Disorders of the Spinal Cord in Children

Michael Pike, ed. Disorders of the Spinal Cord in Children. (Clinics in Developmental Medicine) London, UK: Mac Keith Press; 2013 (250 pages). ISBN 978–1-908316–80–6. USD 170.00

In the view of Prof. Peter Rosenbaum who presented the Foreword, the spinal cord plays the role of (a neglected) “country cousin” to the sophisticated brain, which receives most attention. Therefore, a volume devoted to pediatric spinal cord disorders is most welcome. Dr. Michael Pike presents a book written by 21 experienced and committed authors. The text is organized in nine chapters.

The first chapter “Neurological Examination” provides details about history taking and neurological examination, reminding the readers that cord involvement should be considered in the unconscious child and in intensive care setting as well as that clinical presentation is age dependent. The second chapter “Imaging the Cord” is an outstanding one, as with its informative illustrations, it discusses the application of diverse imaging techniques in various situations, such as in scoliosis, suspected acquired myelopathy, and craniocervical junction pathology. It becomes evident that the investigations have to be tailored to the individual situations.

Chapter 3, “Clinical Neurophysiology,” accounts the use of somatosensory evoked potentials, electromyography, and motor-evoked potentials as adjuncts in diagnosis, disease monitoring, and surgical interventions. The fourth chapter “Spinal Cord Malformations” is another excellent addition to the book, written by two experienced pediatric neurosurgeons, Drs. M. Zerah and A.V. Kulkarni. The two main areas—open dysraphism and occult dysraphism—are comprehensively covered, described, and illustrated with great detail. (Semantic note: As 90% of “occult” dysraphism have a visible cutaneous anomaly, “closed” seems a better term).

Chapter 5, “Spinal Cord Abscess, Hemorrhage, and Trauma,” reviews these rather rare topics. The sixth chapter “Tumors of the Spine” provides an overview of the various intradural (intramedullary and extramedullary) and extradural tumors, illustrated by (too) few figures. The seventh chapter “Inflammatory, Metabolic, Vascular, and Demyelinating Disorders” primarily focuses on transverse myelitis, neuromyelitis optica, and multiple sclerosis. Spinal cord ischemia (infarction) is discussed as well. In the view of its prevalence, it is understandable that not much space is devoted to neurodegenerative disorders (only 1 page for hereditary spastic paraplegias). Metabolic disorders and skeletal dysplasias often resulting in spinal cord compression are not discussed.

The eighth chapter “Specific Issues in Management and Rehabilitation” focuses on acquired spinal cord injuries and myelomeningoceles. It provides a well-illustrated overview of many relevant issues, such as mobility in general, standing and ambulation, ortheses and wheelchairs, skin care, home adaptations, and orthopedic complications. Chapter 9, “Prospects for Spinal Cord Repair,” reviews advances in understanding of spinal cord injuries (mainly in animal models), identification of mechanism responsible for the regenerative failure of central nervous system axons, and lists potential targets for intervention. The index is detailed and the references are generally updated.

Overall, this volume provides useful information on the broad spectrum of spinal cord disorders. It is recommended as a reference tool to colleagues in training as well as trained child neurologists.