C- DISLOCATIONS OF THE VERTEBRAL COLUMN
135
surgeons before contemplating the subjecting of traumatic paraplegics and tetraplegics
with incomplete lesions to surgical procedures on the fractured or dislocated spine.
The most recent detailed analysis following postural reduction has been published
by my pupils and former co-workers at Stoke Mandeville (Frankel
et
a/., 1969) on a total
material of 612 patients admitted within the first 14 days of injury between 1950-68.
Two hundred and sixteen were cervical, 166 thoracic, 205 thoraco-lumbar and 23 lumbar
injuries. These figures include the patients of my own statistic of 1963 discussed in this
book. The method of treatment, before 1964-65, was that of postural reduction on sorbo-
rubber packs and since that time on the Stoke Mandeville-Egerton beds. The pattern of
improvement shown in this large number of patients is in good accordance with that
described in the statistic of 1963. However, the percentage of initially complete cervical
lesions becoming incomplete following conservative treatment is definitely higher—
i.e. 34-15 per cent out of 123 initially complete lesions as compared with 27-12 per cent
in my series of 59 complete lesions. Three initially incomplete lesions became complete
(2-43 per cent).
With regard to late instability only 4 out of 612 patients (0-65 per cent) developed
an instability of their fracture-dislocations after being allowed out of bed. Of these, two
had cervical injuries, in one the spine eventually became stable after 6 months in a
collar, the other having a fusion performed in another hospital. Two patients had thoraco-
lumbar fracture-dislocations. One became stable after an additional 8 weeks in bed, the
other finally uniting in increased deformity after 6 months in a plastic corset. The very
low incidence of late instability is no doubt due to the fact that the patients have an
adequate time in bed, varying between 9 to 13 weeks for the utmost. However, the time,
however long, is not wasted and does not delay the patient's rehabilitation, as physio
therapy, psychological adjustment, occupational therapy and teaching prepare the patient
both physically and psychologically for the later stages of rehabilitation.
Surgical procedures following fractures of the spine
Already, before the introduction of antisepsis and asepsis, operative procedures for
traumatic paraplegia had been advocated by surgeons. In the beginning of the last
century it was, in particular, Sir Astley Cooper (1824-27), in England who was the
main advocate for surgical treatment of these patients, which brought him in strong
controversy with his eminent colleague Sir Charles Bell (1824). The introduction of
asepsis and X-ray and the development of orthopaedic surgery and neurosurgery
have by no means diminished the discrepancy of opinion regarding time, indication and
value of the various methods of surgery. Verbiest (1963) has reviewed the surgical indica
tions for the different types of spinal fractures and their resultant neurological sympto
matology. From this review, it would appear that there is hardly any vertebral damage
under the sun which would not be regarded for immediate surgery, whether it be
laminectomy, open reduction and stabilization of the spine, by wire, metal plates, bone
graft or anterior, antero-lateral or posterior decompression followed by fusion, further
more whether or not the damage to the spinal cord be complete or incomplete and
associated with or without suparachnoidal block. Even psychological considerations
