Cervical Spondylotic Myelopathy (in Contemporary Issues in Neurological Surgery). R.L. Saunders, P.M. Bernini (Editors). Blackwell Scientific Publications. Boston, 1992. Pages: 219. Price: $78.95.
The authors have endeavored to bring together a concise presentation of cervical spondylosis. With the aging of the population, our awareness of this condition has increased since Brain and Russel's book in 1967 made this a recognizable syndrome. The general availability of sophisticated noninvasive imaging such as magnetic resonance imaging makes the anatomical details of the degenerative changes in the cervical spine quick and easy to obtain. Too often, however, the changes are not understood and appropriately interpreted, thereby resulting in inappropriate treatment. The publication of this book at this time is most welcome, especially for those in training or in the general practice of neurosurgery.
The opening section of the book is entitled “The Basics.” The initial chapter reviews the embryology and basic anatomy of the cervical spine, and the following chapter discusses the pathophysiology of spondylosis. Although some of the research and theories regarding the origins of the disease are presented, most of the material is readily available in standard texts.
The chapter on the symptoms and differential diagnosis of cervical spondylosis is concise and well written. The author gives a short, historical review that enhances our later understanding of the syndrome and reviews the longer term follow-up from previous series, raising the critical question of the when and why of surgical treatment. The description of the clinical signs and symptoms is excellent and should be read and understood by anyone concerned with this disease, especially if he or she operates on it. The next chapter on subjective myelopathy emphasizes the problem of diagnosis and the necessity of evaluating appropriate treatment.
The chapter on imaging provides a good review of the methods and tests available, along with some of the pitfalls that may be encountered. More details on these pitfalls would have enhanced this section. Because most people are familiar with basic magnetic resonance imaging and computed tomography, an expanded discussion of their strengths and weaknesses when there is a diagnostic or equipment problem would have been appreciated.
Section II is entitled “The Medical Perspective.” Taken as a whole, it is worthwhile reading for the surgeon, because alternative methods of treatment are discussed. Particularly worthwhile are the chapters on rheumatological disorders and psychiatric considerations. The former is all too often misunderstood and ignored, and the latter is not even considered, often to the postoperative chagrin of the surgeon.
The second half of the book, devoted to surgical considerations, presents the unique experience of a group devoted to long anterior decompressions. They describe the advantages of this method as they see them and their problems and complications. It is their impression that the advantages of this procedure outweigh the disadvantages. Although they report a satisfactory patient experience with their results, the brief biomechanical section does not define the restrictions that occur with this procedure. This information would provide a useful perspective in comparing treatments. Important and key technical factors that aid in doing this operation are discussed, as are the problems encountered.
Because the authors are dedicated to the long anterior decompression, a brief section on posterior decompression is presented. A more complete discussion of laminectomy would have been valuable, because many centers look with favor upon it and have had good results. The book is valuable reading for those in training or interested in cervical spondylosis, both for its basic information and presentation of a unique and important experience.