Handbook of Diagnostic and Therapeutic Spine Procedures

Alan L. Williams and F. Reed Murtagh, ed.. St. Louis: Mosby; 2002. 272 pages, 102 illustrations. $49.95.

The world of neuroradiology continues to move rapidly, with ever-increasing new techniques in imaging and intervention. The progress and demands for interventional spine services in particular have in many places outstripped the ability of some radiologic groups to offer these procedures. In addition to increased residency and fellowship training in this interventional area, what has been needed is a clear and succinct handbook that would allow a radiologist to become involved in such procedures. Drs. Williams and Murtagh have beautifully answered this need with compact, portable, well-written, and well-illustrated handbook.

In this multiauthored (14 contributors) softcover book, the following procedures are covered: epidurography and epidural steroid injections (Thomas D. Berg and Georges Y. El-Kohoury), spinal nerve blocks (Wade H. M. Wong), pulsed radio-frequency techniques (Farshad M. Ahadian), spinal facet and sacroiliac joint blocks (Robert H. Dorwart), intraspinal cyst aspiration (Andrew L. Wagner and F. Reed Murtagh), myelography (Alan L. Williams), percutaneous needle biopsy of the spine (Glen K. Geremiah), percutaneous vertebroplasty (John M. Mathis), diskography (Douglas S. Fenton and Leo F. Czervionke), and automated percutaneous lumbar diskectomy (Wendell A. Gibby), intradiskal electrothermal therapy (Timothy S. Eckel). Of particular note is the fact that the authors contributing to this book are well-published experts in the field of spine intervention. They all have brought to their chapters a straightforward, step-by-step guide to interventional spine procedures.

The book begins abruptly with a chapter on epidurography and epidural steroid injection. This reviewer would have preferred an introductory chapter in which the authors would have given some background on the evolving field of interventional spine procedures along with an evaluation of the literature surrounding each of the procedures that are subsequently described. The authors are encouraged to do this in a future edition because there is significant controversy concerning the benefits of some of the procedures, from both a diagnostic and therapeutic standpoint. Although it is recognized that pros and cons of the procedure was not a primary intent of this book, such an evaluation would have given the book some balance and perhaps have forewarned the reader to which procedures have not been widely adopted and which are commonly accepted procedures. Along these lines, the efficacy of some of the interventions, such as intradiskal electrothermal therapy (IDET) and automated percutaneous lumbar disectomy (APLD), are controversial. Although a list of suggested readings appears at the end of each chapter, it would have been appropriate for the editors themselves or the authors of each of the chapters in which the subject is controversial, such as IDET or APLD, to have presented to the reader a balanced view of the efficacy of the procedures.

The style of each chapter generally has the same format, with the material presented in an easy-to-follow outline form. Beginning with a section on rational/clinical indications for the particular invention under consideration, there followed sections on contraindications, informed consent, anatomic considerations, equipment and supplies, sedation, performance of the procedure, postprocedural care and reporting, CPT coding (as of 2002), and selected references. There are many excellent features of the book, including excellent line drawings that clearly demarcate the anatomy, the access route(s), and the equipment used. There are no radiographics shown, but this in no way detracts from this book because the drawings give the reader a far better understanding of the anatomy and procedure itself.

This reviewer emphasizes the fact that in every chapter, the author takes the reader stepwise through each part of the examination in a logical order. Of equal importance, in doing so, each chapter ends up with a section on CPT coding, a refreshing addition.

When there are so many available books in radiology, most of which deal with the same subject material in a like manner, it is good to see a book that not only is different but is a necessity. Drs. Williams and Murtagh’s book is vital to any radiologist who is involved in spine interventional; not only should this book be in the radiologist’s office, but a copy of it should be readily available in the tech area. It will be referred to often, and I suspect it will not only encourage more physicians to become involved in these procedures, but may also help them stay out of trouble.