Decision Making in Spinal Care.

Decision Making in Spinal Care

Anderson DG, Vaccaro AR, eds. New York, NY 10001, Thieme, 2007, paperback, 528 pp, illus, ISBN: 978-1-58890-415-7, $69.95.

The purpose of this book is stated well on the back cover: "Concise coverage of the entire spectrum of common spine conditions." The editors brought together 89 distinguished medical practitioners to write 70 chapters in a clear and concise manner and in identically structured chapters. All chapters are 4 to 6 pages in length, prefaced with decision-making algorithms and finished with annotated lists of suggested readings. Need to know an orthopedist's decision making on the management of ankylosing spondylitis? Review the chapter with the same title. Management of primary spinal tumors? Just find the chapter.

Each chapter follows the consistent outline of: classification; workup, including history, physical examination, spinal imaging, and special diagnostic tests; treatment; outcome; and complications. The specific chapter topics are arranged under general content sections for quick referencing. For example, the first section, "Cervical Trauma," begins with the following chapters: "Occipitoatlantal Injuries," "C1 Ring Fractures," "Atlantoaxial Instability," "Odontoid Fractures," and "Traumatic Spondylolisthesis of the Axis." Line drawings help clarify each of these injuries as well as the classifications used based on radiographic measurements. When appropriate, other chapters show radiographs, computed tomography scans, or magnetic resonance imaging films to define the diagnosis. Tables also are used to quickly frame classification systems, risk factors, or treatment options related to chronicity of symptoms. In short, each chapter topic has been distilled to the most relevant information and delivered in the most effective mode.

At first glance, the decision-making algorithms appear deceptively straightforward. Admittedly, some are simple. In chapter 62, "Computer-Assisted Spinal Surgery," the choices are electro-optical system versus electromagnetic system. Most of the algorithms, however, clearly depict complicated and thought-provoking processes of decision making that pack a lot on one page. From the management of "Thoracic and Lumbar Vertebral Compression Fractures" to "Pyogenic Infections of the Spine," and from "Cervical Kyphosis" to "Thoracic Disk Herniation," the algorithms enhance the chapter contents. Perhaps the only way to keep chapters short was to use the simplifying graphic of the algorithms. The combination of algorithm, consistently organized text, figures, and tables makes locating information easy and quick.

The book seems too large to carry conveniently in a lab coat pocket, but that may not deter an orthopedic, neurosurgery, physiatry, or internal medicine fellow or resident from trying to do so until a PDA format of this text becomes available.

The editors intended this book to be a quick reference for physicians. The 2 chapters written by a physical therapist on cervical and lumbar spine rehabilitation are decent representations of physical therapy to physicians. A physical therapist's participation on a spinal care medical team will only be enhanced with an understanding of how physicians make treatment decisions for this patient population.

The format of the entire book, and not just the physical therapy chapters, is exceedingly useful for practicing physical therapists as well as students. The chapter contents for the patient history and physical examination in this book overlap, for many spinal conditions, with the patient interview and examination (including systems review) from the patient/client care management model described in APTA's Guide to Physical Therapist Practice. Use of this reference will reinforce and enhance a physical therapist's ability to accurately screen a patient with spinal discomfort as well as identify when a medical referral is needed.

Debra Coglianese

D Coglianese, PT, DPT, OCS, ATC, is a Clinical Specialist with Mercy Rehab Associates in Havertown, PA.

[DOI: 10.2522/ptj.2008.88.6.797]