Second edition. Russell W. Hardy, Jr.; ed. 362 pages. New York: Raven Press; 1993. $125.00.

Low back pain is one of the most frequently encountered patient symptoms evaluated by primary care physicians. Many patients with back pain present with clinical complaints because of abnormalities of the intervertebral discs. Are these alterations of the disc clinically significant? Do these changes require medical therapy? When is surgical intervention necessary?

This book attempts to explain the pathophysiology of intervertebral disc disorders, the illnesses that result from alterations in normal disc function, and the medical and surgical therapies for these diseases. The book also discusses disorders such as lumbar vertebral osteomyelitis and arachnoiditis that primarily affect the lumbar spine but not the intervertebral disc.

The chapters on imaging and epidemiology contain the most current references and are a complete and thoughtful review of their respective topics. The chapter on the history of sciatica gives a useful perspective on the evolution of back pain as an illness, and the chapter on medicolegal implications of spine surgery offers a current outlook on the possible consequences of iatrogenic injuries. The chapters on surgical techniques and their complications are comprehensive and well illustrated. These chapters discuss the latest methods for discectomy, including microdiscectomy and percutaneous discectomy, chemonucleolysis, and spinal instrumentation.

The problem for the nonsurgeon is that 12 of the 31 chapters and 40% of the 362 pages concern topics of greatest interest to orthopedic and neurosurgeons. The chapters that review the medical causes and treatment of low back pain are incomplete and suffer from the absence of current references. Some recommendations for medical therapy are not well accepted. For example, many physicians treating patients with acute low back pain believe that the recommendation of benzodiazepams for muscle relaxation is inappropriate.

Is this book on lumbar disc disease the right choice for general internists? The answer is yes if they are interested in the latest radiographic and surgical techniques for the treatment of lumbar disc disease. If they are interested in the medical aspects of low back pain, internists would do better by selecting from several available texts on low back pain that discuss this disorder from a medical perspective and at a less expensive price.