Preface (Spine)

Back pain is the most common symptom prompting people to seek medical care. In the United States alone, there are more than 50 million patient visits annually for spine related complaints. Moreover, approximately 1% of the American workforce is disabled because of chronic back or neck problems. One study examining spending on personal health care and public health in the United States (JAMA. 2016;316(24):2627-2646) estimated that the cost of caring for back pain exceeds the spending on care for asthma, breast cancer, cirrhosis, heart failure and leukemia – combined.

Back pain often originates from degenerative changes, but in many instances the precise cause is unknown. Intervertebral disc degeneration and facet joint arthritis is frequently seen in people without symptoms too.

Back pain is not the only spinal condition of interest either. The spine can also be affected by acute trauma, infection, tumor, and deformity.

It’s important that I disclose my potential biases. I am an orthopaedic surgeon, working in a neurosurgical unit. I have seen that decompressive spinal surgery can be extremely gratifying for patients, producing near-immediate relief of arm pain or leg pain. After spine surgery done well, patients can experience complete resolution of pre-operative pain, sending a smile across their faces, even when groggy in the post-anesthesia recovery room. Operative fixation of spinal fractures can also have similar awe-inspiring results.

Of course, I have also seen that done poorly, spinal surgery can produce less-rewarding results. I refer not only to infrequent but understandable complications such as infection, dural tears, or nerve root injury, but also to the harmful impact of indiscriminate and unnecessary procedures. The rate of spinal fusion surgery has surged over the last 2 decades, a change driven at least in part by the medical industrial spinal complex.

Accordingly, this volume is not a treatise on spine surgery, but rather an introduction to spinal disorders, aiming to present a sound anatomical and physiological basis for understanding these important conditions.

There is no doubt that our understanding is incomplete, and hopefully subsequent editions will fill in the gaps. In the meanwhile, I am pleased to help share what we do know.

--Nader M. Hebela, MD

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