Yamada S, ed. Tethered Cord Syndrome in Children and Adults. 2nd Ed. Thieme Medical Publishers 2010, 288 pages, 184 illustrations, $139.92.
The tethered spinal cord syndrome is now a well-recognized clinical entity. This accomplishment is thanks in large part to many of the authors who have contributed to the second edition of Tethered Cord Syndrome in Children and Adults, edited by Shokei Yamada (Yamada, 2010). The syndrome of progressive clinical deterioration associated with fixation of the spinal cord secondary to a congenital lesion was described nearly 60 years ago (Bassett, 1950). In spite of this, the diagnosis had remained controversial until just recently. It was not until Harold Hoffman, a contributor to the first edition whose coauthored chapter was retained in this new edition, described a series of children with neurologic and urologic symptoms and an abnormally positioned conus that improved after releasing the tension on the cord that the term “tethered spinal cord” was coined (Hoffman et al., 1976). The pathophysiology of neurologic deterioration remained unclear until a series of physiologic, experimental and clinical studies performed by the editor Dr. Yamada detailed the metabolic changes that take place in the affected spinal cord when under tension as well as the reversal of these experimental changes once the tension is relieved (Yamada et al., 2004). Therefore, a great deal of the credit for our systematic recognition and understanding of the clinical entity of a tethered spinal cord goes to Dr. Yamada and the other contributors to this book.
Dr. Yamada has assembled a group of contributors to this book who are, indeed, the experts on tethered spinal cord making this a relative rarity in the age of over publication and information overload. The authors come from neurology, neurosurgery, radiology, neuroradiology, as well as urology; all experts necessary in the diagnosis and management of the complex clinical and therapeutic challenges of the tethered cord syndrome. The book contains 21 chapters and offers a thorough review of the history, embryology, pathophysiology, examination, imaging, clinical diagnosis and prognosis, as well as the surgical management of tethered cord syndrome. There are also excellent reviews of the intraoperative neurophysiologic monitoring of tethered spinal cord surgery as well as the conservative management of tethered cord syndrome patients. Additionally, chapters regarding the in utero closure of myelomeningocele and the role of folate round out a thorough review of spinal dysraphism.
For the most part, the chapters are well written, referenced and edited. There are some notable exceptions. The most significant of which are contradictory statements as to the normal position of the conus. The normal position of the conus is described to be at or above the mid L2 level in chapter 2 (Dias et al., p.11). However, the imaging chapter states “a conus level terminating at or below the L3-4 is abnormal” (Hinshaw et al., p.54); therefore, leaving the mid L2 level to the L3 level as a grey zone. The question of below what level is the position of the conus abnormal comes up routinely in clinical practice. Clarification of this point would be of great value to the readers. What appears to be absent is a discussion of the clinical context in which the imaging is performed and its relevance to the position of the conus. The images and legends are quite good, but some of the operative photographs fall well short of expectations for a book of this caliber. Absent from the clinical chapters is a discussion of tethering syndromes other than those caused by congenital lesions such as post-traumatic or post-inflammatory tethering of the cord.
This second edition of Tethered Cord Syndrome in Children and Adults is unquestionably the most thorough and authoritative text on congenital spinal cord tethering available in the literature. It will serve as an invaluable reference for any neurosurgeon, radiologist, pediatrician, neurologist, or urologist faced with the dilemma of diagnosis and management of these challenging patients. We will look forward to the third edition of this book by Professor Yamada as he advances our understanding of the tethered spinal cord syndrome.
