The intervertebral disc

Although the title of this book indicates a definitive work on the intervertebral disk, a cursory review of broader scope is included. The initial chapters relating to the anatomy, embryology, pathology, and functional aspects of the intervertebral disk are excellent with satisfactory detail. The major portion;f the book, however, is devoted to the physical diagnosis of disk lesions, with particular emphasis on the degenerated disk and various forms of treatment. A convenient summary of the authors' experience with spine fusions ?f both t~e. anterior intervertebral body and postenor types IS included, although a greater comparison with other authors' works would be beneficial. The text is somewhat uneven, particularly in regard to surgical management of intervertebral disk disease, which probably reflects the two authors' varied enthusiasm for specific techniques. The text has been well edited, and only occasional typographical errors are apparent. The work is well referenced for the most part; I found only one incorrect reference. The reproductions are generally of good quality, with concise legends. One exception is the figures which describe bulging cervical disks as seen on plain films; the structure indicated by arrows appears to be an elongated transverse process of the fifth cervical vertebra rather than a partially calcified bulging intervertebral disk. Perhaps with a better illustration (or on the original film) a different anatomical structure might be identified. The inclusion of a section on congenital and acquired abnormalities of the spine is an ov~r~ll view of differential diagnoses, and these conditions are necessarily treated rather superficially. Such information is necessary in the differential diagnosis of back pain but is perhaps less applicable in a text on the intervertebral disk. Since the syndromes of the cervical, lumbar, and thoracic disks are dealt with in separate sections, some textual material is repeated throughout the book. Such repetition might be desirable in a larger work but is somewhat redundant in this book. Certain statements made by the authors are somewhat dogmatic, without supporting documentation except from their own experience and often without even this substantiation. Some inconsistencies present a paradox, e.g., the denouncement of discography and the authors' emphasis on the distension test for intervertebral disk disease. For the radiologist, the first three chapters provide an excellent review of the pathological processes of the aging disk. For the postdoctoral trainee, the correlation between clinical findings and disk disease is provided in rather broad terms. The amount of detail is somewhat great for the medical student but insufficient for the practicing orthopedist, except as a report of the investigators' work on specific fusion techniques. As a summary of the overall aspects of intervertebral disk disease, including diagnosis, pathology, and management, this is a successful work; however, it cannot be considered a standard reference text for this subject.