Publications
APS Bulletin • Volume 13, Number 5, 2003
Resource Reviews
John D. Loeser, MD, Department Editor
Image-Guided Spine Intervention
Reviewed by John D. Loeser, MD
Douglas S. Fenton and Leo F. Czervionke, Philadelphia, Saunders, 2003, 298 pages $149 (hard cover), ISBN 0-7216-0021-2
This is a superb book. It is clear, concise, authoritative, and generously illustrated with both anatomic sections and radiographic images. The illustration quality is superior.
The first chapter is about basic needle manipulation techniques and the last chapter is on the pharmacology of medications used by spine injectionists. Each of the intervening nine chapters addresses a specific technique, such as discography, sacroiliac joint injection, selective nerve root block, etc. The authors emphasize how to do the procedure, how to dictate the report, and the CPT codes to use. Case reports also are included in each chapter.
Dr. Joseph T. Alexander, a neurosurgical spine specialist, comments on the utility of each technique, lending a touch of clinical reality to the enthusiastic portrayal of each procedure. I do not believe I have seen a better “how I do it” text for these procedures, each of which is heavily dependent upon radiological imaging for successful implementation. A digital presentation of this book featuring video clips would be a magnificent embellishment.
The problem, of course, is the long-term outcome for each of these procedures. There is very little data to support their use as diagnostic steps or treatments with long duration of efficacy for those with chronic pain presumed to be of spinal origin. Dr. Alexander offers appropriate cautions, but his brief paragraphs are swamped by the words and figures for each procedure. Is IDET really useful? Should patients have this procedure before properly conducted trials are reported? Just how useful are epidural steroids? Why have there been so few good outcomes studies?
If you are going to do these procedures or teach others how to do them, you should know this is the best text I have seen. I strongly recommend the book, even though I do not recommend many of the procedures it describes.
Review content represents the opinion of the reviewer, not APS.
Dr. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu.