Brain, Vol. 122, No. 9, 1793-1794,
September 1999
© 1999 Oxford University Press
Book reviews |
SPINAL CORD DISEASES—DIAGNOSIS AND TREATMENT.
.
Harvard Medical School, Boston, USA
Knowledge about the clinical aspects, diagnosis and treatment of spinal cord diseases has lagged behind that of diseases involving other regions which concern clinical neurologists—namely the cerebral hemispheres, basal ganglia, cerebellum, brainstem, peripheral nerves and muscle. Reasons for this relative information gap abound: the spinal cord is a very long cylindrical structure with a very small diameter that is quite difficult to access because of its surrounding bony fortress and anatomical features; biopsy material is rarely available during life for fear of causing major paralytic deficits; diagnostic imaging technologies are imprecise in defining the spinal cord parenchyma; the spinal cord vasculature is difficult to visualize. Most neurology house officers have relatively little exposure to patients with spinal cord diseases in comparison with the frequency that they see brain and neuromuscular conditions.
Spinal Cord Diseases—Diagnosis and Treatment is an attempt to bridge this information gap. This volume is part of the very successful Marcel Dekker series on Neurological Disease and Therapy. The editors of this volume have generated a 672 page hardback book that includes 29 chapters written by 45 different authors. The book has an acknowledged surgical orientation. The preface concludes, `Our main hope, however, is that the chapters will be read as a series of views on the spinal cord and its diseases, so that a surgeon may learn about current practice as well as the wide range of conditions affecting the cord that are outside the field of surgery' (italics are mine). One of the editors is a Professor of Clinical Orthopedics and Neurosurgery (Engler) and the other two editors are neurophysiologists by discipline (Cole and Merton).
Although this volume has some bright spots and a few excellent contributions, many clinical neurologists and neurosurgeons will be disappointed by the book as a whole. The selection of topics to be included, their relative space and emphasis, and the ordering of chapters within the book are quite idiosyncratic and the quality and recency of the chapters vary widely. The book reads as a potpourri of individual contributions without cohesion, integration, or a coherent overview. Some inclusions, such as Kennedy syndrome, bulbar paralysis, chronic inflammatory demyelinative polyneuropathy, sensory neuropathies, motor neurone disease sections on primary lateral sclerosis and dementias associated with ALS, pandysautonomias, and rheumatology of the spine, are unusual selections for a book supposedly devoted entirely to the spinal cord. General aspects common to clinicians caring for patients with cord diseases—imaging, clinical neurophysiology, urological and sexual dysfunction, and pain—are considered at the very end of the volume instead of at or near the beginning.
Spinal tumours (123 pages) and spinal cord injuries (88 pages) are the most thoroughly considered conditions. The chapters on the Chiari malformation, myelodysplasia, decompressive illness, and clinical neurophysiology are excellent contributions and well worth reading. Other chapters are quite weak. The introductory chapter on anatomy, physiology, and clinical signs and symptoms covers only 14 pages and is much too brief and undetailed, and not sufficiently illustrated. A host of spinal cord infections and inflammatory disorders are discussed superficially in one chapter. The chapter on paraplegia, palsy and spinocerebellar degenerations, which covers a wide range of conditions in only 18 pages, has only 15 references half of which are prior to 1990, and the discussion is clearly not up to date. The chapter on spinal cord vascular conditions (6 pages) is hopelessly inadequate. Spinal vascular malformations are mentioned only on one page of this chapter and the chapter has only seven references, none after 1993. Spinal dural fistulae, a very important clinical disorder that concerns both surgeons and neurologists is given no attention except for a brief discussion in the chapter on imaging.
The coverage of various topics is also quite idiosyncratic. A full chapter is devoted to omental transplantation in treating spinal cord injury. Intravesical capsaicin, a treatment for urinary incontinence so far used only in a few patients, is discussed while many standard treatments are given little space. Despite the aim of the book at surgeons, surgical management is not considered in depth except in the chapters on cervical spondylitis and on primary and metastatic tumours. Some chapters are scantily referenced, e.g. the chapter on sexual dysfunction, a very important topic, has only six references. The chapter on the pathology of spinal tumours has only 13 references.
An up-to-date, well-organized, carefully edited book on the clinical aspects of spinal cord disease is badly needed. The monograph `Diseases of the Spinal Cord' edited by Edmund Critchley and Andrew Eisen and published by Springer-Verlag in 1992 is a more evenly balanced book and will be of more use for clinical neurologists than the present volume. A number of monographs on head and spinal cord injury and on central nervous system tumours have more detailed coverage of spinal injuries and tumors. Libraries and neurological and neurosurgical departments are urged to include this present volume in their collections since it includes several excellent contributions well worth reading. Many non-neurologists and trainees will find that the book serves as a useful introduction to more detailed discussions found elsewhere. The book is expensive and difficult to recommend for individuals to purchase.
Notes
Series: Neurological Disease and Therapy Vol. 47.Edited by Gordon L. Engler, Jonathan Cole and W. Louis Merton.
998. Pp. 672. New York: Marcel Dekker, Inc.Price $195.00. ISBN 0-8247-9489-3.
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