Book Review

Interventional Spine: An Algorithmic Approach

N Engl J Med 2008; 358:1527-1528April 3, 2008

Article

Interventional Spine: An Algorithmic Approach
Edited by Curtis W. Slipman, Richard Derby, Frederick A. Simeone, and Tom G. Mayer. 1454 pp., illustrated, with CD-ROM. Philadelphia, Saunders, 2008. $249. ISBN: 978-0-7216-2872-1

Since we began to walk upright, spine pain has been one of our most common complaints, and it has become one of the most costly medical problems in the world. Low back pain is ubiquitous, prompts millions of visits to physicians annually, and is a leading factor in lost productivity, disability, and medical expenditures. Society has a great stake in the correct, evidence-based management of neck and back pain, including surgery as well as conservative and minimally invasive care.

Interventional Spine promises to be the seminal publication that defines the scope of interventional spine care, including the diagnosis, rehabilitation, and medical and minimally invasive treatment of painful disorders of the spine. The treatment of pain is increasingly recognized as an emerging, distinct, and specialized field of medicine, and interventional spine care is already its most well-developed and practical application. Previous books on the subject have been like atlases in format and content, but Interventional Spine goes beyond this design — it is a comprehensive medical textbook.

The book begins with chapters on general principles and theories of pain, inflammation, diagnostic technology, and pharmacology. Next is an excellent, highly detailed section of several chapters that fill more than 200 pages and describe the science and techniques of interventional spine procedures such as spinal injections, radiofrequency ablation, diagnostic discography and intradiscal treatments that are administered percutaneously, implantable devices (e.g., spinal cord stimulators), and vertebroplasty. The most important and largest part of Interventional Spine comprises sections on the painful disorders of the spine. These are in-depth reviews of the anatomy, physiology, diagnosis, and specific medical and procedural treatment of disorders such as radiculopathy, osteoporosis, arthritis, tumors, whiplash, and more. Algorithmic flowcharts are frequently presented and explained, and they illustrate the idea that pain management techniques and interventional spine care are not last-resort options, but are instead typically the first line of a rational, consistent, evidence-based approach to the treatment of most painful spine disorders.

Radiograph Showing Scoliosis in a 16-Year-Old Boy.

The book's emphasis on the role of surgery for back pain — including indications for when it is required and situations in which it can be delayed or avoided — should be part of all physicians' training. The sections on pregnancy and on sports-related spinal disorders are of great interest. The book is supplemented with a CD-ROM that contains the complete set of more than 500 illustrations; it is easy to navigate and readily allows the use of images for teaching purposes. This well-executed feature will make the illustrations widely-used classics.

The breadth of the appeal of this textbook is reflected in the panel of authors — many with recognizable names — who have come together to produce this work, including anesthesiologists, neurologists, primary care physicians, psychiatrists, radiologists, rheumatologists, and surgeons. Curtis Slipman, one of the book's editors, is a physiatrist — a specialist in physical medicine and rehabilitation — as are many of the contributing authors. Physiatrists have been in the news lately, discussing the rehabilitation of soldiers with traumatic brain injuries and amputations. The core training of physiatrists includes spine care, neuromuscular medicine, and musculoskeletal medicine, all of which are highly applicable to the treatment of pain, as this textbook makes evident.

Interventional Spine is timely and may be the single best definitive resource for physicians who specialize in the nonsurgical treatment of back and neck pain. It is made clear in the more than 1400 pages that the management of pain is not merely about prescription writing or injection but is the complex domain of dedicated specialists. It may not resolve all controversies, such as the role of narcotics or appropriate referral patterns; nor will all critics be immediately convinced of the evidence behind the algorithms. But this book is nevertheless an outstanding contribution that best presents the impressive body of evidence that is already available in this very young field.

Just as the drive for medical subspecialization is at last coming around to address our most ancient and common form of suffering, the drive to cut costs threatens to eliminate options for patients with pain. This long-awaited textbook codifies the multidisciplinary body of knowledge of the nonsurgical spine specialist and is a foundation for future evidence-based practice. Has Interventional Spine arrived in time?

John C. Keel, M.D.
Massachusetts General Hospital Pain Center, Boston, MA 02114
jckeel@gmail.com