The second edition of this comprehensive work on the adult spine is an excellent treatise that places pathology, diagnosis, and treatment in the milieu of the economic, social, and disability-related issues surrounding spinal disorders. In tune with contemporary themes, the opening chapters address quality of care as well as the use of algorithms to ensure consistency of treatment and, it is hoped, of outcomes. Discussions on the development and use of databases and the design of clinical research programs precede consideration of pathology and treatment. A discussion of the impact of insurance issues, disability determinations, and litigation on subjective reports of pain by patients leads into a description of the methods of objective documentation of impairment. A carefully crafted chapter reviews numerous psychological testing instruments and discusses the problem of chronic back pain and its treatment in multidisciplinary pain centers. The experienced authors do not take the opportunity to address the role of behavioral specialists in the preoperative assessment of patients who are candidates for operative treatment, and perhaps more attention could have been given to patient selection in a multidisciplinary setting.