James C. Eisenach, M.D., Editor

Anesthesia for Surgery of the Spine. Edited by Susan S. Porter. New York, McGraw Hill, Inc., 1995. Pages: 390. Price:$65.00.

It is with pleasure that I review this compact but reasonably comprehensive textbook. It is multi-authored, containing 12 chapters, 15–60 pages in length. Contributors are respected experts in the field of anesthesia and neurosurgery of the spine. The combination makes for an informative base for discussion of topics shared in common between anesthesiologist and surgeon. Each chapter begins with an outline, providing the reader an opportunity to scan the content for the desired topic.

The early chapters cover anatomy, functional organization, and physiology of the spinal cord. Herein are descriptions of bony and ligamentous vertebral anatomy, followed in sequence by a neuroanatomic review of the spinal cord, and, all important to the anesthesiologist, a review of spinal cord blood flow and responses of the vascular system to metabolic stimulation and anesthetic agents. In these preliminary chapters, the reader is introduced to wonderful drawings, which for the most part are in grey scale. They are simple and adequately labeled and can serve as templates for teaching slides. One of the highlights of the early chapters is a comprehensive review of acute and chronic cervical spinal cord injury that is well referenced and written by noted experts in the field of neurosurgical anesthesia.

The core of the book, some five chapters, proceeds through an anatomically based review of surgical procedures and anesthetic management of spine operations. These deal with cervical and thoracic, thoracolumbosacral, and surgery for radiculopathy and discectomy. Interspersed within this scheme are chapters dealing with intrinsic lesions of the spinal cord and considerations to special aspects for surgery and anesthesia of the arthritides. Although these two chapters interrupt the flow of the anatomic review, they are nonetheless valuable components of the book. Of special note in this section is a chapter covering the anesthesia and surgery for pediatric spine, an extremely well-referenced compendium of current practice on this topic.

The final chapters span electrophysiologic monitoring of spinal cord, intensive care management, and treatment and diagnosis of pain syndromes after spinal cord injury. These also are up-to-date and adequately annotated for later reference by the reader.

There are, however, some disappointing aspects of the book that deserve comment. Although each chapter obviously was designed to be comprehensive and to stand alone, the degree of overlap is excessive. Reading more than one chapter at a sitting, one discovers significant duplication especially regarding general diagnosis and in particular patient positioning. Because perioperative comanagement of patients and positioning are of such importance in spine surgery, a chapter devoted to this would be an outstanding reference. Also, my initial enthusiasm for the illustrations in the early chapters soon found similar disappointment. Mislabeling of a figure and failure to consider that a multicolored graph would not show differences in grey scale were rare and forgivable. However, less acceptable was the reproduction quality of radiographs, magnetic resonance imaging scans, and tissue specimens. These were suboptimal as a result of poor lighting or dark reproductions. On many, labeling with arrows, which would have been helpful, was unclear or absent. One cervical radiograph was positioned upside down. Anesthesiologists increasingly need expertise in reading radiographs, including magnetic resonance imaging scans, for appropriate evaluation of the patient with scoliosis, evidence of cord compression before intubation, and placement of intraoperative monitoring, for example. Reason enough for a second edition!

Despite minor drawbacks, this textbook still has considerable value for the price. The anesthesiologist who only occasionally does anesthesia for spine surgery will find the concise chapter, which can be read the evening before a case, very useful. Even the expert neuroanesthesiologist will find particular chapters on physiology, acute and chronic spinal cord injury, and pediatric spine surgery valuable collections for distribution to fellows and residents.

John A. Ulatowski, M.D., Ph.D.

Division of Neurosurgical Anesthesia and Neurocritical Care Medicine

Chris Breder, M.D.

Fellow in Neurosurgical Anesthesia; Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Meyer 8–140; 600 N. Wolfe Street; Baltimore, Maryland 21287