C • DISLOCATIONS OF THE VERTEBRAL COLUMN
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Holdsworth (1963) reported of 3 cases amongst 150 cervical fractures and fracture-
dislocations who had a delayed onset of tetraplegia. In 2 of these patients, there was
eventually a complete recovery with conservative treatment. In the 3rd patient the
initially partial tetraplegia became rapidly complete. A laminectomy did not produce
any improvement.
Open reduction and internal fixation
There are several methods advocated for open reduction and internal stabilization of the
fractured spine: fixation by bone grafts, wire, metal plates, metal rods with hooks or
anterior, antero-lateral or posterior fusion. Moreover, the combination of laminectomy
with one of these techniques of artificial stabilization has been frequently practised to
counteract instability of the spine following laminectomy. The considerable variety of
these methods reveals the discord amongst surgeons regarding the most suitable method
for this procedure. Above all, there is still discrepancy of opinion as to indication for and
timing of any of these stabilizing procedures. It is the uncertainty of the stability of the
fractured spine and the fear that 'potential' instability may cause later damage of the
spinal cord or spinal roots or increase the initial neurological deficit resulting from the
injury, which still leads many neurosurgeons and orthopaedic surgeons to the dogmatic
view that the restitution of the stability of the spine by conservative means is not possible
or at least uncertain. Although there is ample proof to the contrary (see Chapter on
Classification) many surgeons still advocate immediate or very early open reduction and
stabilization procedures. There is also no statistical proof of the view held by some sur
geons that these immediate surgical procedures will, as a rule, shorten the rehabilitation
of paraplegics and tetraplegics. Some surgeons (Cone & Turner, Rogers, Forsyth and
others) consider open reduction under skull traction safer and more effective in cervical
injuries than manipulation or traction alone. Here again, there are no comparative statis
tics available which can prove this assumption. However, other workers in this field give
first skull traction an adequate trial and only perform stabilizing operations if traction
has failed.
(i) Open reduction and stabilization by metal plates or distracting rods
In 1953, Holdsworth & Hardy, who condemned manipulative reduction, revived Wilson's
method of open reduction and internal fixation of the broken spine by bolting two metal
plates through one or more spinous processes above and below the level of the fracture-
dislocation. In fairness to these authors, it must be stressed that they advocated this
method for fracture-dislocations of the spine at the thoraco-lumbar level only, but other
orthopaedic surgeons have performed this operation, even in simple compression
fractures, at any level of the spine including the cervical spine. This method was described
as simple, safe and effective in preventing redislocation and, moreover, that it would
promote recovery and prevent further damage. Pennybacker (1953) suggested that this
form of stabilization would prevent later angulation. Dick (1955) stated that the spine
can be stabilized in this way so securely that 'ordinary' nursing handling is 'absolutely
