Basic Science of Spinal Diseases Alexander R Vaccaro, Alok D Sharan, Simon Y Tang
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fm1BASIC SCIENCE OF SPINAL DISEASES
fm2BASIC SCIENCE OF SPINAL DISEASES
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
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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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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
Alexander R Vaccarofm6
fm7Contributors fm11Foreword
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
Santa Monica, California, USAfm12
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
Philadelphia, Pennsylvania, USAfm14
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
Hong Kong, SAR, Chinafm16
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
Alexander R Vaccarofm18