ESSENTIAL NEUROSURGERY FOR MEDICAL STUDENTS Spine Faiz U. Ahmad, MD ∗ Erica F. Bisson, MD, MPH ‡ Stephen Shelby Burks, MD § Jason J. Chang, MD ¶ A. Jessey Chugh, MD || Ian Côté, MD § Jason M. Frerich, MD, MSc ∗ Zachary C. Gersey, MD, MS # Benjamin K. Hendricks, MD ∗∗ Michael Karsy, MD, PhD ‡ Manish Kasliwal, MD ‡‡ Katie L. Krause, MD, PhD ¶ Glen R. Manzano, MD § Clinton D. Morgan, MD ∗∗ Laura A. Snyder, MD ∗∗ Christian C. Swinney, MD §§ Khoi D. Than, MD ¶ Christian B. Theodotou, MD § Anand Veeravagu, MD §§ || Jacqueline Ventura §§ ∗ Department of Neurosurgery, Emory University, Atlanta, Georgia; ‡ Department of Neurosurgery, University of Utah, Salt Lake City, Utah; § Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; ¶ Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon; || Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio; # Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; ∗∗ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; ‡‡ Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; §§ Department of Neurosurgery, Stanford University School of Medicine, Stanford, California Given constraints of this publication modality (ie, a book rather than journal articles), the citations and bibliography are not to the level of detail of a journal articles. Readers are directed to the suggested reading lists, which contain references to subsequent references and derivatives of the article content Correspondence: Faiz U. Ahmad, MD, 1365-B Clifton Road, Suite 6200, Atlanta, GA 30322. Email: drfaizns@gmail.com Received, March 5, 2019. Accepted, March 5, 2019. Published Online, May 17, 2019. Copyright C  2019 by the Congress of Neurological Surgeons A mong the wide spectrum of diseases treated by neurosurgeons, few are as gratifying as a good outcome like freedom from pain or disability in a well-selected patient with a spinal problem. Spinal surgery comprises a major part (often up to 70%-80%) of the practice of most general neurosurgeons currently practicing in the USA. The number of spinal operations performed per year in the USA has risen continuously and rapidly over the last 3 decades. With our growing and aging population, this number is almost certain to grow further. Older population means more people with falls and fractures, more tumors in patients who will live longer due to advances in oncology treatment, more degenerative pathologies, and, consequently, more demand to perform procedures to help these patients improve their quality of life. While tremendous advancements have been made in all subspecialties of neurosurgery, this is particularly true in the field of spinal surgery, where new innovations and techniques have totally transformed the landscape over the last 2 decades, helping us take care of more complex problems with shorter hospital stays and less morbidity. The discussion of cutting- edge technologies like robotics, osteobiologics, navigation, and neuromodulation is not the purpose of this section. The purpose of this section is to introduce medical students to the exciting world of spinal pathologies, and cover a breadth of topics like degenerative conditions, ABBREVIATIONS: ACDF, anterior cervical discectomy and fusion; ASIA, American Spinal Injury Association; CES, cauda equina syndrome; CSM, cervical spondylotic myelopathy; DDD, degenerative disc disease; HGS, high-grade spondy- lolisthesis; ISCNCSCI, International Standards for Neurological Classification of Spinal Cord Injury; IV, intravenous; JOA, Japanese Orthopedic Assessment; MAP, mean arterial blood pressure; MPSS, methyl- prednisolone sodium succinate; MRI, magnetic resonance imaging; NASCIS, National Acute Spinal Cord Injury Studies; NSAIDs, nonsteroidal anti-inflammatory drugs; SCI, spinal cord injury; STASCIS, Surgical Timing in Acute Spinal Cord Injury Study tumors, trauma, and emergencies that they are likely to see during their neurosurgical rotation in the clinics and wards. This is geared towards students in their third and fourth years of school, irrespective of their ultimate choice of residency specialty later. Each subsection has a video, case presen- tation with multiple-choice questions and subse- quent explanations, a short didactic text, pearls, and suggested reading. We are confident that this will provide the students with the basic knowledge of spinal pathologies and treatment options, stimulate their interest to ask more questions, and hopefully consider neurosurgery as their career option. This manuscript and the content there within is an educational reference text. No research was conducted and no data were collected or analyzed. Institutional Review Board/ethics committee approval and patient consent were not required. CHAPTER 1: EPIDURAL ABSCESS AND OTHER SPINAL INFECTIONS Case Presentation and Questions A 45-yr-old male who reports no prior medical problems presented to the ER with fever, malaise, severe lumbar back pain, and sudden onset bilateral foot drop within the past 3 h. Magnetic resonance imaging (MRI) of the lumbar spine shows a contrast enhancing lesion just anterior to and causing a significant mass effect on the thecal sac at L5-S1. There does not appear to be any significant bony involvement. 1. Which of the following may be risk factors of the patient’s condition? a. Osteoporosis b. Rheumatoid arthritis c. Intravenous drug abuse d. Ankylosing spondylitis e. All of the above 2. Primary management in this patient will be to a. Initiating empirical antibiotics b. Immediately decompressing the neural elements c. Obtaining percutaneous biopsy d. Fusing the spine OPERATIVE NEUROSURGERY WWW.CNS.ORG VOLUME 17 | NUMBER 2 | AUGUST 2019 SUPPLEMENT | S153 Downloaded from https://academic.oup.com/ons/article-abstract/17/Supplement_1/S153/5491059 by guest on 25 May 2020