Surgery of the Lumbar Spine. Sanford J. Larson and Dennis
J. Maiman. New York, Thieme Medical, 1999. $139.00, 334 pp.
It is refreshing to see a clinical text that has as strong a
foundation in the basic sciences as this book has. The authors,
professors of neurosurgery at the Medical College of Wisconsin (Dr.
Larson is also department chairman), have written a very readable,
well referenced, and largely comprehensive text on the lumbar spine.
This book reflects the sound biomechanical background of the authors,
which is further represented in the cover illustration of a finite-element
model of lumbar vertebrae.
The text begins with chapters on lumbar anatomy, biomechanics
of the spine, and vertebral instability; these are followed by chapters
on metabolic bone diseases, disc degeneration, isthmic spondylolisthesis,
infection, trauma, and tumors (with separate chapters on benign,
primary malignant, and metastatic tumors). The final two chapters cover
bone-grafting and orthoses as well as surgical approaches.
As with any text that is limited to one or two authors, the information
that is presented tends to reflect the experiences and biases of
the authors. This must be kept in mind when one encounters seemingly
absolute statements about treatment and diagnosis. For example,
in the chapter on spondylolisthesis, the authors cite the classic
article by Gill et al. (Gill, G. G.; Manning, J. G.; and White,
H. L.: Surgical treatment of spondylolisthesis without spine fusion.
Excision of the loose lamina with decompression of the nerve roots.
J. Bone and Joint Surg., 37-A: 493-520, June 1955) as justification
for foraminotomy alone for the treatment of radiculopathy associated
with isthmic spondylolisthesis, an option that most orthopaedic spine
surgeons would currently consider only under unusual circumstances.
The strongest sections in this text are the early chapters on
anatomy and biomechanics and the later chapters on tumors. (These
latter chapters are, in my opinion, the best clinical chapters in
the text.) The section on the surgical treatment of sacral tumors
is particularly well written and well illustrated. Although brief,
the discussion on the use of autografts versus allografts in lumbar
fusion is fair and balanced.
Except for the chapter on isthmic spondylolisthesis and brief
sections on ankylosing spondylitis, degenerative spondylolisthesis,
and degenerative scoliosis, discussions of nontraumatic coronal
and sagittal plane deformities such as idiopathic scoliosis and
flatback syndrome are notably absent from this text. Also missing
is any discussion of the transforaminal lumbar interbody fusion
technique as described by Professor J¸rgen Harms and any significant
discussion on the treatment of failed back surgery.
Also disappointing was the extremely brief section on lumbar
discography. The controversy surrounding discography and its role
in the diagnosis and treatment of lumbar spine disorders is addressed
only superficially, and the landmark study by Walsh et al. (Walsh,
T. R.; Weinstein, J. N.; Spratt, K. F.; Lehmann, T. R.; Aprill,
C.; and Sayre, H.: Lumbar discography in normal subjects. A controlled,
prospective study. J. Bone and Joint Surg., 72-A:
1081-1088, Aug. 1990) is not cited.
Nevertheless, Larson and Maiman have written a fine fundamental
textbook that will be of benefit to neurosurgeons, particularly
those in training. This text is appropriate for the libraries of
medical schools, neurosurgical and orthopaedic training programs,
and hospitals; it also should be considered for the library of any
orthopaedic surgeon who is interested in the neurosurgical perspective on
the treatment of lumbar spine disorders.
Jeffrey D. Coe, M.D.
Center for Spinal Deformity and Injury, Los Gatos, California