Spinal Cord Medicine: Principles and Practice

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An injured spinal cord adversely affects more organ systems than virtually any other disease entity and requires the ongoing attention of physicians in multiple specialties. This comprehensive book details the wide range of care needed for the management of this chronic condition. In the preface, the editor refers to Spinal Cord Medicine as a practical guide. It is indeed a practical guide, but it also provides the intellectual and scientific basis for management strategies. The book has sections that deal with acute care, medical management, neurologic aspects of spinal cord care, rehabilitation, advances in research, and the organization of the care of patients with spinal cord injuries. All 74 chapters are extensively referenced and cover every facet of spinal cord injury. As a neurosurgeon who frequently cares for patients with spinal cord injuries long after the initial trauma, I gave particular attention to the sections on the treatment of problems that have proved vexing and difficult to manage: post-injury pain syndromes, respiratory dysfunction, spasticity, and pressure ulcers. These subjects are covered in depth, and the chapters in which they are discussed provide real insights into the pathophysiology and management of these sequelae of spinal injury. Although one tends to associate acute myelopathy with trauma, the chapter on nontraumatic myelopathies is an important addition, with insights into the differential diagnosis of acute spinal cord dysfunction. The series of chapters on mechanisms of injury, pharmacologic strategies, and neural regeneration will provide the reader with information and references that are as up to date as one can expect from a multiauthored book such as this one. Unfortunately, in spite of an increased understanding of the mechanisms of spinal cord injury and regeneration, the ability to translate insights gained in the laboratory into improvement of function in clinical situations has been limited. Alas, several chapters do not measure up to the overall high quality of this book or else contain material that is inappropriate to the book. The two-page chapter on thermoregulation is superficial, with references that are out of date for the most part. The chapter on imaging of the spinal cord is too technical; many of the figures in it are substandard; and the author discusses a wide variety of spinal lesions that have little relevance to the subject of this book. The chapter on the role of pharmacokinetics in optimizing drug therapy seems out of place and more appropriate for a pharmacology textbook. For the most part, however, Spinal Cord Medicine is readable and well organized. The figures and tables are well reproduced, and the subject matter of the chapters is focused, with a balance between practical and theoretical material. This book is essential reading for specialists in rehabilitation medicine, and it is likely to become the standard textbook for specialists in spinal cord injury medicine. It will also be an important resource for primary care and emergency room physicians, internists, neurologists, neurosurgeons, urologists, orthopedic surgeons, physical therapists, and others who care for patients with spinal cord injuries. Paul R. Cooper, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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