Wednesday, January 9, 2013

Decision Making in Spinal Care

Anderson DG, Vaccaro AR, eds. Decision Making in Spinal Care. Second Ed. Thieme; 2012; 638 pgs.; 314 illustrations; $84.99.

This 638-page softcover book edited by Drs. Anderson and Vacarro (both are spine surgeons at Jefferson Medical College), with contributions from 121 authors, divides spine-related surgical and clinical issues into 16 different categories, and discusses various issues primarily through the eyes of the operating surgeon. This is a highly orthopedic-driven book, with minimal space devoted to spinal canal or spinal cord tumors. Considered were subjects under Cervical Trauma, TL Trauma, Cervical Degenerative Disease, Thoracic Degenerative Disease, Lumbar Degenerative Disease, Scoliosis, Kyphosis, Spondylolisthesis, Spinal Tumors (bone  origin), Spine Infections and Inflammatory Disease, Osteoporosis, Minimal Invasive, Surgery, Non-Fusion Techniques, Spinal Imaging (minimal at 12-pages, and very superficial), Intraoperative Spinal Monitoring, and a chapter entitled "Miscellaneous Topics" containing items such as spinal cord stimulators, grafting material, bracing, penetrating spine injuries, and spine emergencies.

In general, each subject (take Scheuermann Disease as an example) has an introductory paragraph(s), classification(s) of the disease (including etiology, appearance, and types), the standard work-up, treatment, outcomes, and surgical complications (if in fact the chapter dealt with surgery). In this review of the randomly selected topic of Scheuermann Disease, one quickly reads of the clinical evaluation and treatment considerations. It is somewhat surprising that an imaging study of this disease was not included. Treatment options, depending on disease severity, are mentioned.

As another example, in the 47-page discussion of OPLL, the authors do not include an imaging example (an MR/CT/plain film would have added to the readability of this chapter). Here, the authors describe the 4 types of PLL but don't describe the contour of the OPLL. While options are stated as anterior approach, posterior approach (laminectomy/laminioplasty with or without fusion), to this reviewer insufficient space is devoted to types of instrumented laminioplasty, how many levels are operated on when an anterior or a posterior is used, etc. In most chapters, improvement could have been achieved with a greater emphasis on the specifics of surgical approaches.

While it is fairly obvious to most radiologists that surgical/non-surgical options vary considerably from center to center and from surgeon to surgeon, it is important for the neuroradiologist in particular to know what factors a surgeon may analyze before an operation (or maybe no operation at all). In any event, this consideration would represent the value of this book to the readers of the AJNR.

Decision Makling in Spinal Care-Second Edition-Anderson






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