17 results
Contributors
-
- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
-
- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
-
- Chapter
- Export citation
Contributors
-
- By Graeme J.M. Alexander, Heung Bae Kim, Michael Burch, Andrew J. Butler, Tanveer Butt, Roy Calne, Edward Cantu, Robert B. Colvin, Paul Corris, Charles Crawley, Hiroshi Date, Francis L. Delmonico, Bimalangshu R. Dey, Kate Drummond, John Dunning, John D. Firth, John Forsythe, Simon M. Gabe, Robert S. Gaston, William Gelson, Paul Gibbs, Alex Gimson, Leo C. Ginns, Samuel Goldfarb, Ryoichi Goto, Walter K. Graham, Simon J.F. Harper, Koji Hashimoto, David G. Healy, Hassan N. Ibrahim, David Ip, Fadi G. Issa, Neville V. Jamieson, David P. Jenkins, Dixon B. Kaufman, Kiran K. Khush, Heung Bae Kim, Andrew A. Klein, John Klinck, Camille Nelson Kotton, Vineeta Kumar, Yael B. Kushner, D. Frank. P. Larkin, Clive J. Lewis, Yvonne H. Luo, Richard S. Luskin, Ernest I. Mandel, James F. Markmann, Lorna Marson, Arthur J. Matas, Mandeep R. Mehra, Stephen J. Middleton, Giorgina Mieli-Vergani, Charles Miller, Sharon Mulroy, Faruk Özalp, Can Ozturk, Jayan Parameshwar, J.S. Parmar, Hari K. Parthasarathy, Nick Pritchard, Cristiano Quintini, Axel O. Rahmel, Chris J. Rudge, Stephan V.B. Schueler, Maria Siemionow, Jacob Simmonds, Peter Slinger, Thomas R. Spitzer, Stuart C. Sweet, Nina E. Tolkoff-Rubin, Steven S.L. Tsui, Khashayar Vakili, R.V. Venkateswaran, Hector Vilca-Melendez, Vladimir Vinarsky, Kathryn J. Wood, Heidi Yeh, David W. Zaas, Jonathan G. Zaroff
- Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
-
- Book:
- Organ Transplantation
- Published online:
- 07 September 2011
- Print publication:
- 11 August 2011, pp vii-x
-
- Chapter
- Export citation
The Medico-Legal Back: An Illustrated Guide
- Robert A. Dickson, W. Paul Butt
-
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003
-
Back pain and back injury is an extremely common problem, producing chronic, debilitating symptoms for sufferers, and resulting in millions of pounds of lost revenue in absence from work and paid in compensation for spinal injuries. Originally published in 2004, The Medico-Legal Back addresses the problem for a legal readership, in a clear, concise and reader-friendly style. It does away with the need to search for and then extract complex information from many different sources, and as such will be an indispensable guide to the problem for all lawyers, judges and medico-legal experts, as well as being of value to the orthopaedic surgeon with an interest in the spine. Of particular value is the use throughout the book of analogies drawn on anatomical technicalities and common movements, situations and incidents of everyday life.
8 - Back Pain and Litigation
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 165-204
-
- Chapter
- Export citation
-
Summary
INTRODUCTION
Those of us in reasonable health and full-time well-paid employment in the medical and legal professions do not, perhaps, realise how fortunate we are. By contrast, to a young bread winner with a family to support and a mortgage and other financial responsibilities and looking forward to enhanced security in the future, a severe injury resulting in significant symptoms as well as an inability to continue working is a catastrophic event. What would we do if it happened to us and how would we cope physically, emotionally and financially? Clearly, financial compensation from a genuine accident-related disability is entirely appropriate and well deserved, but it is no substitute for normality.
We have always been, and will remain, staunch supporters of the concept that an individual who is damaged deserves compensation. That is why compensation for damages is entirely valid, but such damages do seem to be often unfairly distributed.
THE EXPERT WITNESS
Experts involved in trying to help the medico-legal process should, we think, know something about the matter in hand and demonstrate reasonable clinical experience. Orthopaedic surgeons deal with the surgical aspects of all hard parts of the body, the bones and joints, and the muscles, tendons, ligaments and nerves that work them; that is, all bar the contained soft organs.
4 - Degenerative Spinal Disease
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 53-104
-
- Chapter
- Export citation
Frontmatter
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp i-iv
-
- Chapter
- Export citation
7 - Miscellaneous Spinal Conditions
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 143-164
-
- Chapter
- Export citation
-
Summary
INTRODUCTION
This short section, while not being so directly relevant to medico-legal matters, completes the clinical review of spine pathologies, which the spinal surgeon may be asked to address and indicates the wide variety of pathological conditions, which make up the clinical portfolio of the spinal surgeon. In addition, it gives the flavour of how far spinal surgery has come over the past two or three decades.
The great majority of low-back problems are mechanical in origin and, therefore, the patient is going to be less symptomatic, when resting than when active. Night pain is not a feature of degenerative conditions but is the classical symptom of bone destruction. Therefore, it is important when taking a history from a back pain patient to ask specifically about night pain as this is a red flag warning for a worrying pathological process, such as tumour or infection. Being woken up several times and often having to pace the room at night in an attempt to obtain relief is the classical symptom of tumour (Fig. 7.1), whereas back pain, temperature and tenderness are the clinical triad diagnostic of infection. Indeed only infection and fresh injury produce spinal tenderness. Then many low-back conditions are associated with a degree of stiffness in the morning, which tends to wear off after a few minutes of being up and about.
Foreword
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp vii-viii
-
- Chapter
- Export citation
-
Summary
This is a practitioner's book. It is an illustrated guide rather than a textbook, and it will be of immense value in the medico-legal world. How I wish that it had been available during my 40 years of grappling with claims for negligence for back injuries both at the Bar and on the Bench. It would have saved many hours of searching for suitable background information and explanation on an area of the body which is complex and often produces problems that are so difficult to define and nail down that they produce differing expert opinions.
The paramount virtue of this book is that the text is expressed with a clarity which makes it easy to read and readily understandable. Of particular help are the many analogies, which are drawn between anatomical technicalities and movements, situations and incidents, which are part of everyday life. To clarify matters even further, there are abundant illustrations and drawings to augment the text and these help the reader to visualise the problems facing the court. It will be of great assistance to the busy lawyer, especially those who come into a case at a very late stage and have to prepare it under the pressure of time. I suspect that it will be of equal value to orthopaedic and neurosurgeons who are building up their medico-legal experience.
The authors are eminently qualified to produce a book of this kind, as they have added their combined extensive medico-legal experience to their already impressive academic records.
5 - Spondylolisthesis
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 105-120
-
- Chapter
- Export citation
-
Summary
This term is derived from the two Greek words spondyl meaning spine and olisthesis meaning slippage. It most commonly occurs at the bottom of the spine – the joint between the fifth lumbar vertebra and the sacrum (the L5/S1 joint). We classify spondylolisthesis into five different types.
Types of spondylolisthesis
Dysplastic
Isthmic
Traumatic
Degenerative
Pathological
By far the commonest is isthmic spondylolisthesis.
When spondylolisthesis occurs, the vertebra above, with the whole spine on top of it, slips forward on the one below. Having vertebrae slipping around sounds a dreadful situation but, with few exceptions, the condition is much more benign than one would think.
DYSPLASTIC SPONDYLOLISTHESIS
Dysplastic means abnormal formation and the dysplasia in question concerns the posterior facet joint at the back of the spine, which quite simply has not formed properly (embryological failure for whatever reason). You will recall from the earlier biomechanics section that the posterior facet joint aids stability and if it has not formed properly then it may be incompetent in its ability to prevent movement. While the dysplasia is congenital (present at or before birth), slippage may never occur and thus, the dysplasia or even aplasia (no facet joint formed at all) may never be recognised.
Index
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 205-210
-
- Chapter
- Export citation
3 - Biomechanics of the Spine
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 37-52
-
- Chapter
- Export citation
-
Summary
To support the body and provide a wide range of motion while protecting the spinal cord demands stable movements and the prevention of instability and the spine is brilliantly designed for these purposes. It is a column comprising a series of bone segments (vertebrae) separated by discs and joined by ligaments so that considerable movement of the whole is produced by relatively small displacements at many sites rather like a bicycle chain. This is a much more stable configuration than motion occurring at few very mobile joints as in the limbs. Notwithstanding, the spine can be damaged.
The ability of a structure to resist breakage depends upon two things – its shape (geometry) and what it is made of (materials) and bones including vertebrae are no exceptions.
Most matters that concern doctors and lawyers in personal injury or medical negligence are to do with the effects of trauma, which is what happens to the body in response to an applied load, and, therefore, it is necessary to become familiar with some of the more important biomechanical words and phrases. We have already seen that when something is squashed, it is under compression; and when something is stretched, it is under tension. Compression and tension are, therefore, forces applied along the length of the material. The third type of force, shear, is applied to the side of the material at right angles to the long axis, rather like rubbing something.
Compression – squeezing
Tension – stretching
Shear – rubbing
Preface
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp ix-xii
-
- Chapter
- Export citation
-
Summary
A quarter of a century ago one of us (WPB) arrived as a Consultant Radiologist with a particular interest in the musculoskeletal system at St James's University Hospital in Leeds. Shortly thereafter, the other (RAD) took up the position of Professor of Orthopaedic Surgery in the same institution and from then on we have worked on a daily basis seeking to provide an optimal clinical service for patients in the Yorkshire region, and beyond, who have spinal problems. It became abundantly clear that imaging (all forms of X-rays and scans) was an essential partner to safe, sensible, well-intentioned spinal surgery with a minimal complication rate. Thus the spinal surgeon and the spinal radiologist must work together to produce clinical work of the highest quality. Back then, we instituted a regular weekly audit meeting (long before audit was ever envisaged) whereby all patients operated upon the following week were assessed clinically and radiologically by the spinal team (spinal surgeons, nurses, radiologists etc). This practice of course continues today although, mercifully, there is more than one spinal surgeon and one radiologist!
Because we emphasise in this text that, apart from red flag problems such as cancer, scanning in particular has to be surgically-directed, then the marrying up of clinical features with scan appearances is an absolutely essential pre-requisite before surgical intervention.
1 - Some Useful Words
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 1-6
-
- Chapter
- Export citation
Acknowledgements
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp xiii-xiv
-
- Chapter
- Export citation
Contents
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp v-vi
-
- Chapter
- Export citation
6 - Spinal Fractures and Dislocations
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 121-142
-
- Chapter
- Export citation
-
Summary
While soft tissue musculo-ligamentous strains and contusions occur with fairly low violence once the energy considerations rise appreciably then the spinal column is open to significant structural failure. Bones can be broken (fractures), joints can be torn apart (dislocations) and an injury can have a bit of both (fracture–dislocation).
The prevalence of these injuries is rising all the while, mostly in association with steadily increasing traffic density, and the incidence of paralysis is approaching one hundred per million population per year. Neck (cervical) injuries are the commonest, being more than twice as frequent as thoracic injuries with lumbar injuries in between. This is because the neck and lower back have much bigger ranges of motion, while the intervening thoracic intervertebral joints allow much less motion and are further splinted by the attached chest wall (ribs and breast bone). It, therefore, takes bigger energies to fracture or dislocate the thoracic spine and, moreover, there is much less space in the thoracic spine for the spinal cord compared to the cervical and lumbar regions. Not surprisingly, paralysis in association with thoracic spinal injuries is twice as common as with lumbar injuries (43% versus 21%) (Table 6.1).
While the paralysis rate seems very high, the majority fortunately recover and it is important to differentiate patients with complete paralysis on admission from those with partial paralysis since the latter have a very much better prognosis for neurological recovery.
2 - Anatomy of the Spine
- Robert A. Dickson, W. Paul Butt
-
- Book:
- The Medico-Legal Back: An Illustrated Guide
- Published online:
- 10 December 2009
- Print publication:
- 08 January 2003, pp 7-36
-
- Chapter
- Export citation