JOURNAL OF MAGNETIC RESONANCE IMAGING 20:1054 (2004)
Book Review
Image-Guided Spine Intervention,
Douglas S. Fenton and Leo F Czervionke
Jacksonville, Florida: Saunders; 2003. $149; 448 pages; 604 illustrations (134 in full color).
The authors’ stated purpose for the text is “to produce a
volume to become the standard textbook of image-
guided spine interventions, to develop a text that ap-
peals to different group of physicians and to describe
the techniques necessary to perform accurate, safe and
clinically relevant diagnostic and therapeutic proce-
dures for spine-related pain.” The text represents an
excellent collection of information on many aspects of
these fairly new techniques, and all chapters are ade-
quately illustrated with color photographs and dia-
grams. What is new in this volume is that the authors
include the Current Procedural Terminology (CPT)
codes for the procedures discussed, along with samples
of dictations with preoperative and intraoperative nar-
ratives, and each chapter contains the comments of a
spine surgeon on how the procedure under discussion
relates to his or her practice. The 448-page text is di-
vided into 11 chapters, starting from basic principles of
needle manipulations to the final chapter, which in-
cludes a wealth of information on essential pharmacol-
ogy for spine injectionists. Chapters 2 through 10 in-
clude an in-depth discussion of different spine
procedures. All of these chapters have a unified ap-
proach, well-illustrated text, comprehensive discussion
of patient selection, caveats on pertinent anatomy,
highlighted contraindications, potential complications,
and detailed information on preoperative and postoper-
ative care.
This volume starts with a short chapter discussing
basic needle manipulation techniques. At first glance,
the topic of this chapter may seem simplistic and trivial.
However, this well-illustrated chapter forms a corner-
stone for all of the percutaneous needle procedures
discussed in this book.
The second chapter, facet joint injection and medial
branch block, is primarily based on percutaneous in-
jection into the facet joint at different spinal levels and
has many colorful illustrations, although the quality of
the MR images are suboptimal.
The third chapter, facet denervation, has the same
systematic approach to the performance of this proce-
dure as in the other chapters. The only minor criticism
to this chapter is a relative lack of elaboration of com-
plications to a reasonable depth.
Chapters 4, 5, and 6 (selective nerve root block, epi-
dural injections, and sacroiliac joint injection) are all
well-written, with adequate explanations of each ma-
neuver. Specifically, the epidural injection chapter is
comprehensive and well detailed.
Chapter 7, percutaneous spine biopsy, contains good
illustrations and explanations of devices, and different
approaches to spine biopsy are nicely discussed. How-
ever, once again the resolution and quality of the MR
images are not impressive.
© 2004 Wiley-Liss, Inc.
In the next chapter, vertebroplasty, the main discus-
sion is on the delivery methods for polymethyl methac-
rylate (PMMA; cement) to the involved vertebral body.
The transpedicular approach for thoracic and lumbar
vertebra and the anterolateral approach for the cervical
spine are thoroughly elaborated. The quality of images
is very good to excellent and the complication section is
more detailed in this chapter.
Discography, the injection of contrast material into
the nucleus pulposus of the intervertebral disc by
means of a percutaneously-placed needle, is compre-
hensively described in chapter 9. Although discography
is considered by some to be more sensitive for detecting
annular fissures than MRI, the authors do not recom-
mend this procedure for acute back pain evaluation,
and controversy about the clinical role of discography is
not discussed in this chapter. If a patient is considered
for this procedure, this well-written chapter can guide
you step-by-step and answer almost all possible ques-
tions you may have about discography.
Chapter 10 discusses IntraDiscal Electrothermal
Therapy (IDET™). The level of detail in this section is
excellent and should provide an outstanding guide
through this procedure for most interventionists. Image
quality in this chapter is somewhat variable, but on
average is good.
The final chapter provides essential information
about three different groups of medical agents used by
spine injectionist (radiocontrast agents, local anesthet-
ics, and corticosteroids). Finally, the index is extensive
and well cross-referenced, providing easy access to the
abundant information in the text.
In summary, Image-Guided Spine Intervention is an
extremely well-written textbook and comprehensively
elaborates these exciting interventions. Although image
quality could be improved in certain chapters, the over-
all caliber is more than adequate for demonstration of
the procedures. In particular, the chapter on epidural
injection is outstanding in its depth of detail and meth-
ods of demonstration. One possible limitation of this
book, and the authors’ quest to make this the standard
textbook of spine procedures, is the omission of com-
plication management. Outside of this area, this book
can be recommended as a useful guideline for interven-
tional radiologists and also for any other physicians
involved in percutaneous spine interventions.
Shervin Rafie, MD
University Hospitals of Cleveland
Case Western Reserve University
Cleveland, Ohio
DOI 10.1002/jmri.20219
Published online in Wiley InterScience (www.interscience.wiley.com).
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