SAMJ FORUM
BOOK REVIEW

Do you really need back surgery? A surgeon's guide to neck and back pain and how to choose your treatment

By Aaron G Filler. Pp. xiii + 336. Illustrated. R200. Oxford University Press Southern Africa. 2007. ISBN 978-0-19-532708-3

This excellent book should have wide appeal to a range of medical professionals and to patients.

The first part, 'Spinal health', provides a regional review of types of neck and back pain, the non-operative treatment of spinal pain (including commonly used medications), methods of keeping the spine healthy throughout life, and various schools of physical therapy. The anatomy, physiology, and pathophysiology of the spine, aetiology of spinal pain, medical imaging and diagnostic tests used in the management of spinal pain are presented. Congenital anomalies of the spine, recovery and repair of the nerves and of the spinal cord are discussed.

The second part, 'Spine surgery', provides a comprehensive precis of all elements of spinal surgery. Percutaneous procedures for diagnosis and treatment are well presented. Informed consent, preoperative workup and preparations, planning of surgical operations and postoperative care are discussed. The principles of spinal surgery are outlined. A wide range of surgical procedures of the cervical spine, thoracic spine, and lumbar spine are briefly reviewed. The role of biotechnology in spinal surgery, risks, outcomes, choices and recovery after surgery, health insurance, and cost of surgery are discussed. The book has an excellent glossary.

Written by a practising North American neurosurgical spinal surgeon, the book has a few deficits. There is no mention of the many blood tests used in the workup and investigation of spinal pain. Non-surgical causes of spinal pain are barely mentioned. Spinal tuberculosis (and its association with HIV and AIDS) - a scourge in developing communities - is ignored. He plays down the usage of radionuclide investigations, an important tool in the management of spinal disorders and pain.

Despite these few criticisms, the book succeeds in its aim 'to fill a major void by providing a comprehensive and authoritative reference source to patients facing spinal surgery'. It can be recommended with confidence to intelligent patients who have to make a decision regarding surgery to their spines. It can also be recommended to medical professionals who deal with spinal disorders, including young professionals who are embarking on careers in spinal surgery, neurology and radiology, family practitioners, and those involved in medical-aid administration.

J H Crosier