Emergency Orthopedics: The Spine.

Galli RL, Spaite DW, Simon RR. East Norwalk, CT 06855, Appleton & Lange, 1989, hardback, 294 pp. illus, $70.95.

The authors preface this book by stating that it is written to fill a void in the treatment of spinal disorders and is directed, in part, toward the emergency department physician, family physician, internist, and physical therapist. The text is divided into four parts. Part 1 deals with the general approach to the patient with a spinal injury. Part 2 covers medical emergencies including spinal cord syndromes, arthritis, osteoporosis, infections, and neoplasms. The remaining sections are devoted to discussion of the cervical and thoracolumbar spines and problems associated with each. These sections are divided into chapters that cover anatomy, physical examination, radiology, fractures, musculoskeletal injuries, and specific syndromes and disorders.

The book is well written with the general medical practitioner in mind, and it is well referenced overall. The illustrations are clear, and the radiographs and computed tomography scans shown are helpful. The anatomy and physical examination subsections of each chapter are adequate for an internist or a physician specializing in emergency medicine, but a physical therapist may want to check other texts for a more detailed description. The discussions of special tests for each part of the spine are well done. As in other texts of this type, the realibility and validity of each special test is not mentioned. The discussion of each syndrome, common fractures, and radiology of the spine proves to be thorough. The radiology sections include tips on reading radiographs for each area of the spine. This alone makes this book a valuable resource.

Although the authors indicate in the preface that this book is intended, in part, for use by physical therapists, the discussion of physical therapy intervention is sparse. When physical therapy is discussed, it is either mentioned in reference to range-of-motion exercises or prepared by "under the direction of a physician." The book also delves lightly into the treatment of certain musculoskeletal disorders. In the chapter detailing low back pain, a "spray and stretch" technique for trigger points in the lumbar spine is discussed. Although the technique is described and an article by Travell is referenced, a more appropriate discussion of this topic would be to direct the reader to Travell's text for a detailed explanation of the technique before having the clinician attempt it. Another such example of this in the same chapter is the discussion of a spinal manipulation for facet syndromes and subluxation. Athough the manipulation is depicted, the discussion of this treatment is not in-depth, and the practitioner could hardly be expected to repeat it with any degree of accuracy or success. An appropriate statement in this case would be to refer the reader to a detailed reference or suggest a referral to an orthopedic physical therapist for evaluation.

Even with the aforementioned shortcomings, this book comprehensively deals with spinal pathology in a way that is used for physical therapists. I am not aware of many texts that cover such a topic in such a useful way. It would be a welcome and frequently utilized addition to the professional library of a therapist who deals with a general orthopedic population or one who specializes in the spine.

Eugene R Boeglin, Jr, PT Milton Orthopaedic and Sports Physical Therapy, PC Milton, Mass