Book Review

The Pediatric Spine: Principles and Practice

N Engl J Med 1994; 330:1693-1694June 9, 1994

Article

The Pediatric Spine: Principles and Practice
Edited by Stuart L. Weinstein. 1959 pp. in two volumes, illustrated. New York, Raven Press, 1994. $285. ISBN: 0-7817-0028-0

This book provides up-to-date information on the treatment of pediatric spinal disorders, discussed in the context of a clear description of the specific disease, anomaly, or injury of the spine and the natural history of these entities. It provides good documentation of the developmental anatomy of the spine. Illustrations from the authors' large collection of comparative animal studies enhance the presentation of the material on the human embryo. The authors forcefully remind us that there is much more to congenital abnormalities than we can visualize in the roentgenogram. The discussion of the biomechanics of the spine presents information about what is known and a vision of how much is yet to be learned. The discussions of rare conditions such as sacral agenesis, rheumatic diseases, and metabolic disorders provide much of value.

A broad spectrum of expert authors has been enlisted from the United States, Canada, and 10 other countries. The contributions of the overseas authors add substantially to the information available, particularly in the areas of post-poliomyelitis spinal deformity, spinal tuberculosis, and certain types of instrumentation.

Each chapter is essentially a stand-alone monograph. This makes it easy for the reader to find desired information, but it does result in repetition. There is little cross-referencing between the chapters. The authors provide information in a fairly standard format, covering each item of information expected.

The illustrations are of fine quality except for the reproduction of the plain roentgenograms. Too many of the radiographs of the spine are either overexposed or underexposed. The cropping of the plain films could have been improved.

The sections on instrumentation describe the evolution of spinal testing methods from Harrington rods to a combination of Harrington plus segmental wiring, with or without a Luque rod. For the most part, the chapters dealing with more advanced, more rigid fixation of the spine are written by surgeons who have had a great deal of experience using the particular technique but who were not its developers -- for example, Cotrel-Dubousset, Luque, and Isola instrumentation.

In all instances, great care has been taken to make the presentation as unbiased as possible. The authors are quick to point out the limitations of indications and contraindications for the techniques under discussion, and they include many small but important technical details. The experienced spinal surgeon will particularly enjoy and benefit from these pertinent details. The novice should not expect to be able to refer to this book and then go on to the operating room and perform the procedures.

The section on anesthesia is particularly noteworthy. It presents relevant information useful not only to the pediatric spinal surgeon but also to all orthopedists. The chapter on the complications of spinal surgery strengthens the reader's understanding of what can go wrong and discusses how to recognize and manage these potentially severe problems.

Various sections deal with or touch on the role of orthotic devices. Their appropriate use in the unstable spine is for support, but they cannot prevent the progression of curvature. In the conservative management of adolescent idiopathic scoliosis, the use of orthoses is currently confined to the skeletally immature, premenarchal patient who has a curve measuring 30 to 50 degrees, unless a lesser curve has shown progression. Even then, since not all curves increase, the value of orthotics is still open to question.

The book includes contributions from specialists in anesthesia, pediatric rheumatology, neurology, neurosurgery, radiology, histology, developmental biology, rehabilitation, biochemistry, and electrophysiology. Their chapters considerably enrich the book and provide information important to the spinal surgeon that is all too often lacking in other specialty-specific textbooks. For example, the decision tree for treatment of children with hydrosyringomyelia, the Chiari malformation, or both is clear and will serve well those who care for patients with these anomalies.

The bibliographies following each chapter are extensive. The appendixes are of particular value, since they include charts, tables, and illustrations that are important to all who care for children with spinal problems. This collection of basic information on terminology, embryology, growth and maturation, radiographic measurements, and classification of various spinal lesions, injuries, and anomalies will be invaluable to the orthopedic resident, the practicing orthopedist, and the pediatric spinal surgeon.

This book will provide the experienced pediatric spinal surgeon with many hours of enjoyable and informative reading. The personal reflections of the various authors, particularly in the sections devoted to surgical techniques and instrumentation, are especially interesting. For those involved in pediatric orthopedic surgery, this book is a must whether they are currently in practice or in a fellowship. Residents in orthopedic surgery will find it a valuable reference.

William F. Donaldson, M.D.
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213