REGENERATION OF THE SPINAL CORD
87
A control X-ray 9 months after metal clamp-fixation revealed a considerable deformity
of the spine with lateral dislocation of the lower part of the vertebral column. The com–
plete paraplegia in these cases remained unchanged. Street's conclusions on account of
his own and other surgeons' experiences are: 'Concerning the technique for suturing the
cord, we are quite in the dark, since to date the attempts have been unsuccessful'.
Most unfortunate are sensational reports which sometimes appear in the Press or
Television of unproven functional recovery as a result of such operations just mentioned,
which raise false hopes amongst traumatic paraplegics and tetraplegics. This happened
just a few years ago in the case of a Canadian surgeon who claimed functional recovery
in a traumatic tetraplegic and other patients with spinal cord injuries resulting in para–
plegia, following an alleged resection of the damaged vertebra and the traumatized
section of the spinal cord followed by resuture of the cord. An immediate investigation
by the medical authorities concerned revealed that this claim was entirely without
foundation. This case aroused considerable publicity through Press and Television in
various countries, and it took some time to convince paralysed people all over the world,
all hopeful of a miraculous cure, of the fallacy of this claim.
Whether regeneration of the conducting neural elements within the spinal cord
followed by functional recovery is possible in certain types of cord lesions where the
organization of the anatomical compartments at segmental level is not disrupted but
preserved, is still a matter of conjecture. For instance, in a case of complete transverse
lesion caused by a long standing neuro-fibroma or meningeoma, at operation the spinal
cord may be found to be considerably flattened at the site of the tumour: however, to a
greater or lesser degree functional recovery will occur in time, following careful extir–
pation of the tumour. Foerster (1936) described a case of extramedullary tumour in the
mid-thoracic region, who for several years was confined to bed with all symptoms of a
complete transverse cord syndrome. At operation, the cord was found to be compressed
by a hard extramedullary tumour into a flat thin strand. For a full year after operation,
the complete transverse syndrome remained unchanged, but then very gradual recovery
of both motor and sensory functions of the lower limbs occurred, which over a period of
more than four years became almost complete, apart from residual impairment of
posterior column sensibility. Foerster ascribed the functional recovery to a probable
axon regeneration of the cord for the following reasons: the very late beginning of the
recovery, its progression from proximal to caudal direction and the gradual development
of the functional recovery.
In these cases of benign extramedullary tumours, there is no clear relationship
between the degree of cord compression as revealed at operation and the time of recovery
of axonal conductivity and extent of recovery of the clinical symptomatology following
removal of the tumour or other compressing causes. In the writer's monograph on
'X-ray Diagnostic of Brain and Spinal Cord by Contrast Techniques' in Vol. VII (2) of
the
German Handbook ofNeurology
(Guttmann, 1936), a case of calcified meningeoma in a
woman, aged 62, was described. The patient had a very severe though not complete
transverse spinal syndrome below T4« At operation, I found the spinal cord to be most
severely compressed and after careful removal of the hard tumour the compressed part
of the cord did not expand, which was suggestive of long-lasting pressure. Yet, within 6
