There has been an exponential increase in the volume and quality of published research relating to spine care over the last several decades. Among thousands of articles, a small fraction has been shown to be truly "game changing," forcing the entire field to pause and take notice. These landmark studies may describe a new procedure or surgical approach, evaluate the relative effects of known treatments or techniques, introduce a new classification system, or provide new insights into natural history or disease prognosis. Such studies form the foundations of spine surgery today.This book will be a useful reference not only to the established spine surgeon, but also to neurosurgery and orthopedic residents, as well as to spine surgery fellows as they continue to fortify their knowledge surrounding spinal disorders. Further, this will no doubt serve as a useful evidence-based resource for trainees studying for professional examinations and perhaps most importantly challenge and inspire clinicians to produce high-quality impactful research.
Table of Contents
Section One: Tumors. 1. Direct Decompressive Surgical Resection in the Treatment of Sspinal Cord Compression Caused by Metastatic Cancer. 2. A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group. 3. Spinal Metastases: Indications for and Results of Percutaneous Injection of Acrylic Surgical Cement. 4. Primary Bone Tumors of the Spine: Terminology and Surgical Staging. 5. A Revised Scoring System for the Preoperative Evaluation of Metastatic Spine Tumor Prognosis. 6. Surgical Strategy for Spinal Metastases. 7. Radiotherapy and Radiosurgery for Metastatic Spine Disease: What Are the Options, Indications, and Outcomes. 8. Feasibility and Safety of En Bloc Resection for Primary Spine Tumors: A Systematic Review by the Spine Oncology Study Group. Section Two: Trauma. 9. The Three-Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries. 10. A Randomized, Controlled Trial of Methylprednisolone or Naloxone in the Treatment of Acute Spinal-Cord Injury. 11. Methylprednisolone for Acute Spinal Cord Injury: An Inappropriate Standard of Care. 12. Fractures of the Odontoid Process of the Axis. 13. Fractures of the Ring of the Axis: A Classification Based on the Analysis of 131 Cases. 14. A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurological Status. 15. A Comprehensive Classification of Thoracic and Lumbar Injuries. 16. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). 17. New Technologies in Spine: Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures. 18. The Subaxial Cervical Spine Injury Classification System: A Novel Approach to Recognize the Importance of Morphology, Neurology, and Integrity of the Disco-Ligamentous Complex. 19. Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). 20. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. Section Three: Degenerative. 21. Lumbar Disc Herniation. A Controlled, Prospective Study with 10 Years of Observation. 22. Radiculopathy and Myelopathy at Segments Adjacent to the Site of a Previous Anterior Cervical Arthrodesis. 23. Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis. 24. Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis. 25. Surgical versus Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. 26. 2001 Volvo Award Winner in Clinical Studies: Lumbar Fusion versus Nonsurgical Treatment for Chronic Low Back Pain: A Multicenter Randomized Controlled Trial from the Swedish Lumbar Spine Study Group. 27. Cervical Spine Fusion in Rheumatoid Arthritis. 28. Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy: Results of the AOSpine North America Prospective Multicenter Study. 29. Radiographic and Pathologic Features of Spinal Involvement in Diffuse Idiopathic Skeletal Hyperostosis. 30. Degenerative Lumbar Spondylolisthesis with Spinal Stenosis: A Prospective, Randomized Study Comparing Decompressive Laminectomy and Arthrodesis with and without Spinal Instrumentation. 31. Laminectomy Plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. 32. A Randomized Control Trial of fusion Surgery for Lumbar Spinal Stenosis. Section Four: Deformity. 33. Adolescent Idiopathic Scoliosis: A New Classification to Determine Extent of Spinal Arthrodesis. 34. Radiographic Analysis of Sagittal Plane Alignment and Balance in Standing Volunteers and Patients with Low Back Pain Matched for Age, Sex, and Size: A Prospective Controlled Clinical Study. 35. Classification of Spondylosis and Spondylolisthesis. 36. Scoliosis Research Society-Schwab Adult Spinal Deformity Classification: A Validation Study. 37. The Impact of Positive Sagittal Balance in Adult Spinal Deformity. 38. The Comprehensive Anatomical Spinal Osteotomy Classification. 39. The Natural History of Congenital Scoliosis. 40. Effects of Bracing in Adolescents with Idiopathic Scoliosis. 41. Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective Multicenter, Propensity-Matched Cohort Assessment with Minimum 2-Year Follow-Up. 42. Spino-Pelvic Sagittal Balance of Spondylolisthesis: A Review and Classification. Section Five: Surgical Technique. 43. The Paraspinal Sacrospinalis-Splitting Approach to the Lumbar Spine. 44. The Treatment of Certain Cervical-Spine Disorders by Anterior Removal of the Intervertebral Disc and Interbody Fusion. 45. Posterior C1-C2 Fusion with Polyaxial Screw and Rod Fixation. 46. Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Imbalance. 47. Transforaminal Lumbar Interbody Fusion: Technique, Complications, and Early Results. Section Six: Pediatrics. 48. Spinal Cord Injury without Radiographic Abnormality in Children—The SCIWORA Syndrome. 49. Pediatric Spinal Trauma: Review of 122 Cases of Spinal Cord and Vertebral Column Injuries. 50. The Tethered Spinal Cord: Its Protean Manifestations, Diagnosis, and Surgical Correction.
Alexander R. Vaccaro, MD, PhD, MBA
Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery
Professor of Neurosurgery
Co-Director, Delaware Valley Spinal Cord Injury Center
Co-Chief of Spine Surgery
Sidney Kimmel Medical Center at Thomas Jefferson University
President, Rothman Institute
Dr. Vaccaro graduated Summa Cum Laude from Boston College in 1983 with a B.S. in Biology. He received his M.D. degree from Georgetown University School of Medicine where he was promoted with "Distinction." He earned membership in the Alpha Omega Alpha (AOA) Honor Society and graduated with honors in 1987. He completed a year of Surgical Internship at Cedars-Sinai Medical Center in Los Angeles, CA and his Orthopaedic Surgery Residency was at Thomas Jefferson University where he graduated in 1992. Dr. Vaccaro completed a Spine Fellowship at the University of San Diego, CA. He earned a PhD in 2007 in the field of Spinal Trauma and a MBA in 2015.
Dr. Vaccaro is the Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery and Professor of Neurosurgery at Thomas Jefferson University in Philadelphia, Pennsylvania. He was the recipient of the Leon Wiltse award given for excellence in leadership and clinical research for spine care by the North American Spine Society (NASS) and is the past President of the American Spinal Injury Association and current President of the Association for Collaborative Spine Research. He has over 700 peer reviewed and 195 non-peer reviewed publications. He has published over 340 book chapters and is the editor of over 58 textbooks and co-editor of OKU-Spine I and editor of OKU-8. Dr. Vaccaro is the President of Rothman Institute, Chairman of the department of Orthopaedic Surgery, Co-Director of the Regional Spinal Cord Injury Center of the Delaware Valley and Co-Director of Spine Surgery at Thomas Jefferson University Hospital where he instructs current fellows and residents in the diagnosis and treatment of various spinal problems and disorders
Charles G. Fisher, MD, MHSc, FRCSC, is an internationally renowned orthopaedic spine surgeon and a core member of the Vancouver Spine Surgery Institute at Vancouver General Hospital. He is a Professor and Director of Clinical Research for the Division of Spine in the Department of Orthopaedics at the University of British Columbia. He is also the former director of the Spine Surgery Fellowship Program for the Division of Spine, educating and mentoring young spine surgeons from around the world in the area of complex spinal surgery. His practice is confined to adult spine surgery, with special clinical and research interests in trauma, oncology and evidence-based medicine. Dr. Fisher is the current President of the Canadian Spine Society and a leader in the development of a National Spine Registry to help physicians and surgeons work collectively across the country to develop better patient treatment protocols and surgical outcomes for spinal patients. He is co-chair of the Spine Oncology Study Group, an international group of spine surgeons committed to advancing the understanding of spine oncology management through education and research. He is also a member and epidemiologic consultant of the Spine Trauma Study Group. In addition, Dr. Fisher co-chairs the AO Spine International Knowledge Forum for Spine Oncology, a panel of thought leaders coordinating international research and education in primary tumours of the spine. Dr. Charles Fisher has authored over 140 peer-reviewed publications and has co-authored a textbook on the evidence-based treatment of spine disorders. He also sits on the Editorial Board of the Journal of Neurosurgery: Spine and is an Associate Editor for the journal Spine. He is a regular guest lecturer at spinal events around the world. SPECIFICATIONS
Jefferson R. Wilson, MD is currently a Spine Surgery Fellow at Thomas Jefferson University in Philadelphia, PA, USA. He is concurrently a Post Doctoral Research Fellow at Toronto Western Hospital – UHN; Spinal Cord Program, Division of Neurosurgery, University of Toronto as he finishes his neurosurgery residency at the University of Toronto training program. His graduate studies are under the supervision of Dr. Michael Fehlings and will ultimately lead to a PhD in clinical research methods and biostatistics. His main research interests are in the realm of spinal trauma, specifically predictive modeling in spinal cord injury, development of new classification systems for spinal trauma and planning and participating in clinical trials investigating new therapies for SCI. His research work is currently supported by post-doctoral fellowship grants from the Christopher and Dana Reeve Foundation as well as from the Cervical Spine Research Society.
"This is a highly useful review of many important studies in the field that are absolutely essential for spine surgeons, residents, medical students, and support staff to know."
Fady Charbel, MD (University of Illinois at Chicago College of Medicine)