Surgical Disorders of the Sacrum. J.R. Doty, S.S. Rengachary (Editors). Thieme Medical Publishers, Inc., New York, 1994. Pages: 320. Price: $99.00.
To date, the sacrum has received relatively little attention in the orthopedic and neurosurgical literature. This neglect is unwarranted, and in the last decade, there has been an increasing appreciation of the problems arising from a variety of developmental, traumatic, and neoplastic conditions that involve the sacrum and that lend themselves to surgical intervention. Coincident with the appreciation of these pathological states has been the application of improved computed tomographic and magnetic resonance techniques that allow for an accurate delineation of the regional anatomy, collaborative multispecialty approaches to complex problems of the sacrum and pelvis, and the development of instrumentation systems that allow for the radical resection of the sacrum. Because the sacrum and the pelvis behave as a single functional unit, an understanding of the principles of sacropelvic stability becomes a central issue, particularly when dealing with some cases of massive pelvic trauma and when resecting certain tumors that involve the first sacral segments and the sacroiliac joints.
The editors of this volume of 40 chapters and 320 pages have enlisted the help of 53 contributors, almost one-half of whom are neurosurgeons, to produce a compendium that addresses each of these areas of interest in a definitive manner. The chapters on sacral biomechanics and reconstruction, on surgical approaches to the sacrum, and on the techniques of subtotal and total sacral amputation for neoplasm and of sacrectomy are of particular use to the neurosurgeon. The same applies to the chapters on specific neoplasms (ependymoma, neurilemmoma, neuroblastoma, chordoma, teratoma, and rectal neoplasms) that may involve the sacrum and their surgical management. The reviews dealing with the current concepts regarding sacral trauma and the chapters on the caudal regression syndrome and the various types of myelomeningoceles are excellent. Many of the chapters are also enriched by first-class illustrations. Taken together, these various attributes fully justify the book's cost. If there is criticism, it is with the redundancy between the chapters and of the allocation of separate chapters to topics deserving far less recognition: how the sacrum got its name, the embryology of the sacrum, the evolution of the sacrum, the sacral ribs, human tails, and other esoterica that could well have been adequately addressed in a single chapter. However, by bringing all of this material together and making it easily accessible, this book defines the current state of our knowledge and delineates the surgical challenges that remain to be addressed. I would predict that we will see increasing interest in these topics, and this book is the harbinger of this trend.