In the years sin~e publication of the Hrst edition of SurgicaL Approaches to the Spine, a revolution has taken place in spinal surgery, Spinal technology has exploded, thereby in­ creasing the need for multiple access sites to the spine. The book was originally written because the spinal surgeon sometimes lacked the ability to approach the spine with the ideal procedure. As a result, spinal problems were often handled with a posterior approach when the treatment theories and biomechanical considerations of the spine dictated an anterior approach. Then John O'Brien and other anterior surgeons began to emphasize the need to perfect the approach so that the ideal operation was provided for each imli­ vidual patient. Through our work over the last 20 years, with surgeons such as Salvador Brau, a spinal access surgeon, surgeons are now dedicated to providing a safe, pain-free approach to the spine. This will ultimately be to the patient's great advantage. Advances in intradiscal dcvices, prostheses, and fusion techniqucs have mandated a safe and effec­ tive anterior approach to the spine. An operation to relieve spinal pain cannot exist if the approach produces more pain than the original problem. This second edition contains chapters on very complicated operations, such as the ap­ proaches to the sacrum and pelvis, the total vertebrectomy, trans clavicular cervicothoraeic approach, and anterior approach to the clivus of CI-C2. It is these major operations that put the patient' s lif~~ in jeopardy and require expertise in the approach.