The spinal cord, of course, has many features in common with the brain. At the same time, however, it is a unique organ of the central nervous system. It has its own distinctive and well-delineated topographical and vascular anatomy. The spinal cord shares many diseases with the larger organ that sits behemoth-like above it; yet it also has an abundance of its own unique disorders.
For this issue of Continuum, we are indebted to Dr Joseph Berger, who has picked up the gauntlet to lead us through the panoply of conditions affecting the spinal cord. He has assembled an outstanding faculty that has teamed, in ensemble fashion, to assist him. The faculty encompasses both senior and more junior physicians, including Drs Franca Cambi, Alessandro Di Rocco, Adam Kaplin, Douglas Kerr, Sanjay Keswani, Justin Zivin, and Scott Olson. Dr Olson made his contribution while pursuing his fellowship. In addition, the readers benefit from the insights of a nurse, Julie Farace, and a senior research program coordinator, Chitra Krishnan. This multidisciplinary faculty emphasizes the breadth of talent and skill required today to provide optimal care and understanding of complex neurological diseases. Finally, I want to acknowledge the very valuable contribution of Drs Eduardo Benarroch and Douglas Gelb, who skillfully crafted the multiple-choice questions and commentary, which will add considerably to your mastery of the spinal cord disorders discussed in this issue.
The introductory chapter emphasizes the constant imperative with spinal cord disease to rule out compressive myelopathy and provides a framework for evaluating the patient. Autoimmune transverse myelitis, both in a distinctive idiopathic form and as part of other illnesses, is then discussed in detail. This is followed by an exploration of infectious myelopathies, including prion, viral, bacterial, fungal, and parasitic disorders. Our understanding and recognition of genetic disorders involving both the central and peripheral nervous systems is expanding exponentially (see Continuum issue on Neurogenetics, April 2005). This issue extends that theme by providing an extensive discussion of hereditary myelopathies. The specific vascular anatomy of the spinal cord results in several unique features to spinal cord infarction, which are clearly delineated in the chapter devoted to that subject. The issue concludes with a chapter on metabolic myelopathies. It focuses extensively on syndromes of subacute combined degeneration but also discusses the more recently recognized syndrome of copper deficiency myelopathy, as well as adrenomyeloneuropathy and vitamin E deficiency states.
This issue on spinal cord disorders is a highly practical, clinical guide, featuring the ample use of clinical vignettes to illustrate the material. I am confident that you will enjoy the issue and gain added confidence in your ability to diagnose and manage these often confusing and complex conditions.
Aaron E. Miller, MD