Kern Singh, MD graduated from the Pennsylvania State University in 1995, Jefferson Medical College in 1999, and completed his Orthopaedic Surgery residency at Rush University Medical Center (1999 to 2004). He completed a Spine Surgery fellowship at Emory University in 2005 before returning to join the staff of the Department of Orthopedics, Section of Spine Surgery, at Rush University Medical Center as an assistant professor. Dr. Singh currently serves as an editor for the Journal of American Academy of Orthopedic Surgery, American Journal of Orthopedics, and the Journal of Contemporary Spine Surgery. He has co-authored multiple technique and review articles, book chapters, and peer-reviewed manuscripts in the field of spine surgery. Additionally, he has served as a faculty member for both national and international courses in Spine Surgery.

• Contents Dedication Acknowledgements About the Editors Contributing Authors Preface Foreward by John G. Heller, MD Section I Anatomy Question 1 How Do I Know Intraoperatively That I Have Done a Thorough Lumbar Decompression? Rick A. Davis, MD Question 2 When Performing a Lumbar Microdiscectomy, Is It Better to Perform Only a Fragmentectomy or Should I Perform an Annulotomy and be More Aggressive About the Disc Removal? Rick A. Davis, MD Question 3 I Am Going to Perform an Anterior Thoracic Spinal Release. Are There Any Intraoperative Precautions I Can Take to Minimize the Risk of Spinal Cord Infarction? Rick A. Davis, MD Section II Diagnostic Imaging Question 4 I Have a Patient With Degenerative Disc Disease at L5-S1 That Is Clinically Symptomatic. What Is a Discogram and When Should I Order One? Rick A. Davis, MD Question 5 I Have a 34-Year-Old Male With Recurrent Leg Pain 4 Weeks After a Discectomy. What Imaging Study Should I Order? Rick A. Davis, MD Question 6 I Have a Patient With a Small Disk Herniation But He Continues to Complain of Right Lower Extremity Radiculopathy. Is There an Imaging Study or Test I Can Order to Help Me Confirm My Diagnosis? Rick A. Davis, MD Question 7 I Have a 34-Year-Old Female With a Discogram Positive L5-S1 Degenerative Disc Who Wants to Avoid Surgery at All Costs. Is Intradis cal Electrothermal Therapy a Reasonable Alternative? Rick A. Davis, MD Question 8 I Have Patients With Spinal St enosis and Others With Foraminal Stenosis and Facet Degeneration. What Types of Anesthetic Injections Are Available and When Should I Order Them? Rick A. Davis, MD Section III Surgical Approach Question 9 I Have a Lot of Patients with L5-S1 Degenerative Di sc Disease. What Surgical Options Do I Have for Accessing the Anterior L5-S1 Interspace? 25 Joseph D. Smucker, MD Question 10 I Have a Patient With Discogen ic Pain and a Symptomatic L3-4 Intervertebral Di sc. What Are My Options? Joseph D. Smucker, MD Section IV Spinal Instrumentation Question 11 I Have Many Patients in My Office Who Have Symptoma tic Spinal Stenosis. In the Setting of a Lumbar Laminectomy, When Should I Perform a Fusion? Alpesh A. Patel, MD Question 12 What Is the Difference Between a Posterior Lumbar Interbody Fusion Versus a Transforaminal Interbody Fusion? Alpesh A. Patel, MD Question 13 I Have Noticed That When I Do Long Segment Fusions to the Sacrum, My Screws Have Pulled Out of the S1 Pedicle. I Am Not Familiar With Pelvic Fixation Techniques. When Should I Fuse to the Pelvis and What Types of Fixation Are Available? Alpesh A. Patel, MD Question 14 I Have a 34-Year-Old Male Who Has Degenerative Disc Disease at L4-5 and Wants to Avoid a Fusion. What Are the Advantages and Disadvantages of a Lumbar Disc Replacement in a Young Individual? Alpesh A. Patel, MD Section V Tumor Question 15 I Have a 37-Year-Old Male With an Isolated Lytic Bone Lesion in His Thoracic Vertebra. His Biopsy Indicated a Giant Cell Tumor. How Do I Manage This Lesion? Alpesh A. Patel, MD Question 16 I Have an Elderly Patient With Multiple Lesions in the Cervical/Thoracic and Lumbar Spine. Which Laboratory and Imaging Studies Should I Obtain? Alpesh A. Patel, MD Question 17 I Have a 67-Year-Old Female with Metastatic Breast Cancer and Spinal Cord Compression in the Thoracic Spine. When Should I Perform Surgery Instead of Irradiation? Alpesh A. Patel, MD Section VI Infection Question 18 What Risk Factors Will Increase the Likelihood of Postoperative Infection? Ahmad Nassr, MD and Joon Y. Lee, MD Question 19 I Have a Patient Who Has a Draining Wound 2 Weeks After a Lumbar Laminectomy Fusion. How Should I Manage This Patient? What if the Patient Had This Infection 9 Months Later? Ahmad Nassr, MD and Joon Y. Lee, MD Section VII Trauma Question 20 I Have a 28-Year-Old Female With a T12 Burst Fracture. She Is Neurologically Intact With 40 Degrees of Kyphosis and 50% Canal Compromise. Can I Do an All-Posterior Fusion or Should I Plan on Going Anteriorly? Ahmad Nassr, MD and Joon Y. Lee, MD Question 21 What Screening Radiographs Should a Spinal Trauma Patient Get? Ahmad Nassr, MD and Joon Y. Lee, MD Question 22 I Have a 27-Year-Old Male With a C5-6 Facet Dislocation Who Is Awake and Alert. Do I Need to Get an MRI Before I Reduce the Facet Dislocation? Ahmad Nassr, MD and Joon Y. Lee, MD Question 23 What Is Spinal Shock? How Do I Know When It Is Over? Ahmad Nassr, MD and Joon Y. Lee, MD Question 24 I Have a 65-Year-Old Female Who Fell and Suffered a Central Cord Syndrome. What Is Her Prognosis and Are There Other Types of Incomplete Spinal Cord Syndromes? Ahmad Nassr, MD and Joon Y. Lee, MD Question 25 I Have 57-Year-Old Male Involved in a High Speed Motor Vehicle Accident. He Is a C7 ASIA A Who Went to the Emergency Room 12 Hours After His Accident. Should I Give Him Intravenous Steroids? Ahmad Nassr, MD and Joon Y. Lee, MD Question 26 I Have a 34-Year-Old Patient Who Has Had Back Pain and Some Buttock Pain for 2 Weeks. When Should I Get an MRI? Brian Kwon, MD Question 27 I Have a 42-Year-Old Male With a Symptomatic Lumbar Disc Herniation That Has Been Present for 6 Weeks. What Roles Do Therapy and Epidural Injections Have? Brian Kwon, MD Question 28 I Have a 67-Year-Old Female With a T7 Compression Fracture. Are There Any Findings That Can Help Me to Differentiate a Pathological Compression Fracture From an Osteoporotic Fracture? Brian Kwon, MD Question 29 I Have a 72-Year-Old Female With a Symptomatic T12 Vertebral Compression Fracture That Has Failed a Course of Bracing. How Do I Decide Whether She Should Undergo a Kyphoplasty or a Vertebroplasty? Brian Kwon, MD Question 30 I Have a 34-Year-Old Male With Cervical Myelopathy and Multiple-Level Cervical Stenosis. I Am Concerned About Performing a Posterior Cervical Fusion on Such a Young Patient. Are There Any Alternatives That Would Treat His Myelopathy and Preserve His Neck Range of Motion? Brian Kwon, MD Question 31 I Have a 29-Year-Old Male With Right Arm Pain due to a C6 Disc Herniation. Is There a Surgical Alternative to an Anterior Cervical Discectomy and Fusion in This Patient? Brian Kwon, MD Question 32 What Is the Difference Between Cervical Myelopathy and Radiculopathy? Brian Kwon, MD Question 33 I Have a 29-Year-Old Male With a Large Central Disc Herniation at L4-5. He States That He Has Had Difficulty With Urination. How Do I Make Sure He Does Not Have Cauda Equina Syndrome? Brian Kwon, MD Section IX Pediatrics Question 34 I Have a 12-Year-Old Male With a 3-Month History of Back Pain That Does Not Appear to Be Resolving. How Should I Work Up Back Pain in an Adolescent? Shay Bess, MD Question 35 A 9-Year-Old Boy Came to the Emergency Room After Falling From a Tree. He Has a Lot of Neck Pain and Some Motor Weakness in his Upper and Lower Extremities. Is it Possible to Have Spinal Cord Injury Without Any Radiographic Abnormalities? How Should This Patient Be Managed? Shay Bess, MD Section X Bone Grafts Question 36 Some of My Patients Complain That the Iliac Crest Bone Graft Site Is Tender Years After Surgery. What Types of Bone Graft Alternatives Are Available for the Cervical and Thoracolumbar Spine? Shay Bess, MD Section XI Intraoperative Question 37 Do I Need to Perform Neuromonitoring for Every Spine Surgery? The Cost Is Relatively High and I Want to Be Selective About Its Use Shay Bess, MD Section XII Postoperative Patients Question 38 When Should I Brace My Thoracolumbar Fusions? Shay Bess, MD Section XIII Sports Medicine Question 39 I Was at a High School Football Game When I Saw a Football Player Attempt to Spear-Tackle Another Player; His Arms and Legs Temporarily Became Numb. What Happened to That Player and How Should He Be Followed? Shay Bess, MD Question 40 W

Kern Singh, MD graduated from the Pennsylvania State University in 1995, Jefferson Medical College in 1999, and completed his Orthopaedic Surgery residency at Rush University Medical Center (1999 to 2004). He completed a Spine Surgery fellowship at Emory University in 2005 before returning to join the staff of the Department of Orthopedics, Section of Spine Surgery, at Rush University Medical Center as an assistant professor. Dr. Singh currently serves as an editor for the Journal of American Academy of Orthopedic Surgery, American Journal of Orthopedics, and the Journal of Contemporary Spine Surgery. He has co-authored multiple technique and review articles, book chapters, and peer-reviewed manuscripts in the field of spine surgery. Additionally, he has served as a faculty member for both national and international courses in Spine Surgery.

• Contents Dedication Acknowledgements About the Editors Contributing Authors Preface Foreward by John G. Heller, MD Section I Anatomy Question 1 How Do I Know Intraoperatively That I Have Done a Thorough Lumbar Decompression? Rick A. Davis, MD Question 2 When Performing a Lumbar Microdiscectomy, Is It Better to Perform Only a Fragmentectomy or Should I Perform an Annulotomy and be More Aggressive About the Disc Removal? Rick A. Davis, MD Question 3 I Am Going to Perform an Anterior Thoracic Spinal Release. Are There Any Intraoperative Precautions I Can Take to Minimize the Risk of Spinal Cord Infarction? Rick A. Davis, MD Section II Diagnostic Imaging Question 4 I Have a Patient With Degenerative Disc Disease at L5-S1 That Is Clinically Symptomatic. What Is a Discogram and When Should I Order One? Rick A. Davis, MD Question 5 I Have a 34-Year-Old Male With Recurrent Leg Pain 4 Weeks After a Discectomy. What Imaging Study Should I Order? Rick A. Davis, MD Question 6 I Have a Patient With a Small Disk Herniation But He Continues to Complain of Right Lower Extremity Radiculopathy. Is There an Imaging Study or Test I Can Order to Help Me Confirm My Diagnosis? Rick A. Davis, MD Question 7 I Have a 34-Year-Old Female With a Discogram Positive L5-S1 Degenerative Disc Who Wants to Avoid Surgery at All Costs. Is Intradis cal Electrothermal Therapy a Reasonable Alternative? Rick A. Davis, MD Question 8 I Have Patients With Spinal St enosis and Others With Foraminal Stenosis and Facet Degeneration. What Types of Anesthetic Injections Are Available and When Should I Order Them? Rick A. Davis, MD Section III Surgical Approach Question 9 I Have a Lot of Patients with L5-S1 Degenerative Di sc Disease. What Surgical Options Do I Have for Accessing the Anterior L5-S1 Interspace? 25 Joseph D. Smucker, MD Question 10 I Have a Patient With Discogen ic Pain and a Symptomatic L3-4 Intervertebral Di sc. What Are My Options? Joseph D. Smucker, MD Section IV Spinal Instrumentation Question 11 I Have Many Patients in My Office Who Have Symptoma tic Spinal Stenosis. In the Setting of a Lumbar Laminectomy, When Should I Perform a Fusion? Alpesh A. Patel, MD Question 12 What Is the Difference Between a Posterior Lumbar Interbody Fusion Versus a Transforaminal Interbody Fusion? Alpesh A. Patel, MD Question 13 I Have Noticed That When I Do Long Segment Fusions to the Sacrum, My Screws Have Pulled Out of the S1 Pedicle. I Am Not Familiar With Pelvic Fixation Techniques. When Should I Fuse to the Pelvis and What Types of Fixation Are Available? Alpesh A. Patel, MD Question 14 I Have a 34-Year-Old Male Who Has Degenerative Disc Disease at L4-5 and Wants to Avoid a Fusion. What Are the Advantages and Disadvantages of a Lumbar Disc Replacement in a Young Individual? Alpesh A. Patel, MD Section V Tumor Question 15 I Have a 37-Year-Old Male With an Isolated Lytic Bone Lesion in His Thoracic Vertebra. His Biopsy Indicated a Giant Cell Tumor. How Do I Manage This Lesion? Alpesh A. Patel, MD Question 16 I Have an Elderly Patient With Multiple Lesions in the Cervical/Thoracic and Lumbar Spine. Which Laboratory and Imaging Studies Should I Obtain? Alpesh A. Patel, MD Question 17 I Have a 67-Year-Old Female with Metastatic Breast Cancer and Spinal Cord Compression in the Thoracic Spine. When Should I Perform Surgery Instead of Irradiation? Alpesh A. Patel, MD Section VI Infection Question 18 What Risk Factors Will Increase the Likelihood of Postoperative Infection? Ahmad Nassr, MD and Joon Y. Lee, MD Question 19 I Have a Patient Who Has a Draining Wound 2 Weeks After a Lumbar Laminectomy Fusion. How Should I Manage This Patient? What if the Patient Had This Infection 9 Months Later? Ahmad Nassr, MD and Joon Y. Lee, MD Section VII Trauma Question 20 I Have a 28-Year-Old Female With a T12 Burst Fracture. She Is Neurologically Intact With 40 Degrees of Kyphosis and 50% Canal Compromise. Can I Do an All-Posterior Fusion or Should I Plan on Going Anteriorly? Ahmad Nassr, MD and Joon Y. Lee, MD Question 21 What Screening Radiographs Should a Spinal Trauma Patient Get? Ahmad Nassr, MD and Joon Y. Lee, MD Question 22 I Have a 27-Year-Old Male With a C5-6 Facet Dislocation Who Is Awake and Alert. Do I Need to Get an MRI Before I Reduce the Facet Dislocation? Ahmad Nassr, MD and Joon Y. Lee, MD Question 23 What Is Spinal Shock? How Do I Know When It Is Over? Ahmad Nassr, MD and Joon Y. Lee, MD Question 24 I Have a 65-Year-Old Female Who Fell and Suffered a Central Cord Syndrome. What Is Her Prognosis and Are There Other Types of Incomplete Spinal Cord Syndromes? Ahmad Nassr, MD and Joon Y. Lee, MD Question 25 I Have 57-Year-Old Male Involved in a High Speed Motor Vehicle Accident. He Is a C7 ASIA A Who Went to the Emergency Room 12 Hours After His Accident. Should I Give Him Intravenous Steroids? Ahmad Nassr, MD and Joon Y. Lee, MD Question 26 I Have a 34-Year-Old Patient Who Has Had Back Pain and Some Buttock Pain for 2 Weeks. When Should I Get an MRI? Brian Kwon, MD Question 27 I Have a 42-Year-Old Male With a Symptomatic Lumbar Disc Herniation That Has Been Present for 6 Weeks. What Roles Do Therapy and Epidural Injections Have? Brian Kwon, MD Question 28 I Have a 67-Year-Old Female With a T7 Compression Fracture. Are There Any Findings That Can Help Me to Differentiate a Pathological Compression Fracture From an Osteoporotic Fracture? Brian Kwon, MD Question 29 I Have a 72-Year-Old Female With a Symptomatic T12 Vertebral Compression Fracture That Has Failed a Course of Bracing. How Do I Decide Whether She Should Undergo a Kyphoplasty or a Vertebroplasty? Brian Kwon, MD Question 30 I Have a 34-Year-Old Male With Cervical Myelopathy and Multiple-Level Cervical Stenosis. I Am Concerned About Performing a Posterior Cervical Fusion on Such a Young Patient. Are There Any Alternatives That Would Treat His Myelopathy and Preserve His Neck Range of Motion? Brian Kwon, MD Question 31 I Have a 29-Year-Old Male With Right Arm Pain due to a C6 Disc Herniation. Is There a Surgical Alternative to an Anterior Cervical Discectomy and Fusion in This Patient? Brian Kwon, MD Question 32 What Is the Difference Between Cervical Myelopathy and Radiculopathy? Brian Kwon, MD Question 33 I Have a 29-Year-Old Male With a Large Central Disc Herniation at L4-5. He States That He Has Had Difficulty With Urination. How Do I Make Sure He Does Not Have Cauda Equina Syndrome? Brian Kwon, MD Section IX Pediatrics Question 34 I Have a 12-Year-Old Male With a 3-Month History of Back Pain That Does Not Appear to Be Resolving. How Should I Work Up Back Pain in an Adolescent? Shay Bess, MD Question 35 A 9-Year-Old Boy Came to the Emergency Room After Falling From a Tree. He Has a Lot of Neck Pain and Some Motor Weakness in his Upper and Lower Extremities. Is it Possible to Have Spinal Cord Injury Without Any Radiographic Abnormalities? How Should This Patient Be Managed? Shay Bess, MD Section X Bone Grafts Question 36 Some of My Patients Complain That the Iliac Crest Bone Graft Site Is Tender Years After Surgery. What Types of Bone Graft Alternatives Are Available for the Cervical and Thoracolumbar Spine? Shay Bess, MD Section XI Intraoperative Question 37 Do I Need to Perform Neuromonitoring for Every Spine Surgery? The Cost Is Relatively High and I Want to Be Selective About Its Use Shay Bess, MD Section XII Postoperative Patients Question 38 When Should I Brace My Thoracolumbar Fusions? Shay Bess, MD Section XIII Sports Medicine Question 39 I Was at a High School Football Game When I Saw a Football Player Attempt to Spear-Tackle Another Player; His Arms and Legs Temporarily Became Numb. What Happened to That Player and How Should He Be Followed? Shay Bess, MD Question 40 W

Kern Singh, MD graduated from the Pennsylvania State University in 1995, Jefferson Medical College in 1999, and completed his Orthopaedic Surgery residency at Rush University Medical Center (1999 to 2004). He completed a Spine Surgery fellowship at Emory University in 2005 before returning to join the staff of the Department of Orthopedics, Section of Spine Surgery, at Rush University Medical Center as an assistant professor. Dr. Singh currently serves as an editor for the Journal of American Academy of Orthopedic Surgery, American Journal of Orthopedics, and the Journal of Contemporary Spine Surgery. He has co-authored multiple technique and review articles, book chapters, and peer-reviewed manuscripts in the field of spine surgery. Additionally, he has served as a faculty member for both national and international courses in Spine Surgery.

• Contents Dedication Acknowledgements About the Editors Contributing Authors Preface Foreward by John G. Heller, MD Section I Anatomy Question 1 How Do I Know Intraoperatively That I Have Done a Thorough Lumbar Decompression? Rick A. Davis, MD Question 2 When Performing a Lumbar Microdiscectomy, Is It Better to Perform Only a Fragmentectomy or Should I Perform an Annulotomy and be More Aggressive About the Disc Removal? Rick A. Davis, MD Question 3 I Am Going to Perform an Anterior Thoracic Spinal Release. Are There Any Intraoperative Precautions I Can Take to Minimize the Risk of Spinal Cord Infarction? Rick A. Davis, MD Section II Diagnostic Imaging Question 4 I Have a Patient With Degenerative Disc Disease at L5-S1 That Is Clinically Symptomatic. What Is a Discogram and When Should I Order One? Rick A. Davis, MD Question 5 I Have a 34-Year-Old Male With Recurrent Leg Pain 4 Weeks After a Discectomy. What Imaging Study Should I Order? Rick A. Davis, MD Question 6 I Have a Patient With a Small Disk Herniation But He Continues to Complain of Right Lower Extremity Radiculopathy. Is There an Imaging Study or Test I Can Order to Help Me Confirm My Diagnosis? Rick A. Davis, MD Question 7 I Have a 34-Year-Old Female With a Discogram Positive L5-S1 Degenerative Disc Who Wants to Avoid Surgery at All Costs. Is Intradis cal Electrothermal Therapy a Reasonable Alternative? Rick A. Davis, MD Question 8 I Have Patients With Spinal St enosis and Others With Foraminal Stenosis and Facet Degeneration. What Types of Anesthetic Injections Are Available and When Should I Order Them? Rick A. Davis, MD Section III Surgical Approach Question 9 I Have a Lot of Patients with L5-S1 Degenerative Di sc Disease. What Surgical Options Do I Have for Accessing the Anterior L5-S1 Interspace? 25 Joseph D. Smucker, MD Question 10 I Have a Patient With Discogen ic Pain and a Symptomatic L3-4 Intervertebral Di sc. What Are My Options? Joseph D. Smucker, MD Section IV Spinal Instrumentation Question 11 I Have Many Patients in My Office Who Have Symptoma tic Spinal Stenosis. In the Setting of a Lumbar Laminectomy, When Should I Perform a Fusion? Alpesh A. Patel, MD Question 12 What Is the Difference Between a Posterior Lumbar Interbody Fusion Versus a Transforaminal Interbody Fusion? Alpesh A. Patel, MD Question 13 I Have Noticed That When I Do Long Segment Fusions to the Sacrum, My Screws Have Pulled Out of the S1 Pedicle. I Am Not Familiar With Pelvic Fixation Techniques. When Should I Fuse to the Pelvis and What Types of Fixation Are Available? Alpesh A. Patel, MD Question 14 I Have a 34-Year-Old Male Who Has Degenerative Disc Disease at L4-5 and Wants to Avoid a Fusion. What Are the Advantages and Disadvantages of a Lumbar Disc Replacement in a Young Individual? Alpesh A. Patel, MD Section V Tumor Question 15 I Have a 37-Year-Old Male With an Isolated Lytic Bone Lesion in His Thoracic Vertebra. His Biopsy Indicated a Giant Cell Tumor. How Do I Manage This Lesion? Alpesh A. Patel, MD Question 16 I Have an Elderly Patient With Multiple Lesions in the Cervical/Thoracic and Lumbar Spine. Which Laboratory and Imaging Studies Should I Obtain? Alpesh A. Patel, MD Question 17 I Have a 67-Year-Old Female with Metastatic Breast Cancer and Spinal Cord Compression in the Thoracic Spine. When Should I Perform Surgery Instead of Irradiation? Alpesh A. Patel, MD Section VI Infection Question 18 What Risk Factors Will Increase the Likelihood of Postoperative Infection? Ahmad Nassr, MD and Joon Y. Lee, MD Question 19 I Have a Patient Who Has a Draining Wound 2 Weeks After a Lumbar Laminectomy Fusion. How Should I Manage This Patient? What if the Patient Had This Infection 9 Months Later? Ahmad Nassr, MD and Joon Y. Lee, MD Section VII Trauma Question 20 I Have a 28-Year-Old Female With a T12 Burst Fracture. She Is Neurologically Intact With 40 Degrees of Kyphosis and 50% Canal Compromise. Can I Do an All-Posterior Fusion or Should I Plan on Going Anteriorly? Ahmad Nassr, MD and Joon Y. Lee, MD Question 21 What Screening Radiographs Should a Spinal Trauma Patient Get? Ahmad Nassr, MD and Joon Y. Lee, MD Question 22 I Have a 27-Year-Old Male With a C5-6 Facet Dislocation Who Is Awake and Alert. Do I Need to Get an MRI Before I Reduce the Facet Dislocation? Ahmad Nassr, MD and Joon Y. Lee, MD Question 23 What Is Spinal Shock? How Do I Know When It Is Over? Ahmad Nassr, MD and Joon Y. Lee, MD Question 24 I Have a 65-Year-Old Female Who Fell and Suffered a Central Cord Syndrome. What Is Her Prognosis and Are There Other Types of Incomplete Spinal Cord Syndromes? Ahmad Nassr, MD and Joon Y. Lee, MD Question 25 I Have 57-Year-Old Male Involved in a High Speed Motor Vehicle Accident. He Is a C7 ASIA A Who Went to the Emergency Room 12 Hours After His Accident. Should I Give Him Intravenous Steroids? Ahmad Nassr, MD and Joon Y. Lee, MD Question 26 I Have a 34-Year-Old Patient Who Has Had Back Pain and Some Buttock Pain for 2 Weeks. When Should I Get an MRI? Brian Kwon, MD Question 27 I Have a 42-Year-Old Male With a Symptomatic Lumbar Disc Herniation That Has Been Present for 6 Weeks. What Roles Do Therapy and Epidural Injections Have? Brian Kwon, MD Question 28 I Have a 67-Year-Old Female With a T7 Compression Fracture. Are There Any Findings That Can Help Me to Differentiate a Pathological Compression Fracture From an Osteoporotic Fracture? Brian Kwon, MD Question 29 I Have a 72-Year-Old Female With a Symptomatic T12 Vertebral Compression Fracture That Has Failed a Course of Bracing. How Do I Decide Whether She Should Undergo a Kyphoplasty or a Vertebroplasty? Brian Kwon, MD Question 30 I Have a 34-Year-Old Male With Cervical Myelopathy and Multiple-Level Cervical Stenosis. I Am Concerned About Performing a Posterior Cervical Fusion on Such a Young Patient. Are There Any Alternatives That Would Treat His Myelopathy and Preserve His Neck Range of Motion? Brian Kwon, MD Question 31 I Have a 29-Year-Old Male With Right Arm Pain due to a C6 Disc Herniation. Is There a Surgical Alternative to an Anterior Cervical Discectomy and Fusion in This Patient? Brian Kwon, MD Question 32 What Is the Difference Between Cervical Myelopathy and Radiculopathy? Brian Kwon, MD Question 33 I Have a 29-Year-Old Male With a Large Central Disc Herniation at L4-5. He States That He Has Had Difficulty With Urination. How Do I Make Sure He Does Not Have Cauda Equina Syndrome? Brian Kwon, MD Section IX Pediatrics Question 34 I Have a 12-Year-Old Male With a 3-Month History of Back Pain That Does Not Appear to Be Resolving. How Should I Work Up Back Pain in an Adolescent? Shay Bess, MD Question 35 A 9-Year-Old Boy Came to the Emergency Room After Falling From a Tree. He Has a Lot of Neck Pain and Some Motor Weakness in his Upper and Lower Extremities. Is it Possible to Have Spinal Cord Injury Without Any Radiographic Abnormalities? How Should This Patient Be Managed? Shay Bess, MD Section X Bone Grafts Question 36 Some of My Patients Complain That the Iliac Crest Bone Graft Site Is Tender Years After Surgery. What Types of Bone Graft Alternatives Are Available for the Cervical and Thoracolumbar Spine? Shay Bess, MD Section XI Intraoperative Question 37 Do I Need to Perform Neuromonitoring for Every Spine Surgery? The Cost Is Relatively High and I Want to Be Selective About Its Use Shay Bess, MD Section XII Postoperative Patients Question 38 When Should I Brace My Thoracolumbar Fusions? Shay Bess, MD Section XIII Sports Medicine Question 39 I Was at a High School Football Game When I Saw a Football Player Attempt to Spear-Tackle Another Player; His Arms and Legs Temporarily Became Numb. What Happened to That Player and How Should He Be Followed? Shay Bess, MD Question 40 W