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American Pain Society
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John D. Loeser, MD, Department Editor
Reviewed by Ray Baker, MD
Donald L. Renfrew, Philadelphia, Saunders, 2004. Hard cover, 176 pages. ISBN 0-7216-0420-X. $99.00.
This atlas covers diagnostic and therapeutic injections of the spine from epidural steroid injections through vertebroplasty and myelography. The Atlas of Spine Injection is the companion piece to the Atlas of Spine Imaging. Dr. Renfrew presents a well-organized and balanced treatment of common spine injection procedures from an experienced radiologist’s perspective. One will find many standard approaches to common spine injection procedures in the book, along with some variations developed over years of practice. This book is of primary interest to beginning practitioners, although seasoned veterans will find it thought provoking. It well written and illustrated, and I would recommend it as a worthy addition to a beginning practitioner’s library.
The book is divided into 10 chapters. Chapter one is a review of spine pain, and includes a brief history along with anecdotes and advice from the author. Chapters two through ten examine various diagnostic and/or therapeutic spine injections, including epidural steroid injection, nerve blocks, sacroiliac injection, facet joint procedures, discography, percutaneous needle biopsy, vertebroplasty and kyphoplasty, IDET, and myelography. Each of the procedure-related chapters is divided into sections: Definition, Literature review, Rationale for procedure, Equipment and supplies, Informed consent issues, Patient selection, and Procedure description.
Along with the text, excellent quality radiographs depict the anatomy, needle positioning, and both normal and abnormal contrast patterns. I found the sample radiographs throughout the book to represent well the various procedures and anatomic variations a practitioner commonly encounters. In many ways these represent the most valuable part of the Atlas. A beginning practitioner can learn a great deal from studying these normal and abnormal contrast patterns, along with Dr. Renfrew’s description and commentary.
I found the literature review chapters to vary in quality from an in-depth coverage of specific papers on epidural steroid injections to a rather cursory review of sacroiliac joint injections and IDET. The author’s discussion on the varied literature involving provocation discography was of particular interest. Overall, the coverage is good, and includes all of the major literature on the various topics. The patient selection chapters similarly vary, and represent a bias towards the author’s experience and beliefs in most cases. With this in mind, the opinions are valuable to new practitioners as a representation of years of clinical experience and thousands of patients.
The informed consent sections include an overall look at what constitutes informed consent, along with specific risks and complications associated with each procedure. Emphasis on specific risks are useful as a reminder to beginning as well as experienced practitioners, and the reminder that informed consent includes a discussion of alternatives to the procedure is well advised. The procedure description sections each include a ‘step-by-step’ guide for performing the procedure along with a sample report. Although one may quibble regarding specifics of the descriptions or procedure parameters, the overall descriptions are valuable. Specific quantities and types of injectate vary among practitioners and over time, but the general approaches to each injection are often similar. This is a useful book for the proceduralist.
Dr. Baker is Clinical Associate Professor of Anesthesiology at the University of Washington in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu
