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Instrumented Spinal Surgery. Principles and Technique.

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    Instrumented Spinal Surgery. Principles and Technique. Edited byjürgen harms and giuseppe tabasso. (Pp 198, DM248.00). Published by Georg Thieme Verlag, Stuttgart 1999. ISBN3-13-110761-8.

    I very much enjoyed reviewing this textbook of instrumented spinal surgery written by Giuseppi Tabasso under the auspices of Jürgen Harms. Dr Harms is well known to all spinal surgeons and has made a very important contribution to the development of spinal surgery over the past 20 years, based on strong personal convictions. Many surgeons who manage spinal disorders would not choose to implement all of Professor Harms’ solutions but all who have a serious interest in the surgical treatment of the spine admire and are grateful for his contribution. Within this book spinal surgeons will find a rational and practical approach which will allow them to treat a wide range of spinal disorders according to well thought out principles.

    The opening chapter describes spinal biomechanics under normal and pathological circumstances mainly by using easily understood drawings and diagrams. Some of these drawings reminded me of images that I have recently seen on an interactive CD ROM that I bought for my 4 year old son. This is not a criticism and I fully support any attempt to simplify the science of biomechanics which is often cloaked in seemingly contradictory jargon. Most spinal surgeons will be able to assimilate the two basic principles which underpin much of instrumented spinal surgery— namely, that the anterior column resists load compression forces and that the posterior column acts as a tension band which when disrupted should be reconstituted in compression. The remaining chapters cover fracture management, late kyphosis, metastatic tumours, spondylolisthesis, degenerative spinal disease, and infection. Each chapter sets out the principles of management which are illustrated schematically. There then follow case studies illustrated by radiological images including CT and MRI. These have reproduced well and surgeons will admire the technical precision and excellent anatomical reductions illustrated by these clinical cases. It is, however, a source of constant annoyance to spinal surgeons that perfect postoperative films do not always correlate with good clinical results and this discrepancy remains a source of fascination and mystery.

    It is in the degenerative spine that this discrepancy between radiological and clinical findings is most apparent and it is partly for this reason that the management of these conditions is often controversial. It is difficult to disagree with much of the logic presented by the authors in planning their interventions but there is a danger that inexperienced surgeons may be misled into adopting complex solutions when often more simple operations will suffice. The authors’ description of their approach to failed back surgery syndrome illustrates this problem and the inadequacies of attempting to treat a complex clinical problem by focusing on one aspect of it.

    This book will be a useful addition to the shelves of spinal surgery textbooks and many orthopaedic and neurosurgical departmental libraries will wish to buy a copy.

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