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Book Minimally Invasive Spine Surgery

Download or read book Minimally Invasive Spine Surgery written by Roger Haertl and published by Thieme. This book was released on 2012-12-12 with total page 510 pages. Available in PDF, EPUB and Kindle. Book excerpt: Minimally invasive spine surgery, in some form or other, has historical roots dating back more than 100 years, and recent advances in technology now make it increasingly effective in treating suitable spine patients. While minimally invasive approaches have shown to reduce muscle damage, blood loss, and post-operative pain, to perform this t ype of surgery correctly, even highly skilled modern-day surgeons must prepare themselves for a demanding learning curve. For this reason, AOSpine proudly presents Minimally Invasive Spine Surgery: Techniques,Evidence, and Controversies, the most comprehensive book of its kind, which includes more than 500 pages of surgical techniques, illustrations, case images, tips and tricks, and research, providing an invaluable tool for spine surgeons around the world. Each technique is fully examined: The pros and cons of each is objectively reviewed Its spectrum of indications and contraindications is summarized Historical and modern day controversies relating to each technique are discussed Uniquely, chapters in the text are further supported by an evidence-based section summarizing research studies, analysis, and conclusions into each technique, from peer-reviewed journals The text covers more than just a range of interesting medical techniques. By including brief historical introductions on each technique and the surgeons that explored and founded its methods, their early (sometimes self-made) instrumentation, right through to todays current best-practice, this book provides an interesting, informative, and topical instruction on minimally invasive surgery and its increasingly encouraging results for spine-patient care.

Book Controversies in Spine Surgery  MIS versus OPEN

Download or read book Controversies in Spine Surgery MIS versus OPEN written by Alexander R. Vaccaro and published by Thieme. This book was released on 2018-04-06 with total page 658 pages. Available in PDF, EPUB and Kindle. Book excerpt: Master spine surgeons Alexander R. Vaccaro, Richard G. Fessler, and a cadre of esteemed co-editors have compiled the most comprehensive textbook to date detailing minimally invasive spine (MIS) versus open spine surgery techniques. Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations features debates by renowned experts on one of the most provocative topics in spine surgery. Twenty-four chapters systematically organized into four sections — degenerative, trauma, tumor, and other issues, cover procedures and underlying pathologies, backed by a large, diverse body of literature. MIS and open approaches are thoroughly compared and contrasted in each chapter. Evidence is presented and analyzed in an objective manner with 'opposing sides' presenting differing opinions and techniques, resulting in a synchronous collection of pros and cons. Every chapter is masterfully summed up by the book's editors — each of whom have varying stances on the topics at hand. This unique 'duel' and 'duet' discussion enables readers to assimilate information, benefit from the balanced harmony between divergent opinions, and reach their own conclusions. Key Highlights Comparative risks, benefits, complications, and outcomes for a full spectrum of lumbar, thoracic and cervical procedures MIS versus open approaches for lumbar stenosis, synovial cysts, lumbar adjacent segment degeneration, degenerative scoliosis, flatback syndrome, thoracic disc herniation, and dural tears Tumor resection and stabilization, quality of life issues, and potential advantages and risks of MIS techniques Key differences in MIS versus open operations such as radiation exposure and costs Analysis of 3-D navigational imaging to improve outcomes and reduce radiation exposure and operating time This book is a tremendous, evidence-based tool to guide spine surgeons as they make important decisions on selecting the most optimal spine surgery techniques. It is a must-have resource for all resident and veteran orthopaedic surgeons and neurosurgeons who specialize in treating patients with spine conditions. Alexander R. Vaccaro, MD, PhD, FACS, MBA, is Richard H. Rothman Professor and Chairman, Department of Orthopaedic Surgery, and Professor of Neurosurgery, Thomas Jefferson University and Hospitals; and President, The Rothman Institute, Philadelphia, Pennsylvania, USA. Richard G. Fessler, MD, PhD, is Professor, Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Faheem A. Sandhu, MD, PhD, is Professor of Neurosurgery, Director of Spine Surgery, and Co-Director, Center for Minimally Invasive Spine Surgery, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA. Jean-Marc Voyadzis, MD, is Co-Director, Center for Minimally Invasive Spine Surgery and Associate Professor of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA. Jason C. Eck, DO, MS, is an Orthopaedic Spine Surgeon, Center for Sports Medicine and Orthopedics, Chattanooga, Tennessee, USA. Christopher K. Kepler, MD, MBA, is an Associate Professor and Orthopaedic Spine Surgeon, Department of Orthopaedic Surgery, Thomas Jefferson University and Hospitals, and The Rothman Institute, Philadelphia, Pennsylvania, USA. An award-winning international medical and scientific publisher, Thieme has demonstrated its commitment to the highest standard of quality in the state-of-the-art content and presentation of all its products. Founded in 1886, the Thieme name has become synonymous with high quality and excellence in online and print publishing.

Book Controversies in Spine Surgery  MIS versus OPEN

Download or read book Controversies in Spine Surgery MIS versus OPEN written by Alexander R. Vaccaro and published by Thieme. This book was released on 2018-04-06 with total page 574 pages. Available in PDF, EPUB and Kindle. Book excerpt: Master spine surgeons Alexander R. Vaccaro, Richard G. Fessler, and a cadre of esteemed co-editors have compiled the most comprehensive textbook to date detailing minimally invasive spine (MIS) versus open spine surgery techniques. Controversies in Spine Surgery, MIS versus OPEN: Best Evidence Recommendations features debates by renowned experts on one of the most provocative topics in spine surgery. Twenty-four chapters systematically organized into four sections — degenerative, trauma, tumor, and other issues, cover procedures and underlying pathologies, backed by a large, diverse body of literature. MIS and open approaches are thoroughly compared and contrasted in each chapter. Evidence is presented and analyzed in an objective manner with 'opposing sides' presenting differing opinions and techniques, resulting in a synchronous collection of pros and cons. Every chapter is masterfully summed up by the book's editors — each of whom have varying stances on the topics at hand. This unique 'duel' and 'duet' discussion enables readers to assimilate information, benefit from the balanced harmony between divergent opinions, and reach their own conclusions. Key Highlights Comparative risks, benefits, complications, and outcomes for a full spectrum of lumbar, thoracic and cervical procedures MIS versus open approaches for lumbar stenosis, synovial cysts, lumbar adjacent segment degeneration, degenerative scoliosis, flatback syndrome, thoracic disc herniation, and dural tears Tumor resection and stabilization, quality of life issues, and potential advantages and risks of MIS techniques Key differences in MIS versus open operations such as radiation exposure and costs Analysis of 3-D navigational imaging to improve outcomes and reduce radiation exposure and operating time This book is a tremendous, evidence-based tool to guide spine surgeons as they make important decisions on selecting the most optimal spine surgery techniques. It is a must-have resource for all resident and veteran orthopaedic surgeons and neurosurgeons who specialize in treating patients with spine conditions.

Book Controversies in Spine Surgery

Download or read book Controversies in Spine Surgery written by Alexander R. Vaccaro and published by Thieme. This book was released on 2011-01-01 with total page 598 pages. Available in PDF, EPUB and Kindle. Book excerpt: A best evidence approach to key topics in spine surgery Drawing on the expertise of world-renowned orthopedic and neurological spine surgeons,Controversies in Spine Surgery: Best Evidence Recommendations compiles, summarizes, and synthesizes the most relevant scientific literature available in the field today. Each succinct, problem-oriented chapter addresses a different controversial issue where there is a lack of consensus about the best possible course of action. The authors provide guidance and objective recommendations for each scenario based on the most relevant data found in the literature to give surgeons the background they need to make fully informed treatment decisions. Features: Concise outline format enables rapid reading for the busy spine surgeon Invaluable synopses of highly practical evidence-based literature Detailed coverage of commonly disputed issues, such as how to manage vertebral compression fractures, surgery for axial back pain, minimally invasive lumbar fusion, the use of prophylactic antibiotics in spine surgery, and much more Grading of Best Evidence feature in which the authors rate the viability of the data presented Numerous summary tables throughout the text emphasize the main conclusions of published studies Pearls highlight important points in each chapter This cutting-edge clinical reference will help every resident, fellow, and spine surgeon in orthopaedic surgery and neurosurgery streamline their medical decision making process and improve their patient care.

Book Lateral Access Minimally Invasive Spine Surgery

Download or read book Lateral Access Minimally Invasive Spine Surgery written by Michael Y. Wang and published by Springer. This book was released on 2016-11-26 with total page 362 pages. Available in PDF, EPUB and Kindle. Book excerpt: This well-illustrated textbook is the first comprehensive and authoritative source of information on minimally invasive lateral access spine surgery. It covers all aspects of the subject, including patient selection, approach and monitoring techniques, soft tissue management, application in a variety of pathologies, technical nuances, and the prevention and management of complications. In addition, current controversies in the field are discussed and the biomechanics of lateral spinal reconstruction, the physiologic benefits, and cost implications are explained. As use of the lateral approach in spinal surgery has become more popular, so its diversity and complexity have increased. Nevertheless, publications devoted entirely to the technique are lacking, and Lateral Access Minimally Invasive Spine Surgery is designed to fill this vacuum. Written by the world’s experts on the topic, it will be an excellent resource for both beginning and experienced surgeons.

Book Minimally Invasive Spine Fusion

Download or read book Minimally Invasive Spine Fusion written by Mick J. Perez-Cruet, MD and published by CRC Press. This book was released on 2011-07-01 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Minimally Invasive Spine Fusion: Techniques and Operative Nuances provides spine surgeons with the comprehensive information they need to incorporate minimally invasive fusion techniques and instrumentation into their practices. Edited and authored by the experts in spine surgery, this comprehensive publication is filled with detailed clinical information to help the spine surgeon skillfully execute these procedures. Every technique is described in precise step-by-step fashion and incorporates information on preoperative assessment and planning, treatment options, operative technique, potential complications and management, outcome data, and tips and tricks. Beautiful color illustrations and intraoperative photos highlight the key steps for performing these techniques safely and effectively. Numerous preoperative and postoperative images demonstrate the possible results that can be achieved. Instrumentation, monitoring, outcome analysis, and complications are also discussed in detail. In addition, you can step into the operating room with Dr. Perez-Cruet as he demonstrates minimally invasive surgical techniques for treating different spine problems. The invaluable two-DVD set is the perfect companion to the textbook and provides an additional educational value. DVD 1 Contents Microdiscectomy for L5-S1 Transforaminal Lumbar Interbody Fusion Minimally Invasive Thoracic Discectomy at T10-11With L3-4 and L4-5 Decompression Laminectomy and Posterior Lateral Fusion DVD 2 Contents Minimally Invasive Lumbar Laminectomy Minimally Invasive Laminectomy and Posterior Lateral Fusion for Spinal Stenosis For experienced spine surgeons or for those spine surgeons wishing to expand their practices to include minimally invasive techniques, this book and DVD set is a must! No other source provides so much sound, practical advice or such complete coverage.

Book Controversies in Spine Surgery

Download or read book Controversies in Spine Surgery written by Alexander R. Vaccaro and published by Thieme Medical Publishers. This book was released on 2010 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is exactly the book one should have ready access to.-- American Journal of Neuroradiology All providers who care for patients with spinal problems should consider using this book to help with decision making for their patients on an everyday basis.-- Journal of Neurosurgery Drawing on the expertise of world-renowned orthopedic and neurological spine surgeons,Controversies in Spine Surgery: Best Evidence Recommendations compiles, summarizes, and synthesizes the most relevant scientific literature available in the field today. Each succinct, problem-oriented chapter addresses a different controversial issue where there is a lack of consensus about the best possible course of action. The authors provide guidance and objective recommendations for each scenario based on the most relevant data found in the literature to give surgeons the background they need to make fully informed treatment decisions. Features: Concise outline format enables rapid reading for the busy spine surgeon Invaluable synopses of highly practical evidence-based literature Detailed coverage of commonly disputed issues, such as how to manage vertebral compression fractures, surgery for axial back pain, minimally invasive lumbar fusion, the use of prophylactic antibiotics in spine surgery, and much more Grading of Best Evidence feature in which the authors rate the viability of the data presented Numerous summary tables throughout the text emphasize the main conclusions of published studies Pearls highlight important points in each chapter This cutting-edge clinical reference will help every resident, fellow, and spine surgeon in orthopaedic surgery and neurosurgery streamline their medical decision making process and improve their patient care.

Book Minimally Invasive Spinal Surgery

Download or read book Minimally Invasive Spinal Surgery written by Kai-Uwe Lewandrowski and published by JP Medical Ltd. This book was released on 2018-03-13 with total page 278 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a timely, comprehensive and evidence-based review of minimally invasive surgery of the cervical, thoracic and lumbar spine. Minimally invasive techniques are now aided by more advanced endoscopic instruments, video, and computerised navigation systems broadening the range of surgical procedures that can be carried out with similar efficacy as traditional open spinal surgeries, without the significant burden on the patient recovery and rehabilitation. This book thoroughly reviews the preclinical and clinical data on minimally invasive spinal surgery and describes and illustrates the current effective techniques. An authoritative, international team of contributors add their clinical experience and expertise to provide a clear, authoritative and practical guide. The book is organised in four sections covering cervical, thoracic and lumbar spine regions with a final section on the latest advances in technologies and the cost-effectiveness of current treatments.

Book Minimally Invasive Spine Surgery

Download or read book Minimally Invasive Spine Surgery written by Burak Ozgur and published by Springer Science & Business Media. This book was released on 2009-10-08 with total page 193 pages. Available in PDF, EPUB and Kindle. Book excerpt: Minimally Invasive Spine Surgery is a beautifully illustrated atlas describing the 18 most widely accepted minimally invasive procedures in spine surgery. Written by leaders in both neurologic and orthopedic spine surgery, this book offers the most up-to-date material and the broadest perspective on the subject. Procedures range from simple to complex and cover the cervical, thoracic and lumbar regions of the spine.

Book Minimally Invasive Spine Surgery

Download or read book Minimally Invasive Spine Surgery written by Alexander Vaccaro and published by JP Medical Ltd. This book was released on 2015-08-31 with total page 191 pages. Available in PDF, EPUB and Kindle. Book excerpt: Minimally Invasive Spine Surgery combines up-to-date research on surgical techniques with high-definition surgical video and concise algorithmic evidence. Each of its sixteen chapters begins with a brief summary followed by imaging indications, instrumentation, a step-by-step surgical technique (and video guide), as well as the potential complications and adverse outcomes that may develop. Techniques discussed in the text include: Posterior Cervical Foraminotomy; Percutaneous Posterior Pedicle Screw Placement; Lumbar Discectomy; Transforaminal Lumbar Interbody Fusion (TLIF); Lateral Lumbar Interbody Fusion (LLIF). Also included is a discussion on the types of implants and instrumentation available today and the potential advantages they offer, making Minimally Invasive Spine Surgery an essential and relevant book for orthopaedic and neurosurgeons. Key Points Authored by experts from Rush University Medical Centre and Thomas Jefferson University Hospital in the United States Includes DVD to enhance clinical instruction 273 full colour illustrations

Book Benzel s Spine Surgery

    Book Details:
  • Author : Michael P Steinmetz
  • Publisher : Elsevier Health Sciences
  • Release : 2021-05-18
  • ISBN : 0323636691
  • Pages : 1736 pages

Download or read book Benzel s Spine Surgery written by Michael P Steinmetz and published by Elsevier Health Sciences. This book was released on 2021-05-18 with total page 1736 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written and edited by world-renowned experts in the field, Benzel’s Spine Surgery: Techniques, Complication Avoidance and Management, 5th Edition, provides expert, step-by-step guidance on the evaluation and management of disorders of the spine. This definitive, two-volume work explores the full spectrum of techniques used in spine surgery, giving you the tools you need to hone your skills and increase your knowledge in this challenging area. Clearly organized and extensively revised throughout, it features contributions from both neurosurgeons and orthopaedic surgeons to present a truly comprehensive approach to spine disease. Offers a thorough overview of the effective management of patients with spinal disorders, including fundamental principles, biomechanics, applied anatomy, instrumentation, pathophysiology of spinal disorders, surgical techniques, motion preservation strategies, non-surgical management, and complication avoidance and management, as well as controversies. Focuses on both pathophysiology and surgical treatment of spine disease, with an increased emphasis on minimally invasive surgery. Contains new features such as key points boxes at the beginning of chapters and algorithms to help streamline the decision making process. Covers today’s hot topics in spine surgery, such as health economics, artificial intelligence, predictive analytics, new less invasive techniques including endoscopic spine surgery, and the future of spine surgery. Provides expert coverage of key topics including biomechanics of motion preservation techniques, spinal injuries in sports, biologics in spine fusion surgery, anterior sub-axial cervical fixation and fusion techniques, complex lumbosacropelvic fixation techniques, and many more. Features more than 1,500 high-quality illustrations, as well as new procedural videos on en bloc spondylectomy, minimally invasive endoscopic posterior cervical foraminotomy, cervical total disc replacement, minimally invasive lumbar decompression of stenosis, and more.

Book Decision Making for Minimally Invasive Spine Surgery

Download or read book Decision Making for Minimally Invasive Spine Surgery written by Faheem A. Sandhu and published by Thieme. This book was released on 2011-01-06 with total page 369 pages. Available in PDF, EPUB and Kindle. Book excerpt: The essential decision making primer for minimally invasive spine procedures Decision Making for Minimally Invasive Spine Surgery provides the critical tools needed to determine exactly when, for whom, and why minimally invasive spine surgery (MISS) is a viable option. Ten tightly focused chapters each begin with a decision making algorithm that explains how to ascertain if MISS will benefit the patient more than traditional open surgery. Following each algorithm, concise yet detailed information on the preoperative evaluation, surgical techniques, and possible outcomes helps the reader to formulate a clear surgical strategy. The book closes with an incisive analysis of radiosurgery, instrumentation systems, image guidance, and promising advances in MISS that will stimulate further discussion of this emerging area. Features: A realistic assessment of both the advantages and drawbacks of MISS by pioneers in the field Evaluative algorithms allow readers to form rapid, fully informed treatment decisions Intuitive organization by spinal region facilitates quick reference Spine surgeons, residents, or fellows in orthopedic surgery or neurosurgery will refer to this easily accessible manual every time they consider performing a minimally invasive spine procedure.

Book Minimally Invasive Spine Surgery  An Algorithmic Approach

Download or read book Minimally Invasive Spine Surgery An Algorithmic Approach written by Kern Singh and published by JAYPEE BROTHERS MEDICAL PUBLISHERS PVT. LTD.. This book was released on 2013-12-15 with total page 117 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book Minimally Invasive Spine Surgery: An Algorithmic Approach is organized in a logical fashion with an introduction, clinical evaluation, intraoperative positioning, surgical techniques, potential pitfalls and pearls of treatment and discussion. This book has written extremely well-known surgeons who are experts in their respective fields of minimally invasive surgery. This textbook attempts to formally describe a simple to understand decision-making process that is the essence of minimally invasive surgery. The chapters of this book are organized in a very technique-focused text that provides intraoperative pearls, pitfalls and technical descriptions. The reader can quickly review the decision-making algorithm at the beginning of each chapter and read the text for a more detailed description of the decision-making surgical process. Readers will enjoy a high-level sophistication with the text. The remainder of the chapter is devoted to the surgical pearls that are rarely mentioned in other surgical textbooks. All aspects of minimally invasive spine surgery are covered especially special topics including Tumor, Trauma and Deformity. Routine procedures are covered in detail with particular emphasis given to surgical nuances and pearls learned from experienced MIS spine surgeons. All levels of experience will truly appreciate the detail, clarity and sophistication associated with this comprehensive MIS Spine Surgery algorithmic textbook. Make this book well-suited for medical students, residents, fellows, and surgeons who not only want to be introduced to a new method of surgical management but also to refresh an experienced surgeon on a particular surgical technique.

Book Minimally Invasive Spine Surgery

Download or read book Minimally Invasive Spine Surgery written by Chadi Tannoury and published by Lippincott Williams & Wilkins. This book was released on 2017-04-24 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: The field of spine surgery is in a state of flux, with minimally invasive and open surgical procedures vying for dominance. A new volume in the Minimally Invasive Orthopaedic Surgery series, Minimally Invasive Spine Surgery weighs the pros and cons of today’s open versus minimally invasive techniques, allowing you to choose the approaches that will best meet your patients’ needs. In each chapter, accomplished experts describe the advantages, indications, setup, technical aspects, and problem areas associated with a given minimally invasive procedure, including critiques from surgeons who favor a standard open approach – to give you a balanced, objective foundation for surgical decision making.

Book Modern Techniques in Spine Surgery

Download or read book Modern Techniques in Spine Surgery written by Arvind Bhave and published by JP Medical Ltd. This book was released on 2014-11-30 with total page 470 pages. Available in PDF, EPUB and Kindle. Book excerpt: Minimally invasive techniques are now the preferred method for spine surgery because the incision is much smaller, causing less damage to surrounding muscles, pain is usually greatly reduced, and recovery time is faster. This book is a practical guide to minimally invasive diagnostic and surgical techniques for spine operations. Beginning with an overview of spinal anatomy and the basics of minimally invasive surgery, the following chapters examine the management of numerous different spinal conditions. A complete chapter is dedicated to patients with spinal cord injury and rehabilitation. More than 200 clinical photographs, diagrams and tables enhance the comprehensive text, making it an invaluable resource for both trainees and practising spine surgeons. Key points Comprehensive guide to minimally invasive spine surgery Covers diagnosis and treatment of numerous spinal disorders Complete chapter dedicated to spinal injury and rehabilitation Includes more than 200 photographs and illustrations

Book Emerging Spine Surgery Technologies

Download or read book Emerging Spine Surgery Technologies written by Terry P. Corbin and published by CRC Press. This book was released on 2005-09-30 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Today's spinal surgeons are poised at the threshold of technological breakthroughs that will enable them to restore the disc to like-new performance, make every fusion a certainty, and reverse osteoporotic fractures - all with minimally invasive procedures. Yet several of the final barriers to success are unlike those faced by earlier researchers and clinicians. Evidence-Based Medicine Evidence-based medicine, which requires different and more stringent clinical studies than those required for regulatory approval, is now the dominant decision methodology demanded by payers of health care. This is where the treatments to be used by tomorrow's spinal surgeon will be made or broken. To ensure reimbursement, physicians must have access to scientific evidence that a new product is not only safe and effective but also appropriate for a specific condition. This comprehensive book provides a solid evidence-based foundation for evaluating developments in the spine surgery arena. It is essential reading for all spine surgeons. Emerging Spinal Surgery Technologies presents the methods from which the gold standard of the next decade will most likely emerge. It thoroughly details what lies on the horizon in every discipline dedicated to treatment of the spine. And it outlines the many new considerations, FDA approval and ever-rising reimbursement standards by Medicare and the major health insurers, that will influence the course of future developments. Leading Authorities Chapters by distinguished individuals in the field preview the most promising developments in biologic and tissue engineering as applicable to spine fusion, repair and regeneration of the intervertebral disc, and spinal cord repair and regeneration. Chapters describing the leading methods of surgical navigation, often required to verify placement of devices and to visualize anatomy, are also included. Step-by-Step Surgical Technique for All Major Procedures Readers will find authoritative, step-by-step descriptions of surgical techniques and methods for spinal implants and disc replacements. In each chapter the authors outline patient indications and then guide the reader through the intricacies of each procedure. Numerous photographs and radiographs as well as ample boxes and tables add further detail. In addition, tips and tricks, problems and complications, as well as results and benefits are discussed.

Book Minimally Invasive Spine Surgery

Download or read book Minimally Invasive Spine Surgery written by Mick Perez-Cruet and published by BoD – Books on Demand. This book was released on 2022-09-28 with total page 188 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book illustrates some of the latest advances in minimally invasive surgical techniques and technology to treat a variety of spinal disorders. Written by some of the leading minimally invasive spine surgeons, this book teaches surgeons how to perform these procedures safely and effectively. The goal is to advance the field of spinal surgery and ultimately improve the lives of patients suffering from spinal disorders. The book reviews cervical, thoracic, and lumbar approaches.