Seminars in Spine Surgery RSS feed: Current Issue. Seminars in Spine Surgery is a continuing source of current, clinical information for practicing surgeons. Under the direction of a specially selected guest editor, each issue addresses a single topic in the management and care of patients. Topics covered in each issue include basic anatomy, pathophysiology, clinical presentation, management options and follow-up of the condition under consideration. The journal also features "Spinescope," a special section providing summaries of articles from other journals that are of relevance to the understanding of ongoing research related to the treatment of spinal disorders. http://www.semspinesurg.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Seminars in Spine Surgery1040-7383234December 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semspinesurg.com/article/PIIS1040738311000712/abstract?rss=yesMasthead10.1053/S1040-7383(11)00071-2Seminars in Spine Surgery 23, 4 (2011)2011-12-01Seminars in Spine Surgery2011-12-01234S1040-7383(11)X0005-9IFCIFChttp://www.semspinesurg.com/article/PIIS1040738311000724/abstract?rss=yesContributors10.1053/S1040-7383(11)00072-4Seminars in Spine Surgery 23, 4 (2011)2011-12-01Seminars in Spine Surgery2011-12-01234S1040-7383(11)X0005-9iihttp://www.semspinesurg.com/article/PIIS1040738311000748/abstract?rss=yesForthcoming/Previous Issues10.1053/S1040-7383(11)00074-8Seminars in Spine Surgery 23, 4 (2011)2011-12-01Seminars in Spine Surgery2011-12-01234S1040-7383(11)X0005-9iiiiiihttp://www.semspinesurg.com/article/PIIS104073831100075X/abstract?rss=yesTable of Contents10.1053/S1040-7383(11)00075-XSeminars in Spine Surgery 23, 4 (2011)2011-12-01Seminars in Spine Surgery2011-12-01234S1040-7383(11)X0005-9ivivhttp://www.semspinesurg.com/article/PIIS1040738311000463/abstract?rss=yesDuring the past few years, lumbar fusion has been examined with exacting scrutiny by medical professionals as well as the federal government, private insurance payers, and the lay press. Perhaps the root of the onslaught of these inquiries has been the general perception of unreliable outcomes of fusion for low back pain coupled with the rising cost and complexity of such surgeries. Although this indication has deservedly come under fire from nearly all angles, both within and outside spine surgical groups, it has vortexed the appropriateness of lumbar fusion for nearly all other indications into a sea of uncertainty. In a 2006 Medicare Coverage Advisory Committee (MCAC) meeting, what began as a review of fusion for discogenic low back pain quickly morphed into a reappraisal of fusion for all degenerative conditions, including spondylolisthesis, scoliosis, and spinal stenosis. More recently, private insurers have issued stringent criteria by which decisions to cover any lumbar fusion are to be made. Functioning as so-called appropriateness criteria, these policies make specific provisions for which diagnoses and circumstances fusion will be covered, including trauma, tumors, infections, and degenerative disorders. Unfortunately, spinal surgeons have had little input in the development of these coverage policies. Because they are the producers of the evidence that has fueled these decisions and are incomparably poised to make decisions in patients' best interest, it is fitting that this issue of Seminars in Spine Surgery is devoted to an in-depth and comprehensive discussion of lumbar fusion for a wide breadth of spinal disorders.IntroductionChristopher M. Bono10.1053/j.semss.2011.05.001Seminars in Spine Surgery 23, 4 (2011)2011-07-11Seminars in Spine Surgery2011-07-11234S1040-7383(11)X0005-9217217http://www.semspinesurg.com/article/PIIS1040738311000505/abstract?rss=yesThe U.S. population is living longer and staying increasingly more active. Symptoms of degenerative lumbar spinal stenosis are being seen with increasing frequency in older age groups. Many of the more symptomatic patients do not respond to nonoperative care and seek potential surgical solutions. The current article offers an evidence-based review of the literature for surgical treatment of degenerative lumbar spinal stenosis with a focus on the role of lumbar fusion. The author evaluates the evidence for surgical treatment of this condition so that appropriate, patient-centered care can be provided in the safest and most cost-effective manner possible.If, When, and How to Fuse When Treating Lumbar Degenerative StenosisWilliam C. Watters10.1053/j.semss.2011.05.005Seminars in Spine Surgery 23, 4 (2011)2011-07-11Seminars in Spine Surgery2011-07-11234S1040-7383(11)X0005-9218221http://www.semspinesurg.com/article/PIIS1040738311000475/abstract?rss=yesAdult degenerative deformities of the lumbar spine can present with a myriad of radiographic and clinical characteristics. Growing evidence suggests that the pain and disability emanating from the musculoskeletal degeneration of the spine and the resulting neural compression (ie, stenosis) can be successfully treated with surgery in properly selected patients. In addition to the often difficult decision to proceed with surgical treatment, the surgical instrumentation and fusion of adult lumbar deformities involve complex decision making and surgical planning. Important and potentially controversial decisions include the selection of fusion levels as well as the selection of surgical approaches, correction techniques, and the use of osteotomies.Fusing Adult Degenerative Deformities of the Lumbar SpineCharles H. Crawford, Steven D. Glassman10.1053/j.semss.2011.05.002Seminars in Spine Surgery 23, 4 (2011)2011-07-11Seminars in Spine Surgery2011-07-11234S1040-7383(11)X0005-9222226http://www.semspinesurg.com/article/PIIS1040738311000487/abstract?rss=yesChronic low back is one of the most common reasons that patients seek medical attention. There is little agreement on how to treat pain that persists despite an adequate trial of conservative care. When the pain generator can be determined, a logical and targeted treatment plan can be implemented. Diskography can be used to identify an abnormal, painful disk, although the value and safety of this diagnostic tool have been debated. Lumbar fusion for chronic low back pain remains a contentious issue that has been widely debated; however, many studies have inherent flaws that weaken their conclusions. Procedures that do not include interbody fusion ignore the role of the painful disk and might be associated with poorer results. With proper attention to selecting the correct patient, identifying the correct diagnosis, and choosing the correct procedure, good outcomes can be achieved with lumbar fusion for discogenic low back pain.Lumbar Fusion: A Defensible Option for Discogenic Low Back Pain?James E. McGrory, Richard D. Guyer10.1053/j.semss.2011.05.003Seminars in Spine Surgery 23, 4 (2011)2011-10-03Seminars in Spine Surgery2011-10-03234S1040-7383(11)X0005-9227234http://www.semspinesurg.com/article/PIIS1040738311000499/abstract?rss=yesInterest in minimally invasive surgery (MIS) of the spine is on the rise because of advertised advantages over standard open procedures as well as a perceived benefit in perioperative morbidity and patient recovery. This article reviews the current literature concerning MIS lumbar fusion and examines the evidence supporting these proposed advantages along with the limitations of these technically challenging techniques. From the available data, some perioperative advantages might be supported, although the evidence is not robust. In addition, concerns have been raised regarding the potential for increased complications as well as the lack of long-term results with MIS lumbar fusion.Minimally Invasive Lumbar FusionAndrew J. Schoenfeld10.1053/j.semss.2011.05.004Seminars in Spine Surgery 23, 4 (2011)2011-07-11Seminars in Spine Surgery2011-07-11234S1040-7383(11)X0005-9235241http://www.semspinesurg.com/article/PIIS1040738311000554/abstract?rss=yesFor patients with symptomatic recurrent disk herniations that have failed nonoperative treatment, surgical treatment can be considered. Although simple repeat diskectomy can be an effective treatment for first time recurrences, many surgeons would consider the addition of fusion, particularly for second or third recurrences. With a lack of high-level evidence, decision making concerning when and how to fuse for a recurrent lumbar disk herniation remains largely surgeon-dependent because a variety of options are available. Although there are limited data, both posterolateral and interbody fusion can be effective. Future study is needed to better define the indications and ideal method of fusion for recurrent disk herniations.The Role of Fusion for Recurrent Disk HerniationsRobert M. Greenleaf, Mitchel B. Harris, Christopher M. Bono10.1053/j.semss.2011.05.010Seminars in Spine Surgery 23, 4 (2011)2011-07-11Seminars in Spine Surgery2011-07-11234S1040-7383(11)X0005-9242248http://www.semspinesurg.com/article/PIIS1040738311000517/abstract?rss=yesMany surgeons acknowledge that anatomical and biomechanical characteristics specific to the lower lumbar (L3-L5) spine influence management after injury. In this review, the literature was evaluated to determine the surgical indications and optimal operative approach for lower lumbar burst fractures, fracture-dislocations, and flexion-distraction injuries. Low-quality studies (eg, retrospective case series, etc) suggest nonoperative and operative management of neurologically intact lower lumbar burst fractures achieve comparable functional results, with greater complication rates noted in surgical cohorts. Although surgical stabilization of injuries with neurological deficits is determined by sound pathophysiological rationale and allows earlier rehabilitation, it remains unclear whether this alters the natural history of neurological recovery. The surgical strategy should aim to preserve motion segments by minimizing fusion levels and, in select cases, stabilization without fusion is supported.Fusion for Lower Lumbar (L3-L5) Fractures: Surgical Indications and TechniquesRowan Schouten, Charles Fisher10.1053/j.semss.2011.05.006Seminars in Spine Surgery 23, 4 (2011)2011-07-11Seminars in Spine Surgery2011-07-11234S1040-7383(11)X0005-9249256http://www.semspinesurg.com/article/PIIS1040738311000529/abstract?rss=yesThe management of infections or tumors affecting the lumbar spine presents a unique challenge. Indications for surgery and the appropriate timing for interventions are not always clear. Moreover, depending on the location and the extent of the disease as well as the underlying medical condition of the patient, surgical approaches and goals can vary significantly. With improved understanding of the pathologic process and the advent of new surgical techniques, our overall treatment strategies continue to evolve, leading to better outcomes and reduced morbidity. The available literature on the role of lumbar fusions in the treatment of infection and tumor will be presented.Lumbar Fusion in the Treatment of Infections and TumorsSang Do Kim, Christopher M. Bono, Mitchel B. Harris10.1053/j.semss.2011.05.007Seminars in Spine Surgery 23, 4 (2011)2011-10-03Seminars in Spine Surgery2011-10-03234S1040-7383(11)X0005-9257265http://www.semspinesurg.com/article/PIIS1040738311000530/abstract?rss=yesThe objectives are to comprehensively define adjacent segment disease; highlight advances in the approach to spinal disorders, present the identified risk factors; examine outcomes; and summarize current recommendations. The literature supports previous degeneration and altered biomechanics of the spine as causes of adjacent segment disease. Excessive facet degeneration is a risk factor. Clinical outcome scores show improvement irrespective of procedure type. The number of spinal segments fused, fusion level, and age yield conflicting reports regarding their contribution to adjacent segment disease. Arthroplasty, dynamic stabilization, and interspinous process implants are effective in decreasing incidence.Adjacent Segment Disease After Lumbar Spinal Fusion: A Systematic Review of the Current LiteratureWilsa M.S. Charles Malveaux, Alok D. Sharan10.1053/j.semss.2011.05.008Seminars in Spine Surgery 23, 4 (2011)2011-10-03Seminars in Spine Surgery2011-10-03234S1040-7383(11)X0005-9266274http://www.semspinesurg.com/article/PIIS1040738311000542/abstract?rss=yesLumbar pseudoarthrosis is one of the most common complications of spine surgery. The prevalence of lumbar pseudarthrosis following instrumented lumbar fusion in adults is highly variable across studies with lower back pain being the most common complaint. Some researches believe that spinal instability is directly responsible for the painful symptoms sometimes associated with pseudarthoses. However, this point has also been debated.Diagnostic work-up of these cases include flexion and extension radiographs and CT scans. MRI can also be helpful to identify any residual or new areas of nerve compression. The most definitive test to identify a pseudoarthosis is an exploration of the fusion. This is performed when there is sufficient clinical and radiographic data to suggest the presence of a non-union. Given the associated morbidities and high financial expense, careful thought must be exercised by the responsible physician in the selection of the appropriate patient population for revision surgery. Prior to attempted salvage of arthrodesis, other causes of persistent low back pain should be ruled out and more conservative measures of treatment should be tried first.The following manuscript provides an in-depth discussion on the clinical signs and symptoms of lumbar pseudoarthoses as well as a plan for the diagnostic work-up and treatment of these patients.Lumbar Pseudarthrosis: Diagnosis and TreatmentYu-Po Lee, Joseph Sclafani, Steven R. Garfin10.1053/j.semss.2011.05.009Seminars in Spine Surgery 23, 4 (2011)2011-07-11Seminars in Spine Surgery2011-07-11234S1040-7383(11)X0005-9275281http://www.semspinesurg.com/article/PIIS1040738311000694/abstract?rss=yesSeveral nonoperative therapies have been shown to be beneficial in the treatment of chronic low-back pain, including different forms of exercise and spinal manipulative therapy. The efficacy of less time-consuming and less costly self-care interventions remains inconclusive. Bronfort et al performed an observer-blinded mixed-method randomized clinical trial to assess the relative efficacy of supervised exercise, spinal manipulation, and home exercise for the treatment of chronic low-back pain.SpinescopeScott D. Boden10.1053/j.semss.2011.09.001Seminars in Spine Surgery 23, 4 (2011)2011-12-01Seminars in Spine Surgery2011-12-01234S1040-7383(11)X0005-9282287