Fehlings, MG, Vaccaro AR, Boakye M, et al. Essentials of Spinal Cord Injury: Basic Research to Clinical Practice. Thieme; 2013; 682 pgs.; 177 illustrations; $129.
This new text from Thieme provides a broad and comprehensive treatment of the multidisciplinary aspects of spinal cord injury (SCI). The contents encompass virtually every aspect of the neuroscience behind SCI: aspects of critical care, neurophysiology, surgical and medical management, controversies, and future therapeutic options. There are 124 contributors and six editors. The lead editor, Michael G. Fehlings, is one of the most respected clinician/scientists in this field, who has devoted much of his career to improving our understanding of neural repair in SCI. His five co-editors are also household names in spinal trauma and SCI, and they run the spectrum of expertise in spine surgery, neuroscience, and rehabilitation medicine. Over forty of the contributors are from Canada, and over a dozen are experts from outside of North America. This single volume covers the scope and breadth of this very complex topic from a multidisciplinary perspective. The central focus is the spinal cord, not the spine in general. All aspects of SCI are covered, ranging from pathophysiology of SCI, medical and surgical complications, psychosocial aspects, recovery, rehabilitation methods, and controversies to novel therapies and resources available to the SCI patient.
The text is organized into 54 chapters in 7 distinct sections: (1) Principles of Spinal Cord Injury Clinical Practice, (2) Controversies in Management, (3) Neuroprotective and Neuroregenerative Approaches, (4) Neurophysiology and Imaging, (5) Plasticity and Recovery, (6) Resources, and (7) Achieving Success. Each chapter encompasses a distinct topic and is easily consumable; most chapters average about 10 pages in length, with an average of 50 references. The chapters and sections are color-coded for easy reference, the inner margins of each page designating the section heading and chapter title. In addition, each chapter begins with 3 to 6 key points in a color-coded table, and each chapter ends with a handful of take-home bullet points designated as pearls and pitfalls. The intended use of key points, pearls, and pitfalls is inconsistent; authors frequently repeat key points in the pearls and pitfalls, and the distinction between a pearl and a pitfall is unclear. Nevertheless, the bullet points are useful when skimming or reviewing each chapter. The majority of chapters also contain a conclusion section. All of these additional elements make it relatively easy for the reader to skim a chapter and reinforce knowledge. The paper quality, font, font size, page layout, and design are well executed. The figures are clear and the captions are complete and all-inclusive. There are exceptional line drawings and color figures that enhance the quality of many of the chapters. Overall, the layout and design of the book is clean and uncluttered, and the text is readable and navigable.
The first section (“Principles of Spinal Cord Injury Clinical Practice”) is ostensibly the core of the text, containing 22 chapters that span the fundamentals of SCI. There are 2 chapters that provide an excellent overview of the anatomy and physiology of the spinal cord in addition to a requisite chapter on pathophysiology of SCI. The clinical chapters provide a synopsis of nearly every clinical aspect of SCI, including epidemiology of SCI, classification systems, medical and surgical management, recovery and prognosis, and pharmacotherapy with a particular focus on high-dose steroid administration. There are multiple chapters in this section that cover the gamut of complications and intermediate/long-term management principles, including venous thromboembolism, chronic pain syndromes, kyphotic deformity, sexuality, psychosocial disorders, and syringomyelia. One of the lengthiest chapters in the text, which covers pressure ulcer management, is found in this section. While the content in this section is superb and complete, the organization could be improved by dividing the section into acute management and chronic and long-term management sections. For example, the chapter on rehabilitation is second to last and should appear earlier in the section, as should the final chapter on secondary complications. The secondary complications chapter contains cursory material that is repetitive to content contained within other, more complete chapters in the section, and could be restructured without degrading content overall. Moreover, some readers might be critical of the lack of dedicated coverage on cardiovascular, pulmonary, genitourinary, or gastrointestinal complications, as these are superficially covered in the final chapter. Dedicated sections on acute management, long-term management, and complications would best showcase these essential chapters.
The “Controversies in Management” section begins with two chapters that address known areas of debate: timing of surgery and use of hypothermia. These two chapters provide a nice treatment of the literature and evidence value of the literature. This is especially well done in the timing of surgery chapter, where there is valuable summary of the preclinical and clinical studies and levels of evidence. The final three chapters are not structured in the same rigorous fashion and do not take the same evidence-based approach to reviewing the literature. For example, chapter 25, “Management of Cervical Facet Dislocation,” presents mostly anecdotal experience without a critical assessment of the literature or gap analysis. There are treatment algorithms presented with minimal scientific justification. Similarly, the controversy regarding operative versus nonoperative management of thoracolumbar injury is not the central theme of the chapter covering management of acute SCI in thoracolumbar burst fractures. Moreover, the final chapter in this section, on central cord syndrome, does not explicitly present a specific management dispute to this area. Instead there is repetitive cursory material on the merits of early decompression. A topic that is glaringly absent from this section on controversial issues (but is discussed elsewhere in the text) is the dispute over continued use of methylprednisolone in the setting of acute SCI. An entire chapter focusing on the pros/cons and evidence for each would be a welcome addition to this section.
The remainder of the book contains excellent content, but it is presented in a less than thematic fashion. Chapters seem to be inserted in a haphazard fashion into inappropriate sections for lack of a better fit. For example, the first 4 chapters in the section on neuroprotective and neuroregenerative approaches are really about building a research program and starting a clinical trial. There is a random chapter on animal models of SCI also inserted into this section, which does not follow the general premise of the section. In addition, there is a chapter on advanced imaging buried in a section about electrodiagnostics. Again, this material would be more appropriate for a section suited to this particular theme. There are similar losses of continuity in the remainder of the sections that could have been improved with a more organized structure and section headings that more appropriately reflect the content they contain.
Neuroimaging is not the primary focus of this text. While there are cursory references to diagnostic imaging scattered throughout the pages, there are only two abbreviated chapters that discuss imaging in some detail, but not at a level geared toward radiologists. This is a clinical management and research text, and as such, the emphasis is to address how imaging is used as a decision support tool in the clinicians’ diagnostic armamentarium. There are 2 imaging specific chapters: one on imaging fundamentals and another that concentrates on the value of MRI in assessing prognosis and injury severity. This latter chapter (which is buried in a section on electrodiagnostics) offers only a superficial review of advanced techniques (eg, DTI and fMRI).
Overall, Essentials of Spinal Cord Injury: Basic Research to Clinical Practice is an excellent compendium and reference that provides the most complete coverage of all clinical, preclinical, management, and research aspects of SCI in a single attractive volume. While the book is likely not appropriate for the general neuroradiologist, it would clearly be a valuable addition to the library of any individual with a specific clinical or research emphasis in SCI.
