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This comprehensive and practical reference on spinal cord injury medicine is a valuable guide for physical medicine and rehabilitation doctors, neurologists, and orthopedists and an excellent text for candidates preparing for the spinal cord injury medicine subspecialty examination. There are chapters on epidemiology and research with the bulk of the material being discussions of management of spinal cord injury patients.
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Spinal cord injury or disease can result in severe disability and can permanently alter a person's future; nevertheless, many patients with damaged spinal cords lead long and productive lives with the help of modern care. Even high cervical lesions can be managed when great effort and attention are devoted to the many medical consequences of spinal disease; Christopher Reeve is perhaps the most public example of someone who is leading a meaningful life despite a devastating spinal injury. Furthermore, there is growing excitement that research advances in areas such as stem cells and neurotrophic factors will facilitate spinal cord regeneration and functional recovery. For these reasons, Spinal Cord Medicine is a timely review of the causes and consequences of spinal cord disease. Spinal cord injury is fortunately a rare occurrence, but because improved management has increased life expectancy for patients with injured spinal cords, there are now approximately a quarter of a million such patients in the United States. Care of these patients requires a multidisciplinary approach that frequently involves emergency room physicians, orthopedists, neurologists, neurosurgeons, urologists, physiatrists, and persons providing psychosocial support. The editors of Spinal Cord Medicine stress the need for and importance of a coordinated approach. The book encompasses all aspects of spinal injury. The initial seven chapters present the history, anatomy, imaging, epidemiology, and general acute management of spinal cord injury. The next 11 chapters deal with medical aspects of spinal cord damage, such as pulmonary management and the neurogenic bladder. Chapters on rehabilitation are followed by nine chapters dealing with diseases that cause nontraumatic spinal cord injury. Overall, the authors have done an admirable job of presenting all aspects of spinal cord injury. Some of the best chapters discuss the consequences of such injury and the many approaches that can help patients return to normal participation in life. Not only is there a discussion of recreational and therapeutic exercise, but also an entire chapter is devoted to the assessment of a patient's ability to drive. The discussion in chapter 3 on the anatomy and mechanics of spinal support is well done; the detailed drawings and postmortem specimens clearly illustrate the critical anatomical components of spinal integrity and the ways in which spinal stability can be compromised by trauma or disease. The weakest chapters are those that deal with nontraumatic diseases resulting in spinal injury. They tend to be superficial and incomplete. The book suffers from an absence of imaging photographs. Magnetic resonance imaging (MRI) is the most important method of visualizing nontraumatic disease of the spinal column and spinal cord and is often also critical for assessing traumatic injuries after the acute phase. Yet there are no MRI photographs, which should be used to illustrate tumors, infection, vascular disorders, and other diseases of the spine. This baffling absence markedly diminishes the value of the book. It also results in an unexplained emphasis on detailed descriptions (but few photographs) of plain films, bone scans, and computed tomographic images in diseases in which MRI has largely supplanted these other imaging methods. Furthermore, there is no mention of the fact that MRI has been shown to be cost effective even when used as an initial study in patients with these diseases. The lack of attention to MRI makes the book dated and does not reflect the current diagnostic approach to diseases affecting the spinal cord. One also wonders whether the book took many years to compile, because there are few references that are more recent than 1999. Despite these deficiencies, the compilation of all aspects of spinal cord disease and its management in a single book makes it a useful resource for readers in many specialties. Physiatrists will find it most useful. Orthopedists and neurosurgeons who specialize in spinal injury will find the chapters devoted to rehabilitation and practical management most helpful. For internists and neurologists who occasionally encounter patients with spinal cord injuries, portions of the book will be useful. Lisa DeAngelis, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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Book Description LWW, 2001. Condition: New. book. Seller Inventory # M078172869X