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Preface; Contents; Contributors; Part I: Essentials in Lumbar Degenerative Disk Disease; 1: We've Been Standing Up for 10 Million Years; 1.1 Introduction; 1.2 How Did We Become Upright?; 1.2.1 Vertebral Column; 1.2.2 Pelvis; 1.2.3 Lower Limbs; 1.2.4 Upper Limbs; 1.3 Final Considerations; 2: A Historical Overview of Sciatica; 2.1 Introduction; 2.2 Sciatica: Historical Overview; 2.2.1 Final Considerations; References; 3: Lumbar Intervertebral Disk Injury, Herniation and Degeneration; 3.1 Introduction; 3.1.1 Intervertebral Disks; 3.1.2 Disk Injury or Degeneration?

3.1.3 Purpose and Scope of This Chapter3.2 Forces Acting on the Lumbar Spine; 3.2.1 Compression, Shear, Bending and Torsion; 3.2.2 Gravitational Loading; 3.2.3 Inertial Forces During Rapid Movements and Falls; 3.2.4 Forces Arising from Muscle Tension; 3.3 Mechanisms of Disk Injury and Prolapse; 3.3.1 Compressive Injury Causes Endplate Fracture; 3.3.2 Torsion and Bending Injuries Tear the Annulus; 3.3.3 Complex Loading Can Cause Disk Herniation; 3.3.4 Endplate Involvement in Disk Prolapse; 3.3.5 Mechanical Consequences of Disk Injury and Herniation

3.4 Lumbar Disk Ageing and Degeneration3.4.1 Inevitable Age-Related Changes in Human Lumbar Disks; 3.4.2 Features of Intervertebral Disk Degeneration; 3.4.3 What Is 'Disk Degeneration'?; 3.4.4 Two Disk Degeneration 'Phenotypes'?; 3.4.5 A 'Final Common Pathway' for Disk Degeneration?; 3.4.6 Disk Degeneration, Back Pain and Sciatica; 3.5 When Do Disk Injuries Occur In Vivo?; 3.5.1 Moderate Mechanical Loading Strengthens the Spine; 3.5.2 'Injury' Occurs When Loading In Excessive; 3.5.3 Repetitive Loading and 'Fatigue Failure'; 3.5.4 Why Are Some Intervertebral Disks so Weak?

3.5.5 Medicolegal Considerations3.5.5.1 Disk Degeneration vs Herniation; 3.5.5.2 Must a Disk Degenerate Before It Can Herniate?; 3.5.5.3 Mechanical 'Acceleration' of Disk Degeneration?; 3.5.5.4 Who Is Prone to Injury?; 3.5.5.5 Summary of Recent Scientific Advances; References; 4: Advances in Lumbar Degenerative Disk Disease Pathophysiology Comprehension; 4.1 Chronic Back Pain and Disk Degeneration: Physiology and Pathophysiology of the Ageing Spine; 4.2 Structure and Function of the Normal Disk; 4.3 The Morphology of the Disk During Development and Ageing

4.3.1 Embryonal and Foetal Development4.3.2 The Disk of Infants and Adolescents; 4.3.3 The Disks of Young and Medium-Aged Adults; 4.3.4 The Disks of Adults of Advanced Age; 4.3.5 Particular Morphologic Changes of the End Plate; 4.4 Aetiology of Disk Degeneration and Obvious Factors Influencing Disk Degeneration; 4.4.1 Genetic Predisposition of DDD; 4.4.2 Biomechanical Load; 4.4.3 Metabolic and Nutritional Effects; 4.5 Presumed Molecular Mechanisms of Degeneration; 4.5.1 Matrix-Degrading Enzymes; 4.5.2 Pro-inflammatory Mediators; 4.5.3 Growth Factors

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