Physicians from wide-ranging disciplines such as physiatry, gerontology, neurology, internal medicine, orthopedics, and neurosurgery frequently encounter patients complaining of spinal pain. Although most patients with neck or back pain do not require a major workup, and their symptoms remit or resolve within a few weeks, some suffer from serious ailments that may compromise their quality of life or result in permanent disability or death. For patients with spinal disorders such as malignancy or infection, timely diagnosis is critical and may improve the patient's chances of recovery.
Diagnostic tools such as computed tomography (CT) and magnetic resonance imaging (MRI) provide important information that enhance the physician's ability to understand the origin of the patient's complaints and make the most appropriate therapeutic choices, be they conservative or surgical. Frequently, however, X-rays, CT scans, and MRI examinations are ordered and the reports provided from the radiologist are read without the referring physician personally viewing the actual images. On many occasions, only the radiologist's conclusions are read, while the full radiological report is ignored. Though this approach may be expeditious, it does not assure the best possible care. Ignoring the actual films may deprive the physician of key information and lead to wrong therapeutic decisions. Furthermore, in many instances the radiologist who interprets the films is provided with scant clinical information or receives none at all. All he or she can do is report what is seen without being able to correlate the neuroradiologi-cal material with the patient's clinical history and physical examination. As a result, the referring physician is frequently provided with a "menu" of neuroradiological abnormalities affecting various spinal levels, many of which, or sometimes most of which, bear no clinical relevance.
Careful clinical correlation between the patient's history, physical examination, and imaging studies may help both the radiologist and the referring physician identify the structures and processes responsible for the patient's symptoms.
Our book is designed to serve as an introductory guide for those physicians who strive to enhance their clinical skills and ability to provide excellent care to patients suffering from axial pain due to spinal diseases. The clinical presentation of various diseases is presented along with basic critical imaging studies. It is hoped that after reading this book physicians will become familiar with the clinical history, the salient physical findings, and the correlating imaging studies of spinal disorders.
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