Vertebral Body

Delivery systems for drugs, implanted, 273-291 cancer-related pain, outcomes in, 284-285 clinic, 274-276, 276 complications of, 286-290 device-related complications, 287-289 infusate-related complications, 289-290 surgical complications, 286-287 constant flow rate pump, 274 implantation, 281-282 constant flow rate pump, 281-282 programmable pump, 282 pump preparation, 281 intraspinal opioids, exclusion, inclusion criteria, 278 non-cancer-related pain, outcomes in, 285-286 outcomes, 284-286 pain types, characteristics of, 277

patient selection, 276-280,

277t, 278t, 279t programmable pump,

274-275 screening techniques, 280-281 percutaneous technique, 280

surgical technique, 280-281 surgical implantation technique, 282-284 Synchromed implanted drug delivery programmer, 276, 284 World Health Organization analgesic ladder, 279

Demerol, for analgesia, 33 Depo-Medrol. See

Methylprednisolone acetate Depression evaluation of, 46 as exacerbating component of pain, 47 Diabetes, screening for, 44 Diagnostic procedures, 37-52 biological aspects of pain, 40 diagnostic nerve blocks, 44-46 central nerve blocks, 45-46 peripheral nerve blocks, 45 electrodiagnostics, 43-44 electromyography, 43 nerve conduction studies, 44

history taking, 40 imaging studies, 41-43 bone scanning, 42 computed tomography scanning, 42 magnetic resonance imaging, 42 myelography, 42 radiographs, conventional, 41

thermography, 42-43 ultrasound, 42 laboratory tests, 44

screening, 44 physical examination, 41 psychological evaluation, 46-47 anxiety, 46 depression, 46 treatment targets, 38 Dihydrocodeine, for analgesia, 33

Dilaudid, for analgesia, 33 Disc. See under specific disc aspiration of, 145 calcified herniation, 355 intradiscal oxygen-ozone treatment, results with, 355 herniated automated percutaneous lumbar discectomy, 137-148 calcified, 355 lumbar, intradiscal oxygen-ozone in treatment, 349-358

multiple, 354 intervertebral, 8-11, 9-11, 123

spinal pain and, 123 lumbar, annular lesions of,

107 material, 173 narrowing of space, 41 Disc material, pathological filling defect produced by, 173 Disc space, narrowing of, in radiograph, 41 Discectomy, lumbar, automated percutaneous, for herniated disc, 137-148 aspiration of disc, 145 discitis, suspected, 144 far lateral herniation,

143-144 future developments in, 147 herniated nucleus pulposus, classic, 139-142, 140-141 instrument entry point, 144 intradiscal steroid injection, 144

local anesthetic injection, 144 patient positioning, 144 patient selection, 139-144 postoperative care, 147 probe placement for aspiration, 144-145 procedural steps, 144-145, 146

reherniation, at level of previous surgery, 142-143 technique, 144-145 Discitis, 144

suspected, 144 Discogenic pain intradiscal electrothermal therapy, 61 thermal energy for, 61 Discography, 54-56, 94-120 cervical, 112-116, 114-116 lumbar, 96-107, 99-105, 107t lumbar disc annular lesions, classification of, 107 lumbar fusion, 107-108 postdiscography care,

116-117 result reporting, 117 sedation, 95-96 spinal deformity, 107-108

technical considerations, 95 thoracic, 108-112, 109-112 Dolophine, for analgesia, 33 Dorsal-longitudinal arteries, spine, 16 Dural arteriovenous malformation, 292-296, 293t, 295-297 therapy, 296 Dysesthetic pain, 33-34 Dysproteinemia, screening for, 44

Electrical stimulation, for muscle spasm, 51 Electrodiagnostics, 43-44 electromyography, 43 nerve conduction studies, 44 Electromyography, 43 EMG. See Electromyography Endovascular therapy, spine, 292-321 aneurysmal bone cysts, 310-311 therapy, 311 arteriovenous fistulas, malformations, classification scheme for, 292-293 conus medullaris arteriovenous malformation, 299-304, 300-303 dural arteriovenous malformation, 292-296, 293t, 295-297 therapy, 296 epidural arteriovenous fistulas, 292 therapy, 292 extradural arteriovenous malformation, 298-299 therapy, 299 intradural arteriovenous fistula, 296-298, 297 therapy, 298 intramedullary arteriovenous malformation, 299 metastatic lesions affecting spine, 311 neoplastic vascular lesions, spinal cord, 304 cavernous malformations, 304

hemangioblastomas, 304

Spetzler classification of spinal vascular lesions, 292-293 spinal angiography, technique, 311-319, 312-315, 316-318 spinal vascular malformations, 292-304 systemic syndromes with spinal vascular malformations, 306 Cobb's syndrome, 306 Klippel-Trenaunay, 306 Osler-Weber-Rendu

Syndrome, 306 Parkes-Weber syndromes, 306

vertebral hemangiomas, 306-310 type A, 307-308, 308-309 type B, 309-310 type C, 310 Epidural arteriovenous fistulas, 292-302 therapy, 292 Epidural blood patch, 324-328 cerebrospinal fluid hypovolemia, 324-328 alternative treatments, 325

contraindications, 325 prophylactic use of, 326 steroids, 326 technique, 326-328 sumatriptan, 326 Epidural fibrosis pathological changes with, 197

pathological filling defect produced by, 173 spinal endoscopy, 197 Epidural scarring, pathological filling defect produced by, 173

Epidural steroid injection, 60, 149-170 caudal epidural, 157-160, 158-159 initial description of, 149 cervical, 160

complications of, 164-168,

165-166 interlaminar lumbar epidural injection, 151-155, 152, 154-155 midline, introduction of, 149

pathoanatomy, 149-151 technique, 151-164 thoracic, 160 transforaminal, 155-157, 156-157 Epidurography, 171-202 cervical, 197

complications of, 183-187 subarachnoid injection, 187 subdural injection, 187 vascular runoff, 183-187, 184-186 contraindications to, 174-175 indications for, 174-175 informed consent, 177 laboratory work, 177 monitoring of patient,

177-178 normal, 179-183, 180-183 pathological filling defects, structural abnormalities producing, 173 patient preparation, 177-178 positioning of patient, 178 radiation safety, 178 recent developments in,

197-199, 197-200 thoracic, 197 Epidurolysis, 171-202 cervical, 197

contraindications to, 174-175 indications for, 174-175 informed consent issues, 177 injections, 191-197 contrast injection, 191-194,

192-193 hyaluronidase injection, 195 hypertonic saline infusion,

196-197 injection epidurolysis, local anesthetic injection,

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