Preface; Contents; Contributors; Part I: Essentials in Lumbar Degenerative Disk Disease; 1: We've Been Standing Up for 10 Million Years; 1.1 Introduction; 1.2 How Did We Become Upright?; 1.2.1 Vertebral Column; 1.2.2 Pelvis; 1.2.3 Lower Limbs; 1.2.4 Upper Limbs; 1.3 Final Considerations; 2: A Historical Overview of Sciatica; 2.1 Introduction; 2.2 Sciatica: Historical Overview; 2.2.1 Final Considerations; References; 3: Lumbar Intervertebral Disk Injury, Herniation and Degeneration; 3.1 Introduction; 3.1.1 Intervertebral Disks; 3.1.2 Disk Injury or Degeneration?
3.1.3 Purpose and Scope of This Chapter; 3.2 Forces Acting on the Lumbar Spine; 3.2.1 Compression, Shear, Bending and Torsion; 3.2.2 Gravitational Loading; 3.2.3 Inertial Forces During Rapid Movements and Falls; 3.2.4 Forces Arising from Muscle Tension; 3.3 Mechanisms of Disk Injury and Prolapse; 3.3.1 Compressive Injury Causes Endplate Fracture; 3.3.2 Torsion and Bending Injuries Tear the Annulus; 3.3.3 Complex Loading Can Cause Disk Herniation; 3.3.4 Endplate Involvement in Disk Prolapse; 3.3.5 Mechanical Consequences of Disk Injury and Herniation.
3.4 Lumbar Disk Ageing and Degeneration; 3.4.1 Inevitable Age-Related Changes in Human Lumbar Disks; 3.4.2 Features of Intervertebral Disk Degeneration; 3.4.3 What Is 'Disk Degeneration'?; 3.4.4 Two Disk Degeneration 'Phenotypes'?; 3.4.5 A 'Final Common Pathway' for Disk Degeneration?; 3.4.6 Disk Degeneration, Back Pain and Sciatica; 3.5 When Do Disk Injuries Occur In Vivo?; 3.5.1 Moderate Mechanical Loading Strengthens the Spine; 3.5.2 'Injury' Occurs When Loading In Excessive; 3.5.3 Repetitive Loading and 'Fatigue Failure'; 3.5.4 Why Are Some Intervertebral Disks so Weak?
3.5.5 Medicolegal Considerations; 3.5.5.1 Disk Degeneration vs Herniation; 3.5.5.2 Must a Disk Degenerate Before It Can Herniate?; 3.5.5.3 Mechanical 'Acceleration' of Disk Degeneration?; 3.5.5.4 Who Is Prone to Injury?; 3.5.5.5 Summary of Recent Scientific Advances; References; 4: Advances in Lumbar Degenerative Disk Disease Pathophysiology Comprehension; 4.1 Chronic Back Pain and Disk Degeneration: Physiology and Pathophysiology of the Ageing Spine; 4.2 Structure and Function of the Normal Disk; 4.3 The Morphology of the Disk During Development and Ageing.
4.3.1 Embryonal and Foetal Development; 4.3.2 The Disk of Infants and Adolescents; 4.3.3 The Disks of Young and Medium-Aged Adults; 4.3.4 The Disks of Adults of Advanced Age; 4.3.5 Particular Morphologic Changes of the End Plate; 4.4 Aetiology of Disk Degeneration and Obvious Factors Influencing Disk Degeneration; 4.4.1 Genetic Predisposition of DDD; 4.4.2 Biomechanical Load; 4.4.3 Metabolic and Nutritional Effects; 4.5 Presumed Molecular Mechanisms of Degeneration; 4.5.1 Matrix-Degrading Enzymes; 4.5.2 Pro-inflammatory Mediators; 4.5.3 Growth Factors.
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In this book, leading international specialists in the field join forces to discuss topics, issues, and approaches that are of key importance in the optimal treatment of lumbar degenerative disk disease. The coverage is wide ranging, from current understanding of physiopathology and genetics and modern imaging techniques through to the diverse minimally invasive, non-fusion, and fusion surgical techniques. Detailed attention is drawn to the most important aspects to be considered when approaching the patient and making treatment decisions. The role of conservative management is appraised, and surgical techniques and their indications are carefully described. Emphasis is placed on the importance of sagittal balance for treatment success. Among the various other subjects covered are psychosocial issues, legal aspects, outcome evaluation, and the relative merits of evidence-based medicine and individual experience. In the concluding section, some of the top specialists from across the world reflect on the lessons that they have learned during lifetimes in spinal surgery. Advanced Concepts in Lumbar Degenerative Disk Disease is intended as the definitive book on this important subject. It will be an instructive and fascinating source of information for all spine surgeons and other spine care providers.