This book is based on a workshop entitled "New Horizons in Low Back Pain," held in San Diego, California, in 1995. Unlike some publications of this type, the current volume was carefully planned and edited so that the contributions by the many authors complement rather than conflict with each other. The authors, all of whom are leaders in their respective areas of clinical practice or research, are mostly from North America, but Japan and Scandinavia are also strongly represented.
The text covers three main topics: lumbar radiculopathy, idiopathic low-back pain, and spinal stenosis. The discussion of each topic is divided into two sections: one dealing with clinical and epidemiological considerations and the other, with issues related to basic and applied science. This format makes the book easy to read. Each section is followed by a short chapter that contains valuable suggestions for future research.
The lengthy text has been beautifully produced and is supplemented with excellent illustrations and well rendered photomicrographs. The best chapters present in-depth, up-to-date studies of the area under discussion.
Although all of the sections are good, some are better than others. The ten chapters on the epidemiological and clinical aspects of lumbar radiculopathy constitute a splendid review of the present state of knowledge, and they will help the practicing clinician to inform patients properly before advising operative treatment. Because of the evidence-based nature of the book, there is little information about the use of physical therapy for the treatment of disc herniation, other than that provided by a brief chapter on the role of exercise in treatment, which alludes to the lack of appropriate studies concerning the efficacy of physical therapy in general. The discussion of the role of physical therapy for the treatment of chronic low-back pain is brief but informative.
The basic and applied-science sections dealing with radiculopathy and idiopathic low-back pain are very up-to-date and comprehensive; they illustrate the complexities of and the scope for additional research in a field that, a few years ago, was regarded as dull. Mixter and Barr's theory that physical compression of a nerve root is the sole cause of radiculopathy is strongly and believably challenged. The chapters suggesting directions for future research are particularly valuable.
The two sections concerning spinal stenosis falter somewhat. These sections are only about one-third of the length of the others. The clinical section dwells on the old chestnut about the value of internal fixation in improving the rates of fusion. Nevertheless, this section contains an excellent chapter on imaging of the spine. The basic-science section is insubstantial and contains no information about the Japanese studies on the use of epiduroscopy in the treatment of spinal stenosis. In addition, there is no allusion to Porter's work on the arteriolar contribution to the syndrome of spinal stenosis.
The final chapter is unique in that it presents helpful answers to six questions that a patient with back pain might ask. This short (three-page) chapter certainly could have been expanded, particularly with regard to the option of operative treatment (an important issue at a time when informed consent is so vital).
Overall, this is a very good book. It is necessary reading for anyone interested in this new and exciting field. It is also an excellent reference source and will serve as a stimulus for additional reading. Those planning a research project will find the material on research valuable for the completion of grant applications.
Robert C. Mulholland, F.R.C.S.
Spinal Disorders Unit
Department of Orthopaedics and Trauma
University Hospital, Queens Medical Centre
Nottingham, United Kingdom