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Symposium on idiopathic low back pain. A. A. White MD S. L. Gordon PhD. St. Louis C. V. Mosby 1982. 492 pages. 128 illustrations. 54.50

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BOOK REVIEWS
Principles of Rheumatic Diseases. Richard S. Panush, editor.
New York, John Wiley and Sons, 1981. 492 pages. Illustrated. Indexed. $39.50.
This is a book obviously intended for students of
rheumatology, be they nascent physicians or physicians in
practice. The six parts provide a good synopsis of present
knowledge in relatively few pages. The basics are not
neglected: a chapter on structure and function of connective
tissue, joints, and synovial fluid provides the basis for
discussions of evaluation of patients, analysis of synovial
fluid, diagnostic studies, and roentgenographic interpretation. Four chapters covering immune aspects and inflammation follow and they are a very current state-of-the-art
presentation. Part Three discusses chronic polyarthritis:
rheumatoid arthritis of adults and children and spondylarthritis. Various other rheumatic diseases including the connective tissue disorders, infections, and amyloidosis are
covered in Part Four (although I would have preferred to see
Sjogren’s syndrome follow rheumatoid arthritis to serve as a
bridge to these other syndromes). Osteoarthritis, crystalinduced disease, metabolic disorders, and Paget’s disease
can be found in the next section, together with a discussion
of relationships between rheumatic diseases and other systemic disorders. The final part deals with nonarticular rheumatisms on a regional basis.
Fibrositis gets short shrift, and the large area of
psychologic and rehabilitative aspects of the rheumatic
diseases is not even mentioned. This is, then, a no-nonsense
book dealing with what is seemingly concrete in rheumatology: hard facts that can be verified easily. Despite some very
good writing, it is long on the science of medicine and
somewhat short on the art. Of course, that is not a drawback. Several relatively short books have recently appeared
that cover back pain, nonarticular rheumatisms, and those
areas that make rheumatology more comprehensive. To be
all-inclusive, the book would have had to be much longer,
and then it would compete with the several excellent large
encyclopedic texts. The editor was probably wise to confine
the book to under 500 pages and to urge his contributors to
provide readable chapters so that those wishing a glimpse
into rheumatology could be satisfied.
This book manages to avoid the flaw of telling you
more than you want to know. Most of the authors work in
Florida, although many arrived there from Northern climes.
Their work is supplemented by other familiar names, chiefly
from the South, in many instances again transplanted from
the Northeast. That gives the book less of a regional flavor
and yet some congruity. There are not many illustrations,
but those that are provided seem useful for clearer understanding. I have already lent my copy to fellows and
residents, who enjoyed it, and I expect that most persons
learning about rheumatology will feel the same about it.
George E. Ehrlich, MD
Hahnemann Medical College and Hospital
Philadelphia, PA
Symposium on Idiopathic Low Back Pain. A . A. White, MD,
S . L. Gordon, PhD. St. Louis, C . V . Mosby, 1982.492 pages.
128 illustrations. $54.50.
The symposium detailed in this excellent book on
idiopathic low back pain was originally a workshop sponsored jointly by the American Academy of Orthopedic
Surgeons, The National Institute of Arthritis, Diabetes,
Digestive and Kidney Diseases, and the Orthopaedic Research Society. The purpose of the symposium was to
provide an in-depth look at what is known regarding the
etiology of idiopathic low back pain. By design, there is no
attempt to examine treatment modalities, only to enhance
the existing knowledge and to help develop research plans
on an interdisciplinary basis to further aid in our understanding of idiopathic low back pain. The contributors to the
symposium are known experts in the field from a variety of
disciplinary areas (orthopedic surgery, neurology, neurosurgery, anatomy, pathology, rheumatology, biomechanics,
biochemistry, psychiatry, epidemiology, and ergonomics).
This book is divided into five sections. The first
section is devoted to the epidemiology and natural course of
low back pain. This section details what is known regarding
the natural history of low back pain and how external factors
(industrial setting, psychological and/or psychiatric efforts)
may alter its course.
Section I1 emphasizes what is known regarding the
anatomy and ultrastructure of the lumbar spine. This is
evaluated from a functional, structural, and a comparative
anatomic basis.
Section 111 is biomechanically oriented and sets forth
the knowledge of biomechanical factors which affect the
back and may contribute to low back pain. The biomechanics related to the spine in working and lifting as well as in
everyday function are well detailed in this section. Section
IV thoroughly explores and explains the biochemistry of the
intervertebral disc as well as other supporting structures of
the spine in both the normal and degenerative states. Section
V examines neuromechanisms as they relate to low back
pain. Included in this is an in-depth look at the pain
pathways related to back pain, as well as an update on the
possible effects of endogenous mechanisms in modulating
pain reception.
In summary, this excellent symposium on idiopathic
low back pain evaluates the topic inclusively from microstructural details to the epidemiology. Mechanisms for pain,
pain enhancement and reduction are described from the
neurologic levels to biomechanical factors. The chapters are
well laid out, well diagrammed, and easy to read. The book
is remarkably up to date and includes all currently available
knowledge on low back pain. Again, however, it does not
delve into treatment plans and readers should not expect to
find that in this book. This does not detract in any way from
the magnitude of this contribution.
Steven R. Garfin, MD
University of California
San Diego Medical Center
San Diego, CA
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