C • DISLOCATIONS OF THE VERTEBRAL COLUMN
157
matology a laminectomy may be indicated. The causes of such deterioration can be
excessive callous formation at the site of the fracture, osteomyelitis resulting in pachy-
meningitis, chronic posttraumatic arachnoiditis or muscular thrombosis. Riddoch (1941),
Munro (1945), Scarf & Pool (1946) reported satisfactory results of laminectomy in cases
with posttraumatic chronic arachnoiditis. On the other hand, Foerster (1929) and other
surgeons, including myself, were not impressed with the
late
results of myelolysis in post-
traumatic arachnoiditis. Street (1968) also reported only temporary improvement follow
ing myelolysis. The irreversible damage of the cord leading to myelopathy is, as a rule,
due to progressive changes in the vascular supply of the cord. However, in recent years.
Landau, Campbell & Ransohoff (1967) reported a group of 9 patients with incomplete
traumatic conus-cauda equina lesions in whom decompressive laminectomy with or
without neurolysis of extradural and intradural adhesions was carried out. The interval
between injury and surgery ranged from one month to 17 years. There was postoperative
improvement in all cases and in 7 the functional recovery was reported as significant.
Conclusions
1
Conservative treatment of postural reduction, as described in this book, has proved
to be the safest method in the immediate management of complete and incomplete lesions
of the spinal cord and its roots following fractures and fracture-dislocations of the spine.
2
Fractures and fracture-dislocations, even of the worst type, can be successfully
reduced and stabilized and functional recovery of the spinal cord and its roots achieved.
3
Conservative treatment is infinitely superior to any immediate surgical procedure
in safeguarding the vascular supply of the spinal cord already affected or harmed by the
local injury to the spine and spinal cord and general traumatic shock.
4
Indiscriminate exploratory and decompressive laminectomy as routine immediate
management of fractures and fracture dislocations is condemned because of the great
risk, in particular in incomplete lesions, of transforming these into complete ones. The
number of incidents of tragic events after laminectomies are high enough to make any
surgeon very circumspect before indulging in any surgical procedure apart from skull
traction in injuries of the cervical spine with cord involvement, which in these cases
should be the method of choice.
5
There are very rare indications for early surgical procedures such as laminectomies,
open reduction and spinal fusions.
6 There is no statistical proof that laminectomy, open reduction and stabilizing opera
tions by metal plates, etc., or spinal fusions in complete and incomplete lesions of the
spinal cord shorten the period of rehabilitation of the patient.
7 Late laminectomy to restore neurological function has proved uncertain and if at all
is, as a rule, only temporary.
8
Surgeons of whatever specialty who are engaged in the immediate treatment of
spinal paraplegics and tetraplegics should take full account of
all
aspects of the treatment
and not merely the spine itself. This applies in particular to the care of the paralysed
bladder, which by proper initial treatment—i.e. intermittent catheterization can be kept
sterile in the great majority of cases.
