The Spine Dictionary: A Comprehensive Guide to Spine Terminology

Christopher J. Ceneteno, MD. Philadelphia, Pa: Hanley and Belphus; 2001. 290 pages. $69.95

Whether anyone would ever actually buy this book if they had to rely just on the title is not at all certain. The Spine Dictionary does not really sound that engaging; it adequately but unimaginatively describes what is, ultimately, an interesting and useful volume. Medical textbooks do not have to sound appealing to sell, nor do they have to be useful in some medically necessary way. Dr Ceneteno appears to have set out to write the Funk and Wagnall reference for spine terminology in an attempt to collect, in one volume, all of the linguistic terms that might remotely relevant to the diagnosis and treatment of spinal disorders. He mostly succeeds, but he does manage to leave out some important terms. With foresight, Dr Ceneteno does mention in the introduction that he perhaps overlooked a few words, but he promises to include them in future editions.

Is this book in any way relevant to neuroradiologists? Sure. Just ask Pierre Millet or any of his task force of representatives from the ASNR, American Society of Spine Radiology (ASSR), American Society of Neuroimaging (ASN), Congress of Neurological Surgeons (CNS), American Society of Orthopedics (ASO) and other societies who have just released a monumental white paper in which they codified and standardized the nomenclature and terminology for lumbar disk abnormalities (ie, bulge versus herniation and all that stuff). These physicians will be happy to tell you how easy that years-long process was.

As it turns out, Dr Ceneteno’s definitions for disk abnormalities are fairly good, but they are not totally consistent with the published standardized terminology of the aforementioned multidisciplinary nomenclature group. The terms “slipped disc” and “prolapsed disc” are included, along with the more traditional “bulges,” “protrusions,” and “extrusions.” The first two are mentioned in the dictionary, but they not recognized in the standardized nomenclature. The last three are identified, fairly accurately, as types of “herniations” in the dictionary; however, they are not clearly delineated from “herniated nucleus pulposis,” as in the standard nomenclature. In all fairness, it should be pointed out that the dictionary likely went to press well before the results of the nomenclature task force were released. The author will probably correct these terms in the next edition, as promised.

The fact that the author omits the terms ASNR and ASSR but includes several orthopedic society acronyms (eg, ASO) is not as easily forgiven, though. As if that were not enough for a radiologist to boycott the book, when one looks up ACR in this dictionary, one finds “American Society of Rheumatology,” not American College of Radiology. It was also mildly disconcerting to find not one reference in this supposed comprehensive dictionary to Dr Michael Modic. Whereas the ever-humble Dr Modic might forgive this omission, surely the popular tendency to refer to degenerative changes in the vertebral body endplates as Modic types I–III deserves some mention.

This dictionary does contain some terms and topics that we, as neuroradiologists, probably have never seen before and that might prove helpful when we communicate with clinicians. Terms used in orthopedic spinal surgery, such as “pseudoarthrosis,” are clarified, and a short discussion is offered by way of definition. Drugs useful in the treatment of back pain are well covered, and their discussions are easily accessible. Physical examination signs (eg, those with straight-leg raising or the flexion, abduction, and external rotation [FABER] test) are included. Physical therapy and rehabilitation terms are included, even many dealing with Workmen’s Compensation analysis. Chiropractic terms, almost guaranteed to have never entered our lexicon, are included as well. Who knew what the Gonstead technique was?

Some complex concepts are fairly well explained in brief sections that are, for the most part, clear and concise. Some topics are not well addressed, but at least they are mentioned. For instance, facet joint anatomy and pathology are covered in one paragraph, as is the epidural space and the technique of epidural injection. Apparently, all that there is to know about MR imaging is explained in one, albeit fairly long, paragraph. Similarly, CT scanning is discussed in a paragraph. If these are comprehensive, what have we been doing with ourselves all these years, anyway?

Overall, this book represents a valiant attempt to include all that there is to know about the spine within one volume. It is more interesting than it originally appeared to be. The text is actually helpful, but some glaring omissions are noted. This book is probably worth having in the reading room where spine images are interpreted because it may help in improving communication with the referring physicians or, possibly, it could just help satisfy our curiosities, especially when we our own back pain acts up.