By: 24 August 2011

Good texts on Spinal Surgery are rare and one as lovingly crafted and comprehensively executed such as this, are exceedingly rare. As indicated in the preface, this tome is a collection of articles on new and cutting edge technique in spinal surgery, presented either by pioneers or highly skilled and experienced professionals. This spinal text aims to be a beacon to spinal surgeons and budding spinal surgery enthusiasts worldwide. It professes to act as a valuable resource to trainees and I have no doubt that it will and indeed does.

I must mention at the outset that I was impressed with this publication. The coverage, packaging, the illustrations, the sheer areas covered and the depth of discussion makes this volume comprehensive and a one stop shop for all that is recent in spinal surgery. Edited by a practicing Spinal surgeon and a prolific endoscopist, with contributions by world leaders in this exciting speciality adds depth, dimension, perspective, opinion and comprehension. The foreword by Dr. Oheneba Boachie-Adjei, Professor of Orthopaedic Surgery at the Hospital for Special Surgery, New York has paid glowing tributes. In his own words, “Bhave and his team of stellar authors should be congratulated for doing a yeoman’s work with this superbly organised text for the orthopaedic community”.

The text is divided into 5 broad sections: Endoscopic Spinal surgery, Minimally Invasive Spine surgery, Non-fusion technology, Spinal Fixation and Spine Molecular advances. This clear distinction allows the reader to jump to the area of primary interest.

Endoscopic Spinal Surgery treats the basics from indications, positioning, marking and then goes on to describe several procedures in glorious detail. This metamorphoses from the endoscopic treatment of spinal painful degenerative conditions to Interlaminal endoscopic discectomy, to transforaminal thoracic discectomy, facet joint ablations using laser endoscopy and thoracic and lumbar sympathectomy. I was impressed by the logical progression from simple to the complex, from anatomy to technique, from lumbar to cervical in that order. The illustrations are clear, concise and easy on the eye.

Section 2 starts with vertebroplasty in all scientific detail and if an orthopaedic surgeon has ever planned to sub-specialise in spinal surgery, I believe this is a great starting point to embark on this journey. The clarity and the progression of planning and execution will impress the most astute of readers and clear most areas dealing with this technique. Tips for avoiding complications are listed, no doubt a valuable pointer arising from years of experience and cases which follow well illustrate the technique. Many new terminologies and techniques are discussed and elucidated and at the end of the section you will know your Vesselplasty from Vertebroplasty and Kyphoplasty from Arcuplasty. A flowchart approach makes decision making easier still.

Section 3 deals with Non-fusion technology. Even though this sounds daunting, this simply includes cervical disk arthroplasty, lumbar total disc replacement to the total posterior arthoplasty systems and nucleus arthroplasty devices. All major current technology is included, which makes for comprehensive and cutting-edge knowledge of particular note for new entrants and the candidates for the exit examinations in orthopaedic surgery. Interspinous implants seem to have got the short straw though as I felt this chapter was inadequate and only seemed to skim the surface. Interspinous locker fixation is very well treated. Pedicle screw based dynamic stabilization systems are revisited and the principles and current available technology spelt out. The ideology for skip laminectomy and selective laminectomy for cervical myelopathy is convincing.

Section 4 deals with Spinal instrumentation and fusion techniques which encompasses video-endoscopy assisted spinal fusions and cervical pedicular screw fixations. The illustrations and the clinical photographs which accompany these sections are superb and make concepts crystal clear. Management of Spinal tumourous conditions is commendable, but with a voluminous area like this it is virtually impossible to do justice to every technique and protocol outlined. Treatment of spinal tuberculosis also finds a place here as it is still a major public health issue in the developing countries.

Section 5 gives an overview of molecular advances in Spinal applications, including stem cells, types and usage, therapies and protocols for spinal cord injury and experimental therapies likely to impact this speciality. This section, though thin on the ground, gives sufficient knowledge which a working spinal surgeon may need.

The DVD accompanying the book is a valuable learning and teaching aid and has everything in there to recommend it. You can also go to various sections quickly and navigate quite easily.

This volume suffers from only a couple of drawbacks, none of which detract from the excellent treatment otherwise in almost every area. The section should be colour-coded on the sides so that the section may be accessed direct. Section numbers also confuse with chapter numbers, an issue which seems to have been overlooked. More references are needed at the end of each chapter, or at least each section, so that the reader can cross reference and look for more details elsewhere. Current results using most common techniques need to be mentioned, though I appreciate that some techniques may be so new as to have virtually no short or long term results yet. This will stop the novice heading into complex areas armed only with coloured manuals and cloudy understanding. I am sure all of these can be easily ironed out in the next edition.

In conclusion I found this to be a ground-breaking spinal surgery manual with easy to read comprehensive and current text, superb illustrations and excellent quality clinical photography. The hard bound edition is a pleasure to handle and store. A must-have spinal ipad (if I may call it that) for all spinal surgeons and a cannot-do-without for a medical library of any repute.