Image-Guided Spine Intervention

Rating:
Summary: Great book
Review: I have recently received my book and am thrilled. I have seen it at several pain meetings, but hadn't pulled the trigger on which pain book would give me my most bang for the book (Waldman, Raj, etc.). Image-Guided Spine Intervention is an excellent book and accomplishes exactly what it sets out to do, that is being a "how-to" book with superb imaging. In fact, I have yet to see a book that has more clear images than this book. While there are a few things that are missing in this book (discographic manometry, kyphoplasty-although the book came out just as this was emerging), all in the book is well worth the price. Reading Dr. Petersohn's commentary I wonder if we received the same book. The book is a "how-to" book and therefore is not intended to give clinical algorithms, although I admit it would make it an even more comprehensive book. The authors made the patient positioning understandable by referring to the projection with relation to the patient as opposed to the direction of the x-ray beam, which can be confusing. Perhaps in future editions, both positioning techniques can be given. With cervical transforaminal injections, one does not need a limiting AP projection to make sure one does not have cord or subdural penetration. If you follow their positioning and technique and intentionally hit the superior articular process, then walk a few mm anteriorly, you will necessarily be in the correct position, which is confirmed with contrast. For thoracic facet injections, previous reports including Dreyfuss demonstrate that one needs to start well inferior to the facet joint and angle cephalad in order to enter the coronally oriented thoracic facets. This book describes a technique, which demonstrates that this does not need to be done and that one can take a straight AP approach (proven with a CT injection) and still get the contrast into the entire joint. Dr. Chua's thoracic medial branch anatomy was just published this last year and post-dates this book. I agree there is no reason to give steroid after a facet denervation. The chapter on pharmacology was adequate for all pain practitioners. The book never sets out to be something to study for the boards. The statement "may be appropropriate for radiologists or physiatrists" sounds fairly hostile as well. As for discography, their approach to lumbar discography is reasonable. NASS and ISIS are only GUIDELINES not standards and there is no proof that there is an increased infection rate with single STYLETTED needle discography vs. double needle technique. They do not complain about L5-S1 access, rather that it is more difficult and that double-needle technique is often unnecessary. It makes sense to perform discography with a single needle since the new intradiscal procedures are performed that way. The authors do not list "pseudoarthrosis" as a contraindication to discography, but do list a solid posterolateral bone fusion as one due to lack of access.
I, too, am looking forward to a second edition that may have more clinical algorithms; more interventional techniques and those things that the authors may find have changed or should be improved on. However, I think this book is an excellent first attempt and is a much-needed book no matter who wrote it.

Rating:
Summary: Xiulu Ruan, MD
Review: I would like to thank and congratulate Dr. Fenton and Dr. Czervionke for the wonderful work in making this book available to all spine intervention specialists. I am a Physiatrist, currently receiving pain management fellowship training in the Dept. of Anesthesiology, Univ. of Michigan at Ann Arbor. Of all the interventional pain management books I have read, "Image- Guided Spine Intervention" is the best. The fine details of relavent anatomic consideration supplimented by numerous high quality illustrations, three-dimensional surface rendered CT images, MR images, step-by-step illustrations of needle placement as well as state-of-the-art radiographic images all make ths book a must-to-have for those who want to become spine interventionists. The Chapters on SNRB, Transforaminal ESI, RFA, Discogrphy, IDET are totally outstanding. My personal experience with reading this book as well as utilizing the technique taught during procedures has been incredible. Additionally, the inclusion of possible complications, routine postprocedure care, patient follow up, sample dictation and CPT codes for the procedures dicussed makes it a very practical manual as well. I could not be happier with this most wonderful book!

Rating:
Summary: Great book
Review: This is a laudable first effort which will undoubtedly be much improved on a second edition. The first edition is a welcome breath of air to help teach new residents and fellows the basics of needle manipulation, anatomy and spinal imaging, but falls short in many of the finer clinical points, mostly due to out of date or limited scope of references. There is no comprehensive discussion of appropriate clinical algorithims for selection of interventional techniques for clinical evaluation and treatment except for some superfical surgical commentary (see below). Consideration of the clinical neurosurgical and orthopedic spine surgery literature as well as the interventional pain literature is limited, although this bias is understandable in a book written by radiologists.

Patient positioning is described only in reference to the operating table, not to the more usual surgical position descriptors that most interventional physicians and surgeons commonly employ. A simple discussion on segmental anatomicaly enumeration and transitional anatomy would be a welcome addition.

Several glaring defects are apparent: The section on cervical injections does not discuss limiting AP radiographic landmarks for transforaminal injections (to avoid spinal cord or sub-dural injection) nor does it discuss the importance of the transforaminal ligaments in contrast distribution. The discussion of how to establish the optimal degree of fluoroscopic obliquity for cervical injections for both good imaging and patient safety is inadequate for the difficulty of the task. The thoracic facet injection section is incomplete, failing to including Paul Dreyfuss's procedural description or Chua's data on the locations of the mid-thoracic medial branches.

In a sample procedure note for radiofrequency rhizotomy, they routinely include postoperative injection of steroid, a technique of uncertain and, to my knowledge, unpublished efficacy. The authors should specifically acknowledge when they recommend or reference such matters as controversial or unsupported.

The section on pharmacology may be appropropriate for radiologists or physiatrists, but it is grossly inadequate for anesthesiologists. It is inadequate for preparation for the CAQ Pain Management Examination.

The discusssions of discographic technique are dated, incomplete and do not adequately reflect or reference the standards of ISIS or NASS (or the breadth of these groups published reviews on these topics). The recognized use of discography to study possible symptomatic pseudarthrosis is listed wrongly as a contraindication. Most of the authors complaints about the difficulty of L5-S1 discography can be resolved with use of double-needle technique, which the authors disparage without adequate rationale. There is inadequate detail paid to current literature on discography and the mechanism of discogenic pain generation which appear in the surgical and anesthesia literature. There is no clinical information on the history of trauma and production of annular injury. Discussion of the controversy over the inferential extension of clinically valid information from lumbar discography to its use in studying cervical or thoracic structures which would be welcome, if only to add balance to the discussion of technique. At a minimum, the anatomic differences of the cervical and thoracic discs should be discussed.

They have not explicitly discussed intervention of any sort in the post-instrumentation or post-fused spine, which benefits greatly from double-needle techniques.

The discussion of IDET is lengthy, obsessive in procedural details, but in many ways, entirely too superficial to guide a neophyte in an unsupervised setting.

The sugical comment sections, ostensibly added to provide clinical gravitas, are monolithic, gratuitous and fail to provide clinical relevance to the text.

The section on vertebroplasty is rambling, but adquate. Nonetheless, the book is recommended to residents and first year fellows as a secondary text and should be acquired by departmental libraries, especially if they budget to buy the second edition, which I'm certain will be much better. I would not generally recommend this book to my X-ray technologists although the CT illustrations are very well done - it simply doesn't justify the price of the book.

Rating:
Summary: Image-guided Spine - An introduction only
Review: This is a laudable first effort which will undoubtedly be much improved on a second edition. The first edition is a welcome breath of air to help teach new residents and fellows the basics of needle manipulation, anatomy and spinal imaging, but falls short in many of the finer clinical points, mostly due to out of date or limited scope of references. There is no comprehensive discussion of appropriate clinical algorithims for selection of interventional techniques for clinical evaluation and treatment except for some superfical surgical commentary (see below). Consideration of the clinical neurosurgical and orthopedic spine surgery literature as well as the interventional pain literature is limited, although this bias is understandable in a book written by radiologists.

Patient positioning is described only in reference to the operating table, not to the more usual surgical position descriptors that most interventional physicians and surgeons commonly employ. A simple discussion on segmental anatomicaly enumeration and transitional anatomy would be a welcome addition.

Several glaring defects are apparent: The section on cervical injections does not discuss limiting AP radiographic landmarks for transforaminal injections (to avoid spinal cord or sub-dural injection) nor does it discuss the importance of the transforaminal ligaments in contrast distribution. The discussion of how to establish the optimal degree of fluoroscopic obliquity for cervical injections for both good imaging and patient safety is inadequate for the difficulty of the task. The thoracic facet injection section is incomplete, failing to including Paul Dreyfuss's procedural description or Chua's data on the locations of the mid-thoracic medial branches.

In a sample procedure note for radiofrequency rhizotomy, they routinely include postoperative injection of steroid, a technique of uncertain and, to my knowledge, unpublished efficacy. The authors should specifically acknowledge when they recommend or reference such matters as controversial or unsupported.

The section on pharmacology may be appropropriate for radiologists or physiatrists, but it is grossly inadequate for anesthesiologists. It is inadequate for preparation for the CAQ Pain Management Examination.

The discusssions of discographic technique are dated, incomplete and do not adequately reflect or reference the standards of ISIS or NASS (or the breadth of these groups published reviews on these topics). The recognized use of discography to study possible symptomatic pseudarthrosis is listed wrongly as a contraindication. Most of the authors complaints about the difficulty of L5-S1 discography can be resolved with use of double-needle technique, which the authors disparage without adequate rationale. There is inadequate detail paid to current literature on discography and the mechanism of discogenic pain generation which appear in the surgical and anesthesia literature. There is no clinical information on the history of trauma and production of annular injury. Discussion of the controversy over the inferential extension of clinically valid information from lumbar discography to its use in studying cervical or thoracic structures which would be welcome, if only to add balance to the discussion of technique. At a minimum, the anatomic differences of the cervical and thoracic discs should be discussed.

They have not explicitly discussed intervention of any sort in the post-instrumentation or post-fused spine, which benefits greatly from double-needle techniques.

The discussion of IDET is lengthy, obsessive in procedural details, but in many ways, entirely too superficial to guide a neophyte in an unsupervised setting.

The sugical comment sections, ostensibly added to provide clinical gravitas, are monolithic, gratuitous and fail to provide clinical relevance to the text.

The section on vertebroplasty is rambling, but adquate. Nonetheless, the book is recommended to residents and first year fellows as a secondary text and should be acquired by departmental libraries, especially if they budget to buy the second edition, which I'm certain will be much better. I would not generally recommend this book to my X-ray technologists although the CT illustrations are very well done - it simply doesn't justify the price of the book.