Spinal Disorders

Spine disorders are a common, multifaceted (no pun intended), medically challenging group of conditions. The direct and indirect costs to society of back pain alone approach $50 billion dollars annually. In addition, back symptoms are the most common cause of disability among adults younger than 45 years. The loss of personal and professional productivity is a huge drain on patients, families, and society.

The diagnostic evaluation and treatment of spine disorders often includes combined assessment of the anatomic and functional integrity of the bony spine, spinal cord, and nerve roots. As a result, management of spine disorders is at the cusp between multiple disciplines including neurology, medicine, orthopedics, neurosurgery, and pain management. In an ideal medical world spinal disorders would be managed by harnessing the expertise of these diverse groups.

Some implications for neurology are obvious. For example, neurologists need to know more about the operative options for treatment in order to better advise patients and determine whether postoperative symptoms and signs are due to underlying disease, a complication of surgery, or both. Neurology needs to join our surgical and medical colleagues in the search for better diagnostic methods and treatments. This search will necessitate the use of stringent clinical research methods that employ multiple disciplines as collaborators rather than competitors. Neurology should be both a leader and a partner in the design of clinical trials to evaluate the natural history of spinal disorders and potential new medical or procedure-based treatments.

This issue of Seminars in Neurology does not attempt to cover all aspects of spine disease, but does highlight disorders in which there has been progress in our understanding or management. The first four articles explore specific myelopathies, and the next five articles address specific disorders of the bony spine and nerve roots. The last two articles review the utility of neurophysiologic and neuroradiologic diagnostic techniques as applied to the spine. In keeping with the philosophy expressed above, the authors span a range of disciplines including neurology, orthopedic surgery, neurosurgery, neurointerventional radiology, and neuroradiology.

I want to thank each of the authors for reaching across the ``great divide'' between specialties and contributing their goodwill and energy to this issue of Seminars in Neurology. This collaboration is an outgrowth of the development of multidisciplinary didactic spine and neuroradiology conferences that have enabled us to work closely together and to appreciate how different specialties conceptualize and manage similar medical problems. Further multidisciplinary efforts will ultimately improve our understanding of spine disorders and result in more optimal treatment of our patients.