Dickson RA, Harms J. Modern Management of Spinal Deformities: A Theoretical, Practical, and Evidence-based Text; Thieme; 2018; 330 pp; 935 ill; $224.99
Created through the collaboration of two pioneers in the field, Modern Management of Spinal Deformities, A Theoretical, Practical, and Evidence-based Text synthesizes their collective insight and experience to provide a comprehensive discourse on the development of modern practices in caring for patients with deformities of the spine, regardless of their age or etiology of their disease. Addressing a pathology with ever-expanding prevalence and scope of available treatment options, invaluable wisdom is combined, distilled, and presented in a highly effective and accessible manner.
The text is organized in a well thought-out and intuitive manner. Chapter 1 begins by succinctly describing the historical narrative of spinal deformity and its management. This gives the reader a working context of current treatment modalities and their origins. Chapter 2 moves on to introduce the basic principles of treatment. This presentation effectively provides a conceptual foundation of relevant biomechanics as well as the corresponding abilities and goals of both surgical and non-operative management. It introduces the language used in the evaluation and treatment of this pathology, making the discussions of subsequent chapters immediately accessible. Chapter 3 proceeds to describe fundamental causal factors of spinal deformity which further elucidate an understanding of which treatment frameworks have been developed. The reader then moves on to the subsequent chapters well equipped to efficiently ingest information specific to more specific types of deformity and how they affect respective patient populations.
The organization and method of approaching the topic results in an excellent overall teaching value. The text reads, at times, like a novel, with the author’s personal experiences shining through the presentation; leaving the reader feeling as if he or she has received personal tutelage through a progression of thorough understanding. The presentation of information also facilitates utilizing the book as a reference to review specific topics on demand.
A high level of accuracy is noted throughout the text. All historical information is well cited, using primary literature and descriptions of pathology, as well as recommended treatment algorithms. The breadth of the topics included would prepare a clinician to formulate a thorough understanding to guide the initial management of any spinal deformity, regardless of etiology or patient demographic. Presentation of treatment decisions tend to stop at recommendation for operative versus non-operative methods, at times including a brief comment on outcomes. Inclusion of higher-level discussion regarding operative techniques, pre-operative planning and other surgical decision making is lacking. No mention of minimally invasive surgical techniques is made, a modality which has become a growing topic of exploration in the field of spinal deformity.
References for each chapter are comprehensive and user-friendly. The bolded “key-references” facilitate finding additional sources for reading broadly on the topic, and ample in-text citations make exploration of specific data or talking points readily accessible. The information provided in this text is almost exclusively sourced from primary studies that have been published in high-quality scholarly journals. Indicative of the focus of this text on the historical development and context of current management principles, the majority of references span the 20th century, with a relative dearth of recent publications.
All images included in the text are high resolution, with detail easily appreciated. The abundance of images included within the body of each chapter is a highlight of the work. Few pages are without an image or table, a feature which facilitates efficient digestion of the contents of each chapter. X-rays are, at times, correlated with clinical photographs, which serve to provide clinical context. The corresponding legends are inclusive of context, relative to the nearby text, and are also thorough enough to allow for appreciation and use of the image; without necessitating reading the text it serves to augment. When viewed while reading a chapter, legends are rarely too extensive as to take away from the flow of the text’s narrative.
When compared to other books on the same subject, this text is without equal in its discussion of historical progression of the understanding of spinal deformity and evolution of management. Its comprehensive review of the conceptual framework that guides current treatment is also second to none. While its model of two primary authors without a large group of contributors creates a unified voice and unique personal style throughout the work, this may create a scope limited by experience or perspective.
Modern Management of Spinal Deformities is reviewed with attention paid to its relevance to professionals in the field of neuroradiology. From this perspective, the text may be, at most, moderately worthwhile. Description of neurologic involvement in the setting of spinal deformity or of neurologic complications that may result from surgical intervention are largely absent. Clinical manifestations of the effects that a patient’s deformity may have on the spinal cord or nerve roots is what would conceivably involve a neuroradiologist most directly in their care. Furthermore, this involvement would likely take the form of interpretation of 3-dimensional imaging, including CT and MRI, as these tools offer a heightened level of evaluation of the condition of neural elements relative to the spine. These radiographic tools have also become a mainstay in the pre-operative planning techniques of surgeons treating deformity. The majority of images included in the text as well as explanations of the role of imaging in diagnosis and guidance of treatment is centered around X-ray. From the vantage point of a neuroradiologist seeking to become better equipped to contribute effectively to the care of patients with spinal deformity, or of a spine surgeon interested in honing his or her skills, a more extensive inclusion of the application of CT and MRI would be beneficial.
This book is enthusiastically recommended for medical students, orthopedic or neurosurgery residents, and all practicing spine surgeons regardless of training background. It provides an excellent review of the pathophysiology and principals of clinical decision-making, an understanding of which are imperative to properly inform appropriate initial management of patients with spinal deformity. This book would not be highly recommended as a primary reference for spine surgeons seeking high-level guidance regarding operative strategy and surgical technique. While the target audience does not seem to include neuroradiologists specifically, any clinician with an interest in broadening his or her understanding of the fundamentals of spinal deformity would benefit greatly from this reading this text.
