Interventional Spine: An Algorithmic Approach

The 7 parts and 133 chapters of this textbook include a section on general principles, interventional spinal techniques, specific disorders, extraspinal disorders, pregnancy, sports, and new frontiers. Generally, the book is inclusive, including common disorders such as lumbar and cervical radicular disease as well as more elusive diagnoses such as pyriformis syndrome. The emphasis is on nonsurgical approaches, including rehabilitation as well as interventional techniques with an emphasis on injections.

The role for surgery is briefly presented in various chapters, although some chapters are more in depth in the area of surgery. Notably missing from the section on specific disorders is the treatment of deformity and trauma. The sections on bone biology and osteoporosis are especially good, with algorithmic illustrations provided. The sections on interventional techniques including spinal injections, radiofrequency denervation, diskography, and others are well presented and adequately illustrated. The section on extraspinal disorders includes chapters on sacroiliac disease, hip pathology, and coccydynia. Return to play, acute evaluation, and an intervention approach to the athlete are well covered in the section on interventional spinal techniques and sports. The section on new frontiers includes chapters discussing total disk arthroplasty, minimally invasive spinal fusion, and endoscopic diskectomy and foraminal decompression. Although the literature supporting these approaches is evolving, the highest level of evidence is available and presented in the chapter on total disk arthroplasty.

The editors—with the exception of neurosurgeon Simeone—are specialists in physical rehabilitation medicine. Several associate editors represent nonoperative specialties including physical medicine and rehabilitation, anesthesiology, and orthopedic surgery. Chapter authors are predominantly physiatrists.

In the preface, Slipman puts into perspective the approach of this book, which is to provide “the least aggressive care feasible” to achieve optimal clinical outcomes for a spectrum of spinal pathologies. He also states that “an algorithmic approach can be offered that adequately balances the potential outcomes and known side-effects or complications” of various treatment approaches. The editors have set out to provide an evidence-based textbook, though they acknowledge that level I evidence in support of specific treatment options in spinal disease is often lacking. Lenrow points out that methodology in many epidemiologic studies is flawed. In his chapter on epidemiology, he discusses factors influencing back pain and disability, such as weight, occupation, secondary gain issues, psychological issues, smoking, and age, and presents the available literature. An added feature is a CD-ROM that contains figures from each of the chapters that can be downloaded to generate PowerPoint presentations.

By intention and design, Interventional Spine is not a surgical text. It is a well-written, well-organized textbook with a focus on nonoperative spinal care. It provides the reader with a spectrum of spinal pathologies, along with an excellent discussion of and algorithmic approach to the basis of disease and pain—all based on the best current data and evidence.