142
CHAPTER 12
cord function may not be permanently lost following spinal cord injuries—for it depends
entirely on the severity of the initial trauma whether function may recover or not. It has
been proved again and again by many patients, both paraplegics and tetraplegics, that
the initial complete paraplegia and tetraplegia may recover even to a great extent without
surgical intervention, in the stages of reorganization within the damaged area of the cord.
(b) Chemical prevention of post-traumatic damage to the cord
The other study reported at that Congress was that carried out by Dr Osterholm and his
colleagues, J.Mathews, B.Kalesnick and G.Irvin from the Hahnemann Medical College.
Their work is based on the findings that after spinal cord injury there is a marked increase
in the concentration of norepinephrine in the traumatized area of the cord. This increase
is four times that of the normal amount. Their experimental studies were directed to
preventing the synthesis of norepinephrine and by blocking the receptor site for this
chemical. Altogether 18 drugs and drug combination were studied in cats. Control
animals were given infusions of normal saline into the femoral vein. Most of the animals
were killed after 24 hrs and histological examination was made to determine the extent
of the areas of haemorrhagic necrosis. From this data the percentage of total necrosis
and remaining normal tissue were calculated. It was found that the highest protection
was achieved by Alpha Methyl Tyrosine (97 per cent) and Reserpine (93 per cent).
Osterholm found that the cords of the animals treated with these chemicals showed
invariably smaller necrosis than the controls. However, he admitted that these results
are not at all mathematically comparable with each other, as different dosages of drugs
were used. Although the results obtained by this study seem to be encouraging it is too
early to make definite conclusions from these experiments.
Indications of laminectomy in the early treatment
The question arises whether there is any indication for laminectomy in the early treat
ment of spinal injuries—i.e. within the first 2 weeks after injury. T.B.Dick (1949)
published a statistic relating to 27 patients subjected to laminectomy more than 7 days
after injury performed at the former Spinal Injuries Centre, Winnick. Twenty-two had
complete lesions before the operation and, although only two proved at operation to be
complete transections, no patient showed evidence of later recovery. Five laminectomies
were performed on patients with incomplete lesions of whom three showed doubtful
improvement which probably, as the author states, was not attributable to the operation.
There are, however, instances, although very rare, where this procedure may be justified
and even indicated.
(i) Ascending neurological deficit in complete transverse lesions
It is not uncommon that in the first few days after injury a complete transverse lesion
may ascend over 1-2 segments. This is due to circulatory disturbances and oedema
around the damaged region of the cord and is in no way justification for laminectomy, for
this increase of clinical symptoms is temporary and will recede spontaneously. However,
