Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC
Alexander R. Vaccaro, editor. New York: Marcel Dekker; 2003. 751 pages. $195.00.
In his introduction to this book, Dr. Vaccaro states that his goal was to provide a quick and easy reference to fracture subtypes, spinal injury management protocols, and aftercare. He notes that he asked his contributing authors to focus on particular issues of spinal pathophysiology and fracture subtypes rather than on regional spinal pathology. In this well-organized and generally well-written book, the editor and his authors have adhered to this plan and, for the most part, have achieved their goals.
The book begins with a number of introductory chapters that will appeal to a widespread audience and that are generally quite good. The chapter on etiology and demographics and the chapter on emergency management are both outstanding, as is the chapter dealing with theoretical issues regarding the timing of surgery in patients who have a spinal cord injury. A chapter on the biomechanics of the injured cervical spine is somewhat disappointing; it is cursory and the information that it contains could have been incorporated into the chapters dealing with specific injuries. The next section deals with specific cervical spinal injuries. This section is very good on the whole, particularly when providing, as the editor promises, specifics regarding the management of relatively uncommon injuries, which often have been covered in a cursory manner in other texts. The chapters on injuries of the occipitocervical junction, on atlantoaxial rotatory instability, and on lateral mass fractures are excellent. Those chapters are followed by several chapters on the surgical and nonsurgical treatment of cervical spine injuries in general. For the most part, these chapters are very good and are appropriately thorough. The highlights of this section are the chapter on cervical traction and reduction, which includes a common-sense discussion of the controversial topic of the role of magnetic resonance imaging prior to closed reduction of facet dislocations, and the chapter on posterior cervical fixation techniques, which includes an excellent discussion of the emerging technology of cervical pedicle screw instrumentation.
Thoracic and thoracolumbar trauma are discussed next. This section of the book begins with a disappointing chapter on classification, dealing mostly with the Magerl (AO) classification system, which is not widely used in this country. This chapter is followed by some general chapters grouped according to region. The chapters on fractures of the thoracic spine and fractures of the sacrum and coccyx are particularly good. Treatment is covered next. Like most orthopaedic texts, this book is skewed toward surgical treatment of spine injuries, as evidenced by the fact that nonoperative management is discussed in only seven of the 118 pages dealing with treatment. While it is understandable that much more can be written about surgery, this proportion, and the book on the whole, leads the reader to draw the conclusion that surgery is the only appropriate treatment for most fractures of the thoracolumbar spine. Having said that, I found these surgical chapters to be generally very good, particularly the discussions of exposure, decompressive techniques, and spinopelvic fixation. Finally, there are several chapters dealing with special conditions or considerations related to spinal trauma. Most of those chapters are excellent, including the chapter on osteoporotic spinal fractures and the one on syringomyelia. The chapter on posttraumatic deformity, however, is cursory and disappointing. The final chapter of the book provides an excellent overview of rehabilitation, but since the editor set out to provide a reference to aftercare, this one single chapter may be a disappointment to the reader.
On the whole, this book is informative and is mostly well written. While the book is well organized overall, the format of each chapter, presumably imposed by the publisher, is awkward. In addition, a number of the radiographs are of very poor quality. Most of the line drawings, however, are excellent. Even though a number of the chapters, mostly in the introductory section, will be of general interest to readers of The Journal, most of the book appears to be aimed at the subspecialist. This book will be especially useful for physicians who treat patients who have spinal trauma, and it also will serve as an important addition to the libraries of trauma centers and orthopaedic teaching programs.