Roberto Vialle L, ed. Berven SH, de Kleuver M, guest eds. AOSpine Masters Series, Volume 9: Pediatric Spinal Deformities. Thieme; 2017; 170 pp; 155 ill; $119.99
AOSpine Masters Series, Volume 9: Pediatric Spinal Deformities presents the reader with a comprehensive overview of the pathophysiology, diagnosis, and management of pediatric spinal deformities. The book, edited by Luiz Roberto Vialle with guest editors Sigurd H. Berven and Marinus de Kleuver, is high-yield yet easy to read with excellent illustrations. While there is a significant portion of the book dedicated to surgical management, the book still provides valuable information to the diagnostic radiologist.
The book begins with a discussion of early onset scoliosis (EOS), or scoliosis in patients less than 10 years of age. This is a condition distinct from adolescent idiopathic scoliosis (10–18 years). The book differentiates types of EOS, including idiopathic scoliosis, neuromuscular early onset scoliosis, and congenital scoliosis. Pediatric deformities are not accurately described by existing adult deformity classifications, such as the Lenke classification for adolescent idiopathic scoliosis or the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification. As a result, study groups collaborated to form the Classification of Early-Onset Scoliosis (C-EOS). The book nicely details the C-EOS grading system and how to apply this clinically.
Subsequently, the authors discuss adolescent idiopathic scoliosis, the most common type of spinal deformity in the pediatric population. They define scoliosis radiographically (curve greater than 10 degrees) and give a brief overview of which patients benefit from observation, which are treated with a brace, and which are considered for surgery. There are also thorough descriptions of the King, Lenke, and 3D classification systems with radiographic examples and detailed illustrations. The authors even provide a very helpful chapter describing the sequelae of untreated scoliosis, including impaired pulmonary function, acute or chronic back pain, and a significant increase in mortality in patients with untreated, severe scoliosis.
Perhaps the highest yield for the radiologist is in Chapter 3: Preoperative Evaluation and Imaging Techniques. Although there is emphasis on the physical exam in this chapter, the authors nicely describe a step-wise approach to the radiographic evaluation of pediatric deformity, including a discussion of balance with emphasis on pelvic obliquity and the measurement of sagittal parameters like the sagittal vertical axis, lumbar lordosis, and thoracic kyphosis. There is also an excellent discussion of the role of right and left bending radiographs and how the findings from these studies are factored into management such as presurgical planning. There are brief mentions of CT and MRI, but the emphasis is on static and dynamic radiographs.
A significant portion of the book is dedicated to surgical techniques, outcomes, and even revision strategies. An understanding of the hardware used in correction would be useful for the diagnostic radiologist, but the majority of this section is aimed at the surgical population.
Finally, the book provides an excellent discussion of pediatric spondylolysis and spondylolisthesis—something that would benefit nearly all diagnostic radiologists. There is an excellent overview of the pathophysiology and epidemiology of spondylolysis. The authors also provide a concise yet thorough overview of the classification systems, imaging techniques, and treatment of spondylitic spondylolisthesis, with diagrams and a case example.
In summary, the book gives a comprehensive overview of pediatric spinal deformity. While there is a portion of the book dedicated to surgical management, there is still a significant portion of this book that would be useful for a diagnostic radiologist.
