This book provides an objective (if not complete) review of many of the currently available systems for internal fixation of the spine. The characteristics, benefits and risks, and proposed clinical uses of the various systems are discussed in detail.
The initial chapters, which focus on spinal anatomy, biomechanics, and preoperative planning, are generally excellent. The recommendations regarding preoperative planning provide a framework for decision-making and for completing tasks while minimizing problems or complications. The critical ingredient, patient selection, could have been elaborated on, particularly with regard to those who have axial back-pain syndrome; however, this was not the primary purpose of the book. The sections on anatomy and biomechanics are superb and provide an excellent foundation for what follows.
Subsequent chapters focus on devices that are designed to help correct or stabilize the spine from either an anterior or a posterior approach. Although these chapters are generally well written and well illustrated, they concentrate more on the technical aspects of the procedures than on the reasons for performing them.
The chapters on anterior fixation of the thoracolumbar and lumbar spine with the use of anterior locking plates (new devices designed for anterior interbody fixation and arthrodesis of the lumbar spine) are particularly interesting and well written. This innovative technique, used in other countries, is less expensive than conventional methods. The final chapter, on the use of coral implants for interbody and supplementary grafting, seems out of place, but some surgeons may regard this technique as a form of internal fixation.
Notably lacking is a discussion of the regulatory issues currently influencing the use of spinal fixation devices and of other implants that are in widespread use. However, this generally informative book will be useful to most surgeons who perform sophisticated operations on the spine, and it should be included in the libraries of medical schools with programs designed to train residents and fellows in the treatment of spinal disorders. This volume nicely complements other texts in the series.
Edward N. Hanley, Jr., M.D.
Department of Orthopaedic Surgery
Carolinas Medical Center
Charlotte, North Carolina