The ASNR and ASSR are pleased to report breaking news from the Lancet. The Vertebroplasty for Acute Painful Osteoporotic fractURes (VAPOUR) trial has provided compelling evidence in support of the use of vertebroplasty as a treatment for painful acute (less than 6 weeks’ duration) vertebral compression fractures. Our own Drs. Hirsch and Chandra provided an invited commentary dubbed the Resurrection of Evidence for Vertebroplasty?
Vertebroplasty burst onto the American scene in 1997 when NeuroInterventional Radiologists Lee Jensen, Jacques Dion and colleagues published their initial experience with the treatment in the AJNR. That foundational manuscript remains one of the most cited articles in the Journal’s history.
In the decade that followed that initial publication, there was huge enthusiasm for vertebroplasty and a related procedure, kyphoplasty. In 2009, two blinded randomized controlled trials were published simultaneously in the New England Journal of Medicine that raised questions regarding the efficacy of vertebroplasty. These trials were subjected to intense scrutiny and extensive criticism. The challenge facing supporters of augmentation was that the vertebroplasty cohort performed in many ways as one might expect they would. It was the control group performing better than expected that, in large part, led to the question of unproven benefit for vertebroplasty.
VAPOUR randomized 120 patients with acute fractures and intense pain (at least 7 on a 10-point scale) to undergo either vertebroplasty (n=61) or a sham control procedure (n=59). A statistically significant different number of vertebroplasty patients achieved better pain relief (scores of 4 or less) at 14 days, compared with the sham cohort, and these observations were maintained through the 6-month post-treatment observation period.
Given the challenges of conducting randomized controlled trials related to pain, we believe it appropriate to pause and appreciate what Dr. Clark and colleagues have demonstrated. Vertebroplasty, which Neuro- and …
Haaga JR, Boll DT, eds. CT and MRI of the Whole Body. 6th ed. Elsevier; 2016; 2832 pp (including ill); $434.99
The newest edition (6th) of CT and MRI of the Whole Body is a major publication in Diagnostic Radiology. Edited by Drs. John Haaga and Daniel Boll and co-authored by over 171 contributors, the book strives to be all-encompassing. Two volumes, with 2671 pages, cover the basic principles of CT and MR, neuroradiology (brain, spine, head/neck), chest, abdomen/pelvis, MSK, and image-guided procedures. The neuroradiology and abdomen/pelvis portions of the book compose nearly two-thirds of the material. While much of the information can be obtained from multiple other sources (books, review articles, imaging clinics, online information), it is beneficial to have this information under “one roof.” As is common in many publications these days, the book comes with a scratch-off code, allowing one to access the book/images on any device electronically.
From the neuroradiology aspect, the authors have done a good job in combining standard imaging with more advanced techniques. An example of the latter is the chapter on fMR where the fundamental concepts of fMR task involvement, image analysis, and clinical applications are described and shown. Likewise, the 36-page chapter on brain MRs is a thorough description of the technique involved and the value of adding this to routine imaging. The chapter benefits greatly from having a physicist (Dr. Kwock) as the senior author. Throughout multiple chapters, imaging other than standard sequences are shown, such as CT/pMR, permeability curves, PET/CT, and DTI maps. While most of these techniques are applied to the brain, some examples are part of other areas like neck masses. The book is abundantly illustrated with generally acceptable high-quality images (although the chapter on the orbit has some very dated and low-resolution images). Of course, …
Tamimi DF, Hatcher DC. Specialty Imaging: Temporomandibular Joint. 1st ed. Elsevier; 2016; 800 pp; 2000 ill; $299.99
Do not be fooled by the title of this book: Temporomandibular Joint. The book is just under 900 pages in length, so one can immediately suspect that there is far more here than just the TMJ. Without actually counting the pages that directly address the joint itself, a conservative estimate is that there are 100 pages. That leaves 85% of the book for adjacent critical areas of the neck and spine. All this is said so that one can get a feeling for the encompassing nature of the book.
Done in the usual superb and inclusive manner of all of the books in this multi-year series from Amirsys/Elsevier, the two chief editors/authors, Drs. Tamimi and Hatcher, and 43 authors have put together a book which addresses areas we deal with on a nearly daily basis and other areas we less frequently encounter. The book comes (as do virtually all of the books in this series) with a code which allows access to the eBook version.
There are 7 sections: Understanding of the TMJ; Anatomy; Modalities Used for the TMJ Imaging: Diagnoses; Radiographic Differential Diagnosis; Clinical Differential Diagnosis; and Imaging of TMJ Procedures. These section titles belie the fact that there is much in such sections which are apart from the TMJ itself.
Virtually everyone in radiology knows the quality of these books, with their illustrations, graphics, imaging (CT/MR), and bullet points. This particular book is no exception. While some of the material is reproduced from their other publications, the bringing together of this material in anatomic regions adjacent to the TMJs has its advantages. Wide-ranging subjects are covered; for example, in Section 4 (400 pages) entitled Diagnoses, the beginning portion (150 …
Labruzzo SV, Loevner LA, Saraf-Lavi E, Yousem DM. Neuroradiology Imaging: Case Review Series. 1st ed. Elsevier; 2016; 416 pp; 530 ill; $69.99
Most radiologists love case-based books and for good reason. One gets to see and analyze images which might infrequently or rarely be seen in the course of a year’s practice. Further, it is an enjoyable way of challenging the depths of one’s knowledge.
Enter a new book (publication date 2017) entitled Neuroradiology Imaging: Case Review Series, written by Drs. Labruzzo and Yousem from John Hopkins, Dr. Loevner from the University of Pennsylvania, and Dr. Saraf-Lavi from the University of Miami. They have collected important and instructive cases encompassing material related to the brain, spine, and head/neck. In a familiar fashion, a case is presented with a few images and a brief history. Four questions follow (which often give away the diagnosis), and the over page features the answers to each question with an explanation and half page of comments related to the case. There are 200 cases mixed between brain/spine/H&N and bunched into categories which the authors consider relatively easy to more difficult. Under the answers to each question, the images shown on the prior page are repeated, albeit in a smaller format. Here the authors missed an opportunity to label the key findings, presuming that the findings were so obvious they did not have to be labeled. That may be true for most cases, but not for all. Take one example: the case of a TMJ with displacement of a disc without recapture. Here labeling the displaced disc would have been beneficial to those who do not have TMJ MR experience, as would labeling of inner ear abnormalities in Down syndrome. There are other examples where labeling the smaller images would have been worthwhile.
Cavalcanti DD, Preul MC, Kalani MYS, Spetzler RF. Microsurgical anatomy of safe entry zones to the brainstem. J Neurosurg. 2016;124(5):1359–1376. doi:10.3171/2015.4.JNS141945.
In this image rich paper, the authors examined 13 safe entry zones on the brainstem (previously described in the literature) and used cadaveric dissections to evaluate the main surgical approaches currently employed to manage intrinsic brainstem lesions. Through dissection images of these approaches, they demonstrate what can be seen on the brainstem through each of these surgical corridors and delineate the safe entry zones provided by each approach. The approaches described include three midbrain regions (anterior mesencephalic zone, lateral mesencephalic sulcus, intercollicular region), 6 pontine zones (peritrigeminal zone, supratrigeminal zone, lateral pontine zone, supracollicular zone, infracollicular zone, median sulcus of the fourth ventricle), and 4 medullary zones (anterolateral and posterior median sulci of the medulla, olivary zone, and lateral medullary zone). In addition to the surface anatomy, the paper describes the general surgical approaches to the regions, including Orbitozygomatic, Subtemporal, Subtemporal Transtentorial, Anterior Petrosectomy, Suboccipital Telovelar, Median Supracerebellar Infratentorial, Extreme Lateral Supracerebellar Infratentorial, Retrosigmoid, Far Lateral, and Retrolabyrinthine.
13 illustrations and 2 tables.
Close to all a Neuroradiologist needs to know about surgical approaches to the brainstem, and then some.
Drazin D, Nuño M, Patil CG, Yan K, Liu JC, Acosta FL. Emergency room resource utilization by patients with low-back pain. J Neurosurg Spine. 2016;24(5):686–693. doi:10.3171/2015.7.SPINE14133.
The authors conducted a retrospective analysis of patients with LBP discharged from hospitals according to the Nationwide Inpatient Sample (NIS) between 1998 and 2007. A majority (65%) of patients discharged from hospitals in the US from 1998 to 2007 with a primary diagnosis of LBP were admitted through the ER, with more patients being admitted via this route each year (183,151 patients). These patients were less likely to be discharged directly …