Book Review

Spine Care

N Engl J Med 1995; 333:951October 5, 1995

Article

Spine Care
Edited by Arthur M. White, with Jerome A. Schofferman. 1757 pp. in two volumes, illustrated. St. Louis, Mosby, 1995. $299. ISBN: 0-8016-6328-8

Three decades ago, the treatment of spinal disorders was something of a backwater, rarely taught in medical school and occupying a secondary place in the training of neurosurgeons, orthopedists, and others. More recently, however, management of spinal problems has attracted the attention of a variety of surgical and nonsurgical specialists. This is due in part to the emergence of new therapeutic techniques (e.g., spinal instrumentation) and in part to socioeconomic factors.

One manifestation of the increased interest in the spine is the appearance of a large number of books dealing with the subject. Spine Care, edited by Arthur White and Jerome Schofferman, is the most recent example, and on balance I think it is quite a good book. As its name implies, Spine Care attempts to present a complete overview of the operative and nonoperative management of spinal problems.

The book is divided into two volumes. The first covers diagnosis and nonoperative management, as well as the measurement of treatment outcomes, an area that in the past was often neglected but that has become increasingly important. There are also some interesting chapters covering spinal lesions in athletes, and others on nonoperative management techniques. There is a chapter on spinal manipulation, a controversial area that is not always given a fair hearing (however, it should have included information on the neurologic complications of manipulation, which, though rare, can be serious).

The second volume covers operative treatment and is also quite good. Particularly noteworthy are the technical chapters on arthrodesis and osteosynthesis and on the management of spinal trauma. I was somewhat disappointed that the chapter on the surgical treatment of spinal tumors did not include a discussion of intramedullary or intradural tumors, which are important not only in their own right but also in the differential diagnosis of pain and neurologic symptoms of spinal origin. The chapters on surgical technique are in general very well illustrated. There is a large section devoted to the techniques of endoscopic spine surgery. Although this section is quite informative, it is important to realize that the superiority of some minimally invasive techniques has yet to be established.

One of the problems with a multiauthored book is that it is sometimes difficult to obtain a proper balance in the presentation of controversial or novel forms of treatment. Often the authors of individual chapters are enthusiastic proponents of a technique and do not always provide a balanced discussion of the subject. The chapter on discography is an example. Discography is highly controversial and lends itself to considerable abuse. Those of us with experience in the technique realize that both the images and the pain responses can be hard to interpret and very misleading. Similar criticisms apply to chapters describing some of the more radical surgical techniques, such as anterior and posterior fusions with instrumentation. I believe that Spine Care would have been considerably improved either by editorial commentaries or rebuttals following some of the more controversial chapters.

The majority of the authors in this book are orthopedists or medical spine specialists. There are relatively few chapters by neurosurgeons, which is somewhat surprising in view of the fact that an enormous amount of operative and nonoperative spine care is rendered by neurosurgeons. A broader representation would have improved the book and given a more complete presentation in a number of areas.

These criticisms notwithstanding, I think this is a very good book and would recommend it to surgical and medical specialists who are called upon to manage spinal disease.

Russell W. Hardy, Jr., M.D.
Case Western Reserve University School of Medicine, Cleveland, OH 44106