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CHAPTER 12
From these statistics, it would appear that initially complete lesions of the thoracic
cord show the lowest percentage of improvement. This may be accounted for by the
smaller diameter of the spinal canal as compared with its diameter in the cervical and
lumbar regions. Therefore, the possibility of the spinal cord escaping the impact of
violence is greatly reduced. Conversely, if a cord lesion due to fractures of upper and
mid-thoracic vertebrae had initially been incomplete, a remarkably high percentage of
neurological improvement was found. This may be due to fixation of the spine through
splintage by the rib cage, which more readily prevents additional damage of the spinal
cord caused by movements of the patient during transport or by manipulations during
X-ray examination, operation, etc., than in injuries of the cervical and lumbar vetebral
columns with their infinitely greater mobility.
Of special interest is the high percentage of functional recovery, both motor and
sensory, in incomplete, but also, though to a lesser degree, in complete lesions of the
cervical cord. It must be stressed that in traumatic tetraplegics, who at first appeared
clinically complete, although anatomically incomplete, functional recovery may occur
as late as 3-5 weeks after injury, as we found in several of our cases. This fact should
always be kept in mind before contemplating rushing routinely into immediate or early
surgical procedures other than head tractions, in particular laminectomy and fusions.
In three cases only, progression of the initial level of the lesion occurred following
reduction. Two patients died from pulmonary embolus. In one of them with an initially
complete Ti2 lesion there was a progression of the symptoms to Ty. I had decided
to perform a laminectomy but he died from an embolus on the morning before the
operation. At post mortem a haemotomyelia was found.
In 1965 Meinecke of the well-known German Accident Hospital, Bergmannsheil,
Bochum, published a very detailed statistic of the conservative management of 134 out
of 500 cases of fracture dislocation with spinal ccrd lesions, who were admitted within 24
hours after injury. There were 104 complete and 30 incomplete lesions. With regard to
neurological recovery following conservative treatment, the author distinguished 5
groups: i, very good—i.e. recovery including bladder and bowel functions; 2, good—
i.e. recovery of motor function in at least two major joints of two paralysed limbs; 3,
moderate recovery of motor function in at least one major joint of two paralysed limbs;
4, little recovery—i.e. recovery of motor function in individual muscles only or recovery
of sensory function over at least four segments; 5, insignificant or no recovery. The results
of the total material of 134 cases showed 60-5 per cent satisfactory vertebral reduction
and 49-3 per cent functional recoveries, as compared with 35 per cent in my own cases.
In the 104 complete lesions, there was 61-5 per cent satisfactory vertebral reduction and
38-5 per cent functional recoveries, in my own 202 complete lesions, the rate of recovery
was 14 per cent. In the 30 incomplete lesions, 56-6 per cent showed satisfactory vertebral
reduction and 90 per cent functional recovery, as compared with 64 per cent improve
ment amongst 143 incomplete lesions of my own statistic. Although these two statistics
are not absolutely comparable because of the difference in the size of material and, pos
sibly, different type and severity of the vertebral injuries, they demonstrate a remarkable
accordance in the high percentage of functional recovery in incomplete lesions following
the conservative treatment. This fact should always be considered very carefully by
