C • DISLOCATIONS OF THE VERTEBRAL COLUMN
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'because, in 32 of these patients the loss of function following laminectomy is documented
with tragic clarity'. Laminectomy was performed in 42 of these patients. Twenty-two
patients (52 per cent) lost neurological function. In contrast, without laminectomy 15
of 28 patients (54 per cent) improved and no deterioration occurred in this group. Only
J 4 (33 Per cent) with incomplete lesions improved neurologically after laminectomy.
Unfortunately, no data of time-interval between laminectomy and the resultant neuro
logical improvement is given, which might have clarified how many of the improved
cases can really be attributed to the laminectomy. The authors quite rightly acknowledge
that the statistic derived from the study cannot be applied to all laminectomies performed
for incomplete cord lesions, as other patients who may have made rapid or complete
recovery in an acute hospital will not be admitted to a rehabilitation hospital. On the
other hand, this statistic is also incomplete in that the authors do not have any data of
the number of patients operated in the acute hospital from which they received their
cases and how many of them have died in the acute hospital. Sixty-eight per cent of the
patients who had laminectomies required stabilization procedures immediately or some
time during the course of their rehabilitation. This confirms the well-known fact that
the stability of the spine may be profoundly disturbed, the more so as further damage of
the muscles at the site of the fracture as a result of the operation adds to their initial
traumatic damage and thus helps to promote the development of spinal deformities.
It is significant that even radical advocates of immediate and early laminectomy
have changed their attitude in view of their unfortunate results. Covalt, Cooper, Hoen &
Rusk (1953) pointed out that laminectomy carries 'a low mortality and morbidity rate'.
This is hardly acceptable from either a medical or ethical point of view. Nor is their
other argument acceptable by anyone who is familiar with the pathology of the spinal
cord following closed injuries of the spine that 'unless it has been determined by surgical
exploration that the spinal cord has been transected one cannot conclude during the
early weeks after injury that a patient is permanently or irreversibly paraplegic'. Such a
statement is surprising as there is general knowledge that no conclusion can be drawn
from the macroscopic appearance of the cord as to the prognosis of functional recovery if
at operation the continuity of the spinal cord is found intact. For the irreversible damage
may be vascular, due either to an anterior spinal artery catastrophy, such as thrombosis
or haemotomyelia, or direct squeezing damage of the soft and highly vascular central
tissues of the cord up and down the site of the impact of the violence leading to colli-
quative necrosis (Bedbrook, 1966). Further unfortunate experience of these authors'
indiscriminate surgical approach must have changed their views fundamentally, for a
later publication of the same institute (Kaplan, Powell, Grynbaum & Rusk, 1966) now
frankly admits that development of paralysis following laminectomy is not a rare occur
rence and that 'this complication points out the need to be extremely circumspect in
exploratory laminectomy, when the degree of paralysis is minimal'. This warning applies,
of course, at least as much to incomplete lesions with a greater degree of paralysis.
To what grotesque deformity an early laminectomy following a spinal fracture may
lead is strikingly demonstrated in Fig. 75 of a girl, aged 16, who sustained a rather severe
incomplete transverse cord syndrome as a result of a compression fracture-dislocation of
C5 vertebra. Thirteen days after injury a decompressive laminectomy was performed by a
