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Image Guided Spine Intervention, Douglas S. Fenton, MD, and Leo F. Czervionke, MD, WB Saunders, 2003
The Spine Journal 4 (2004) 248–249
Information Resource Reviews Analytic Neurology: Examining the Evidence for Clinical Practice, Michael Benatar, Butterworth, Heinemann, Elsevier, 2002. Because every facet of medicine involves a neurologic manifestation, including sensory abnormalities, variation in sensorium and alteration of motor function, a working knowledge of neurology is paramount to providing competent care. Obviously, subspecialists who deal directly with the neurologic system must develop a thorough understanding of both surgical and nonsurgical neurologic disease. However, the difficulty of that task for nonsubspecialists and subspecialists alike is amplified by the additional challenge of staying current with the literature and updates in management. Through an evidence-based approach, Dr. Benatar, who is a Clinical Fellow in Neurology at Harvard Medical School, attempts to summarize the more clinically relevant neurologic diseases while providing a current review and interpretation of the literature. The soft cover text is reasonably priced. Each chapter includes important questions that highlight the diagnosis, management and prognosis of each entity; then the questions are answered with an analysis and discussion of the current relevant literature. Finally, there is a summary of the important points covered in the material. From the perspective of a spine surgeon, the chapters that deal with spinal disorders, including cervical spondylosis, amyotrophic lateral sclerosis, are quite simple in substance and analysis. On the other hand, the chapters on spinal cord injury and compression, Parkinson disease and multiple sclerosis are thoughtfully done. The majority of the book quite typically covers neurological topics that the spineoriented health-care provider will find informative but outside the scope of their care. However, for the target audience of neurologists, neurology residents, neurointensivists, neurosurgeons and internists, this text would serve well as a concise reference with supporting literature for common neurological disorders. The well-referenced appendixes are a useful addition and contain various grading systems and scales. Although the author does address a variety of topics, many of the treatises are somewhat simplistic in their Dr. Cahill co-wrote this review prior to his untimely death (see Dr. Benzel’s Letter in this issue). We will all miss him.
1529-9430/04/$ – see front matter
쑖 2004 Elsevier Inc. All rights reserved.
attempts to present the current consensus. Some areas are well interrogated by way of the question/answer format, and other topics are superficially covered. Some questions raised are pertinent, and others lack the complexity to elevate the essential issues to mind. Some readers may find the summaries somewhat vague. Others may appreciate the basic approach. In summary, this text is a useful reference for common neurologic diseases and serves well as a review of the current management. However, it may not be complex enough for the more penetrating questions concerning neurologic disorders. Caple A. Spence, MD, and David W. Cahill, MD, FACS Tampa, FL doi: 10 .1 0 1 6 / S1 5 29 - 9 4 30 ( 0 3) 0 0 17 5 - X
Image Guided Spine Intervention, Douglas S. Fenton, MD, and Leo F. Czervionke, MD, WB Saunders, 2003. Image Guided Spine Intervention fills an important void in medical texts devoted to treatment of spinal disorders. Its particular strength is the quality of the illustrations that demonstrate the injection techniques, especially the anatomy that is pertinent to each procedure. For each injection procedure, a number of different types of images are typically shown, including drawings, photographs, cross sections from cadavers, radiographic images, magnetic resonance imaging scans and computed tomography (CT) scans and three-dimensional CT surface-rendered images. Presenting the subject matter in this fashion fosters three-dimensional thinking, which is crucial to performing precision injection procedures. Novice spinal injectionists are well advised to treat this book as they would one of their medical school textbooks, that is, to thoroughly study the appropriate chapter before attempting any of the procedures covered in the book. Expert injectionists, on the other hand, should browse through the book at their leisure, much as they would a coffee table book, primarily for the purpose of appreciating the superb illustrations. Although I recommend this book for both novice and expert spinal injectionists, I do have some criticisms. Each chapter contains a discussion of the indications for the procedure, as well as a separate section that presents the perspective of a neurosurgeon. These are of minimal value, because in general the discussion of indications is cursory, and the
Information Resource Reviews / The Spine Journal 4 (2004) 248–249
comments by the neurosurgeon are brief and reflect only one person’s opinion in a field where there is a surfeit of opinions and a shortage of evidence. A more significant failing is the lack of a discussion on interpretation of pain responses to injections. Mastering needle placement for injections is an important skill, but interpreting the pain responses to injections is perhaps more important to the overall success of the procedure. Although this is a complicated topic, because it requires delving into the physiology of spinal pain, the book would have been strengthened by devoting a chapter to it. I also take issue with the authors’ recommendations regarding the use of CT guidance for certain injection procedures. Although CT guidance is a particularly elegant method for performing injections, it does have a number of drawbacks. Certainly, it is much more time consuming and expensive than fluoroscopically guided injections. Of more concern is that CT guidance does not allow for an assessment of vascular uptake during contrast injection. This is an important point because the risk associated with vascular uptake is high, particularly in the cervical spine where there have been case reports of spinal cord infarct, presumably resulting from injection of radiculomedullary arteries. The authors themselves demonstrate some ambivalence in their recommendations for CT guidance, because they recommend that cervical selective nerve root injections be performed under CT guidance and that transforaminal cervical epidural injections, which call for a technique virtually identical to that for cervical selective nerve root injections, be performed under fluoroscopic guidance. Finally, the authors include sample dictations and Current Procedural Terminology codes for the various procedures performed, which seem to be included primarily to facilitate proper billing for these procedures. Although this is important information, it is out of place in a text of this nature. These relatively minor criticisms aside, Image Guided Spine Intervention is a superb atlas of interventional spine injection procedures. I would highly recommend it for anyone who performs these procedures on a regular basis, novice and expert alike. However, anyone who is performing these procedures should also be aware that important considerations related to the indications for injections and interpretation of the pain responses to injections are not well represented in the book and must be obtained from other sources. Conor O’Neill, MD San Francisco, CA doi:1 0 .1 0 1 6/ j . sp i n e e .2 0 03 .0 8 .0 0 2
To the Editor We recently lost a true colleague and friend, David Cahill. Dr. Cahill has left a tremendous legacy to the spine and neurosurgery communities. He was one of the few true renaissance surgeons. Not only was he an accomplished
249
complex spine surgeon (for which his prowess is commonly acknowledged), he also made a mark in cranial and cerebrovascular surgery, and as an academic leader. In the latter vein, he established the neurosurgery residency and spine fellowship programs at the University of South Florida. These programs have reached national and international acclaim. Dr. Cahill received his BS and MD degrees from the University of Virginia, where he became an Echols Scholar. He performed his surgical internship and his residency in neurology at the Medical College of Virginia and his surgical residency at the University of Maryland. While there, he was elected chief resident in 1982. He completed residency training in neurosurgery at the University of Maryland and became double board certified in neurology and neurosurgery. He joined the University of South Florida (USF) College of Medicine in 1983 to run the Division of Neurosurgery. He served the USF College of Medicine for 20 years as chief of neurosurgery. In 1994, he established the neurosurgerytraining program within the Division of Neurosurgery. In 2000, Dr. Cahill became the chairman of the newly established Department of Neurological Surgery. Throughout this timeframe, he taught USF medical students and residents in surgery, neurology, orthopedic surgery and neurosurgery, thus bringing the neurologic and neurosurgery awareness at USF to higher and higher levels. He was an attending neurosurgeon at Tampa General Hospital, James A. Haley Veterans Administration Hospital and H. Lee Moffitt Cancer Center. He was a diplomat of the National Board of Medical Examiners, American Board of Psychiatry and Neurology and the American Board of Neurological Surgery. Dr. Cahill was nationally respected for his skill in complex spine surgery. His extensive research publications include work in the fields of biomechanics and repair of the spinal cord, as well as brain regeneration and Parkinson disease. His contributions to the field of spine surgery are recorded in more than 100 published articles and books. David was an internationally renowned neurosurgeon and spine surgeon. He was noted for his teaching, his innovations in spinal instrumentation and his love for flying. Loved by his residents, respected by his colleagues and feared by any who attempted to challenge the breadth or depth of his knowledge, Dr. Cahill was perhaps best known for rapidly cutting to the essence of an issue and displaying an intelligence described as “alarming.” He will be remembered as the consummate surgeon; devoted to family; committed to patients, students, residents, fellows and colleagues; passionate about flight and as a true friend and colleague. His wit and insightfulness will be remembered for years. His loss will be felt for decades. Edward C. Benzel, MD Cleveland, OH doi: 10.1016/j.spinee.2003.11.002
Information Resource Reviews Analytic Neurology: Examining the Evidence for Clinical Practice, Michael Benatar, Butterworth, Heinemann, Elsevier, 2002. Because every facet of medicine involves a neurologic manifestation, including sensory abnormalities, variation in sensorium and alteration of motor function, a working knowledge of neurology is paramount to providing competent care. Obviously, subspecialists who deal directly with the neurologic system must develop a thorough understanding of both surgical and nonsurgical neurologic disease. However, the difficulty of that task for nonsubspecialists and subspecialists alike is amplified by the additional challenge of staying current with the literature and updates in management. Through an evidence-based approach, Dr. Benatar, who is a Clinical Fellow in Neurology at Harvard Medical School, attempts to summarize the more clinically relevant neurologic diseases while providing a current review and interpretation of the literature. The soft cover text is reasonably priced. Each chapter includes important questions that highlight the diagnosis, management and prognosis of each entity; then the questions are answered with an analysis and discussion of the current relevant literature. Finally, there is a summary of the important points covered in the material. From the perspective of a spine surgeon, the chapters that deal with spinal disorders, including cervical spondylosis, amyotrophic lateral sclerosis, are quite simple in substance and analysis. On the other hand, the chapters on spinal cord injury and compression, Parkinson disease and multiple sclerosis are thoughtfully done. The majority of the book quite typically covers neurological topics that the spineoriented health-care provider will find informative but outside the scope of their care. However, for the target audience of neurologists, neurology residents, neurointensivists, neurosurgeons and internists, this text would serve well as a concise reference with supporting literature for common neurological disorders. The well-referenced appendixes are a useful addition and contain various grading systems and scales. Although the author does address a variety of topics, many of the treatises are somewhat simplistic in their Dr. Cahill co-wrote this review prior to his untimely death (see Dr. Benzel’s Letter in this issue). We will all miss him.
1529-9430/04/$ – see front matter
쑖 2004 Elsevier Inc. All rights reserved.
attempts to present the current consensus. Some areas are well interrogated by way of the question/answer format, and other topics are superficially covered. Some questions raised are pertinent, and others lack the complexity to elevate the essential issues to mind. Some readers may find the summaries somewhat vague. Others may appreciate the basic approach. In summary, this text is a useful reference for common neurologic diseases and serves well as a review of the current management. However, it may not be complex enough for the more penetrating questions concerning neurologic disorders. Caple A. Spence, MD, and David W. Cahill, MD, FACS Tampa, FL doi: 10 .1 0 1 6 / S1 5 29 - 9 4 30 ( 0 3) 0 0 17 5 - X
Image Guided Spine Intervention, Douglas S. Fenton, MD, and Leo F. Czervionke, MD, WB Saunders, 2003. Image Guided Spine Intervention fills an important void in medical texts devoted to treatment of spinal disorders. Its particular strength is the quality of the illustrations that demonstrate the injection techniques, especially the anatomy that is pertinent to each procedure. For each injection procedure, a number of different types of images are typically shown, including drawings, photographs, cross sections from cadavers, radiographic images, magnetic resonance imaging scans and computed tomography (CT) scans and three-dimensional CT surface-rendered images. Presenting the subject matter in this fashion fosters three-dimensional thinking, which is crucial to performing precision injection procedures. Novice spinal injectionists are well advised to treat this book as they would one of their medical school textbooks, that is, to thoroughly study the appropriate chapter before attempting any of the procedures covered in the book. Expert injectionists, on the other hand, should browse through the book at their leisure, much as they would a coffee table book, primarily for the purpose of appreciating the superb illustrations. Although I recommend this book for both novice and expert spinal injectionists, I do have some criticisms. Each chapter contains a discussion of the indications for the procedure, as well as a separate section that presents the perspective of a neurosurgeon. These are of minimal value, because in general the discussion of indications is cursory, and the
Information Resource Reviews / The Spine Journal 4 (2004) 248–249
comments by the neurosurgeon are brief and reflect only one person’s opinion in a field where there is a surfeit of opinions and a shortage of evidence. A more significant failing is the lack of a discussion on interpretation of pain responses to injections. Mastering needle placement for injections is an important skill, but interpreting the pain responses to injections is perhaps more important to the overall success of the procedure. Although this is a complicated topic, because it requires delving into the physiology of spinal pain, the book would have been strengthened by devoting a chapter to it. I also take issue with the authors’ recommendations regarding the use of CT guidance for certain injection procedures. Although CT guidance is a particularly elegant method for performing injections, it does have a number of drawbacks. Certainly, it is much more time consuming and expensive than fluoroscopically guided injections. Of more concern is that CT guidance does not allow for an assessment of vascular uptake during contrast injection. This is an important point because the risk associated with vascular uptake is high, particularly in the cervical spine where there have been case reports of spinal cord infarct, presumably resulting from injection of radiculomedullary arteries. The authors themselves demonstrate some ambivalence in their recommendations for CT guidance, because they recommend that cervical selective nerve root injections be performed under CT guidance and that transforaminal cervical epidural injections, which call for a technique virtually identical to that for cervical selective nerve root injections, be performed under fluoroscopic guidance. Finally, the authors include sample dictations and Current Procedural Terminology codes for the various procedures performed, which seem to be included primarily to facilitate proper billing for these procedures. Although this is important information, it is out of place in a text of this nature. These relatively minor criticisms aside, Image Guided Spine Intervention is a superb atlas of interventional spine injection procedures. I would highly recommend it for anyone who performs these procedures on a regular basis, novice and expert alike. However, anyone who is performing these procedures should also be aware that important considerations related to the indications for injections and interpretation of the pain responses to injections are not well represented in the book and must be obtained from other sources. Conor O’Neill, MD San Francisco, CA doi:1 0 .1 0 1 6/ j . sp i n e e .2 0 03 .0 8 .0 0 2
To the Editor We recently lost a true colleague and friend, David Cahill. Dr. Cahill has left a tremendous legacy to the spine and neurosurgery communities. He was one of the few true renaissance surgeons. Not only was he an accomplished
249
complex spine surgeon (for which his prowess is commonly acknowledged), he also made a mark in cranial and cerebrovascular surgery, and as an academic leader. In the latter vein, he established the neurosurgery residency and spine fellowship programs at the University of South Florida. These programs have reached national and international acclaim. Dr. Cahill received his BS and MD degrees from the University of Virginia, where he became an Echols Scholar. He performed his surgical internship and his residency in neurology at the Medical College of Virginia and his surgical residency at the University of Maryland. While there, he was elected chief resident in 1982. He completed residency training in neurosurgery at the University of Maryland and became double board certified in neurology and neurosurgery. He joined the University of South Florida (USF) College of Medicine in 1983 to run the Division of Neurosurgery. He served the USF College of Medicine for 20 years as chief of neurosurgery. In 1994, he established the neurosurgerytraining program within the Division of Neurosurgery. In 2000, Dr. Cahill became the chairman of the newly established Department of Neurological Surgery. Throughout this timeframe, he taught USF medical students and residents in surgery, neurology, orthopedic surgery and neurosurgery, thus bringing the neurologic and neurosurgery awareness at USF to higher and higher levels. He was an attending neurosurgeon at Tampa General Hospital, James A. Haley Veterans Administration Hospital and H. Lee Moffitt Cancer Center. He was a diplomat of the National Board of Medical Examiners, American Board of Psychiatry and Neurology and the American Board of Neurological Surgery. Dr. Cahill was nationally respected for his skill in complex spine surgery. His extensive research publications include work in the fields of biomechanics and repair of the spinal cord, as well as brain regeneration and Parkinson disease. His contributions to the field of spine surgery are recorded in more than 100 published articles and books. David was an internationally renowned neurosurgeon and spine surgeon. He was noted for his teaching, his innovations in spinal instrumentation and his love for flying. Loved by his residents, respected by his colleagues and feared by any who attempted to challenge the breadth or depth of his knowledge, Dr. Cahill was perhaps best known for rapidly cutting to the essence of an issue and displaying an intelligence described as “alarming.” He will be remembered as the consummate surgeon; devoted to family; committed to patients, students, residents, fellows and colleagues; passionate about flight and as a true friend and colleague. His wit and insightfulness will be remembered for years. His loss will be felt for decades. Edward C. Benzel, MD Cleveland, OH doi: 10.1016/j.spinee.2003.11.002