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laryngospasm requiring tracheostomy, dural tears, intermittent dysphagia, neurological
complications (Horner's syndrome, transverse lesion), wound infection leading to
osteomyelitis and postoperative atelectasis and lung infiltration. The authors admit that
the management of the complications delay recovery.
The posterior approach to spinal fusion followed by fixation with wire in patients
with dislocations or subluxations is also by no means a guarantee of an improvement
of the clinical symptoms or preventing spinal deformity of even marked degrees later,
as shown in Fig. 82. Especially tragic are, of course, those patients who, before the
operation had no or only mild neurological defects, and who after the operation have
become tetraplegics. As an example of an unsuccessful posterior fusion following open
reduction of the distal cervical spine the following case may be quoted in detail.
A woman, aged 57, was involved in a car accident in Spain on 22 December 1964,
when the car overturned and she hit her head against the roof and was also struck on the
back of the neck by a suitcase. She was not unconscious but experienced severe pain in
the neck, shoulders and arms, especially on the right. She was not paralysed and could
walk with help to a car which took her to the nearest hospital where she was detained for
2 weeks, then mobilized for 2 days before being discharged. A week later she returned to
England, still walking but still complaining about pain. After she returned home she was
seen by an orthopaedic surgeon on 18 January 1965, who found a partial dislocation of the
6th cervical vertebra onto the yth. There were only minimal and indeed indefinite signs
of a cord involvement diagnosed by some weakness in the legs and some sensory impair
ment. There was no disturbance of bladder and bowel functions of any kind. The X-ray
showed only a very slight dislocation of the spine between the 6th and yth cervical verte
brae and cervical spondylosis (Fig. 83). The surgeon felt that the vertebral injury was
unstable and 'potentially' dangerous and advised an operation to fix the broken spine,
which was carried out on 21 January 1965 with bone chips taken from the right hip and
fixation of the spine by wiring between the 5th and yth spinous cervical processus. When
the patient came round from the anaesthesia she could not move her arms being unable
to ring the bell to call the nursing staff and she was generally pretty ill. On the third day
after the operation a complete tetraplegia was diagnosed. Although a lumbar puncture
did not reveal any sign of a compression a second operation was performed, the wire and
bone grafts were removed and the dura opened, but neither haemorrhage nor a com
pression of the cord was found. The bone chips were reinserted but no fixation by wiring
was possible. In due course, following admission to Stoke Mandeville, the patient made
a good recovery as far as the function of the upper limbs was concerned, in spite of the
fact that the dislocation had recurred, but she is still paralysed in both lower limbs and
confined to a wheelchair for the rest of her life.
Munro (1965) reported 28 cases admitted to his department at the Boston City Hos
pital who, all but one, had been grafted or splinted internally elsewhere. These cases
were referred to Munro because of disabling symptoms after these operations. Fourteen
bone grafts, 6 wirings, 2 sets of steel screws and one metal plate were removed and this
was followed by relief of the symptomatology. Of the bone grafts, eight were united,
one was fractured, one was degenerated, two had developed osteomyelitis and one osteoma.
Three patients had multiple bone fusions and one multiple wirings. One case was
