Low back pain is a very common problem. Various treatments are available, but surgery has acquired increasing importance. In the United States, low back pain is now the principal reason for spinal surgery, and the number of procedures performed for this reason is similar to the number of total hip replacements. Consequently there is a need for careful evaluation of the possible surgical approaches to low back pain, with detailed appraisal of the factors leading to their success or failure. This book aims to meet such a need. It explains the scientific basis for surgery and considers the different diagnostic techniques that may be employed, thereby providing a better understanding of the surgical rationale, indications, and contraindications. The value of conservative options is also assessed to help the reader weigh the need for surgery. The various surgical modalities, including the most recent, are then fully described and evaluated with the aid of numerous illustrations. The book concludes with a chapter devoted to evidence-based analysis of the outcome of surgery in patients with low back pain. This book will be invaluable to orthopaedic and neurosurgeons, rheumatologists, neurologists, and all who are concerned with the effective treatment of this often debilitating condition.

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Contents
Part I Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 The Biology of Intervertebral Disc Degeneration . . . . . . . . . . . . . . . . 3
Cornelia Neidlinger-Wilke and Hans-Joachim Wilke
1.2 Low Back Pain: Where Does the Pain Come From? . . . . . . . . . . . . . . 11
Helena Brisby
1.3 The Role of Cytokines in the Degenerative Spine . . . . . . . . . . . . . . . . 17
Björn Rydevik and Helena Brisby
1.4 Psychosocial Aspects of Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . 23
Christine Cedraschi and Valérie Piguet
1.5 Instability and Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Tommy Hansson
Part II Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
2.1 Dynamic MRI of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
J. J. Abitbol, Soon-Woo Hong, Sana Khan, and Jeffrey C. Wang
2.2 Assessment of Status of End Plate and Diffusion
in Degenerative Disc Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
S. Rajasekaran
2.3 The Role of Physician Extenders in a Low Back Pain Practice . . . . . 57
Michael R. Zindrick, Michael N. Tzermiadianos, Cary R. Templin,
and Raymond E. Hines III
Part III Conservative Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
3.1 Natural Evolution of Nonspecific Low-Back Pain . . . . . . . . . . . . . . . . 65
Michel Benoist and Thibaut Lenoir
3.2 Prescribing Conservative Treatment for Low Back Pain . . . . . . . . . . 73
F. Balagué and J. Dudler
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3.3 Comprehensive Rehabilitation for Low back Pain
and Back Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Margareta Nordin
3.4 The Place of Chiropractic Care in the Treatment
of Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Christopher J. Colloca
3.5 Efficacy of IDET and PIRFT for the Treatment
of Discogenic Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Brian J. C. Freeman
3.6 Lumbar Orthoses to Prevent and Treat Low-Back Pain . . . . . . . . . . . 101
Michel Benoist and Thibaut Lenoir
Part IV Surgical Treatment: Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
4.1 Indication for Lumbar Spinal Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Max Aebi
4.2 Evidence for Efficacy of Pedicle-Based Systems . . . . . . . . . . . . . . . . . 123
Jeremy Fairbank
4.3 Low Back Pain Is Not an Indication for Stabilisation
in Patients Operated for Lumbar Spinal Stenosis . . . . . . . . . . . . . . . . 127
E. Munting
4.4 Hybrid Construct for DDD in the Lumbar Spine:
The Compromise Between Fusion and Nonfusion . . . . . . . . . . . . . . . . 131
J. C. Le. Huec, R. Meyrat, F. Debusscher and S. Aunoble
4.5 The Management of Spondylolysis and Spondylolisthesis . . . . . . . . . 137
Brian J. C. Freeman and Ujjwal K. Debnath
4.6 Transpedicular-Transdiscal-Transcorporal (TPDC)-Fixation . . . . . . 147
Max Aebi
4.7 Facet Problems: A Surgical Indication? . . . . . . . . . . . . . . . . . . . . . . . . 155
F. Pellisé
4.8 Adjacent Level Disease: Myth or Fact . . . . . . . . . . . . . . . . . . . . . 159
David A. Wong and Katherine E. Wong
4.9 Pelvic Girdle Pain: Indication for Surgery? . . . . . . . . . . . . . . . . . . . . . 165
Bengt Sturesson
4.10 Blood Loss Management in Major Spine Surgery . . . . . . . . . . . . . . . . 169
Serena S. Hu and Jeremy A. Lieberman
Contents ix
Part V Surgical Treatment: Other Technologies . . . . . . . . . . . . . . . . . . . . . 175
5.1 How Disc Replacement Fits in the Treatment
Algorithm for Degenerative Disc Disease:
Refining Indications for Disc Replacement . . . . . . . . . . . . . . . . . . . . . 177
Richard D. Guyer and Donna D. Ohnmeiss
5.2 Clinical Factors that May Affect Outcome
in Lumbar Total Disc Replacement. What Is the Evidence? . . . . . . . 183
Michael R. Zindrick, Mark Lorenz, Leonard I. Voronov,
Michael N. Tzermiadianos, and Alexander Hadjipavlou
5.3 A Prospective Randomized Comparison
of Two Lumbar Total Disk Replacements . . . . . . . . . . . . . . . . . . . . . . 193
Richard D. Guyer and Donna D. Ohnmeiss
5.4 Limitations of Lumbar Disk Arthroplasty . . . . . . . . . . . . . . . . . . . . . . 199
Serena S. Hu
5.5 Is Posterior Dynamic Stabilization an Option
to Avoid Adjacent Segment Decompensation? . . . . . . . . . . . . . . . . . . . 207
Missoum Moumene and Jürgen Harms
5.6 Immediate Biomechanical Effects
of Lumbar Posterior Dynamic Stabilisation . . . . . . . . . . . . . . . . . . . . . 213
Brian J. C. Freeman and Caspar E. W. Aylott
5.7 Overview of Pedicle Screw-Based Posterior
Dynamic Stabilization Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Richard D. Guyer, Donna D. Ohnmeiss, and Kevin R. Strauss
5.8 Semirigid Fixation System for the Lumbar Spine . . . . . . . . . . . . . . . . 227
Dieter Grob, Andrea Luca, and Anne F. Mannion
5.9 Nonrigid Stabilization of the Spine Problems Observed:
Screw Loosening/Breakage/Implant Failure/Adjacent
Segment Degeneration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Paul F. Heini
5.10 Interspinous Implants: State of the Art
and Research of Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Marek Szpalski, Robert Gunzburg, Christopher J. Colloca,
and Robert J. Moore
5.11 NuBac Disc Arthroplasty System:
Rationale and Clinical Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Massimo Balsano, Domagoj Coric, and Margreet Derks
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Part VI Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
6.1 Outcome Assessment for Cost-Utility Evaluations:
SF-6D vs. EQ-5D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Rikke S gaard, Terkel Christiansen, and Finn Bjarke Christensen
6.2 Review of the Medical Evidence Regarding
the Surgical Treatment of Low Back Pain . . . . . . . . . . . . . . . . . . . . . . 267
Andrew P. White, Justin G. Brothers, and Alexander R. Vaccaro
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
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