Vaccaro AR, Fehlings MG, Dvorak MF. Spine and Spinal Cord Trauma: Evidence-Based Management. Thieme 2010, 620 pages, $229.99.
With the emergence of newer strategies for the treatment of acute spine and spinal cord injury, such as prolonged hypothermia, immediate spine decompression, and newer drug therapies, it is increasingly important for neuroradiologists to be familiar with strategies dealing with these injuries. There are many nuances in interpreting the images in spine injury which are of critical importance to the surgeon, and such may often go undescribed in an imaging report. Similarly, in the spine operated on for posttraumatic instability and/or for the removal of a compressive lesion such as a bone fragment, disc, or hematoma, there should be more than a superficial recognition of what the surgeon accomplished in the OR so that we can identify any complications.
Enter the newest book in the field, entitled Spine and Spinal Cord Trauma: Evidence-Based Management, edited by an orthopedic surgeon (Alexander Vaccaro), a neurosurgeon (Michael Fehlings), and a pediatrician who heads a spine program (Marcel F. Dvorak). This 571-page hardcover book, accompanied by a DVD (more about this later), consists of nine sections: (1) Evidence-Based Medicine; Outcomes Assessments; (2) Fundamental Principles and Clinical Assessment; (3) Imaging; (4) Problem-Based Approach to the Principles of Spinal Imaging Management; (5) Upper Cervical Injuries and their Management; (7) Thoracolumbar Spine Injuries and Their Management; (8) Rehabilitation following Spinal Injury and Late Complications; (9) Emerging Techniques and Transitional Research. While imaging per se comprises just 4 chapters, imaging is replete throughout the entire text, as one would expect.
First, concerning the accompanying DVD, there are 13 types of injuries shown and described, and each one has a case presentation and images, indications for surgery, severity score, key technical pearls, a video showing exactly how the surgery is performed (some with accompanying cadaveric models), and then a final set of images. One can move nicely from procedure to procedure, and for those who have never been exposed to spine injury, these individual surgical clips are worth viewing and doing so in concert with and while reading the appropriate portions of the textbook.
The imaging section of the book is 36 pages long and covers 4 areas: emerging imaging of the thoracic and lumbar spine, clearing the cervical spine, nomenclature and measurements for spine injuries, and spinal stability. There is, in fact, only one set of images (CT and MR in the same patient), poorly described, of low quality, and unlabeled. In fairness, this section was apparently put together to give guidelines for imaging rather than showing/describing images themselves. Imaging is abundant throughout the rest of the book, and most chapters contain examples of CT/MR/radiographs. When there is no oversight by a radiologist (there is not one radiologist listed as an author), mistakes and serious misleading statements may appear. Take for example the chapter on treatment and outcomes of pediatric spinal cord injury, where the authors describe a case of SCIWORA in which they say that the images shows “significant spinal cord injury.” What the T2 WI does in fact show is CSF flow artifact in front of and behind the cord. On other cases, the images are of poor quality, are incompletely described, and go unlabeled (e.g. a child with a C1 -occiput dislocation). Since there are many other examples of inappropriately described images, the editors should consider including a spine radiologist as a co-editor on any future editions. The book begs for up-to-date imaging and accurate/thorough legends to accompany them.
What a radiologist does learn from this book are the treatments, particularly the surgical procedures, for each type of injury. Radiologists also would gain an insight on certain parameters/methods used in obtaining outcome data. Also of value are the drawings, replete throughout the book, which graphically show the various types of fractures, dislocations, and ligamentous injuries. Unfortunately, clinical images do not accompany some of the drawings; for example, in the chapter on sacral fractures, there are instructive drawings, but the authors fail to include any radiographs or CTs.
For those interested in transitional research as it pertains to acute spinal cord injury, a nice chapter (10 pages) at the end of the book summarizes various clinical trials relative to drugs, surgery, hypothermia, and cell implantation.
For image analysis, the previously published text by Schwartz and Flanders (Spinal Trauma: Imaging, Diagnosis, and Management, published in 2007) is a more favored text. However, for a complete look at all the clinical issues involved with spine injury, the book reviewed here is appropriate for that use.
For neuroradiologists who have a deep interest in spinal injury, this book can be recommended, but for others I would steer the reader towards more image-based publications.
