Imaging of Vertebral Trauma3rd Edition. By Richard H. Daffner. Cambridge, UK: Cambridge University Press, 2011; 219 pp; $130 (hardcover).


The purpose of Imaging of Vertebral Trauma is to educate physicians on the imaging modalities currently available for the evaluation of the vertebral column in trauma patients. The intended audience for this text is physicians who will use and read imaging studies for the evaluation of potential traumatic vertebral injuries. This text can essentially be broken down into four sections. These are review of anatomy/forces of injury, imaging, mechanisms of injury/approach to reading imaging, and special considerations in imaging. Throughout the entire text there are detailed illustrations and images with excellent descriptions to help the reader conceptualize and apply the topic being presented.

The first section of the text begins with a description of the pertinent anatomy and forces of injury. The text starts with an overview of vertebral injuries at a level that health care providers of different specialties can comprehend. The text next gives the reader a detailed overview of the anatomy of the vertebral column. This is accomplished by describing the development, anatomic variation, and ligamentous structure of the spinal column. Once the text has reviewed the anatomy, it moves on to the biomechanical principles of vertebral motion. This concept is essential to understanding how forces affect the vertebral column and how to anticipate patterns of injury.

The next section of the text is devoted to discussion of imaging. Chapter 4 starts the initial discussion on imaging by presenting indications and controversies of vertebral imaging in trauma. This chapter presents the NEXUS criteria and the Canadian C-spine rules for determining patients at high and low risk for cervical spine injury. It provides a well-written overview of the concerns and scope of imaging of the spine. The next two chapters discuss the different modalities of imaging. These two chapters are well presented and provide the reader with a good overview of the indications, techniques, and limitations of the various modalities of imaging.

The third section of the text outlines the mechanisms of injury to the spine, as well as injury patterns associated with these mechanisms. It also details a logical approach to reviewing imaging. Chapter 7 introduces forces including flexion, extension, rotation, and shearing. There are detailed descriptions of each of these forces and the injury patterns that they produce. Chapter 8 describes the method of using the ABCS for evaluation of the spine. This is a stepwise evaluation of imaging considering anatomical, bony, cartilage, and soft tissue abnormalities.

The final section of the text examines special considerations for spinal imaging. Imaging of the spine in pediatric patients provides unique problems that are detailed in Chapter 9. The unique considerations are presented there, along with some imaging study protocols to consider for pediatric patients. This information is presented nicely, with good attention to anatomical differences of children and how they result in different injury patterns than seen in adults. The next chapter (Chapter 10) discusses vertebral instability. The text presents the radiographic findings consistent with instability in spinal fractures. It also discusses the six radiographic findings that would be consistent with instability. The final chapter (Chapter 11) presents normal variants and pseudofractures. There is a discussion of normal anatomic variants and their radiographic appearances. The text also describes the idea of psuedofractures that appear as the result of optical illusions originating from multiple different factors.

Considerations of the book in general: According to the preface of the first edition, the book was originally intended as a guide for radiologists to aid in the interpretation of imaging in patients with suspected vertebral trauma. The third edition has been expanded to include indications, current controversies, and clinical decision tools. This expansion has widened the utility of the text beyond the reading room of radiologists to the clinical setting where studies are ordered and medical decisions are made. Unfortunately, the detail that is required to make the text a valuable resource for the practicing radiologist also makes it a challenging read for the average emergency medicine provider.

Adding to the difficulty of the read is the placement of the images and illustrations within the text. Although the images are of high quality and high relevance to the text, they are rarely found on the same page as the text to which they pertain. This forces the reader to constantly page back and forth to gain the understanding and learning that the images provide for the text. The actual content of the book is excellent, yet there are some minor typographical errors within the text. The most obvious of these errors is a nine-page stretch in chapter 3 where the word “biochemical” was mistakenly substituted for the intended word “biomechanical” on the heading of each page. Although a critical evaluation of the text may find trivial errors, no clear misinformation in the book was discovered.

Overall, Imaging of Vertebral Trauma is well thought out and well written. It provides the necessary information for physicians to feel confident while ordering and interpreting imaging for patients with potential vertebral injuries. The third edition contains updates that are needed to keep pace with current imaging modalities, technology, and literature. It adds those updates to a solid framework that was built in the previous two editions. The book is applicable to all health care providers who assess vertebral trauma; however, it may be less useful when used at the time of patient care in clinical practice due to the complexity of the explanations. The strength of the text is its ability to help the reader build a fund of knowledge and to develop a logical approach when ordering and interpreting imaging concerning patients with suspected vertebral trauma.