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Lumbar disc lesions
Book Reviews Lumbar Disc Lesions. By J. R. Armstrong, M.D., F.R.C.S. Second edition, 242 pages. WiIIiams & WiIkins Co. Baltimore, 1958. Price $12.00. M.CH.,
Mr. Armstrong’s new edition, six years after pubIication of the original, fohows basically the pattern of the first edition and measures up to the standards previousIy set. The 242 weI1 iIIu.strated pages with bIack and white and coIored drawings and cIear roentgenograms add much to simplify the often perplexing probIem of lumbar disc Iesions. The first three chapters deaI with the anatomy and function of the intervertebra disc and also a review of the shock-absorbing mechanism, water exchange and function of the annuIus and nucIeus. The early, normal development of the Iumbar disc is presented with the suggestion that embryoIogicaI abnormality may be an etiological factor in the formation of tower intervertebra protrusions. Chapters IV and v review the pathology of the lumbar disc Iesion. The author states that 40 per cent of patients with herniations give no history of trauma as a possibIe mechanism of protrusion. The IocaI disc changes are classilied in three stages: (I) softening and fragmentation of the nucleus and posterior annuIus, (2) posterior dispIacement of part or all of the nucleus, and (3) fibrosis, decrease in size of the herniated nucleus and annulus with absorption and caIcihcation. The clinica picture (Chapters VI through IX) describe in detai1 the subjective and objective hndings of lumbar disc Iesions. The remainder of the book from Chapters x to XVII is concerned with the differentia1 diagnosis, conservative and operative treatment, Mr. Armstrong’s arguments on the unnecessary emphasis of leg traction in acute Iumbar disc Iesions will bring many a provocative debate as we11 as his advocation of a greater exposure (removal of the entire spinous process of Lq, exposure of the fourth Iumbar lamina and part of the sacrum) for a lifth lumbar disc surgica1 approach. The author’s many readers wiII be pleased to crystalhze their thoughts concerning the relaAmerican
Journal
OJ Surgery,
Volume
99, February,
~960
tionship between remova of a disc and arthrodesis. It warms my heart to read Mr. Armstrong’s statement, “In the opinion of the author, arthrodesis of the affected joint cannot be justified as an immediate and routine measure in a11 patients operated on for a disc Iesion.” The author does not profess to answer a11 the probIems of Iower Iumbar disc Iesions in his book, but his vast clinica experience, cIarity and orderIy approach contribute toward a better understanding of this diffrcuIt and at times IittIe understood problem. I beheve the resident and practicing orthopedic surgeon wilI welcome this book as part of his armamentarium. PAUL S. DERIAN, M.D.
Neurological Basis of Behavior. Edited for the Ciba Foundation by G. E. W. Woktenholme, o.B.E., M.A., M.B., B.CH. and Cecilia M. O’Connor, B.SC. 10g iIIustrations, 400 pages. LittIe, Brown & Co. Boston, 1958. Price $9.00. This voIume is another in a series of symposia which have been fostered by the Ciba Foundation of London, EngIand, and contains the papers that were presented at a meeting in 1957. The authors and discussants inctuded such worId renowned figures as Lord Adrian, Sir Russell Brain, Professor J. C. Eccles and Dr. WiIder G. PenheId. The subjects presented were of wide variety and ranged from basic work on the nerve ceI1 to complex human behavior, with studies of comparative neurophysiology, neural chemistry and the action of drugs on the nervous system. At present, the relationship of these basic disciplines to human behavior is far from established but it is believed that such reIationships must exist and that symposia such as this one wilI eventuaIly place psychology and psychiatry on a neurologica1 basis. This is a book that should broaden the outlook of every student of human behavior. DWIGHT M. PALMER. M.D. 264
Mr. Armstrong’s new edition, six years after pubIication of the original, fohows basically the pattern of the first edition and measures up to the standards previousIy set. The 242 weI1 iIIu.strated pages with bIack and white and coIored drawings and cIear roentgenograms add much to simplify the often perplexing probIem of lumbar disc Iesions. The first three chapters deaI with the anatomy and function of the intervertebra disc and also a review of the shock-absorbing mechanism, water exchange and function of the annuIus and nucIeus. The early, normal development of the Iumbar disc is presented with the suggestion that embryoIogicaI abnormality may be an etiological factor in the formation of tower intervertebra protrusions. Chapters IV and v review the pathology of the lumbar disc Iesion. The author states that 40 per cent of patients with herniations give no history of trauma as a possibIe mechanism of protrusion. The IocaI disc changes are classilied in three stages: (I) softening and fragmentation of the nucleus and posterior annuIus, (2) posterior dispIacement of part or all of the nucleus, and (3) fibrosis, decrease in size of the herniated nucleus and annulus with absorption and caIcihcation. The clinica picture (Chapters VI through IX) describe in detai1 the subjective and objective hndings of lumbar disc Iesions. The remainder of the book from Chapters x to XVII is concerned with the differentia1 diagnosis, conservative and operative treatment, Mr. Armstrong’s arguments on the unnecessary emphasis of leg traction in acute Iumbar disc Iesions will bring many a provocative debate as we11 as his advocation of a greater exposure (removal of the entire spinous process of Lq, exposure of the fourth Iumbar lamina and part of the sacrum) for a lifth lumbar disc surgica1 approach. The author’s many readers wiII be pleased to crystalhze their thoughts concerning the relaAmerican
Journal
OJ Surgery,
Volume
99, February,
~960
tionship between remova of a disc and arthrodesis. It warms my heart to read Mr. Armstrong’s statement, “In the opinion of the author, arthrodesis of the affected joint cannot be justified as an immediate and routine measure in a11 patients operated on for a disc Iesion.” The author does not profess to answer a11 the probIems of Iower Iumbar disc Iesions in his book, but his vast clinica experience, cIarity and orderIy approach contribute toward a better understanding of this diffrcuIt and at times IittIe understood problem. I beheve the resident and practicing orthopedic surgeon wilI welcome this book as part of his armamentarium. PAUL S. DERIAN, M.D.
Neurological Basis of Behavior. Edited for the Ciba Foundation by G. E. W. Woktenholme, o.B.E., M.A., M.B., B.CH. and Cecilia M. O’Connor, B.SC. 10g iIIustrations, 400 pages. LittIe, Brown & Co. Boston, 1958. Price $9.00. This voIume is another in a series of symposia which have been fostered by the Ciba Foundation of London, EngIand, and contains the papers that were presented at a meeting in 1957. The authors and discussants inctuded such worId renowned figures as Lord Adrian, Sir Russell Brain, Professor J. C. Eccles and Dr. WiIder G. PenheId. The subjects presented were of wide variety and ranged from basic work on the nerve ceI1 to complex human behavior, with studies of comparative neurophysiology, neural chemistry and the action of drugs on the nervous system. At present, the relationship of these basic disciplines to human behavior is far from established but it is believed that such reIationships must exist and that symposia such as this one wilI eventuaIly place psychology and psychiatry on a neurologica1 basis. This is a book that should broaden the outlook of every student of human behavior. DWIGHT M. PALMER. M.D. 264