Editors Alok D Sharan MD
Chief, Orthopedic spine service Montefiore medical center Assistant professor Albert Einstein College of medicine Bronx, New York, USA
Simon Y Tang PhD
Assistant Professor Orthopedic Surgery, Biomedical Engineering, Mechanical Engineering and Materials Science Washington University, St Louis Musculoskeletal Research Center, St Louis, Missouri, USA
Alexander R Vaccaro MD PhD
The Everrett J and Marion Gordon Professor of Orthopedic Surgery Professor of Neurosurgery Co-Director of the Delaware Valley Spinal Cord Injury Center Co-Chief, Spine Surgery Co-Director, Spine Surgery Thomas Jefferson University and the Rothman Institute Philadelphia, Pennsylvania, USA
Forewords Jeffrey C Wang Ashwini Sharan Kenneth MC Cheung
JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD
Courtesy of the first photograph on the cover of the book: Ruiz S, Brennand K, Panopoulos AD, Herrerias A, Gage FH, et al. (2010) High-Efficient Generation of Induced Pluripotent Stem Cells from Human Astrocytes. PLoS ONE 5(12): e15526. doi:10. 1371/journal.phone.0015526fm4
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This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Basic Science of Spinal Diseases
First Edition:2013
9789350904695
Printed at:
fm5Dedication
I would like to dedicate this book to my wife Radhika whose enduring support and
dedication provides me with the strength to pursue an academic career.
To my kids, Raina and Arjun, who provide me with the daily pleasures in life
Alok D Sharan
I gratefully dedicate this text to my parents, who have inspired me to be
intellectually curious and to pursue my dreams, and Nikki,
who has always been supportive of my endeavors
Simon Y Tang
As I age, I understand the great importance of the values instilled in me by my parents,
Alexander and Sue Vaccaro. May I strive to walk in their footsteps as
I raise my kids and take care of my family
fm7Contributors
- Howard S An md
- The Morton International Professor
- Director of Spine Surgery
- Department of Orthopedic Surgery
- Rush University Medical Center
- Chicago, Illinois, USA
- D Greg Anderson md
- Professor, Departments of Orthopedic
- and Neurological Surgery
- Thomas Jefferson University
- Rothman Institute
- Philadelphia, Pennsylvania, USA
- Antigone Aryriou
- Resident
- Department of Rehabilitation Medicine
- Montefiore Medical Center
- Bronx, New York, USA
- Joshua D Auerbach md
- Chief of Spine Surgery
- Bronx-Lebanon Hospital Center
- Assistant Professor of Orthopedic
- Surgery
- Albert Einstein College of Medicine
- Department of Orthopedics
- Bronx, New York, USA
- Evan Baird md
- Resident
- Department of Orthopedic Surgery
- Mt Sinai School of Medicine
- New York, NY, USA
- Edward C Benzel md
- Chairman
- Department of Neurosurgery
- Neurological Institute
- Cleveland Clinic
- Cleveland, Ohio, USA
- Niklas Bergknut DVM phd
- Department of Clinical Sciences of
- Companion Animals
- Faculty of Veterinary Medicine
- Utrecht University
- Utrecht, The Netherlands
- Tarun Bhalla MD PhD
- Cleveland Clinic
- Department of Neurological Surgery
- Cleveland, Ohio, USA
- Scott D Boden md
- Director
- The Emory Orthopedics and
- Spine Center
- Professor and Vice Chair
- Department of Orthopedic Surgery
- The Emory University School of
- Medicine
- Staff Physician
- Atlanta VA Medical Center
- Atlanta, Georgia, USA
- Christopher M Bono md
- Chief, Orthopedic Spine Service
- Associate Professor
- Harvard Medical School
- Brigham and Women's Hospital
- Boston, Massachusetts, USA
- Brian Braaksma md
- Rockford Orthopedic Associates
- Rockford, Illinois, USA
- Allan L Brook md fsir
- Director of Interventional
- Neuroradiology
- Montefiore Medical Center
- Professor of Clinical Radiology and
- Neurosurgery
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Alan Carl md
- Professor of Surgery and Pediatrics
- Albany Medical College
- Albany, New York, USA
- Eugene J Carragee md
- Department of Orthopedic Surgery
- Stanford University School of
- Medicine
- Redwood City, California, USA
- Ferdinand Chan bs
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Joseph S Cheng md ms
- Associate Professor of
- Neurological Surgery
- Director
- Neurosurgery Spine Program
- Vanderbilt University Medical Center
- Nashville, Tennessee, USA
- Isabelle Citone
- Albany Medical Center
- Albany, New York, USA
- Jason M Cuéllar md phd
- Resident
- NYU Hospital for Joint Diseases
- Department of Orthopedic Surgery
- New York, NY, USA
- Ashvin K Dewan md
- Orthopedic Resident
- Department of Orthopedic Surgery
- Johns Hopkins School of Medicine
- Batlimore, Maryland, USA
- Wouter JA Dhert md phd
- Department of Clinical Sciences of Companion Animals
- Faculty of Veterinary Medicine
- Utrecht University
- Utrecht, The Netherlands
- Tiffany R Dugan md
- Resident
- Department of Orthopedic Surgery
- University of Pittsburgh School of
- Medicine
- Pittsburgh, Pennsylvania, USA
- Thomas J Errico md
- Professor of Orthopedic and
- Neurologic Surgery
- NYU School of Medicine
- Chief, Division of Spine Surgery
- NYU Hospital for Joint Diseases
- New York, NY, USA
- Research Coordinator
- Rush University Medical Center
- Chicago, Illinois, USA
- Bhavuk Garg mbbs ms (orth) mrcs
- Assistant Professor
- Department of Orthopedics
- All India Institute of Medical Sciences
- New Delhi, India
- John German md
- Department of Neurologic Surgery
- Albany Medical Center
- Albany, New York, USA
- Jason H Ghodasra
- Northwestern School of Medicine
- Chicago, Illinois, USA
- Andrew I Gitkind md
- Chief of Interventional Spine
- Assistant Professor of Phyiscal
- Medicine and Rehabilitation
- Montefiore Medical Center and
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Regina Hanstein phd
- Department of Neuroscience
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Herman AW Hazewinkel dvm phd
- Department of Clinical Sciences of
- Companion Animals
- Faculty of Veterinary Medicine
- Utrecht University
- Utrecht, The Netherlands
- Wellington K Hsu md
- Assistant professor
- Department of Orthopedic Surgery
- Director of Research
- Northwestern Feinberg School of
- Medicine
- Chicago, Illinois, USA
- Keita Ito md scd
- Professor of Orthopedic
- Biomechanics
- Department of Biomedical
- Engineering
- Eindhoven University of Technology
- Eindhoven, The Netherlands
- Walter Jacobsen do
- Department of Neurologic Surgery
- SUNY Upstate Medical Center
- Syracuse, New York, USA
- Shiveindra Jeyamohan md
- Neurologic Surgery
- Albany Medical Center Albany
- New York, USA
- James D Kang md
- Professor of Orthopedic and
- Neurological Surgery
- UPMC Endowed Chair in Spine Surgery
- Vice Chairman
- Department of Orthopaedic Surgery
- Director of Ferguson Laboratory for Spine Research
- University of Pittsburgh School of Medicine
- Pittsburgh, Pennsylvania, USA
- Rishi M Kanna ms mrcs fnb Spine
- Associate Consultant
- Spine Surgery, Ganga Hospital
- Coimbatore, Tamil Nadu, India
- Christopher K Kepler md mba
- Assistant Professor
- Department of Orthopaedic Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- A Jay Khanna md mba
- Associate Professor of Orthopedic
- Surgery and Biomedical Engineering
- Johns Hopkins University
- Bethesda, Maryland, USA
- Hendrik-Jan C Kranenburg dvm phd
- Resident small animal surgery (ECVS)
- Department of Clinical Sciences of
- Companion Animals
- Faculty of Veterinary Medicine
- Utrecht University
- Utrecht, The Netherlands
- Virginie Lafage phd
- Director, Spine Research
- NYU Hospital for Joint Diseases
- New York, NY, USA
- William Lavelle md
- Assistant Professor
- Department of Orthopaedic Surgery
- SUNY-Upstate Medical Center
- Syracuse, New York, USA
- Eric H Ledet phd
- Associate Professor
- Department of Biomedical
- Engineering
- Rensselaer Polytechnic Institute
- Troy, New York, USA, and
- Adjunct Professor
- Division of Orthopedic Surgery
- The Albany Medical College
- Albany, New York, USA
- Dante Leven DO PT
- SUNY Downstate Medical Center
- Brooklyn, New York, USA
- William D Long III md
- Resident Physician
- Department of Orthopedics and
- Rehabilitation
- Yale University School of Medicine
- New Haven, Connecticut, USA
- Andres Maldonado md
- Neurosurgery Resident
- Cleveland Clinic
- Department of Neurological Surgery
- Cleveland, Ohio, USA
- Kevin B McGowan phd
- Musculoskeletal Clinical Regulatory
- Advisers LLC
- Washington DC, USA
- Björn P Meij dvm phd
- Department of Clinical Sciences of
- Companion Animals
- Faculty of Veterinary Medicine
- Utrecht University
- Utrecht, The Netherlands
- Emmanuel N Menga md
- Resident
- Department of Orthopedic Surgery
- The Johns Hopkins University School
- of Medicine
- The Johns Hopkins Hospital
- Baltimore, Maryland, USA
- Resident Physician
- Department of Orthopedic Surgery
- University of Pennsylvania
- Philadelphia, Pennsylvania, USA
- Abhay Nene mbbs
- Consultant Spine Surgeon
- PD Hinduja National Hospital
- VS Marg, Mahim
- Mumbai, Maharashtra, India
- Michael S Nickoli md
- Resident Physician
- Northwestern University Feinberg
- School of Medicine
- Department of Orthopaedic Surgery
- Chicago, Illinois, USA
- Edwin Numsuwan md
- Montefiore Medical Center
- Department of Physical Medicine and
- Rehabilitation
- Division of Interventional Spine
- Assistant Professor of Physical
- Medicine and Rehabilitation
- Bronx, New York, USA
- Matthew Oglesby ba
- Medical Student
- Penn State University Hershey
- Medical Center
- Hershey, Pennsylvania, USA
- F Cumhur Öner md phd
- Department of Orthopedics
- Utrecht University Medical Center
- Utrecht University
- Utrecht, The Netherlands
- Dean Papaliodis md
- Orthopaedic Surgery
- Albany Medical Center
- Albany, New York, USA
- Alpesh A Patel md facs
- Associate Professor
- Department of Orthopedic Surgery
- Northwestern University
- Chicago, Illinois, USA
- Ashish Patel md
- Resident Physician
- SUNY Downstate Medical Center
- Brooklyn, New York, USA
- Miguel Pelton bs
- Medical Student
- Georgetown University School of
- Medicine
- Washington DC, USA
- Srinivas Prasad ms md
- Assistant Professor
- Director, Spine Fellowsip Program
- Division of Spine and Peripheral
- Nerve Surgery
- Department of Neurological Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Xuan Qiu md
- Resident
- Department of Orthopedic Surgery
- Montefiore Medical Center
- Bronx, New York, USA
- Sheeraz Qureshi md mba
- Assistant Professor
- Orthopedic Surgery
- Spinal Surgery
- Mount Sinai Hospital
- Mount Sinai School of Medicine
- New York, NY, USA
- S Rajasekaran ms(ortho) dnb(ortho) mch (liverpool) phd
- Chairman
- Department of Orthopedic and
- Spine Surgery
- Ganga Hospital, Coimbatore
- Adjunct Professor
- Dr MGR Medical University
- Coimbatore, Tamil Nadu, India
- Raj D Rao md
- Professor of Orthopedic Surgery and
- Neurosurgery
- Vice Chairman
- Department of Orthopedic Surgery
- Medical College of Wisconsin
- Milwaukee, Wisconsin, USA
- Ratnav Ratan mbbs ms(ortho)
- Senior Resident
- Department of Orthopedics
- All India Institute of Medical Sciences
- New Delhi, India
- Timothy T Roberts md
- Orthopedic Surgery
- Albany Medical Center
- Albany, New York, USA
- Frank Schwab md
- NYU Hospital for Joint Diseases
- Chief of the Spinal
- Deformity Service
- Clinical Associate Professor
- New York University School of Medicine
- New York, NY, USA
- Ahmed Shakir md
- Department of Neurologic Surgery
- Vanderbilt University Medical Center
- Nashville, Tennessee, USA
- Alok D Sharan md
- Chief, Orthopedic spine service
- Montefiore Medical Center
- Assistant Professor
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Kartik Shenoy bs
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Ajoy P Shetty ms dnb ortho
- Consultant
- Spine Surgery
- Ganga Hospital
- Coimbatore, Tamil Nadu, India
- Andrew K Simpson md
- Spine Fellow
- Emory University School of Medicine
- Emory Spine Center
- 59 Executive Park South
- Atlanta, Georgia, USA
- Kern Singh md
- Associate Professor
- Department of Orthopedic Surgery
- Rush University Medical Center
- Chicago, Illinois, USA
- Orthopedic Resident
- Department of Orthopedics
- Rush University Medical Center
- Chicago, Illinois, USA
- Lucas A Smolders dvm phd
- Department of Clinical Sciences of
- Companion Animals
- Faculty of Veterinary Medicine
- Utrecht University
- Utrecht, The Netherlands
- William R Spiker md
- Orthopedic and Neurosurgical Fellow
- Spine Surgery
- The Rothman Institute
- Thomas Jefferson University
- Philadelphia, Pennsylvania, USA
- Jeffrey M Spivak md
- Director, Spine Center
- NYU Hospital for Joint Diseases
- Department of Orthopedic Surgery
- New York, NY, USA
- David C Spray phd
- Professor
- Dominick P Purpura
- Department of Neuroscience and
- Department of Medicine (Cardiology)
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Isaac Syrop bs
- Albert Einstein College of Medicine
- Bronx, New York, USA
- Simon Y Tang phd
- Assistant Professor
- Orthopedic Surgery, Biomedical
- Engineering, Mechanical Engineering
- and Materials Science
- Washington University, St Louis
- Musculoskeletal Research Center
- St Louis, Missouri, USA
- Marianna A Tryfonidou dvm phd
- Department of Clinical Sciences of Companion Animals
- Faculty of Veterinary Medicine
- Utrecht University
- Utrecht, The Netherlands
- Alexander R Vaccaro md phd
- The Everrett J and Marion Gordon
- Professor of Orthopedic Surgery
- Professor of Neurosurgery
- Co-Director of the Delaware Valley
- Spinal Cord Injury Center
- Co-Chief Spine Surgery
- Co-Director Spine Surgery
- Thomas Jefferson University and the
- Rothman Institute
- Philadelphia, Pennsylvania, USA
- Antonio Valdevit phd
- Assistant Professor
- Department. of Chemistry, Chemical
- Biology and Biomedical Engineering
- The Stevens Institute of Technology
- Hoboken, New Jersey, USA
- Sayed E Wahizi md
- Department of Physical Medicine
- Montefiore Medical Center
- Bronx, New York, USA
- Jianru Wang md phd
- Professor
- Department of Spine Surgery
- The First Affiliated
- Hospital of Sun, Yat-sen University
- Guangzhou, PR China
- Mei Wang phd
- Associate Professor
- Department of Orthopedic Surgery
- Medical College of Wisconsin
- Milwaukee, Wisconsin, USA
- Peter G Whang md facs
- Associate Professor
- Department of Orthopedics and
- Rehabilitation
- Yale University School of Medicine
- New Haven, Connecticut
- USA
- Adam L Wollowick md
- Assistant Professor
- Department of Orthopedic Surgery
- Bronx, New York
- USA
- Cyrus Wong md
- Resident Physician
- Department of Neurologic Surgery
- Vanderbilt University
- Medical Center
- Nashville, Tennessee
- USA
- Chengyuan Wu md msbme
- Resident Physician
- Department of Neurological Surgery
- Thomas Jefferson University
- Philadelphia, Pennsylvania
- USA
- Praveen K Yalamanchili md
- Attending Spine Surgeon
- Seaview Orthopedic
- Ocean, New Jersey, USA
- Zhaomin Zheng md phd
- Professor
- Deputy Head
- Department of Spine Surgery
- The First Affiliated
- Hospital of Sun
- Yat-sen University
- Guangzhou, PR China
There are a number of textbooks in the field of spinal surgery, and although there are some differences between them, many are structured the same and may contain the same basic information. It is very refreshing to see a new textbook that breaks new ground in the spine surgery arena.
I congratulate all the editors and the authors of this particular textbook for their unique vision in creating this novel approach to presenting the pathology of the spine. Not only is the information contained in this book new, but the combination of looking into the basic science and animal models of disease processes, along with the biomechanics and the clinical aspects of the pathology of spinal diseases, is truly revolutionary. There is no other source that contains this information, and is itself a new way for spine surgeons to approach the diseases of the spine. The foundation for the disease processes is presented, and the basic science and biomechanics of our proposed treatments is also presented. I am especially excited for young spine surgeons and those residents and fellows in training programs. I feel that this textbook will allow them to learn about spine surgery in a unique way that will allow them a better understanding of the current status of our knowledge of the spine.
The structure of the clinical chapters start with a relevant case presentation, followed by the supporting information. Each chapter then ends with three questions for future investigations. There are also chapters on relevant animal models for spinal research that allows basic science researchers to understand the current status of spinal research. This is an invaluable collection of information for those looking to start laboratory research in many areas of spinal research. I am not aware of any other resource that collates this particular information.
The authors are all knowledgeable experts in their fields and the chapters contain all the latest information in their specific areas. The editors who have created this vision should be congratulated and very proud of this very impressive collection of information. The entirety of the chapters come together to form a very unique educational resource. I am very excited by this particular textbook and look forward to future updates.
Jeffrey C Wang md
Vice Chair of Clinical Operations
UCLA Department of Orthopedic Surgery
Chief, Orthopedic Spine Service
Professor of Orthopedic Surgery and Neurosurgery
UCLA Comprehensive Spine Center
fm13Foreword
Basic Science of Spinal Diseases is a first of its kind book that consolidates 30 chapters of science basics and many of the key components that form the foundation for modern treatment paradigms for patients with spinal disease.
The editors have to be congratulated in compiling this particular set of works by experts in the field of spinal diseases. The core basis of the book is organized in four major sections: Anatomy and Physiology of the Intervertebral Disc, Pathophysiology of the Intervertebral Disc, The Science of Spinal Instrumentation, and The Science of Spinal Interventions. Following this, the editors have formatted every chapter to begin with a clinical presentation, followed by a full discussion of the science in the particular area, and ending with questions for future investigation. The chapters cover both animal and clinical research providing interest to both scientists and clinicians.
The current treatment of spinal disorders is quite fragmented and patients often seek guidance from a variety of specialists such as physiatrist, neurologists, physical therapists, neurosurgeons, and orthopedic surgeons. Most commonly the treatments are based on anecdotal evidence and not scientific methodologies. Basic Science of Spinal Diseases is the only book currently available that brings to this field a compilation of the scientific works necessary for anyone's sound understanding of spinal disease. This book is an asset for many different types of readers, and should become a MUST KEEP text for all young readers entering the field of spinal disorders.
Ashwini Sharan md facs
Professor of Neurosurgery and Neurology
Chief, Division of Functional Neurosurgery
Neurosurgical Program Director
Department of Neurosurgery
Thomas Jefferson University
fm15Foreword
As a spine surgeon, I find that I am being increasingly exposed to a myriad of new treatment options for spinal disorders, from mechanical motion preservation technologies, to new surgical approaches and biological solutions. I feel that in order for us to make rational decisions on the best treatment for our patients, one needs a firm grounding on the science behind such technologies and techniques.
The name of this book, Basic Science of Spinal Diseases, belies its intended readership. I feel that this book would be very useful for everyday practicing spine professionals, as it provides a comprehensive overview of the science behind the current, and possibly, future technologies. Whether you are a spine surgeon, an allied health professional or a basic scientist, this book will provide you with an understanding of the state-of-the-art in this field. Not only will you be better informed for making choices for your patients, you will also be better equipped with relevant knowledge, such that you can follow the literature on the science of spinal diseases more easily.
I would like to congratulate the editors and the authors for having the vision to write a clinically relevant book on the science of spinal diseases. I look forward to future iterations of this book as our knowledge in the basic sciences advance.
Kenneth MC Cheung MBBS(UK) MD(HK) FRCS FHKCOS FHKAM(Orth)
Jessie Ho Professor in Spine Surgery
Head, Department of Orthopedics and Traumatology
The University of Hong Kong
fm17Preface
The field of spine surgery is currently undergoing an exciting rapid evolution. Historically, spinal fusion was seen as the only treatment for patients with a variety of disorders. Through a natural progression, as well as recognition of its unintended consequences, practitioners have begun to look for solutions beyond fusion. Although not universally accepted, the spine community is evaluating the role of motion-preserving technologies, including disc replacements and dynamic systems, as alternatives to fusions. Beyond these technologies, there are investigators who are examining new and novel regenerative therapies including stem cell delivery and growth factor modulation.
This book grew out of many conversations over research collaborations between a spine surgeon and an orthopedic scientist. As the dialogue continued, it became apparent that a resource, such as the one that we have compiled here, that surveys the current state-of-the-art knowledge in spinal diseases and treatments, would be of tremendous benefit to us. We hope that the readers would find this text to be equally valuable in their own academic endeavors. Critical to the adaptation and widespread clinical implementation of these treatments and therapies is a deep understanding of the theories and science behind disease mechanisms of spinal disorders and their treatments.
Basic Science of Spinal Diseases represents the work of numerous international and national surgeons who have performed translational research, as well as basic science investigators who are authorities in physiology, biology, biomechanics, mechanobiology, and beyond. Our hope is that this book will provide the foundation in knowledge for any individual who is interested in developing new solutions for spinal disorders. Chapters have also been included that discuss the patent process as well as the regulatory pathway for individuals who would like to further their ideas.
A textbook of this enormity could have only been completed with the help of many individuals. The editors would first like to thank our publishers, in particular Ms Chetna Malhotra Vohra (Senior Manager—Business Development), Ms Saima Rashid and Ms Payal Bharti of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their help in completing this project. The authors have done a tremendous job in providing outstanding content, and we are grateful for their contributions. We would also like to acknowledge the hard work put in by Ferdinand Chan for his help in finalizing all the chapters.
Alok D Sharan
Simon Y Tang