Lumbar Disc Herniation [Hardcover]

Robert Gunzburg (Author), Robert Gunzburg Hentz (Editor), Marek Szpalski (Editor)

Book Description

Publication Date: December 15, 2001 | ISBN-10: 0781736005 | ISBN-13: 978-0781736008

Written by an international group of recognised experts, this volume is the most comprehensive and up to date reference on lumbar disc herniation. The contributors thoroughly examine the causes, natural history, and diagnostic workup of disc herniation, the full range of current nonsurgical and surgical treatment options, and also the economic and ethical aspects of patient management.Chapters offer practical advice on when to treat nonsurgically and when to operate and provide complete information on all current surgical procedures, including discectomy, microdiscectomy, automated percutaneous discectomy, laser discectomy, arthroscopic discectomy, and lumbar posterior endoscopic microdiscectomy. There are also recommendations for managing failed back surgery

Editorial Reviews

From The New England Journal of Medicine

During the past 20 years, there have been rapid changes in the neuroradiologic-imaging and surgical approaches to symptomatic lumbar-disk herniation. Conservative management of back pain and sciatica associated with the lumbar disk has also changed. Symptomatic patients are encouraged to get out of bed sooner (after one to two days rather than after one to two weeks) and are offered a multitude of pharmacologic and physical treatments to decrease pain and improve function. For these reasons, a working, up-to-date knowledge of the lumbar disk is essential for physicians who treat back pain. The first two sections of Lumbar Disc Herniation deal with the physiology and pathophysiology of the lumbar disk. The introductory chapters highlight the fact that little is known about the regulatory mechanism involved in lumbar-disk health and degeneration. The authors imply that better treatments for back pain and sciatica will follow, once the mechanism of disk degeneration is understood. Subsequent chapters highlight the dilemmas involved in treating symptomatic lumbar-disk herniation. It is the clarity of the approach to the patient's symptoms that is the book's strength. The chapter addressing the physiologic aging of the lumbar disk in adults is one of the strongest in the book. In this chapter, the authors emphasize that a large number of lumbar-disk herniations occur without symptoms -- the so-called silent disk that may be seen on magnetic resonance imaging (MRI). The natural history of the silent disk is largely unknown. Better studied is symptomatic lumbar-disk herniation, which has a favorable clinical outcome in the majority of patients. The authors emphasize that disk herniation cannot be diagnosed by history taking and clinical assessment alone, since physical examination has a low degree of accuracy. Similarly, positive results on MRI of the lumbar region in a patient without appropriate symptoms is not helpful. This and other chapters provide useful guidelines for managing back pain and sciatica. Subsequent chapters cover electrodiagnostic techniques and conservative treatment. The description of neurophysiologic testing and its interpretation is excellent and will be particularly helpful to the nonspecialist. Although the sensitivity and specificity of such tests are too low for use in diagnosis of nerve-root compression, the authors believe that they may be helpful in ruling out other neurologic disorders. The section on conservative treatment is, in general, well organized and consistent in style, depth, and detail. An excellent chapter on the sensitivity and specificity of diagnostic tests has been misplaced in this section. A chapter on the use of nonsteroidal antiinflammatory drugs, analgesics, and corticosteroids, on the other hand, would be well suited to this section. The chapter on physical medicine offers vague recommendations for conservative treatment and will not be useful to the nonspecialist. As a physician practicing physical medicine and rehabilitation, I found the chapter to lack essential information on physical treatments commonly prescribed for back pain and sciatica. The use of moist heat, ice, massage, and therapeutic exercises in the treatment of back pain is based on sound scientific principles. Included in this section on conservative treatment are two chapters about chemonucleolysis, an invasive treatment used to chemically dissolve a herniated disk. Although this treatment is commonly used in Europe, it is rarely used in the United States. Much of the value of this book comes from the chapters on surgical treatment and new treatments. A particularly comprehensive chapter addresses the question of when to operate. The author argues that when there is no evidence of bowel or bladder dysfunction, the lumbar-disk herniation will resolve without any surgical intervention if the patient waits long enough. The authors of a later chapter caution against the promotion of new surgical techniques on the basis of small series in this age of evidence-based medicine. These chapters will help physicians weigh the risks and benefits of lumbar spinal surgery for symptomatic lumbar-disk herniation. The final section of the book addresses the ethical and economic aspects of the management of the lumbar-disk herniation. The strongest chapter in this section describes the difficulty of predicting clinical outcome in patients with lumbar-disk herniation. The authors emphasize that the relation between lumbar-disk herniation and pain is often unclear. The writing is clear, and each chapter is well-organized, with up-to-date references. The quality of the graphics and the production quality are uniformly high. This book succeeds as one of the most comprehensive and concise books about herniated lumbar disks. It is easy for both specialists and nonspecialists to understand. Physicians will find this book to be exactly the source they need in order to be confident when managing cases of lumbar-disk herniation. Elisabeth Lachmann, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Product Details

• Hardcover: 320 pages
• Publisher: Lippincott Williams & Wilkins (December 15, 2001)
• Language: English
• ISBN-10: 0781736005
• ISBN-13: 978-0781736008
• Product Dimensions: 10.2 x 7.2 x 0.9 inches
• Shipping Weight: 1.9 pounds
• Amazon Best Sellers Rank: #2,946,125 in Books (See Top 100 in Books)