Thoracolumbar Spine Fractures.

Floman Y, Farcy JPC, Argenson C, eds. New York, NY 10036, Raven Press, 1993, hardback, 507 pp, illus, $130.

This work presents the methods of diagnosis, treatment, and rehabilitation of thoracolumbar injuries. The text is a collaborative effort among orthopedic surgeons, neurosurgeons, biomechanists, anatomists, and experts in the fields of neurophysiology, radiology, and physical medicine and rehabilitation. It is aimed at an audience of medical students, orthopedic surgeons, spine surgeons, neurosurgeons, and physiatrists.

The text is organized into sections that cover basic sciences, imaging and diagnostic modalities, classification and management of spinal injuries, surgical technique and spinal instrumentation, specific problems related to age and etiology, and the management of complications and rehabilitation.

Although all chapters are equally relevant for physical therapists, several warrant special consideration. The opening section on anatomy and spinal development offers a detailed foundation for subsequent material. Authors link information on the biomechanics of the thoracolumbar spine and structural characteristics to injury mechanism, providing a better understanding of treatment intervention. Building on this framework, the authors present their choices and rationale for surgical technique and cover design changes in implantation hardware. The authors address how hardware designs affect stability and weigh the advantages and drawbacks of various designs. Surgical goals are clearly defined, with treatment methods based on the degree of orthopedic and neurological damage. Case studies are frequently presented to offer examples of specific surgeries and follow-up studies compare treatment outcomes.

The section on the classification of spinal injuries presents a biomechanically and anatomically based framework in which to group injuries according to the degree of stability. Considerable time is spent addressing past and current classification systems. The authors compare these schemes and present a new classification system for thoracolumbar fractures. A classification system for sacral fractures is also presented, with thorough coverage of the various types of sacral fractures. Also noteworthy is the presentation of mechanisms of injury, and in particular, the propensity for injury based upon anatomy and biomechanics.

The section on spinal injuries in children offers material that physical therapists involved in pediatric rehabilitation would find applicable to their daily practice. The special needs and considerations of the pediatric population are discussed, including general concepts of treatment, with emphasis on the interrelationship between developmental and mechanical forces.

The chapter on osteoporosis offers an understandable presentation of the incidence, clinical course, and treatment of the disease, including a brief mention of the role of exercise. The single chapter on the rehabilitation of thoracolumbar injuries presents a broad overview of the team approach to rehabilitation, and except for a short subsection on functional electrical stimulation, offers little new information. The chapter on systemic complications of spinal cord injury, however, details the damage done to various organ systems and provides elucidating information on post-traumatic sequelae.

A chapter on ankylosing spondylitis describes the unique mechanical characteristics of this disease and addresses the specifics of its surgical management. Because of their heavy medical emphasis, chapters on imaging and ultrasonography are not particularly relevant for physical therapists. The electrophysiology section, however, although still highly technical, provides a better understanding of electrodiagnostic studies and their interpretation.

A hallmark of this work is the authors' ability to clearly define the unique problems of specific diagnoses and to address in detail strategies for intervention. Accordingly, relevant research is frequently cited throughout the text. Although the text is well organized and follows a logical progression, the coverage of electromyographic findings located in the chapter on rehabilitation would have been more aptly placed in the diagnostic and imaging section. Highly technical material is well written. Chapters contain an abundance of footnotes and a list of timely and appropriate references. The text is richly illustrated with computed tomography scans, magnetic resonance imaging, studies, clearly labled diagrams, photographs, and tables that complement the text and highlight salient points. Paragraphs that introduce each chapter outline the material to follow, but only some chapters have a summary section. Didactic in tone, the multiple authors generally write in a consistent manner.

This work summarizes the latest knowledge in the management of traumatic and nontraumatic thoracolumbar spine injuries, covering the broad spectrum from immediate care to postoperative sequelae and late deformity. The text successfully disseminates timely, detailed information in sufficient depth for its target audience. Although not specifically meant for the physical therapist, this work would expand the physical therapist's theoretical knowledge base and would make a welcome addition to the libraries of physical therapists in spinal cord rehabilitation.