The timing of this fourth edition is perfect, for now we have reached the age of 'minimally invasive' procedures used to treat pain generators of the spine. Chapters on disc pain and posterior element pain stress not only the anatomy of these structures but also review the pathophysiology of the degenerative process and its relationship to pain. More importantly. these chapters stress what biomechanical changes may occur as a result of doing destructive procedures. After reading the fourth edition in preparing to write this Foreword, 1 a,m humbled by how much 1 have learned (or how much I have forgotten) about the basic anatomy and biomechanics of the lumbar spine and sacrum. I found myself learning and relearning many things I could apply on a daily basis to my practice of spinal interventions and pain management.
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