This fourth rendition of the classic work by Ian Macnab, one of the fathers
of modern spinal surgery and of the diagnostic thinking that has come to be
associated with the art, is just as relevant and well done as the first
edition with regard to elegance, simplicity, and practicality. The two
authors, disciples of the larger Canadian progeny emanating from the
Macnab-Toronto group, have done justice to their forebearer's utilization of a
wealth of experience in the diagnosis and treatment of lumbar disorders. The
book is well written, in a simple style, and has practical line drawings that
drive home the pathoanatomic principles that are so critical to diagnosis and
treatment. These features will make the book very attractive to orthopaedic
and neurosurgical residents and fellows as a basic treatise and will also
cause the book to be of interest to physical therapists, chiropractors, and
medical students who wish to explore the topic of backache in a more indepth
manner.
Other appealing features are the quotes that are printed in blue font at
the beginning of each chapter, which I found appropriate and interesting; and
the anatomic pearls (clearly germinated by John McCulloch and Macnab) that are
interspersed throughout the book. These concepts form the basis of lumbar
microsurgery but are extremely useful to those who perform open surgery as
well. Examples are the three-story concept of the lumbar spine, and the
description of the most common positions of lumbar herniations.
A slight criticism of this book would be the lack of updating of the
figures related to modern imaging techniques. While the figures do demonstrate
the teaching points, much better imaging examples are currently available and
could have been used. Despite this, the educational objectives related to this
topic have been met.
Overall, this book is still a hit thirty years after it was first
published. It is a "must read" for those practitioners of spinal
medicine and surgery who want to "do the right thing" with regard
to diagnosis and intervention for disorders associated with backache.