A Short Practice of Spinal Surgery PDF
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Henry V. Crock A Short Practice of Spinal Surgery Second, revised edition With a Contribution on Medical Aspects in the Management of Spinal Surgical Patients by Bryan P Galbally Springer-Verlag Wien GmbH Henry Vernon Crock, A.O., M.D., M.S., F.R.C.S., F.R.A.C.S. Consultant Spinal Surgeon, Senior Lecturer, Honorary Consultant, The Royal Postgraduate Medical School, Hammersmith Hospital and The Cromwell Hospital, London, U.K. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. © 1993 Springer-Verlag Wien Originally published by Springer-Verlag Wien New York in 1993 Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting pharmaceutical literature. The use of registered names, trademarks, etc. in the publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. With 278 partly coloured Figures Frontispiece: From a wood-block by the artist Tate Adams, based on a dissection of the lumbar spine prepared by Dr. Carmel Crock. ISBN 978-3-7091-7370-1 ISBN 978-3-7091-6650-5 (eBook) DOI 10.1007/978-3-7091-6650-5 Foreword This volume is a treatise by a master surgeon on the spine. Mr. Crock has already produced classic papers and beautifully illustrated books on the anatomy of the spine and his studies with injection techniques provide new data on the arterial supply and venous drainage of the vertebral bodies, spinal cord and nerve roots. Using this traditional classical method he describes new approaches to spinal surgery, a particularly difficult field. The text is lucidly written and beautifully illustrated with X-rays, injection studies, dissection specimens, CT and MR scans. These are all of the highest quality and many of the techniques used are new and provide information that was previously not available. Mr. Crock divides surgery of the spine into different sections, in most of which he himself has been responsible for adding important new data, especially in nerve root canal stenosis and internal disc disruption. The book covers all aspects of disc disease and spondylolisthesis and there is also a section on surgery of the cervical spine. I feel that this work - the result of personal research, surgical experience and extreme hard work - will be essential reading for all orthopaedic and neurosurgeons who venture to operate around the delicate spinal cord and its major nerve roots. Sir Roy Caine, F.R.S. Preface In the nine years which have passed since the first edition of this book was published many changes have occurred to modify the practice of spinal surgery. There has been an explosive growth of publications including new journals such as Neuro Orthopaedics, Rachis, The European Spine Journal and hosts of books and mono graphs on many different topics, scientific and clinical, relating to the human spine in health and disease. Burgeoning interest in the whole field of spinal disorders has led to the forma tion of many new spine societies in the 1980's, national and international. Under their influence many of the animosities over the questions of who should treat and operate on patients with spinal problems have begun to break down. Spinal surgery has emerged from the decade as an independent speciality. In this period advances in imaging technology have had the greatest impact on the diagnosis of spinal disorders. The developments in biochemical testing of disc tissues alluded to in the 1983 preface have not had any impact on clinical practice. Hence most practitioners continue to recognise only two forms of disc disease - prolapse or degeneration. Controversy over the treatment of the first persists while the management of the second often remains clouded by uncertainty. Enthusiasm for the treatment of disc prolapses by chemonucleolysis with chymopapain has waned in the North American continent although work on the use of other enzymes such as collagenase continues. Micro-discectomyand percuta neous discectomy have emerged as the latest methods for dealing with some disc prolapses. Finally there have been major developments in the design and application of devices for spinal fixation. I have added important new material while maintaining a rather conservative stand on the use of some of the surgical techniques which have been introduced in the past nine years. I hope that this book will continue to serve as a useful, practical and safe guide to those who care for patients who may require spinal operations. London 1992 Henry V. Crock Photograph: David Bache Since 1986 the author has practised in London. He holds the post of Honorary Senior Lecturer and Consultant Spinal Surgeon in the Department of Orthopaedic Surgery at the Royal Postgraduate Medical School, Hammersmith Hospital and is Director of the Spinal Disorders Unit at the Cromwell Hospital, London where he is joined by his wife Dr. M. C. Crock and Dr. B. P. Galbally. Acknowledgements The second edition of this book has been produced in England with new material derived from my experience while working in London since 1986. I wish to thank the many colleagues who have given me support since my arrival here, too many to be mentioned individually by name. I am particularly grateful to the British Ortho paedic Association for having elected me to Fellowship. When I first returned to London to commence practice I was given remarkable assistance by Mr. J. P. O'Brien, formerly director of the spinal disorders unit at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry. Professor Ruth Bowden (now retired) and Professor C. Sinatamby from the anatomy department at the Royal College of Surgeons of England have both pro vided me with opportunities to perform dissections which are illustrated in this volume. I have had enormous encouragement from my colleagues in the department of orthopaedic surgery at the Royal Postgraduate Medical School, Hammersmith Hospital where in particular I have worked in Mr. J. Patrick England's unit. Profes sor Graham Bydder and Professor Robert Steiner of the MRC research unit for magnetic resonance imaging have given me wonderful assistance. Among my orthopaedic colleagues I am particularly indebted to Peter Baird, John Scott Ferguson, David Sharp, George Raine, and Professor Al Haddad. At the Cromwell Hospital I have to thank many colleagues but especially Dr. Derek Kingsley and Dr. John Dawson with whom I have worked closely in Neuro-radiology, and Dr. Micheal Espir and Dr. Kevin Zilkha in Neurology. The medical directors, Dr. Nizami and Dr. Hameed have provided excellent facilities for the spinal disorders unit. The nursing staff both on the wards and in the theatres and the physiotherapists Misses Vandana Patel and Amanda Capstick have contributed significantly to the care of many of the patients whose problems are discussed in this book. I thank also my European colleagues Professor Franco Postachinni from Rome, Dr. Roberto Binazzi from Bologna and Dr. Giuseppe Tabasso from Turin. I have also received enormous encouragement from Professor Peter Schulitz of the Univer sity of Dusseldorf, and Professor Sven Olerud of the University of Upsalla. X Acknowledgements I am especiallv indebted to Dr. Joseph Assheuer, one of Germany's leading neuro-radiologists from Cologne, for providing me with the most important MRI images which are reproduced in chapters 3 and 8. Professor Norbert Gschwend and Dr. Dieter Grob have given me special assist ance since my arrival in Europe in 1986. Shortly before I completed this manuscript my dear friend and collaborator in the first edition of this book died in Perth, Western Australia. Sir George Bedbrook had been a friend to me and to my twin brother since we were medical students in the University of Melbourne in 1949 when we first had contact with him as a teacher of anatomy. Like us he was also an identical twin. I wish to pay a special tribute to his genius and warm humanity. In addition I wish to record my gratitude to the late Sir Roy Douglas Wright who helped to mould my medical career and that of my twin brother Professor Emeritus Gerard Crock. Pansy Wright wrote the forward to the first edition. He died in 1990. Sir Roy CaIne FRS my friend and colleague since 1957 when we first met as postgraduate students in Oxford has kindly consented to write the Foreword to this edition. I am, as ever, deeply grateful to him. Many of the new drawings in this edition have been prepared by Miss Lizzie Butler who has worked tirelessly in the past few months on the preparation of all the illustrative material. To her lowe a special debt of gratitude. My secretaries Misses Andrea Keenan and Linda Wilkinson have prepared this manuscript most skilfully despite their routine heavy workload. I would also like to thank Dr. Tateru Shiraishi for his remarkable help with the editorial preparation of this manuscript. Finally I wish to thank the staff of Springer-Verlag, Wien for their continuing support. I have had an excellent working relationship with them now for many years. Henry V. Crock Contents 1. Nerve Root Canal Stenosis 1 1.1. Isolated Lumbar Disc Resorption 1 a) Natural History 1 b) Anatomy of the Nerve Root Canals and Intervertebral Foramina 13 i) Normal 13 ii) Pathological 21 c) Venous Obstruction 23 d) Clinical Studies 24 e) Investigations 24 i) Plain X-Rays 24 ii) Radiculography 25 iii) Magnetic Resonance Imaging 25 iv) Lumbar Discography 27 v) Computerised Axial Tomography 27 vi) Epidural Venography 27 f) Operations 27 i) Types 27 ii) Technique of Lumbar Nerve Root Canal and Foraminal Decompressions at L5/S1 Level 30 1.2. Miscellaneous Causes of Nerve Root Canal Stenosis 36 a) Congenital Abnormalities 36 b) Space Occupying Lesions 36 c) Localized Degeneration 41 2. Internal Disc Disruption 45 2.1. Clinical Features 45 a) Symptoms 45 b) Spinal Movements 46
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