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Lumbar Disc Herniation
  1. RODNEY LAING

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    Lumbar Disc Herniation. By franco postacchini. (Pp 623, US$299.00). Published by Springer-Verlag, Wien, 1999. ISBN3-211-83118-5.

    Professor Franco Postacchini is an orthopaedic surgeon at the University “La Sapienza” in Rome and is a well known widely respected spinal surgeon. He is to be congratulated on the production of this book which is wide ranging, comprehensive, and beautifully illustrated. The management of lumbar disc disease is fraught with uncertainty and there are many diagnostic and therapeutic pitfalls. The author has succeeded in addressing most of these controversies in a clear and logical fashion. He occasionally blurs the distinction between theories and established scientific fact forgetting that the practice of medicine and in particular the management of spinal disorders is full of paradoxes. For example, he states that large extruded disc fragments are unlikely to resolve spontaneously and will usually require surgical treatment. This seems a logical proposition but my experience is that many of these large extrusions undergo complete clinical and radiological resolution within 2 or 3 months. Paradoxically, it is often the smaller contained disc prolapses which fail to improve with conservative measures. Like many orthopaedic surgeons he is persuaded by the alluring theories of discogenic low back pain and worships at the altar of segmental microinstability. However, I agree with much that he has written and differences of emphasis are inevitable in a field that is strong on dogma and short of established truths.

    I would have no hesitation in recommending the text to trainees as the book is very readable and makes a good introduction to the management of lumbar disc disease. Nearly all aspects of diagnosis and treatment are covered but I was disappointed with the chapter discussing results of surgery. There is no mention of the use of objective validated disability and quality of life instruments in the assessment of outcome. For a text that aims to be comprehensive this constitutes a serious omission. It is because practitioners have failed to use objective outcome measures to establish the natural history of lumbar disc disease and the effects of therapeutic interventions that there remains so much uncertainty about management. These uncertainties cover (among others) physiotherapy, manipulation, timing of radiology, timing of surgery, whether spinal fusion is ever indicated, and what treatments are clinically and cost effective. Despite these drawbacks, surgeons who manage lumbar disc disorders will want to have a copy of this book, either on their own or their departmental library’s shelf.

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