Mukherji SK, consulting ed. Mathis JM, guest ed. Neuroimaging Clinics of North America: Image Guided Spine Interventions. Volume 20, Number 2, May 2010. Theclinics.com, pages 145-258, subscriptions 4 issues per year $293, single issue $105.
Low back and neck pain are leading causes of doctor visits and loss of work in the USA. The cost of back pain exceeds a hundred billion dollars in the USA alone. Many of these patients often proceed to surgery. It is now believed that surgery may offer no long term advantage, compared to more conservative treatment options; this is for the vast majority of patients experiencing pain without motor symptoms or significant neurology. Minimally invasive image guided spine procedures have been around for decades but have evolved, and the range of procedures available have expanded. Treatment options other than surgery, with the associated anesthesia risks, are therefore now available ,and an attractive, effective option to treatment.
Image Guided Spine Interventions gives a comprehensive but condensed account of many of the minimally invasive image guided spine procedures currently in practice.
This text is divided into eleven sections:
Section 1: “Vertebral Body Reconstruction: Techniques and Tools”
Vertebroplasty and Kyphoplasty have become the standard of care procedures in the treatment of painful vertebral insufficiency fractures of the spinal axis. The procedures are briefly described and compared. Advances in vertebral body reconstruction techniques are elucidated and discussed under 6 major subheadings. Mention is made of the latest controversies in the literature regarding vertebroplasty. Many clear images and photographs are included.
Section 2: “Biomechanics of Vertebral Bone Augmentation”
Stabilizing osteoporotic fractures by vertebral augmentation has been shown to potentially adversely affect the levels above and below the stabilized vertebrae. The risk of adjacent fractures is discussed and multiple diagrams are used to illustrate the distribution of stress on the endplates after filling with PMMA (cement).
Section 3: “Vertebroplasty Technique in Metastatic Disease”
This section starts with the epidemiology and clinical presentations of spinal metastases. Treatment options and the technique of percutaneous image guided vertebral augmentation, with Radiofrequency Ablation and Vertebroplasty +/- tumor debulking is described. A useful treatment algorithm is suggested.
Section 4: “Sacral Fractures and Sacroplasty”
The incidence causes and clinical presentation, including diagnosis of this condition is outlined. Treatment options are usually medically orientated to reverse the underlying osteoporosis. However, with intractable pain and loss of function, percutaneous sacroplasty is advocated. The technique of sacroplasty and its intricacies is described.
Section 5: “Percutaneous Therapy for Symptomatic Synovial Cysts”
The causal mechanisms are detailed, and their clinical presentation and imaging appearances are presented. Multiple cross sectional images are provided to demonstrate the pathology. The percutaneous technique in treating these cysts is then detailed.
Section 6: “Epidural Steroid Injections”
The techniques detailed in this section are an important treatment modality in the management of back and neck pain syndromes. This detailed chapter deals with patient selection, contraindications, image guidance methods as well as the technical considerations related to each anatomical region. Pertinent use is made of tables detailing and comparing the various glucocorticoids in use for these procedures. There are plentiful images, and anatomical models detailing specific points in the text.
Section 7: “Radiofrequency Neurolysis”
Facet syndrome and lumbar facet joint pain is often a difficult diagnosis. This section deals with the presentation and pathophysiology of the mechanism of pain generation. Diagnostic facet joint blocks are detailed and are an important diagnostic and therapeutic tool in treating these syndromes. The anatomy of the medial branches of the dorsal ramus involved in the pain production is described in detail. Techniques for performing medial branch blocks are described and clear annotated images included. Lastly, radiofrequency neurotomy, which is the next step in the treatment of this condition is discussed.
Section 8: “Pharmaceuticals Used in Image Guided Spine Intervention”
Choosing the correct corticosteroid is an important aspect when doing spine injections to minimize complications and maximize the effect of the injectate. This section deals with the agents and their pharmacological properties commonly used in image guided procedures.
Section 9: “Percutaneous Lumbar Discectomy”
The cost to the healthcare system from discogenic leg pain is staggering. Taken together, back pain and discogenic leg pain, result in more days lost than any other combined illnesses and injuries. Anatomy of the basic functional spine unit and pathophysiology of pain production is detailed in this section. A description of percutaneous lumbar discectomy and the instruments required is discussed.
Section 10: “Minimally Invasive Stabilization of the Degenerated Lumbar Spine”
Is a detailed section on much of the theory relating to this topic. It is a technique that endeavors to maintain motion in the spine without fusion, while still markedly reducing the intradiscal pressure. There are multiple illustrations and images which aid in the understanding of this section.
Section 11: “Spinal Cord Stimulation: Uses and Applications”
Management of chronic pain and the use of spinal cord stimulators is discussed. Technical challenges and techniques of implantation of these devices are shown. As mentioned, the above sections are complemented with reference to multiple diagrams, illustrations and well annotated images. This book would provide a concise and handy reference text to those either performing or interested in performing these type of procedures. Each section is well organized and clearly written. It is presented in a concise, easy to follow manner. Images detailing procedures and techniques have ample annotations and suitably descriptive legends.
Although this publication would be useful to the neuroradiology audience and those radiologists interested in the latest in image guided spine interventions, the detail and emphasis is more appropriate to those practitioners performing these procedures. This text would be especially valuable to any practitioner contemplating a career in image guided spine procedures. Subject matter is covered comprehensively without being too detailed. The “non –procedural” neuroradiology audience may find certain technical procedural aspects as well as for example the pharmacology, not that relevant to their scope of practice. There are many other texts on image guided spine procedures available. Many of these are books targeted to specific procedures and as such contain a lot more detail.
Having said that, this text offers a good compromise in covering each chosen topic comprehensively without going into too much detail or being too verbose. A comprehensive list of references from current publications and leading authors in this field are included at the end of each section. Where appropriate, mention and a brief discussion is made of the controversies arising from recent studies.
Overall, this is a well written and detailed but concise text on image guided spine interventions. This would be extremely useful and informative to those practitioners already doing or interested in doing image guided spine procedures.
