138
CHAPTER 12
takes place (Haynes, 1946). From the many tragic results of this 'dynamic' attitude
described in the literature and from personal observations, one must ask whether in
patients with such disability the risk of immediate or early laminectomy is justifiable in
any but the very exceptional cases, as mentioned later in this book. What tragedy the
transformation of an incomplete cord lesion into a complete one means for the unfortunate
victim needs no further emphasis and is one which no statistics can alter.
If decompression by laminectomy were really so beneficial as is claimed by its
advocates, there should be, by now, after the tremendous number of laminectomies
carried out throughout the years in many countries, abundant and quite overwhelming
statistical proof of the efficacy of this operation and its superiority to conservative
management. However, statistics on a large scale have clearly shown the contrary.
Comarr (1959) reported 212 amongst 947 paralysed patients who had laminectomies
carried out within 24 hours of injury. Only 15-5 per cent showed improvement of symp
toms while 304 patients without laminectomy showed 31 per cent improvement.
The detrimental effect of immediate and early exploratory or decompressive laminec
tomy in traumatic spinal cord lesions, especially of the cervical cord, in increasing cord
damage and causing death, is by no means a rare incidence if one considers only those
cases reported in the modern medical literature (Taylor, 1929; Merle d'Aubigne, Benassy
& Ramadier, 1956; Guttmann, 1949-69; Leimbach, 1962; Carey, 1965; Band, 1963;
Harris, 1963, 1971; Holdsworth, 1963; Verbiest, 1963; McSweeney, 1964; Bedbrook,
1970). Special mention may be made in particular of the observations made by Merle
d'Aubigne and his co-workers. These outstanding accident surgeons found not the
slightest improvement amongst their 54 laminectomized patients and very often increase
of the cord lesion. Benassy
et al.
(1967) published a series of 600 traumatic paraplegics
and tetraplegics and came to the conclusion that laminectomy was not helpful in most
patients with injuries of the thoracic and lumbar spine. Junghanns (1968) quoted Professor
Schmieden in Schmorrs handbook
Die gesunde und kranke Wirbelsaule im Rontgeribild
und Klinik
who, from his extensive personal experience and as a result of information
gained from questionnaires to other surgeons, came to the following conclusions: The
immediate and early laminectomy as routine treatment of severe spinal fractures resulting
in paralysis has failed. In particular, it is not suitable to improve most severe cases and
does not reduce the mortality rate. This surgical procedure is not indicated in any case
of total dislocation with complete transverse lesion and likewise in other cases where a
thorough neurological observation has revealed an absolutely definite transverse lesion.
In this connection the unsatisfactory results reported by Benes (1968), an experienced
neurosurgeon, as a result of immediate or early laminectomy, particularly in traumatic
lesions of the cervical cord, speak for themselves.
Of special interest is a recent detailed study by the American surgeons Morgan
et al.
(1971) on 230 patients with traumatic spinal cord injuries admitted to Montebellow State
Rehabilitation Hospital, Baltimore, from 1953-68. One hundred and twenty-eight
patients had complete transection of the cord and none of these at any level benefited
from exploratory or decompressive laminectomy. Seventy of the remaining patients had
well documented incomplete spinal cord lesions. These cases were selected for the study
