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Spinal cord medicine, principles and practice
  1. R W H Walker

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    Edited by D Cardenas, N C Cutter, F Frost, et al. Demos Medical Publishing, New York, 2002, US$225.00, pp 1085. ISBN 1- 888799-61 7

    Basically, this is a book about the consequences of severe spinal cord lesions, mainly traumatic injury (spinal cord injury; SCI), and the management of them. It is not a book about spinal cord diseases. So, if you are wondering about the pathogenesis of spinal interneuronitis, or the classification of spinal muscular atrophies, do not look here. But if you spend a significant amount of time involved in the care of patients who are wheelchair dependent as a consequence of SCI or a severe chronic myelopathy such as advanced multiple sclerosis, then the book comes into its own. There are excellent comprehensive chapters about fundamentally important SCI related problems such as respiratory and cardiovascular dysfunction, as well as coverage of more esoteric matters like the immune system and inflammatory response in persons with SCI. Major strengths are found in the multidisciplinary inputs to acute and chronic management and rehabilitation, encompassing for instance functional restoration of the upper extremity in tetraplegia, heterotopic ossification, and medical and surgical management of pressure ulcers.

    With one editor-in-chief, eight associate editors, and more than 130 authors, repetition and redundancy might be predicted, and unfortunately there is lots of it. For example, no fewer than three chapters cover electroejaculation in varying detail. The author of the foreword writes that the book is a magnum opus. It might be another magnum opus to go through the whole book and sort out the cross referencing, but it needs it. And there is considerable variability. Normal and abnormal micturition is dealt with in just four pages with seven references. The very next chapter, on renal insufficiency in patients with SCI, has 36 pages and 282 references.

    This is an American book written for Americans. All of the contributors work in USA or Canada. Poliomyelitis “no longer exists in the US or Canada” so gets no further mention—by those writing the clinical chapter, but no one told the neurophysiologist, who gives polio a whole page (and deals with Kennedy’s syndrome too). There is a whole chapter of addresses of useful North American organisations—for example, the telephone company that will install sip and puff dialling. Readers from many countries, perhaps including the UK, will be gobsmacked at the resources available to and spent on SCI patients in the US. At least some countries less blessed than America do not have gunshots as the cause of 17% of new SCI (41% in “African Americans”).

    I welcome this book and trauma centres, SCI units, rehabilitation units, and neurology and neurosurgery libraries will be enriched by it, but the authors need to read each others contributions and adjust their own correspondingly.

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