Download or read book Axial Twist of the Lumbar Spine written by Colin David McKinnon and published by . This book was released on 2017 with total page 121 pages. Available in PDF, EPUB and Kindle. Book excerpt: While a link between magnitudes of spinal axial twist motions and the various modes of associated injury, pain reporting, and lost time claims has been tentatively established, there is need for greater investigation and understanding of the mechanical impact of axial twist motions. Researchers have compiled data sets demonstrating the relationship between twisting motions and moments and low back injury outcomes, but do not create a link to gross occupational exposures. Further, few studies can create a direct relationship between workstation design, trunk postures, and spine joint specific pain and failure mechanisms. When this limited mechanistic understanding is paired with injury prevalence statistics, they highlight a clear need to investigate the role of tissue-level axial twist exposures on occupational injury risk and workstation design guidelines to mitigate that risk. The global objective of this research was focused on developing a relationship between working axial twist postures and intervertebral joint injury risk. The four specific questions asked were (1) What is the relationship between externally measured thoracopelvic axial twist and the actual segmental axial twist motion of the intervertebral joints? (2) Can we use ultrasound as a modality to consistently and accurately measure vertebral axial twist motion? (3) What amount of lumbar axial twist presents an elevated injury risk for working populations? (4) What movement strategies do people use to perform reaching tasks at different hand locations, and how do task parameters impact these strategies? Study 1: Ultrasound has the potential for use to evaluate boney movement during axial twist of the lumbar spine in both in vivo and in vitro evaluations. Such segmental rotations could then be measured under controlled external thoracic axial twist conditions and in response to mechanical loading. The purpose of this study was to measure vertebral segmental rotations in a porcine model of the human lumbar spine using an ultrasound imaging protocol, and to validate use of this imaging technique with an optical motion capture system. Twelve porcine functional spinal units were fixed to a mechanical testing system, and compression (15% of compressive tolerance), flexion-extension, and axial twist (0, 2, 4, or 6 degrees) were applied. Axial twist motion was tracked using an optical motion capture system and posterior surface ultrasound. Correlation between the two measurement systems was greater than 0.903 and absolute system error was 0.014 across all flexion-extension postures. These findings indicate that ultrasound can be used to track axial twist motion in an in vitro spine motion segment and has the potential for use in vivo to evaluate absolute intervertebral axial twist motion. Study 2: The relationship between externally measured and internal spine axial twist motion is not well understood. Ultrasound is a validated technique (Study 1) for measurement of vertebral axial twist motion and has the potential for measuring segmental vertebral axial twist in vivo. The purpose of this study was to evaluate lumbar segmental axial twist in relation to external thoracopelvic twist using an ultrasound imaging technique. Sixteen participants kneeled in a custom-built axial twist jig which isolated motion to the lumbar spine. Participants twisted from neutral to 75% of maximum twist range of motion in an upright flexion-extension posture. Thoracopelvic motion was recorded with a motion capture system and L1 to S1 vertebral axial twist was recorded using ultrasound. Maximum thoracopelvic axial twist motion was 41.1 degrees. The majority of axial twist motion occurred at the L2-L3 (46.8% of lumbar axial twist motion) and L5-S1 (33.5%) intervertebral joints. Linear regression fits linking axial twist at each vertebral level to thoracopelvic axial twist ranged from 0.43 to 0.79. These findings demonstrate a mathematical relationship between internal and external axial twist motion, and suggest that classic use of L4-L5 to represent lumbar spine motion may not be appropriate for axial twist modeling approaches. Study 3: Axial twisting exposures have been repeatedly identified as a risk factor for occupational low back pain and injury, but there is a need for an improved understanding of the role of axial twist magnitude and associated moment as modifiers of the cumulative load tolerance of intervertebral joints. The purpose of this study was to mathematically characterize the relationship between axial twist motion magnitudes and the cumulative load tolerance of porcine cervical functional spinal units. Twenty-four porcine functional spinal units were fixed in a mechanical testing system under compressive load (15% of compressive tolerance) and in a neutral flexion-extension posture. Specimens were axially twisted to 5, 7.5, 10, 12.5, 15 or 17.5 degrees at 1 Hz until failure or 21 600 total cycles. Cumulative applied axial twist was recorded, and exponential functions were fit to the twist magnitude-cumulative twist moment recordings. Weighting-factor functions for cumulative axial twist moment injury risk were developed based on absolute axial twist magnitude and twist normalized to maximum range of motion. The non-linear weighting-factors have potential use in assessment of cumulative axial twist injury risk in occupational tasks. Study 4: The magnitude of axial twist in the lumbar spine in relation to reaching tasks is currently unknown. Therefore, the purpose of this study was to investigate lumbar spine axial twist during simulated occupational tasks across a range of forward and lateral reach distances, task heights, and exertion directions. Twenty-four participants performed single-handed, right-handed exertions against a load cell in three directions (upward, downward, forward push), at two heights (shoulder, elbow), and at 11 different hand target locations corresponding to current ergonomic reach guidelines. Thoracopelvic and right upper limb postures were recorded using an optical motion capture system, and trunk muscle activation was recorded using surface electromyography. Participants performed a contralateral twist at both the thoracopelvic spine and pelvis about the feet for directly forward hand targets, and twisted up to 19.9 degrees and 12.1 degrees at the lumbar spine and pelvis, respectively, at the most lateral hand target locations. Lumbar flexion and shoulder elevation each increased with reach distance to a maximum of 5.6 degrees and 64.9 degrees, respectively, at the furthest, directly forward hand target location. Hip and abdominal muscle activation exceeded 10% MVC for the most lateral hand target locations, and exhibited the highest activation for upward and forward push exertions. These findings suggest that future ergonomics guidelines should assess reaching and exertion tasks to hand target locations beyond 60-degrees from the midline of the body and consider them as non-optimal zones. The collection of studies in this thesis was structured to improve current ergonomics reach guidelines and provide a physiological and biomechanical basis for reach distance recommendations incorporating the low back. The findings from these studies have important implications for researchers, ergonomists, and clinicians assessing injury risk related to twisted occupational postures.

Download or read book Axial Twist Loading of the Spine written by Janessa Dale Marie Drake and published by . This book was released on 2008 with total page 153 pages. Available in PDF, EPUB and Kindle. Book excerpt: There are several reasons to research the effects of axial twist exposures and the resulting loading on the spine. The lack of consensus from the limited work that has previously examined the role of axial twist moments and motions in the development of spine injuries or generation of low back pain is the primary reason. From recently published works, axial twist moments appear to represent an increased risk for injury development when it acts in concert with loading about other physiological axes (i.e. flexion, extension, and compression). However, there is a large body of epidemiologic data identifying axial twist moments and/or motion as risk factors for low back disorders and pain, demonstrating the need for this series of investigations. It is likely that these combined exposures increase risk through altering the spine's load distribution (passive resistance) by modifying the mechanics, but this deduction and related causal mechanism need to be researched. The global objective of this research was focused on determining whether there is evidence to support altered load distribution in the spine, specifically between the intervertebral disc and facets, in response to applied axial twist moments (when added in combination with one and two axes of additional loading). Also included was whether these modes of loading can modify spine mechanics and contribute and/or alter the development of damage and pain. This objective was addressed through one in-vivo (Drake and Callaghan, 2008a- Chapter #2) and three in-vitro (Drake et al., 2008- Chapter #4; Drake and Callaghan, 2008b- Chapter #5; Drake and Callaghan, 2008c- Chapter #6) studies that: (1) Quantified the amount of passive twist motion in the lumbar spine when coupled with various flexion-extension postures; (2) Documented the effects of flexion-extension postures and loading history on the distance between the facet articular surfaces; (3) Evaluated the result of axial twist rotation rates on acute failure of the spine in a neutral flexion posture; and (4) Explored whether repetitive combined loading has the ability to cause enough deformation to the spine to generate pain. Through the combination of findings previously reported in the literature and the outcomes of Drake and Callaghan (2008a- Chapter #2) and Drake et al. (2008- Chapter #4), a postural mediated mechanism was hypothesized to be responsible for governing the load distribution between the facet joints and other structures of the spine (i.e. disc, ligaments). Increased flexed postures were found to decrease the rotational stiffness by resulting in larger twist angles for the same applied twist moment in-vivo relative to a neutral flexion posture (Drake and Callaghan, 2008a- Chapter #2). This suggested there might be an increased load on the disc due to a change in facet coupling in these combined postures. Similarly, increased angles were observed in flexed and twisted postures for in-vitro specimens relative to a neutral flexion posture. These observed differences were found to correspond with altered facet joint mechanics. Specifically that flexed twisted postures increased the inter-facet spacing relative to the initial state of facet articulation (Drake et al., 2008- Chapter #4). These finding supported the postulated postural mechanism. Therefore, in a neutral posture the facet joints likely resisted the majority of any applied twist moment based on the limited range of motion and higher axial rotational stiffness responses observed. It was suspected that the changes in mechanics would likely cause a change in the load distribution however the magnitude of change in load distribution remains to be quantified.

Download or read book Comparison of Thoracic and Lumbar Spine Angles and Transient Between Standing and Supine Neutral Axial Twisted Positions written by Aaron K. Siu and published by . This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Suspected mechanisms by which axial twist contributes to low back pain have recently been investigated using MRI. However, the impact of the supine orientation required in horizontal MRI, and prevalence of prohibitive transient pain development from the non-neutral positions during scanning have not been quantified. Therefore, the goal of this study was to quantify spine kinematics in neutral and axial twist postures between standing and supine positions, and to quantify and characterize transient pain development during a prolonged supine axial twist protocol. Kinematics, muscle activation, self-reported pain data were collected from 20 university aged male during trials of standing and supine in neutral and axially twisted postures and prolonged supine axial twist trial. Heeding a recommended 15min limit to minimize transient pain development, attention should be paid to lumbar lordosis and axial twist in supine neutral and lumbar lateral bend in supine axial twist.

Download or read book Biomechanics Principles and Applications written by H.W. Huiskes and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 451 pages. Available in PDF, EPUB and Kindle. Book excerpt: Biomechanics as a scientific activity is not new. Already involved (or so it is said) in its practice were Aristotle (384-327 BC) and Leonardo da Vinci (1452-1519). Recently, however, it has become fashionable as a separate field, as witnessed by the existence of a Journal of Biomechanics (1968), an Interna tional (1973), a European (1976) and an American (1977) Society of Biomechanics, and an amount of (usually recently erected) Biomechanics Laboratories at Uni versities or other institutions throughout the world. If one or~anises a Con ference on Biomechanics, a relatively large number of scientists leave their cubicles or workshops to visit the place of worship. It becomes quickly evident, however, that such a forum for scientific communication is far from being homo geneous. All are not of the same believe, and the variety in professional inte rests almost parallels the number of attendants. "Biomechanics, the science of applying methods and principles of Mechanics to biological tissues and medical problems" is a definition which, in one form or another, has found wide acceptance among biomecanicians. Nevertheless, Bio mechanics is interwoven and thus often confused with other scientific endeavors. It is colored differently by its many fields of application (e. g. Orthopaedic and Cardio-Vascular Surgery, Dentistry, Rehabilitation, Physical Medicine, Injury Prevention, Sports and others), and the backgrounds of its disciplina ries. It partly overlaps sciences as Biomaterials, Medical Physics and Biophy sics, Physiology, and Functional Anatomy.

Download or read book Sagittal Balance of the Spine written by Pierre Roussouly and published by Thieme. This book was released on 2019-07-25 with total page 736 pages. Available in PDF, EPUB and Kindle. Book excerpt: Unique resource from internationally renowned experts details the key role of sagittal spine balance Through evolution, human verticality became associated with a wide range of normal pelvic shapes and associated pelvic incidence angles (PIs). While all types of sagittal alignment generally provide adequate support to young adults, age, stress, and related degeneration can progressively lead to sagittal imbalance and contribute to various spinal pathologies. Sagittal Balance of the Spine by Pierre Roussouly, João Luiz Pinheiro-Franco, Hubert Labelle, Martin Gehrchen, and a cadre of esteemed international contributors focuses on the importance of sagittal alignment and spino-pelvic shape identification in clinical practice. Offering the most comprehensive text on sagittal balance to date, this state-of-the-art, richly illustrated book fills a void in the literature, offering clinical pearls throughout seven sections and 24 chapters. Key Highlights The biomechanics of sagittal balance including spine modeling, primary parameters, spinal curves segmentation, and lumbar lordosis classification The role of sagittal balance in low back pain and degeneration, with discussion of spinal orientation and the contact forces theory, spinal degeneration associated with spinopelvic morphotypes, and compensatory mechanisms Comprehensive analysis of the relationship between sagittal imbalance and isthmic lysis spondylolisthesis, degenerative spondylolisthesis, Scheuermann's kyphosis, adolescent idiopathic scoliosis, and adult scoliosis Posterior and anterior treatment approaches – from spinal fixation and spinal fusion – to spinal osteotomy techniques and management of surgical failure This text is essential reading for every neurosurgical and orthopaedic resident, as well as veteran surgeons who evaluate and treat patients with spine conditions. Clinicians will learn why incorporating sagittal balance evaluations into spinal exams is integral to devising more effective treatment strategies and achieving improved outcomes.

Download or read book The Lumbar Spine written by James Taylor and published by Elsevier Health Sciences. This book was released on 2020-09-22 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt: This exceptional book is a collection of more than 140 anatomical images documenting the development, maturation and ageing of the lumbar spine and pathologies associated with ageing and injury. It provides a unique guide to support the clinical diagnosis of lumbar spine trauma and pain due to age and injury. The collection represents the extensive research conducted by Professor James Taylor into the lumbar spine gathered from his study of 266 autopsies over almost a decade. It complements The Cervical Spine: An atlas of normal anatomy and the morbid anatomy of ageing and injuries, based on the same collection. With legislative changes now making collection of such work impossible in Australia, this book makes a never-to-be-repeated contribution to the understanding of spinal injury and rehabilitation globally, and will be invaluable for patient assessment, diagnosis and treatment. Unique, high-quality images document age-related and injury-induced changes to the lumbar spine Combination of wet specimens and stained specimens Includes many soft-tissue specimens Unprecedented breadth and diversity in range of injuries covered Logical sequence from normal anatomy, through to age-related changes and changes resulting from injury Invaluable for students of physiotherapy, chiropractic and osteopathy An eBook included in all print purchases

Download or read book The Lumbar Spine written by Harry N. Herkowitz and published by Lippincott Williams & Wilkins. This book was released on 2004 with total page 1018 pages. Available in PDF, EPUB and Kindle. Book excerpt: The official publication of the International Society for the Study of the Lumbar Spine, this volume is the most authoritative and up-to-date reference on the lumbar spine. This edition provides more balance between basic science and clinical material and has been completely reorganized for easy reference. New chapters cover gene therapy, outcomes assessment, and alternatives to traditional nonoperative treatment. The editors have also added chapters on preparation for surgery, surgical approaches, spinal instrumentation, and bone grafts. Chapters on specific disorders have a consistent structure—definition, natural history, physical examination, imaging, nonoperative treatment, operative treatment, postoperative management, results of surgery, and complications.

Download or read book The Soft Hard Tissue Junction written by Neil D. Broom and published by Cambridge University Press. This book was released on 2018-11-29 with total page 403 pages. Available in PDF, EPUB and Kindle. Book excerpt: Discover how the detailed structures of musculoskeletal tissue junctions relate to their mechanical function. This pioneering book, richly illustrated with tissue images, offers a rigorous, biomechanical approach to understanding the soft-hard tissue interface across multiple scales of resolution.

Download or read book Rothman Simeone The Spine E Book written by Harry N. Herkowitz and published by Elsevier Health Sciences. This book was released on 2011-02-10 with total page 2021 pages. Available in PDF, EPUB and Kindle. Book excerpt: Rothman-Simeone The Spine helps you achieve optimal outcomes in the clinical practice of spine surgery in adults and children. Drs. Harry N. Herkowitz, Steven R. Garfin, Frank J. Eismont, Gordon R. Bell, Richard Balderston, and an internationally diverse group of authorities help you keep up with the fast-paced field and get the best results from state-of-the-art treatments and surgical techniques, such as spinal arthroplasty and the latest spinal implants and equipment. An all-new full-color design and surgical videos online at www.expertconsult.com make this classic text more invaluable than ever before. Get the best results from the full range of both surgical and non-surgical treatment approaches with guidance from the world’s most trusted authorities in orthopaedic spine surgery. Find important information quickly through pearls, pitfalls, and key points that highlight critical points. Watch experts perform key techniques in real time with videos, on DVD and online, demonstrating minimally invasive surgery: SED procedure; thorascopic techniques; lumbar discectomy; pedicle subtraction osteotomy (PSO); C1, C2 fusion; intradural tumor; cervical laminoforaminoty; and much more. Apply the newest developments in the field thanks to expert advice on minimally invasive surgery, spinal arthroplasty and the latest spinal implants and equipments. See procedures clearly through an all new full-color design with 2300 color photographs and illustrations placed in context. Access the fully searchable contents of text online at www.expertconsult.com.

Download or read book Clinical and Radiological Anatomy of the Lumbar Spine written by Nikolai Bogduk and published by Elsevier Health Sciences. This book was released on 2012-01-30 with total page 273 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical and Radiological Anatomy of the Lumbar Spine 5e continues to offer practical, comprehensive coverage of the subject area in a unique single volume which successfully bridges the gap between the basic science of the lumbar region and findings commonly seen in the clinic. Prepared by an author of international renown, Clinical and Radiological Anatomy of the Lumbar Spine 5e provides clear anatomical descriptions of the individual components of the lumbar region, as well as the intact spine, accompanied by a full colour artwork programme. Detailed anatomical descriptions are followed by an explanation of the basic principles of biomechanics and spinal movement together with a comprehensive overview of embryology and the influence of age-related change in the lumbar region. The problem of low back pain and instability are also fully explored while an expanded section on medical imaging completes the volume. Clinical and Radiological Anatomy of the Lumbar Spine 5e offers practical, validated and clinically relevant information to all practitioners and therapists working in the field of low back pain and will be ideal for students and practitioners of chiropractic, osteopathic medicine and osteopathy, physiotherapy, physical therapy, pain medicine and physiatry worldwide. Presents a clear and accessible overview of the basic science relating to the structure and function of the lumbar spine Written by an internationally renowned expert in the fields of both clinical anatomy and back pain Describes the structure of the individual components of the lumbar spine, as well as the intact spine Goes beyond the scope of most anatomy books by endeavouring to explain why the vertebrae and their components are constructed the way they are Provides an introduction to biomechanics and spinal movement with special emphasis on the role of the lumbar musculature Explores both embryology and the process of aging in the context of spinal structure and function Explores mechanical back pain within the context of the structural and biomechanical principles developed earlier in the volume Extensive reference list allows readers seeking to undertake research projects on some aspect of the lumbar spine with a suitable starting point in their search through the literature Perfect for use both as an initial resource in undergraduate training in physiotherapy and physical medicine or as essential reading for postgraduate studies Greatly expanded section on medical imaging Increased elaboration of the regional anatomy of the lumbar spine Includes chapter on reconstructive anatomy, which provides an algorithm showing how to put the lumbar spine back together Presents an ethos of ‘anatomy by expectation’ - to show readers what to expect on an image, rather than being required to identify what is seen

Download or read book Clinical Anatomy of the Lumbar Spine and Sacrum written by Nikolai Bogduk and published by Elsevier Health Sciences. This book was released on 2005-01-01 with total page 262 pages. Available in PDF, EPUB and Kindle. Book excerpt: Bogduk aims to provide a foundation of knowledge upon which an understanding of the various treatment and therapy techniques of the different specialities involved can be built. This edition includes discussion of the sacrum and sacro-iliac joint.

Download or read book Surgical Care of the Painful Degenerative Lumbar Spine written by Edgar N. Weaver, Jr. and published by Thieme. This book was released on 2018-04-26 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: The learning curve in the management of painful degenerative lumbar spine patients is steep because every case has singular characteristics. Surgical Care of the Painful Degenerative Lumbar Spine: Evaluation, Decision-Making, Techniques by Edgar Weaver reflects more than 35 years of neurosurgical practice devoted to refining degenerative spine disease evaluation and techniques. The book emphasizes and instructs a symptom-focused approach in the surgical decision-making process, with determinant radiographic features used mainly supportively. The text begins with a thorough overview of anatomy, spino-pelvic and sagittal balance metrics, stabilization, and clinical evaluations. Throughout 11 chapters, step-by-step guidance is provided on therapeutic decision-making to achieve optimal individualized outcomes. From the fundamentals of open and minimally invasive techniques to the impact of socioeconomic factors on the treatment of PDLS patients, the authors offer invaluable firsthand insights. Key Features Discussion of techniques including en bloc laminectomy, the U-turn approach to root decompression, hemilaminectomy – a safe and versatile decompressive technique, and the lateral intra-muscular planar (LIMP) procedure The use of a descriptive clinical sub-classification system for low back pain and grading scale based on a simple testing maneuver Extensive post-operative care chapter emphasizes pain and infection control Challenges including chronic axial lumbar pain, post-operative junctional stress, sagittal imbalance, spondylolisthesis, and coronal deformity Uniquely insightful, this concise guide covers the fundamental clinical and technical skills necessary to care for patients with degenerative lumbar spine pain. It is essential reading for neurosurgical and orthopedic residents, spine fellows, spine surgeons and all clinicians involved in administrating surgical and nonsurgical spine care.

Download or read book Low Back Disorders written by Stuart McGill and published by Human Kinetics. This book was released on 2007 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: This second edition of 'Low Back Disorders' provides research information on low back problems and shows readers how to interpret the data for clinical applications.

Download or read book Occupational Ergonomics written by Waldemar Karwowski and published by CRC Press. This book was released on 2003-03-26 with total page 678 pages. Available in PDF, EPUB and Kindle. Book excerpt: Occupational Ergonomics: Engineering and Administrative Controls focuses on prevention of work-related musculoskeletal disorders with an emphasis on engineering and administrative controls. Section I provides knowledge about risk factors for upper and lower extremities at work, while Section II concentrates on risk factors for work-related low back

Download or read book Low Back Disorders 3E written by McGill, Stuart M. and published by Human Kinetics. This book was released on 2015-10-22 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt: Low Back Disorders, Third Edition, written by internationally recognized low back specialist Stuart McGill, guides readers through the assessment and treatment of low back pain, providing evidence-based research on the best methods of rehabilitation and prevention of future injury.

Download or read book Clinical Anatomy of the Lumbar Spine written by Nikolai Bogduk and published by . This book was released on 1991 with total page 212 pages. Available in PDF, EPUB and Kindle. Book excerpt: A comprehensive account of the structure and function of the lumbar spine, which provides therapists with a basis for the diagnosis and management of low back pain and mechanical disorder. All material has been revised, references expanded and the chapter on biomechanics includes axes of rotation.

Download or read book Surgical Care of the Painful Degenerative Lumbar Spine written by Edgar Weaver and published by Thieme. This book was released on 2018-04-26 with total page 295 pages. Available in PDF, EPUB and Kindle. Book excerpt: The learning curve in the management of painful degenerative lumbar spine patients is steep because every case has singular characteristics. Surgical Care of the Painful Degenerative Lumbar Spine: Evaluation, Decision-Making, Techniques by Edgar Weaver reflects more than 35 years of neurosurgical practice devoted to refining degenerative spine disease evaluation and techniques. The book emphasizes and instructs a symptom-focused approach in the surgical decision-making process, with determinant radiographic features used mainly supportively. The text begins with a thorough overview of anatomy, spino-pelvic and sagittal balance metrics, stabilization, and clinical evaluations. Throughout 11 chapters, step-by-step guidance is provided on therapeutic decision-making to achieve optimal individualized outcomes. From the fundamentals of open and minimally invasive techniques to the impact of socioeconomic factors on the treatment of PDLS patients, the authors offer invaluable firsthand insights. Key Features Discussion of techniques including en bloc laminectomy, the U-turn approach to root decompression, hemilaminectomy – a safe and versatile decompressive technique, and the lateral intra-muscular planar (LIMP) procedure The use of a descriptive clinical sub-classification system for low back pain and grading scale based on a simple testing maneuver Extensive post-operative care chapter emphasizes pain and infection control Challenges including chronic axial lumbar pain, post-operative junctional stress, sagittal imbalance, spondylolisthesis, and coronal deformity Uniquely insightful, this concise guide covers the fundamental clinical and technical skills necessary to care for patients with degenerative lumbar spine pain. It is essential reading for neurosurgical and orthopedic residents, spine fellows, spine surgeons and all clinicians involved in administrating surgical and nonsurgical spine care.