Lumbar Spinal Stenosis. Edited by Robert Gunzburg and Marek
Szpalski. Philadelphia, Lippincott Williams and Wilkins, 2000. $105.00,
432 pp.
This nicely compact, easily portable small book provides a timely
synopsis of most of the state of the art in spinal stenosis at the
turn of the millennium. The book begins with great promise but weakens
as it progresses. The almost exclusively European origins of the
contributors provides an interesting (if occasionally somewhat dry)
flavor to the presentation.
Section I, "Basics," contains four chapters on embryology, anatomy,
and biomechanics that are simply superb. Embryology in particular
is presented with a level of clinical relevance and clarity that
may be unprecedented. These chapters are a joy to read.
Section II, "Classification," comprises six chapters that are
similarly thorough to those in section I but lack the impact of
the first grouping. Comments regarding soft-tissue "scar" and heterotopic ossification
as frequent factors in stenosis are a bit vague.
Section III, "Imaging," and section IV, "Presentation and Pathophysiology,"
consist of eight chapters that are thorough but soldierly. By now
the reader is having a heavy go of it as the information flies thick
and fast.
Section V addresses nonsurgical treatment in four chapters but
holds little hope for these patients short of the operating room.
The chapter on spinal cord stimulation seems a bit optimistic and
might be better suited to a discussion of failed surgery. This section
lacks the requisite discussion of natural history that would allow
an assessment of treatment benefits.
Section VI, "Surgical Treatment Modalities," comprises an encyclopedic
fifteen chapters. The first five chapters cover spinal stenosis
surgery. The remaining ten chapters digress to the topic of fusion
surgery and would be better suited to a text of that title. The
latter chapters are long on principles but weak on outcomes, and
several amount to thinly disguised sales pitches for particular
instrumentation systems. It might have been more useful to have
substituted a more pointed discussion of the possible benefits of
fusion surgery in patients who have stenosis with associated instability.
Section VII, "Economics and Ethics," comprises five light chapters
that raise more questions than they answer but provide a pleasant
springboard for the reader's musings and further investigation.
This is a good summary text for the spinal surgeon's bookshelf.
The unfortunate focus on fusion and instrumentation systems in section
VI may be confusing for those without an expert knowledge base.
Accordingly, this book should be read by trainees, generalists,
and allied-health personnel with that caution in mind.
Drew A. Bednar M.D.
Division of Orthopaedics, Department of Surgery
McMaster University
Hamilton, Ontario, Canada