Interventional Spine Procedures: A Case-based Approach Alexander R Vaccaro, Jeremy Simon, Mitchell Freedman, Michael J Mehnert
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1INTERVENTIONAL SPINE PROCEDURES: A CASE-BASED APPROACH2
3INTERVENTIONAL SPINE PROCEDURES: A CASE-BASED APPROACH
Editors Jeremy Simon MD Clinical Instructor, Rothman Institute 1118 West Baltimore Pike Media, Pennsylvania, USA Mitchell Freedman DO Medical Director Physical Medicine and Rehabilitation Rothman Institute Associate Professor, Physical Medicine and Rehabilitation Thomas Jefferson University Hospital Philadelphia, Pennsylvania, USA Michael J Mehnert MD Clinical Instructor of Rehabilitation Medicine Thomas Jefferson Medical College Department of Physical Medicine and Rehabilitation Philadelphia, Pennsylvania, USA Alexander R Vaccaro MD PhD Vice Chairman and Professor Department of Orthopedics and Neurosurgery Thomas Jefferson University Philadelphia, Pennsylvania, USA
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Interventional Spine Procedures—A Case-based Approach
First Edition: 2014
9789351521693
Printed at:
5Dedicated to
My wonderful wife, Karen Simon, who is the smartest person I know and a dedicated wife, mother and OB/Gyn. She is an unending supply of encouragement, support and inspiration. I also dedicate this book to my beautiful children, Zachary and Rosanna Simon, who had to sacrifice some time with Daddy to let him work on this book. Lastly, to my wonderful parents Alan and Jill Simon, who encouraged me to be the best I could be.
Jeremy Simon
This book is a reflection of the hard work and dedication of Jeremy Simon, Michael Mehnert and the Physical Medicine and Rehabilitation team of the Rothman Institute.
Mitchell Freedman
For the many great teachers, I have had along the way….
Michael J Mehnert
Effective spinal care without the support of pain management physicians specializing in diagnoses, medicinal treatment, physical therapy, diagnostic and interventional injections and behavioral therapy would be nonexistent.
Alexander R Vaccaro
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7Contributors 9Preface
This book is intended as a teaching tool to reinforce the concepts of common problems encountered in the spine clinic. It presents real case scenarios and emphasizes the importance of a thorough history and physical examination, as well as confirmation via appropriate imaging. The judicious and appropriate use of procedures in spine care cannot be stressed enough. Proper patient selection and realistic goals, as well as the use of a multi-disciplinary approach are paramount to patient success. This text may be used in the clinic and as a spring-board for discussion as well, as other treatments may often be considered in select patient presentations.
We hope that you find this text educational and thought-provoking.
Jeremy Simon
Mitchell Freedman
Michael J Mehnert
Alexander R Vaccaro
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11Acknowledgments
I would like to give special thanks to my right hand and medical assistant Esther Coward, my caring and dedicated nurses Stephanie Graham rn bsn and Merrie Fitzgerald rn, and my awesome X-ray Technician Patricia Chase. All of you played an important role in obtaining pictures and treating my patients with dignity and respect.
I would also like to thank my mentor, friend and former fellowship director Michael Furman md ms who taught me to be a clinician first and interventionalist second. He also taught me how to thoughtfully approach interventional spine procedures.
Many thanks to M/s Jaypee Brothers Medical Publishers (P) Ltd. New Delhi, India, for their invaluable guidance and support in this endeavor.
Jeremy Simon
23Introduction
As clinician-instructors, we often teach during office hours or in the procedure room. Having a case-based, concise text for reference and to drive home the important teaching points and patient presentations for clinical vignettes serves as an efficient tool. This book is intended to introduce common problems and presentations faced in the practice of interventional spine care.
This text is not intended to be a purely a “how-to” book on interventional procedures. A formal fellowship with experienced and competent instructors is recommended for learning safe and proper technique. This text is also not meant to suggest that all patients with these presentations should have a procedure as a treatment. Appropriate non-invasive conservative care and careful patient selection is paramount to ethical care. In addition, procedures performed for pain should be used judiciously and presented as therapeutic options, not as the only method of treatment.
As a clinician and a teacher, having texts for medical students, residents and fellows to refer is very helpful to direct their learning. There are several excellent and comprehensive books for reinforcing interventional techniques in spine care. There are excellent texts that give detailed background information and in-depth discussions regarding pathophysiology and pharmacology.
The purpose of this text is to allow the clinician-instructor to present a typical pain pattern, patient history and physical examination findings with appropriate imaging and their interpretation. We emphasize the importance of the history and physical examination, as well as alternative treatment options.
All of the contributors in this book practice musculoskeletal medicine and these vignettes represent real patients in our practices. The bolded type in the physical examination section is intended to emphasize clues to making the diagnosis.
We hope that you find this text to be educational and informative.