16 Oct, 08 | by Karim Khan
Clinical anatomy of the lumbar spine and sacrum (2005)
By Nikolai Bogduk
Published by Churchill Livingstone
pp 324, US$90. ISBN: 0-443-10119-1
This publication can be considered a classic for those clinicians involved in the care of patients with lower back problems. The purpose of the book is given in the foreword and the first paragraph of the author’s preface to the 4th edition: “There have been no changes in the anatomy of the lumbar spine in the past 20 years, but our understanding of some of the controversial issues has. Among them the presence of new data on zygoapophyseal joint pain, suggesting that it is not as frequent as once thought, whereas discogenic pain seems to be on the up once more, with better knowledge of the process of internal disc disruption.”
The book covers comprehensively the expected topics: bones, joints, ligaments, muscles and fascia, blood and nerve supply in various chapters, as well as embryology and development. There is a separate chapter for the sacroiliac joint.
The book has been written as a text book for the International Spine Intervention Society (ISIS): it is required reading for students and a key reference to instructors to review before teaching the Society’s anatomy courses.
As a clinician with an interest in low back and pelvis patients (but not involved in intervention procedures) I found the “extra” chapters particularly interesting. In the chapter “Age changes in the lumbar spine” Professor Bogduk stresses in his own emphatic style that many changes observed in imaging studies are nothing more than the result of the normal ageing process, not pathological findings.
From a clinician’s point of view the last three chapters on low back pain, instability and radiographic anatomy are of particular interest. The author addresses controversial topics as is his custom: with thoroughly researched references, available clinical evidence and very definite opinions. A number of the references are obviously form the first edition (1987), but still valid. The instability chapter has an excellent biomechanical basis, and is presented in a very logical fashion, that makes understanding of the issues easier. There is no reference, however, to the available literature on the link between low back pain and changes in muscle recruitment patterns, which is clinically significant. I also would have liked to see the last chapter on the radiographic anatomy expanded to cover other imaging modalities, rather than limited to simple x ray films. In fairness to the author, he indicates that further material is covered in the instructional CD of the ISIS.
These criticisms are not sufficient to change my opinion of this book: it is an excellent resource for all those who have an interest in the lumbar spine, from surgeons to interventionists, anatomists, physiotherapists, chiropractors and osteopaths.
M F Cusi
University of Notre Dame
Sydney School of Medicine
Evidence bass 18