Nearly a decade after publication of the first edition, Camden Whitaker and Stephen H. Hochschuler submit an updated second edition of The Pocket Spine. As the title suggests, the book is designed to be a compact, quick reference of spinal conditions to guide the reader in evaluation and management. Through 12 chapters written by an expert panel of neurosurgeon and orthopedic surgeons, a spectrum of spinal topics is reviewed. The book is broadly organized into chapters covering pre- operative and postoperative care, imaging, trauma, cervical degenerative disease, rheumatoid arthritis of the cervical spine, deformity (pediatric and adult), lumbar radiculopathy, compres- sion fractures, low back pain, spinal stenosis, sacroiliac joint disease, and tumors. The format for each chapter is consistent and intuitive: clinical presentation, relevant physical examination, diagnostic studies, management options and treatment algo- rithms, surgical techniques, and complications. When appropri- ate, a brief discussion of the supporting clinical literature is presented.
As Lawrence Lenke points out in the Foreword, there has been a “tremendous explosion” recently in spine care treatment options, yet the underlying conditions and indications remain relatively finite and constant. The Pocket Spine therefore may serve as a potentially valuable educational resource for students and trainees to gain understanding of basic spinal disorders. This particular demographic is likely the target audience; the book is manageable in length (,300 pages), with many chapters ,20 pages. The book is organized for easy reference, allowing quick review for teaching rounds or conference. Text is commonly presented via bullet points. Figures, tables, and charts provide facile reference for various classification and grading systems. More than 50 illustrations and photos demonstrate clinical examination and radiologic findings. Outlined treatment algorithms (eg, cervical radiculopathy, lumbar stenosis) and sample postoperative admission orders may be particularly useful for residents performing inpatient consultation. Throughout, “Red Flags” boxes provide critical, clinical pearls. The compact design of the book is such that it will easily fit in a white coat. According to the publisher’s Web site (CRC Press), an electronic format is also available, which may allow access on personal mobile devices.
Whitaker indicates in the Preface that The Pocket Spine originated as a natural extension of the personal notecards that he made while in training. Therein lie many of the limitations of the book; the abbreviated format may often lead readers to look for missing information. For example, notable omissions include osteomyelitis, ankylosing spondylitis, spina bifida, and spinal dysraphism, conditions not infrequently encountered by residents covering the wards. Elsewhere, broad generalizations are made that are not entirely accurate. The discussion of spinal schwannomas is followed by a single statement: “use nerve stimulator to identify nerve fascicles intraoperatively.” Inexplicably, the review of surgical treatment options for rheumatoid atlantoaxial instability inappropriately lists “anterior cervical discectomy and fusion,” “anterior cervical corpectomy,” and “laminoplasty” as potential options.
To this reviewer, there also appears to be an inconsistent distribution of topic coverage, which may reflect the particular expertise of the authors. For example, there is an extensive review of the Lenke classification for adolescent idiopathic scoliosis. There are nearly 8 pages devoted to discussing bone morphogenetic protein in spine surgery, 2 pages more than the entire chapter review of lumbar radiculopathy. The spinal trauma chapter contains a detailed overview of the Allen and Ferguson classification of cervical fractures, without any mention of Hangman fractures, occipital condyle fractures, or atlanto-occipital dislocation. The review of chymopapain as a potential treatment for lumbar radiculopathy may suggest an area of particular expertise of the authors because this modality is not widespread common practice.
Ultimately, most surgeons who routinely perform spine surgery will likely find The Pocket Spine to be too basic and frequently incomplete. The Pocket Spine is ideal for students and trainees for quick reference. Postgraduate orthopedic and neurosurgeons who do not generally practice spine may use this quick reference to supplement preparation for board certification or maintenance of certification. Finally, interested readers may find that the limited information provided here will help direct them to authoritative and comprehensive texts for more in-depth study.
The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Daniel J. Hoh, MD
Department of Neurological Surgery University of Florida Gainesville, Florida