tooth"), 68
depression, 56
Dermabond, 182, 182, 293
dermatome, 97, 99
desk work, 42
diagnosis, 52, 119-37. See also imaging
diazepam (Valium), 17, 31, 32
Diclofenac (Voltaren XR), 29, 30
Diclofenac with misoprostol (Arthrotec), 29
diffuse idiopathic spinal hyperostosis (DISH), 116
Dilantin (phenytoin), 39
Dilaudid (hydromorphone), 34, 36
discography: annular tears, 82-83; contrast agents, 126; myelogram compared to, 128; procedures, 128-29, 160-61, 161, 251
disks: anatomy, 70-71; artificial disks, 236-37, 237, 255-56; bulging disks, 81-84, 84, 86, 87, 87-88, 156, 160-61; discitis (infections), 273-74; discogenic pain, 82, 164, 251; discoplasty, 167-69; diskectomies, 186-89, 188, 230-32, 272; replacement technologies, 264; tears, 128, 164-65, 165; thoracic spine, 69
dislodgment, 281-82
distracting stimuli, 27
distribution, 24-25
dorsal root ganglia, 73, 134, 146
double-blind randomized trials, 282-83
drainage, 294
Drug Enforcement Agency (DEA), 35
dual-energy X-ray absorpsiometry (DEXA) scan, 93, 122
dura: anatomy, 73; Arnold-Chiari malformations, 110; epidural injections, 158; myelography, 127, 203; surgery inside dural lining, 201-6; tumor locations, 198, 199
Duragen, 203
Duragesic (Fentanyl patch), 34, 36
E
elasticity, 263-64
Elavil (amitripyline), 39
electrical nerve testing, 98
electrical stimulation, 53
electrodiagnosis, 134-37, 136
electromyography (EMG), 135, 136
electroneural interfaces, 151-52
electronic fusion stimulators, 268
electronic pain relief, 163-67
eloquent (neurological quality), 14
embolization, 197-98
emergencies, 8, 172
Empirin (codeine and aspirin), 34
end plates, 64
endorphins, 38
endoscopy, 168-69, 178, 245, 246, 253-54
entubulation, 144-45
epidural abscesses, 274
epidural injections, 13, 156-58, 157
epidural stimulators, 166, 166-67
epiduroscopy, 158-59
epineurium, 73, 141
ergonomics, 20, 41-49
esophagus, 16
evoked potential, 136, 136-37
exercise. See activity and exercise
expectations of patients, 51
expense of treatments, 51
experimental procedures, 171, 310-11
exploratory surgery, 137
extrusions, 83-84, 88
F
facet joints: anatomy, 64, 65-66; artificial joints, 259; facet blocks, 157, 159, 164; facetectomy, 194; pain in, 159, 164, 243, 249
fascia, 181, 291-92
fascicles, 140, 141, 145
feet, 15
Feldenkrais, 18-19, 59
fellowship training for surgeons, 287
femoral nerves, 74, 76, 97
fentanyl oral swab (Actiq), 34, 36, 37
Fentanyl patch (Duragesic), 34, 36
fetuses, 129
fibrocytes, 140
fibrosis (scarring): antiscarring agents, 181; of the dura, 202; limiting, 150; lysis of adhesions, 158-59; nerve compression and, 140-41; nerve regeneration and, 143, 150; spinal cord injuries, 145, 147, 148; surgical wound, 293-94
fibula bone, 135
"fight or flight nerves," 75
filum terminale, 109
financial considerations, 299-311
fingers, 14, 15, 87, 99-100, 117
Fioricet (butalbital), 39
fixation, 209-21
"flat back syndrome," 252
Flexeril (cyclobenaprene), 17, 31, 32
flexibility, 58
flexion-extension studies, 92, 123
fluoroscopy, 120, 121, 209, 210, 257-58
Food and Drug Administration (FDA): artificial disks, 236, 256; carbon-fiber spine implants, 224; cervical lateral mass screws, 241; disk replacement technologies, 264; Luque system, 215; oversight authority, 171; pedicle screws, 217-18
foramen: anatomy, 65; foraminotomy, 192-93, 194, 230-32, 237-38; radiculopathy, 87; stenosis, 85, 86
foramen magnum, 110-11, 111, 202
fosamax (alendronate), 93
fractures: cervical spine, 210, 219-20, 221; diagnosis, 131; osteoporotic fractures, 94; risks, surgical, 280; seat belt fractures, 218-19; spontaneous spine fractures, 93; thoracic spine, 244, 248; unlocking, 208-9
fragile bones, 93-94. See also osteoporosis
"funny bone," 100
furniture, 43
fusion: anti-inflammatory agents, 176; benefits, 211-12; blood loss, 180; cervical spine, 232-33, 237, 238; electronic fusion stimulators, 268; failed fusions, 280, 281, 296; grafts, 232-33, 240; implants, 222, 232; lumbar spine, 91, 251-52, 255, 294; posterolateral fusion, 258; proteins and, 265-67, 266; spine carpentry, 209-21; time required, 294-96
G
gabapentin (Neurontin), 38, 39
ganglion, 73
gene therapy, 38-39, 265, 267
Glacier Cross, Inc., 53
Gore-Tex, 202-3
grafts. See also implants: advantages, 233-34, 254, 282; disadvantages, 262, 281; dural substitutes, 202-3; fusion, 232-33, 240; lumbar implants, 254; nerve grafts, 144-45; rejection, 281; sources, 249, 255, 261-65; for vertebral disks, 221; vertebrectomies, 195, 249, 249-50
gray matter, 71-72, 72, 146, 146-47
H
hamstring muscles, 58
hands, 14-15, 75, 85, 86, 117, 117
hardware for bone repair, 186, 210-11, 212-24. See also implants
Harrington, Paula, 213
Harrington rod, 213-15, 214, 219
headaches, 15, 111, 202
heart problems, 16, 17, 102
heat, 53
Hellerwork, 18-19
helplessness, feelings of, 56
hemilaminectomy, 190-91
herniation: anatomy, 69; cervical spine, 98-99, 99; discectomy, 186-89; imaging, 131; injections, 157; location of, 87-88; lumbar spine, 97; radiculopathy, 88; recovery from, 140; reherniation, 296; results of, 83-84; sciatica, 96-98, 97, 98; thoracic spine, 243, 244; types of, 84
hip joint, 58
hoarseness, 172-73, 230, 275
holistic approaches, 20
holograms, 129-30
home environment, 43-44, 54
hot wires, 189
Hounsfield, Sir Godfrey Newbold, 125
hydrocodone and aspirin (Vicoprofen), 34, 35
hydrocodone and Tylenol (Norco, Lorcet, or Vicodin), 34, 35
hydromorphone (Dilaudid), 34, 36
hypnosis, 18-19
I
ibuprofen (Motrin), 17, 28, 29
imaging. See also specific technologies such as X-rays, magnetic resonance imaging (MRI) or CT scans: available technologies, 119-37, 132; bone spurs, 86; carbon-fiber implants, 223, 223, 263; contrast agents, 126-29; diagnosing chronic pain, 101; discography, 82, 160; facet blocks, 159; false positives, 96, 156; flexion and extension, 92, 123; identifying slippage, 89; image-guided surgery, 179, 224-26, 225, 227, 239, 247, 248-49, 257, 257-58; injections and, 82-83, 101, 156-63, 157 (see also discography); myelography, 127, 203; prenatal imaging, 129; risks, 131; spinal cord compression, 104; spinal cord injuries, 148; spine carpentry, 207; stenosis, 193; surgery preparations, 174; torn spinal ligaments, 92, 92
immobilization and healing, 27
Imodium, 33
impingement syndromes, 99
implants. See also grafts: carbon-fiber implants, 222-24, 223, 263; fusion and, 232-33; infections, 274-75; interbody implants, 220-21, 252-56; metal implants, 127, 250; risks of surgery, 280-82; in spine carpentry, 210-11; titanium implants, 234-36, 249, 254, 255, 263, 264; types of, 254
incentive spirometer, 273
incisions, 177-79
Indocin (indomethacin), 29
infections, 9, 102, 172, 272-75
inflammation, 24, 55, 114-15, 157, 281
informed consent, 171-74, 285-86
InFuse, 267
injections: diagnosis and treatment, 156-63; epidurals, 13, 156-58, 157; imaging, 82-83, 101, 156-63, 157 (see also discography); intradiscal injections, 82-83, 164; local anesthetic, 277; locations, 157; outcomes, 51-52
instability in spinal joints, 89-92
insurance, 299-302, 304-11
intention, 76-77
interactive therapies, 56
Interbody Fusion System, 220
intercostal nerves, 74, 243
intradiscal anesthetic injections, 164
intradiscal electrothermy (IDET), 128, 164-65, 165
intraoperative electrodiagnostic monitoring, 136, 136-37
introspective methods, 55-56, 58
intubation, 275-76
iodine, 126
irritation of nerves, 140
isometrics, 61
J
joints of the spine: artificial, 259; bone spurs (osteophytes), 85; costovertebral joints, 69; facet joints, 64, 65-66, 159, 164, 243, 259; instability in, 89-92; multiple joint facet syndrome, 159; rehabilitation for, 52-53; risks of surgery, 279-80; slippage in (spondylolisthesis), 89-92, 90, 116; unco-vertebral joint, 192
K
Kadian (morphine slow-release), 34
Kaneda, Kiyoshi, 219
Keppra (levitiracetam), 39
Kerrison punch, 193
Kessler, Richard, 217-18
ketoprofen (Orudis), 29
ketorolac intravenous (Toradol), 29, 30, 276
kidneys, 9, 102
knees, 97, 98
Kuslich, Stephen, 220
kyphoplasty, 196, 197
kyphosis, 191
kyphotic deformity, 191
L
Lamictal (Lamotrigine), 39
lamina, 64, 65, 185, 189, 258
laminectomy, 113, 115, 189-92, 193
laminoplasty, 115, 189-92, 191
Lamotrigine (Lamictal), 39
lasers, 167, 189, 198
lateral mass, 65
lateral mass screws, 238-40, 239, 241
lateral recess stenosis, 194
lateral X-ray, 122
Lauterbur, Paul, 130-31
legal rights, 173-74. See also litigation
legs: anatomy, 74, 76; claudication pain, 13-14; herniation in the lumbar spine, 83; neck injury and, 15; ossification of the posterior longitudinal ligament, 115; sciatica, 11-13; spinal stenosis, 85, 157; spondylolisthesis, 89
levitiracetam (Keppra), 39
liability litigation, 174, 216-18, 223, 278
lidocaine derivative-oral (Mexilitene), 32, 32
lidocaine (injectable anesthetic), 32
lidocaine patch (Lidoderm), 32, 32
lifting, 42-43, 44, 292
ligaments, 10, 10, 92, 92, 100
ligamentum flavum, 87, 187
lioresal (Baclofen), 17, 32
lipomyelomeningocele, 108-9
litigation, 174, 216-18, 223, 278
loading and lubrication, 52
localization, 95
long tracts of white matter, 71-72, 79, 146, 146-47
Lorcet (hydrocodone and Tylenol), 34
lumbar spine: anatomy, 10, 63, 64, 65, 68, 68, 74; artificial lumbar facet joints, 259; exercise-based treatments, 58; foraminotomy, 193; fusion, 91, 251-52, 255, 294; herniation, 83, 97; imaging, 156; implants, 252-56; lumbar disks, 70; lumbar drain, 202; lumbar support, 43, 45; number of vertebrae, 117-18, 118; pain in, 9-10; pedicle screws, 256-58; recovery from surgery, 295; risks of surgery, 279; sciatica, 12, 98; slippage in spinal joints, 91; stenosis, 87; surgery, 251-59, 279, 295; traction, 53
lumbosacral plexus, 74, 76
lungs, 16, 17
Luque system, 215-16
M
magnetic resonance imaging (MRI): carbon-fiber implants, 223, 223; chronic pain, 101; discography, 82, 160; facet blocks, 159; false positives, 96, 156; functions, 130-34; identifying slippage, 89; lumbar spine, 156; MR angiography, 133-34; MR myelogram, 134; MR neurography, 98, 133-34, 134; narrowing of the foramen, 193; osteophytes, 86; surgery within scanners, 226, 227; torn spinal ligaments, 92; types, 132
manipulation, chiropractic, 14, 16, 18-19, 59-60, 61
Mansfield, Sir Peter, 131
manual reduction of fractures, 208-9
Marcaine (injectable anesthetic), 32
marrow, 64
massage, 18-19, 20, 53, 61
median nerves, 74, 99
Medicare, 306-7, 308-9
medications. See also anesthesia; specific drug names: addiction, 37; blood thinners, 276; categories, 25, 28-39, 29, 32, 34, 39; centrally acting pain medications, 39