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The Lumbar Spine and Back Pain.

Oro, John J.

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Columbia, Missouri

The Lumbar Spine and Back Pain. Malcom I.B. Jason (Editor). Churchill Livingstone, New York, 1992. Pages: 637. Price: $148.00.

Dr. Malcom Jason brings together a large group of specialists, many pioneers in their field, to focus on improving our understanding of low-back pain. The book opens with a delightful chapter on the development of locomotion, beginning with the multicellular organism and progressing to humans. The structure, role, and stresses on the back are put in an evolutionary context. Authors present lucid reviews of the pathological changes of the intervertebral discs and apophyseal joints, biomechanics, and intradiscal pressures. In the chapter on the neurophysiology of pain, the author puts forth a fascinating hypothesis that chronic back pain may in part be related to a molecular alteration of a neuron and synapse, which may result from the activation of immediate early genes by repetitive noxious stimuli. The remainder of the basic section contains excellent chapters on the pathogenesis of nerve root damage, fibrosis and chronic inflammation, and the biochemistry of the disc.

The book's middle section focuses on clinical assessment and syndromes encountered in patients with lower back pain. Among the chapters is a sober and critical analysis of facet joint syndrome, provided by one of the early pioneers in this treatment. Conversely, the concept of isolated disc resorption, although very controversial, is the least well documented. The reviews of lumbar stenosis, lumbar instability, and deformities are well written.

The final section of the book, which focuses on treatment, prevention, and rehabilitation, may be the most valuable for the practitioner. Current evidence on facet joint injections, epidural steroids, and corsets is analyzed. The evaluation of three back schools, all different in approach, should be valuable for readers exploring the development of primary prevention programs. Appropriate emphasis is placed on the full understanding of the patient with back pain, including the component of suffering and the psychological factors involved. Finally, a functional restoration program is described, as is the role of medicine in the prevention of back pain in industry.

Well written and illustrated, this book should be of great value to the neurosurgeon managing patients with lumbar spine pain. The book clearly presents the complexity of this disorder and challenges us to reach beyond the traditional disease model, with its focus on disease, and emphasize making the patient better.

Copyright © by the Congress of Neurological Surgeons

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