Ross JS. Specialty Imaging: Postoperative Spine. Lippincott Williams & Wilkins 2012, 400 pages, $249.00.
In the second edition, Diagnostic Imaging: Spine (published in 2010), part 7 was devoted to the postprocedural imaging of the spine; it was approximately 120 pages in length and included postoperative imaging/complications, hardware, and postradiation and chemotherapy complications. Now, following the immense success of that book, Jeff Ross, as editor, has expanded this (with contributions from 8 co-authors) into an important specialty book—a standalone text on the post-operative spine.
A disadvantage experienced by many radiologists who interpret postoperative spine films is a lack of understanding of exactly what the surgical approaches to different spinal conditions are and, as a result, what the images (both normal and abnormal) should show postoperatively. While all parts of this book are important, the areas which will in this reviewer’s opinion have the greatest impact on the reading skills of the radiologist are Section 2 (Surgical Approaches), Section 3 (Regional Surgical Approaches), and Section 4 (Devices and Instrumentation). These 3 sections alone encompass 100 pages out of a total of nearly 400 pages. When thoroughly digested it will allow the radiologist to speak in terms of familiar to the spine surgeon. It could, as a consequence, avoid overinterpreting or misinterpreting images because there will be an appreciation of the surgery itself.
In addition to the aforementioned sections, there are sections on Normal Anatomy and Techniques (9 chapters, including one on metal artifacts and how to deal with them), Complications (38 chapters, the majority written by Jeff Ross) and Remote Complications (16 chapters).
For the bulk of the book, the format follows that which is seen in other textbooks in this extensive series. Specifically, a certain entity, let’s take PLIF (posterior lumbar inter-body fusion) as an example. Here we are introduced to the procedure by two representative plain radiographs (AP and lateral) in which a two-level PLIF with fibular allografts, a rod/pedicle screw posterior instrumentation, morselized lateral bone, and one level threaded cage from a prior ALIF are shown. From that one set of figures, and from the brief legend, one sees why it is important to understand a number of issues like why there is just a unilateral pedicle screw at L4, why the allografts are positioned in the anterior portion of the disc spaces (Dr. Ross succinctly indicates the reason) and why an ALIF at L5-S1, instead of a PLIF, was done at that level. This 4-page description and associated images (total of 14) cover all the important points and do so in easy-to-read manner. One quickly reads the basic differences between a TLIF and a PLIF, when a PLIF is preferred over an ALIF, and what can be considered advantages of an ALIF over a PLIF. Materials that can be used (cages, allografts, autogenous bone), the variation between open PLIF and minimally invasive PLIF, expected outcomes, complications, and selected references. A table summarizes the brief facts of PLIFs, and 2 pages of images are included. Even in reading just these 4 pages there are innumerable hidden gems such as the importance of fatty end plate changes as one indicator of a probable stable fusion, the doubling of the incidence of CSF leaks with TLIF revisions, the risk calculations for nerve root damage during the procedure. The illustrations in this section (as in all the sections) add to one’s understanding—the effect of bone morphogenic protein, both in bone (resorption) and the potential of serous accumulations adjacent to fusion masses here possibly due to BMF (not indicated in the legend). The former may mimic an osteomyelitis; the latter, prior hemorrhage or infection. This reviewer has mentioned just this one 4-page section in order to highlight how complete it is. Going over each section like this shows how thorough a job has been done.
As with all the Amirsys books, online access is included, where the complete text can be reviewed. For the author to consider in future editions of this book might be the insertion of video clips showing the actual live surgical approach: such would nicely complement both the drawings and images. For example, in an XLIF (or DLIF) or in a TLIF we could see the partial bone resection, the approach relative to the exiting roots, the surgical entrance into the diseased disc, and the insertion of the bone graft or cage into the disc space. This could be shown for just a few of the most common approaches.
Even the remote Complications Section will be of interest. This includes many of the situations (with images) that one would expect in any type of major surgery; for instance, DVTs, PEs, AMI, brain infarction, but also some less common problems such as postoperative visual loss and the reasons this may develop in a spine operated patient. This chapter compliments the prior chapter which describes the direct surgical or postsurgical complications in the operated spine
From normal anatomy to measurements used, to normal expected appearances, to abnormal appearances, and to virtually all approaches and complications, this book is a gem.
In summary, Jeff Ross has done a spectacular job in crafting this needed textbook. It fills a void in medical publications, and is recommended to every radiologist (not just those in neuroradiology).
