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Spinal trauma
European Journal of Radiology 42 (2002) 83 – 84 www.elsevier.com/locate/ejrad
Editorial
Spinal trauma
‘‘I keep six honest serving men (They taught me all I knew); Their names are What and Why and When And How and Where and Who’’ Rudyard Kipling (1902) The Elephant’s Child These monosyllables in Kipling’s poem form the foundations of scientific research, audit and outcome assessments. It is vital that these pursuits are relevant to the patient’s needs rather than the doctor’s intellectual ‘interests’. The topics I have chosen are deliberately broad so as to allow the author the opportunity to address What, Why, When, etc. My contribution, through this editorial and ‘Optimising the imaging options’ completes the contributions from the ‘six honest serving men’ in this European Radiology issue dedicated to spinal trauma. The authors are national and international authorities on the subject. They are all life-long learners, driven by professionalism, and an intense desire to learn how to manage spinal injuries better. I am lucky to have them as friends and knowing their busy schedule, I am truly grateful for the time they have taken on behalf of the Journal. In the second section, Professor John Harris addresses ‘Malalignment: signs and significance’ in a clear and co-ordinated manner. The presentation is effortless and easy to follow with an abundance of ‘pearls’ along the way to aid in the differentiation of physiological from pathological causes of mal-alignment in the spine. Years of experience and observation are distilled in his contribution. Read this carefully, and then re-read it as it provides a very comprehensive hitchikers guide to the subject. In ‘Vertebral injuries: detection and implications’ Professor Richard Daffner reviews and evaluates the imaging of fractures of the vertebral column. On the one hand he relies on traditional and accepted concepts which are well tried and tested. On the other hand he is keen to introduce the reader to new concepts on how imaging can be harnessed to optimise diagnosis. His delivery is unobtrusive in thought and full of insight
with a vast amount of experience. Daffner’s ‘fingerprints’ and ‘footprints’ enable the reader to conceptualise injuries. Like all new concepts, they test traditional methods while at the same time undergoing evaluation themselves. They may not fill the gap in our knowledge, but they at least alert us to the gap. Dr Matthew White and his co-author Professor George El-Khoury review in a truly masterly fashion the literature with special reference to CT and MRI (including MR angiography) over the last 10 years, to provide a succinct review of ‘Neuro6ascular injuries of the spinal cord’. There are multiple mechanisms that can conspire to complicate vertebral column injury, rendering the cord at risk to neurological dysfunction and the vertebral artery prone to injury. Imaging provides a vast wealth of new information which is having a profound impact on the prognosis and choice of treatment in individual cases. The chapter is well covered and dovetails with the concepts introduced in the first three chapters. After detection of a spinal injury, the end-point of the investigative algorithm to a large extent is governed by the treatment options. I am truly indebted to Mr J Trivedi, Consultant Orthopaedic Spinal Surgeon who has I believe, presented without bias and prejudice, a carefully balanced chapter on ‘Therapy— options and outcomes’. This topic is at best controversial, with a lot of variation in treating the same condition worldwide. There is a myriad of factors, including facilities and resources, individual expectations, clinician’s motivation, and institutional ethos which affects the decision making process. The author relies on evidence, wisely keeping away from anecdotal and intuitive opinions which would serve only to distract the reader. In this way, as knowledge increases, so does the scope of improving doctor performance and patient outcomes. The debate concerning the issues for and against surgical intervention in the thoraco-lumbar burst fractures is invaluable to all radiologists. Modern methods in rehabilitation and care of the spinally injured, has resulted in a virtually normal life expectancy. Imaging plays a pivotal role in the management of chronic spinal injury and Dr Roger Bodley outlines the vast spectrum of problems that can con-
0720-048X/02/$ - see front matter © 2002 Published by Elsevier Science Ireland Ltd. PII: S 0 7 2 0 - 0 4 8 X ( 0 2 ) 0 0 0 4 3 - 8
84
Editorial
front the patient, attending doctor and radiologist. This chapter, ‘Imaging in chronic spinal cord injury— indications and benefits’ is beautifully crafted and condenses the variable problems and how best to image them in an efficient manner. All too often the emphasis is on imaging spinal injury in the acute stage, and yet it is the long-term care that determines the quality and longevity of life in these patients. The changes within the cord after injury need to be known by all radiologists who interpret post-injury MRI.
I am fortunate indeed to have such a fine cast to help me in my role as Section Editor in this issue on Spinal Trauma. The authors see and perceive clearly, judge carefully, and write with reason and grace. I hope you the reader, can enjoy the legacy of their unique gifts. ‘Why do we write’? There are many valid reasons. On the one hand, as WB Yeats said, ‘education should not be the filling of a pail, but the lighting of a fire’. One of the objectives without doubt is to stimulate the reader to further reading on the subject. Medically however, the core reason must be to ultimately make a difference to the patients’ outcome. As this extract (written by a 15-year-old tetraplegic) below shows, if we can help prevent and help reduce the risk of neurological dysfunction in the spinally injured patient, it will be truly worthwhile, even though the patient may not necessarily be aware of this. ‘‘E6ery single morning, as I drift from sleep to consciousness, I regress back to the age of 7. Just for that split second, I think I’m going to jump out of bed and start the day as I used to, with nothing to hold me back. Then reality starts to hit me ….’’
V.N. Cassar-Pullicino Department of Radiology, The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
Editorial
Spinal trauma
‘‘I keep six honest serving men (They taught me all I knew); Their names are What and Why and When And How and Where and Who’’ Rudyard Kipling (1902) The Elephant’s Child These monosyllables in Kipling’s poem form the foundations of scientific research, audit and outcome assessments. It is vital that these pursuits are relevant to the patient’s needs rather than the doctor’s intellectual ‘interests’. The topics I have chosen are deliberately broad so as to allow the author the opportunity to address What, Why, When, etc. My contribution, through this editorial and ‘Optimising the imaging options’ completes the contributions from the ‘six honest serving men’ in this European Radiology issue dedicated to spinal trauma. The authors are national and international authorities on the subject. They are all life-long learners, driven by professionalism, and an intense desire to learn how to manage spinal injuries better. I am lucky to have them as friends and knowing their busy schedule, I am truly grateful for the time they have taken on behalf of the Journal. In the second section, Professor John Harris addresses ‘Malalignment: signs and significance’ in a clear and co-ordinated manner. The presentation is effortless and easy to follow with an abundance of ‘pearls’ along the way to aid in the differentiation of physiological from pathological causes of mal-alignment in the spine. Years of experience and observation are distilled in his contribution. Read this carefully, and then re-read it as it provides a very comprehensive hitchikers guide to the subject. In ‘Vertebral injuries: detection and implications’ Professor Richard Daffner reviews and evaluates the imaging of fractures of the vertebral column. On the one hand he relies on traditional and accepted concepts which are well tried and tested. On the other hand he is keen to introduce the reader to new concepts on how imaging can be harnessed to optimise diagnosis. His delivery is unobtrusive in thought and full of insight
with a vast amount of experience. Daffner’s ‘fingerprints’ and ‘footprints’ enable the reader to conceptualise injuries. Like all new concepts, they test traditional methods while at the same time undergoing evaluation themselves. They may not fill the gap in our knowledge, but they at least alert us to the gap. Dr Matthew White and his co-author Professor George El-Khoury review in a truly masterly fashion the literature with special reference to CT and MRI (including MR angiography) over the last 10 years, to provide a succinct review of ‘Neuro6ascular injuries of the spinal cord’. There are multiple mechanisms that can conspire to complicate vertebral column injury, rendering the cord at risk to neurological dysfunction and the vertebral artery prone to injury. Imaging provides a vast wealth of new information which is having a profound impact on the prognosis and choice of treatment in individual cases. The chapter is well covered and dovetails with the concepts introduced in the first three chapters. After detection of a spinal injury, the end-point of the investigative algorithm to a large extent is governed by the treatment options. I am truly indebted to Mr J Trivedi, Consultant Orthopaedic Spinal Surgeon who has I believe, presented without bias and prejudice, a carefully balanced chapter on ‘Therapy— options and outcomes’. This topic is at best controversial, with a lot of variation in treating the same condition worldwide. There is a myriad of factors, including facilities and resources, individual expectations, clinician’s motivation, and institutional ethos which affects the decision making process. The author relies on evidence, wisely keeping away from anecdotal and intuitive opinions which would serve only to distract the reader. In this way, as knowledge increases, so does the scope of improving doctor performance and patient outcomes. The debate concerning the issues for and against surgical intervention in the thoraco-lumbar burst fractures is invaluable to all radiologists. Modern methods in rehabilitation and care of the spinally injured, has resulted in a virtually normal life expectancy. Imaging plays a pivotal role in the management of chronic spinal injury and Dr Roger Bodley outlines the vast spectrum of problems that can con-
0720-048X/02/$ - see front matter © 2002 Published by Elsevier Science Ireland Ltd. PII: S 0 7 2 0 - 0 4 8 X ( 0 2 ) 0 0 0 4 3 - 8
84
Editorial
front the patient, attending doctor and radiologist. This chapter, ‘Imaging in chronic spinal cord injury— indications and benefits’ is beautifully crafted and condenses the variable problems and how best to image them in an efficient manner. All too often the emphasis is on imaging spinal injury in the acute stage, and yet it is the long-term care that determines the quality and longevity of life in these patients. The changes within the cord after injury need to be known by all radiologists who interpret post-injury MRI.
I am fortunate indeed to have such a fine cast to help me in my role as Section Editor in this issue on Spinal Trauma. The authors see and perceive clearly, judge carefully, and write with reason and grace. I hope you the reader, can enjoy the legacy of their unique gifts. ‘Why do we write’? There are many valid reasons. On the one hand, as WB Yeats said, ‘education should not be the filling of a pail, but the lighting of a fire’. One of the objectives without doubt is to stimulate the reader to further reading on the subject. Medically however, the core reason must be to ultimately make a difference to the patients’ outcome. As this extract (written by a 15-year-old tetraplegic) below shows, if we can help prevent and help reduce the risk of neurological dysfunction in the spinally injured patient, it will be truly worthwhile, even though the patient may not necessarily be aware of this. ‘‘E6ery single morning, as I drift from sleep to consciousness, I regress back to the age of 7. Just for that split second, I think I’m going to jump out of bed and start the day as I used to, with nothing to hold me back. Then reality starts to hit me ….’’
V.N. Cassar-Pullicino Department of Radiology, The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK