Patel VV, Burger E, Brown C, eds. Spine Trauma: Surgical Techniques. Springer 2010, 339 pages, 349 illustrations, $219.00.
This multi-authored text with three editors (Drs. Patel, Burger, Brown) is intended primarily to demonstrate and discuss surgical indications, approaches, and techniques in spine injured patients. Naturally, there is an abundant amount of imaging involved (nearly exclusively CT and plain radiographs). The book gives the radiologist a firm understanding of the various surgical approaches, with the resultant fixation instrumentation from CI down through the sacrum. The setup is such that there are chapters containing general information on the particular area under consideration and then numerous individual chapters that start off with a “Case Example”. Following the case study history, there are varying but reasonably uniform sections within each chapter such as background information relative to the type of injury/fracture/dislocation, indications for the surgical procedure, potential contradictions, surgical procedures (frequently accompanied by drawings and artist’s rendition of the procedure), surgical techniques and options, postoperative complications, and patient follow-up. All this material is augmented by appropriate imaging. To this reviewer, it is an excellent way of presenting spinal column trauma and the resultant surgical treatment. Examples of problems that the surgeon can run into, or issues the surgeon must deal with, which the radiologist should be aware of are shown such as a tiny pedicle at C2 secondary to a huge vertebral artery (pedicle screw insertion at this level is dangerous to impossible), or measuring possible screw trajectories/angles, and various complications. To this reviewer there was too limited material on spinal cord injury and the timing for cord decompression and an insufficient amount of material on postoperative complications.
Just as the issue with pedicle size mentioned above, the radiologist learns of imaging findings frequently of concern to the surgeon which the radiologist often may not appreciate such as the thickness of occipital bone in the mid-line (the “keel”) in preparation for an occipital to cervical fixation. While this is clearly not something a radiologist would be expected to include in a report, it is of value to understand the imaging concerns of our surgical colleagues. Other such examples were found throughout the book.
The intraoperative pictures along with the diagrams allow one to fully appreciate why certain devices are used with an understanding of the resultant postoperative images and how complications may occur. For those radiologists working in a facility with a busy spinal trauma center, this book would be useful and informative.
