Anyone who is familiar with the size and magnitude of most current tomes on spinal surgery will be pleased and intrigued with this volume, which arrives without benefit of a forklift.
The editors and their contributors have produced a wonderfully digestible "all-about" book aimed at primary-care physicians and junior orthopaedic trainees who are seeking basic knowledge about elective (non-fracture-related) spinal surgery. Because they make no pretense of presenting a "how-to" book, they accomplish this goal remarkably well. The book will also be of value for allied-health-care and nursing staff.
It is of interest that the text does not take the reader to the operating room until page 113, six chapters after the introduction.
The sections on anatomy, imaging, electrophysiology, and anesthesia are concise yet thorough, and the section on physical examination is excellent. The section on history is lacking; although symptoms are well described, pain behavior and the difference between pain and disability, both of which are important in determining whether a patient is a candidate for operative treatment, are not addressed.
The section on the indications for operative treatment is written almost entirely from a biomechanical point of view. It is missing a thorough discussion on nonoperative care, which is dealt with in a miscellaneous chapter at the end of the book.
There are eight chapters on operative treatment. In the first six chapters, the approach and technique in reconstructive operations on the spine are addressed thoroughly and well. The chapter on scoliosis falls below the standards of the rest of the book, as the reader is subjected to a rather shameless sales pitch for the authors' preferred techniques. The classification of scoliosis is not mentioned, and indications for the operative treatment of this disorder are presented only marginally. The subsequent chapter on arthroscopic discectomy is also disappointing.
The book would benefit from the inclusion of a chapter on postoperative care and rehabilitation, which often are more important than what is done in the operating room.
The book closes with superb chapters on complications and pain management; however, some discussion of the so-called failed back-surgery syndrome would be useful here.
Overall, this book will be of value in bringing trainees and support staff up to date. It belongs not only in the libraries of surgeons but also in those of hospitals and medical schools.
Drew Bednar, M.D.
McMaster University
Hamilton, Ontario, Canada