K J Burchiel (ed) Published by Thieme, Stuttgart and New York: 992 pp. ISBN 3 13 125981 7; DEM 549.00

This 992-page book is nothing if not encyclopaedic. Being multi-author (73 chapter authors, less than a dozen of whom come from outside North America, and 77 commentary writers) it has, not surprisingly, been several years in the compilation. Like all such books on fast-moving subjects, it suffers somewhat from this; a random glance at some chapter bibliographies could find no references later than 1998. In general, however, Kim Burchiel is to be congratulated on putting together such a comprehensive tome.

It is perhaps unfortunate that, in a textbook, the chapter (2) on neuropathic pain should have been entrusted to an elegantly-writing but highly controversial author (Ochoa) who believes that the condition doesn't really exist; this chapter surely properly belongs in a review rather than in a textbook. Most experts would agree that neuropathic pain (central as well as peripheral) can be briefly defined as pain in an area of partial sensory deficit.

There is no mention of NMDA receptors and their blockers in the chapter on pain modulation (by a neurosurgeon), which is in fact about descending inhibitory systems and not about pharmacology. NMDA receptor antagonists are only mentioned as a therapeutic tool in chapter 78 on `Innovative Intrathecal Analgesics'. But what an excellent chapter by Melzack and Katz on clinical pain measurement!

Neither in the chapter on `Physical Medicine Interventions' nor elsewhere (including the Index) could I find mention of physiotherapy/chiropractic – a vital treatment option in both low back pain (chapter 25) and reflex sympathetic dystrophy (chapter 34).

As for the chapter on regulations governing the prescription of controlled drugs – the book is supposed to be international (its publishers are in Germany), so it would be nice to see recognition of the fact that there are readers in other countries – or to add the words `in the USA' to the chapter title.

The chapters (20–37) on Specific Pain Syndromes offer some rich fare. Bogduk (chapter 25) gives a careful description of acute and chronic low back pain and treatment. But he specifically excludes pain going down the leg. The following two chapters (22 pages) are mainly concerned with `failed back syndrome' – the principal source of income to a large proportion of American spinal surgeons. They mention sciatic pain, almost en passant. I could not find sciatic or root pain in the index; and indeed pain radiating down the leg gets little mention throughout the book.

Post-Thoracotomy Pain Syndrome rates a chapter (29), although how it differs from other forms of Complex Regional Pain Syndrome (Chapter 34), apart from being 100% iatrogenic, is a mystery to this reviewer. Similar syndromes follow inevitable operative trauma to nerves, e.g. in herniorrhaphy.

Chapters 38–75 (421 pages) are the neurosurgical meat of the book – `how to do it'. It would be invidious for this reviewer, not being a surgeon, to comment on much of this aspect.

Syringomyelia is only mentioned by a commentator following RK Simpson's 5-page chapter on SCI pain. Pain-producing spinal cord tumours do not seem to be mentioned at all; meningo-myelocoeles and myelocoeles (not indexed) are fleetingly mentioned in the earlier chapter (26) on lumbar spine disorders. Arachnoiditis, an important and intractable form of spinal pain, is even more fleetingly mentioned as `a complication' of myelography or surgery.

The chapters which deal with indications and results of anterolateral cordotomy refer but briefly to painful postcordotomy/postmyelotomy dysaesthesia, and fail to mention the important clinical distinction that in these conditions pinprick deficit is retained, while in `return of pain' it is lost. And nowhere in the book could I find discussion of the fact that anterolateral cordotomy and midline myelotomy do not abolish neuropathic pain, thus showing that, contrary to popular myth, the ascending anterolateral funiculi are not the unique `pain pathway'.

Much of the information in this book is, inevitably, scattered among, often, a large number of chapters. It is a pity that the book could not have been cross-referenced, which would have added greatly to its value as a reference work.

While this book should certainly be in the library of any Department where surgery on the peripheral or central nervous system is performed, or even considered, there is disappointingly little in it of interest to people whose primary interest is in the spinal cord.