Omission Of Group Research Articles

This is a large-volume text aimed at surgeons involved in the field of spinal implantation, including orthopaedic and neurosurgical spinal surgeons as well as fellows and trainees with a specific interest in spinal surgery. The authorship is certainly comprehensive, with the contributors' list reading as a who's who of North American and continental European spinal surgery. The book aims to be a comprehensive (and it claims ‘complete’) guide to modern spinal instrumentation. In a different approach to many traditional operative surgery texts, it focuses on implant-specific guidance with a chapter on each proprietary device that the authors have identified as being part of the armamentarium of the modern spinal surgeon. It does not attempt to describe or address different pathologies in the spine and their differing instrumentation requirements but structures the chapters in broad anatomical applications, with a useful summary chapter of anatomical approaches heading each group of implant chapters. The authors have, therefore, made a laudable attempt to provide an ‘implant roadmap’, using each chapter to identify the indications for use, surgical application, advantages, pitfalls, limitations and complications of different implants, often with the collaboration of contributors closely involved in their design. Many chapters contain useful hints for those surgeons using the implants and are clearly written, with useful diagrams by authors who have experienced both the highs and lows associated with their use in spinal surgery. However, the attempt to provide such a gazetteer leads to the inevitable flaw in such a text. In the rapidly evolving world of spinal implantation, no textbook will ever be able to provide a complete guide. This is exemplified by the book's omission of new developments in pedicle screw systems such as Pangea (Synthes SpineRRR) and Expedium (DePuy SpineRRR) and the complete omission of groups of commonly used implants; flexible stabilisation systems, such as the Dynesys (Zimmer SpineRRR) and Wallis (AbbottRRR) systems; and interspinous spacer devices such as the X-Stop (St Francis Medical TechnologiesRRR). This text inevitably covers many implants that will gradually become superseded by technological and biomechanical advances. In the attempt to be comprehensive, the reader becomes somewhat ‘lost’; for example, in the 20 chapters of different anterior cervical plates described in detail over 126 pages. This is not to underestimate the text in the areas that it addresses well. The anatomical approach chapters are generally excellent – clear, concise and relevant to surgeons, not just anatomists. Particularly good chapters involve the anterior approaches to the cervical, lumbar and lumbosacral regions as well as the craniocervical junction. However, these could be accommodated in a much smaller text. For a trainee preparing for a supervised operation using a new implant or an established consultant surgeon wishing to explore the range of implants on offer, this text offers some valuable guidance. Nevertheless, in a field moving so fast, one does wonder whether the authors' efforts would have been better placed in a more adaptable web-based resource. A further point for us all to remember is that the implant used is only as good as the indication for which it is chosen and the skill and experience of the surgeon who applies it. Many surgeons frequently use implants for which they have derived significant training and have experience of their use in training programmes and specialist fellowships. In addition, this text should not be regarded as a shopping list for implants nor a training manual. In summary, the text is a useful addition to the reference library of any spinal unit, especially in larger departments where there may be a range of implants frequently used. However, in view of the speed of developments, the authors are likely to find the need for addition and revision may come sooner than they wish.

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