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were given as indication for decompression by laminectomy (Comarr, 1959). In my and
other workers' experience in this field the refusal to carry out any operation on the spine
merely on psychological reasons or the resistance to pressure from the patients or
their relatives 'to do something' has had not the slightest delay in the patient's rehabili
tation, provided the physician or surgeon has properly explained the reason for the
futility of such procedure. Moreover, the advocates of this indication are remarkably
silent about the psychological effects of an unsuccessful operation, which has resulted in
transforming a spinal injury without any or only partial damage of the spinal cord into a
complete transverse lesion.
As the main controversy still applies to the indications for the various surgical pro
cedures in the immediate (within 24 hours) and very early stages following spinal cord
injuries, they will be discussed individually.
The methods practised in the immediate and early stages are as follows.
Skeletal traction by skull calipers
This method is used for the reduction and stabilization of fractures and fracture-dislo
cations of the cervical spine. The previously applied method of head traction by the Glis-
son sling has been replaced by most workers in this field by skull traction with calipers
since these were first introduced by Crutchfield (1933). This has been, indeed, a major
advance in the immediate and early management of cervical injuries, and striking examples
of the great value of this method are shown in figures of the chapters on cervical fractures.
Modifications of Crutchfield's original design have been published by Cone & Turner
(1937), Barton (1938) and Vinke (1948). Cone has improved Barton's design and the
Barton-Cone caliper has the advantage of larger tongs as compared with other designs,
and the points of the tongs make an angle of 180 degrees which diminishes the danger of
pulling out or penetrating the skull and causing infection or direct damage to the brain.
The points are inserted 2 inches above the external auditory meatus—i.e. more distally
than with the Crutchfield technique. At Stoke Mandeville, Crutchfield, Blackburn and
Barton-Cone calipers were used and we found the latter more satisfactory. Skull traction
with wires (Hoen, 1936) and with fishhooks under the zygomatic or zygomatico-molar
arches have been described (Neuheiser, 1933; Selmo, 1939; Batchelor, 1946; Soustelle,
1951) but have more or less been abandoned because of the great discomfort to the
patient and the obvious danger of infection to the tissues. We admitted two patients with
this type of head traction. Both patients felt most uncomfortable and one had a severe
infection. This head traction was discontinued immediately.
Laminectomy
This is still the most widely debated and most controversial subject amongst the surgical
procedures advocated for the immediate, early as well as late, treatment of spinal injuries.
What then are the reasons for many surgeons to justify laminectomy as routine immediate
and early treatment in traumatic cord and cauda equina lesions ? In the first place it is
the ill-conceived idea that compression of the cord resulting from a vertebral fracture is
