Low Back and Neck Pain: Comprehensive Diagnosis and Managemented 3.

Low Back and Neck Pain: Comprehensive Diagnosis and Management, ed 3 Bernstein DG, Wiesel SW, Baden SD. Philadelphia, PA 19106, Saunders, 2004, hardcover, 921 pp, illus, ISBN: 0-7216-9277-X, $99.

This third edition combines two separate, previously published books, Low Back Pain and Neck Pain, and is written by the same authors, 1 rheumatologist and 2 orthopedic surgeons.

This updated edition is divided into 4 sections. The chapters in section I, "Anatomy, Biomechanics, Epidemiology, and Sources of Spinal Pain," contain material that readers would expect in a section with this title. The information is thorough and referenced. The same is true for the chapters in section II, "Clinical Evaluation of Neck and Low Back Pain." The material in these first 2 sections is not developed beyond what would be found in other texts with similar chapter topics and, in fact, many of the figures used in this book are familiar. It is interesting to note that the chapter "Physical Examination" begins the examination process with a general medical screening of the patient, which is great reinforcement for the use of a systems review in a doctoring profession.

The value of this text lies in section III, "Diseases Associated With Spinal Pain." Chapter topics in this section range from mechanical and rheumatologic disorders, infections, tumors, and infiltrative lesions, to endocrinologic and metabolic disorders of the spine. Chapter topics are subdivided into distinct encapsulated presentations of specific spinal disorders. For example, in the chapter, "Rheumatologic Disorders of the Spine," 14 disorders are covered, including psoriatic arthritis, familial Mediterranean fever, and ankylosing spondylitis. The information in each subchapter is thorough, up-to-date, and organized by prevalence and pathogenesis, clinical history, physical examination, laboratory data, radiographic evaluation, differential diagnosis, treatment, and prognosis. A capsule summary introduces each subchapter and supporting references follow.

The last section, "Therapy," contains 2 chapters: "Surgical Therapy," and the other, "Medical Therapy." The former helpfully outlines an orthopedist's critical weighing of a patient's signs and symptoms to determine whether surgical intervention is indicated. The chapter on medical care, however, displays little critical thinking. It contains subchapters on such topics as bed rest, u-action, physical modalities, and corsets and braces. Physical therapy exercises for neck and low back are presented along with magnet therapy, injections, and medications, to name a few additional subchapters.

Appendixes A and B organize, in tables, differential diagnosis and treatment information for 155 disease entities that can manifest as neck or low back pain. Although "controlled rest" and "exercises" are listed as treatment for some of the entries, "physical therapy" appears only once as a treatment--for neck hyperextension injuries.

The material in the first 2 sections of Neck and Low Back Pain can be found in a number of other texts and, with respect to the material on clinical examination, is presented more cohesively elsewhere. Similarly, other sources exist that more effectively develop physical therapy strategies for treatment of neck and low back pain. The information on disorders of the spine contained in section III makes Neck and Low Back Pain a useful reference for a physical therapy department library or the personal library of a physical therapist who specializes in spinal disorders.

Debra Coglianese, PT, DPT, OCS, ATC 

Massachusetts General Hospital 

Boston, Mass

Dr Coglianese practices in an outpatient satellite clinic of Massachusetts General Hospital. She specializes in the treatment of orthopedic disorders.