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Spinal Cord Diseases-Diagnosis and Treatment

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    Spinal Cord Diseases-Diagnosis and Treatment. Edited by gordon l engler, jonathan cole, and w louis merton. (Pp 675, US$195). Published by Marcel Dekker, New York, 1998. ISBN0-8247-9489-3.

    This is volume 47 of a series entitledNeurological Disease and Therapy, series editor W C Koller. This volume is edited by an American surgeon and two British neurophysiologists. Most of the 45 contributors are American or British, almost half of whom, including Dr Cole, are from Southampton. The book begins with a pathophysiological introduction setting the scene for the five main disease sections covering developmental/genetic disease, spinal injury, infection, tumour, and the effect of neurological and systemic disease on the spinal cord. This chapter covers a wide area from multiple sclerosis to motor neuron disease to vascular disease to metabolic diseases. Then follows a section on investigation considering imaging, neurophysiology, and urodynamics. Finally, there is a miscellaneous section covering clinically important entities such as pain, sexual problems, and terminal care associated with spinal cord disease but also including a highly specialised chapter on the role of omental transfer in spinal cord injury.

    This is an ambitious attempt at being comprehensive. The editors themselves worry that the emphasis favours surgical conditions. Although this might be the case, many surgical cases present to the neurologist or rheumatologist, care for spinal disease often falling between several specialties. Therefore, it is of benefit to the clinician to have all aspects of spinal disease in one volume. The standard and style of the individual chapters varies, that on motor neuron disease being up to date and topical, malignancies being covered in depth. That on sexual problems associated with spinal cord disease is excellent, particularly practical and a must for both doctors dealing with spinal disease and for patients themselves who are often uninformed (our fault, not theirs). The chapter on decompression illness will be food for thought for many doctors who enjoy recreational diving, for although studies have not yet shown adverse affects on the quality of life in those who dive frequently but without incident, the evidence for cumulative neurological damage from neurophysiological, imaging, and pathological studies is compelling.

    The quality of illustration is high. Perhaps not surprisingly, this is particularly evident in the imaging section (where there is a rather spectacular sagittal T2 weighted MRI of a intramedullary arteriovenous malformation). In addition to imaging many of the chapters also make good use of schematic diagrams and line drawings to enhance the text.

    Drs Engler, Cole, and Merton end their preface by commenting that “Our main hope, however, is that the chapters will read as a series of views on the spinal cord and its disease, so that a surgeon may learn about current practice as well as the wide range of conditions affecting the cord that are outside the field of surgery”. While I agree that educating surgeons is an admirable aim, I think that the authors rather undersell themselves and that this book’s main strength, as I have said above, is that it will appeal to all disciplines that deal with spinal cord disease, bringing together neurological, rheumatological, and surgical disease that is often covered in separate textbooks.

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