Neurotrauma and Critical Care of the Spine. By JackJallo, MD, PhD, and Alexander R.Vaccaro, MD, PhD, MBA. New York: Thieme Medical Publishers, 2018; 225 pp; $179.99 (hardcover)

Neurotrauma and Critical Care of the Spine is a second edition state-of-the-art text that offers the reader a comprehensive look at the complete management of spinal injuries from prehospital setting through rehabilitation. This text constitutes a wealth of information regarding the epidemiology, pathophysiology, basic science, biomechanics, physical examination, prehospital and ED management, surgical management, critical care issues, and rehabilitation of spinal injury. The authors are neurosurgical or orthopedic spine specialists, which for an emergency physician reader at times presents an issue of perspective and relevance to our specialty. The chapters flow from epidemiology to basic science to management and critical care culminating with rehabilitation issues in spinal cord injury (SCI). Some chapters, such as chapter 8 on thoracolumbar injuries, repeat concepts like prehospital management and steroid treatment and demonstrate a need for better cohesion between chapter authors. The entire book, however, is truly comprehensive with a text that generally flows. Figures, tables, illustrations, and images are plentiful, at least in the early chapters, and add significantly to the text. It would be helpful to add even a single figure/table to the pharmacology, infection, and rehabilitation chapters. It was surprising to see a number of plain radiographs instead of CT images in multiple chapters, given the trend and recommendations requiring CT to avoid missed spinal injuries. Additionally, some chapters, especially chapters 4, 11, and 14, had extremely poor-quality figures that were blurred and below average quality. Neurotrauma and Critical Care of the Spine incorporates some truly state-of-the-art concepts from leading research scientists in the field. Chapter 3 on spinal cord protective and regenerative therapies reflects the newest arguments and concepts debated in 2018 at the International Neurotrauma Society meeting. Chapter 9 does an admirable job describing the C-spine clinical clearance criteria for both NEXUS and Canadian C-spine rules. The chapter otherwise recommends CT, which neglects the fact that plain films were the “criterion standard” for both the NEXUS study and the Canadian C-spine rules. Chapter 10 on early surgery is the most comprehensive thoughtful chapter ever written on this subject. The chapter on emerging therapies for SCI is likewise up to date and well written. Unfortunately, some chapter concepts are poorly referenced and seem significantly out of date. Chapter 8 suggests using prehospital dopamine to increase peripheral tone and MAST pants to increase peripheral blood return in neurogenic shock. There is no discussion that dopamine is absolutely contraindicated in hypotensive trauma patients until hemorrhage can be ruled out and that it has the highest incidence of life-threatening side effects of all pressors. MAST pants are no longer used in the U.S. prehospital setting, and the reference for these recommendations comes from a 1987 article. Since this textbook is intended to be essential reading for “emergency specialists” the addition of an emergency physician and prehospital provider chapter author would lend an important perspective to prehospital and ED management. At times, the text contained colloquial or outdated terminology and language that contemporary professionals in emergency care may find insulting. Additionally, chapter 15 on mean arterial pressure (MAP) control does not reference multiple newer studies on MAP treatment and improvement in blunt injury outcomes but focuses on a recent reference demonstrating lack of value in penetrating injury. There is also no comment on recent pressor choice papers or discussion of complications in elderly patients. The addition of a neurotrauma-trained, critical care physician author would be valuable. Overall Neurotrauma and Critical Care of the Spine is a solid attempt to describe and update the whole spectrum of spinal injury. The textbook would have benefitted from improved printing and specialist input outside of the surgical specialties for some key chapters. Hopefully, the next edition will address these issues and become the textbook of choice for this multidisciplinary disease.

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