The aim of this textbook is to provide a comprehensive, single source of
information pertaining to new and emerging techniques and technologies in
spine surgery. In total, ninety-three authors from nine countries and five
continents, many of whom are leading authorities on spine surgery worldwide,
contributed to this work.
Overall, I found the book compelling, easy to read, and superbly
illustrated. A total of forty-one chapters have been thoughtfully organized
into four parts: Part I, Basic Considerations; Part II, Biologic and Tissue
Engineering; Part III, Surgical Navigation; and Part IV, Surgical
Techniques.
One of the more fascinating features of Part I is the insight that it
provides into the complicated process of developing a new product, obtaining
the necessary regulatory approvals, and justifying reimbursement from
third-party payers. This type of information is provided in a unique and
effective format, making use of the market introduction of INFUSE (Medtronic
Sofamor Danek, Memphis, Tennessee), a recombinant human bone morphogenetic
protein-2 product, as a model. By extending the discussion beyond regulatory
approval and including how important it has become to use evidence-based
medicine to demonstrate enhanced value and cost-effectiveness to third-party
payers as a prerequisite for the success of any new product, the authors have
touched on a practical concern that has become increasingly important in the
evolution of spine surgery. The discussion on the complexities of developing
new techniques for treating such a multifactorial and poorly understood
clinical entity as low back pain is also extremely insightful, as is the case
that is made for "scientific scrutiny and healthy skepticism" in
the evaluation of these emerging techniques.
Part II serves as an important review of the various biologic processes
that are integral to our current and future treatment of spinal disorders.
Although the discussion is broad, the chapters are well illustrated and are
written in a concise, focused manner by some of the true experts in this
domain. In general, succinct yet comprehensive reviews of specific topics,
such as the biology of fusion or disc biology, are followed by chapters on
various techniques that target one or more of the previously described
biologic processes as a way of achieving the desired treatment goal. An
expertly written review of spinal cord injury, regeneration, and repair rounds
out a section that I found to be considerably more interesting,
thought-provoking, and readable than other treatises I have previously read on
the basic science of spine surgery.
Part III serves as an informative and, again, well-illustrated overview of
some of the options currently available for use in image-guided surgery.
Part IV, which is the core of this book, describes various types of
surgical interventions for spinal conditions, including a wide range of
minimally invasive and motion-sparing techniques, some of which are still
experimental. I anticipate that, for obvious reasons, this section will be of
greatest interest to surgeons. Broadly speaking, the chapters are organized
into sections on history and/or background, indications, preoperative
planning, surgical technique, postoperative care, problems and complications,
and outcomes. These sections have been covered thoroughly in most chapters,
and most authors were forthright about potential complications and limitations
of the described techniques. Some of the chapters also include one or more
interesting case examples. I found this section of the book enlightening,
generally well written, and universally well illustrated. I believe the
readers will find the chapter on the CHARITÉ total disc replacement to
be particularly valuable, as it provides step-by-step illustrations and
procedural details, outlines a detailed postoperative regimen, and provides an
extremely useful and insightful section on avoiding complications.
Overall, the authors have successfully accomplished their goal of providing
a book that describes a variety of evolving spinal surgery technologies and
techniques in a somewhat condensed, nicely illustrated, and easily readable
format. My only criticism pertains to some of the chapters on specific
surgical techniques. Even after taking into consideration the fact that many
of the newer implant and/or product categories discussed in this book are only
made by one or a handful of companies and that many of the authors have very
appropriately used their expertise to help develop these products, I still
found it difficult in some of the chapters that focus on a specific implant to
identify the transition between objective analysis and opinions that may have
been influenced by commercial interests. The role of some of the editors and
authors as founders, executives, or employees of spinal implant manufacturers
raises similar questions, regardless of their obvious expertise on their
respective topics. These concerns may be particularly warranted in a textbook
such as this one, in which a considerable amount of the material is relatively
new, with little or no scientific validation, and in which the reader
therefore depends on the author to give a balanced and unbiased view of the
relative strengths and weaknesses of a certain procedure or implant. That
said, I did not identify any overt commercial bias. Also, I believe that it
may not be entirely appropriate to include analyses of outcomes data that have
not been previously subjected to the scrutiny of a peer-reviewed publication,
as was occasionally done in this textbook.
Aside from these criticisms, with compliments to Drs. Corbin, Connolly,
Yuan, Bao, and Boden and their eighty-eight coauthors, I believe this book
will be of great interest and value to any clinician who treats spinal
conditions and is interested in the future direction of interventional spine
care. I anticipate referring to it frequently in the future.