CHAPTER 8
NEUROPATHOLOGY OF THE SPINAL CORD
AND SPINAL ROOTS
The pathological changes in the neural elements and blood supply of the spinal cord
resulting from closed injuries differ from those following gunshot and stab wounds in
that in the two latter conditions the dura in most cases is opened and C.S.F. leakage
and infection such as meningitis, epidural and subdural abscess formation, may not
uncommonly occur. An extensive literature exists on this subject in many countries,
especially those involved in the two world wars, and the reader is referred to the publica–
tions and comprehensive reviews of Jacob (1919), Roussy & L'Hermitte (1920), Guillain
& Barre (1917), Hassin (1923), Foerster (1929), Marburg (1936), Davison (1945), Scarff&
Pool (1946), Greenfield (1958) and in more recent years Ziilch (1954, 1967), D.Tonnis
( I 963)a Jellinger (1966), Wolman (1964), Hughes (1965), Klaue (1969) and Mayer &
Peters (1971).
In the following, an account is given of the pathological changes in the spinal cord
and its vascular supply, as found in our own clinical material following concussion,
contusion, laceration and transection of the cord resulting from closed injuries of the
vertebral column. In addition details of pathological changes in the cord produced by
angiomatous malformation will also be presented.
CONCUSSION (COMMOTIO MEDULLAE SPINALIS)
Since Obersteiner (1878) advanced the theory of the 'molecular disturbances of neurones'
as the underlying cause of concussion, this condition has been differently defined by
various authors. L'Hermitte (1932), for instance, postulated for the diagnosis of con–
cussion the integrity of the spine a view which cannot be accepted. Most authors share
Hartmann's view (1900), that spinal cord concussion is a totally reversible functional
disorder of the spinal cord. However, as Marburg (1936) rightly emphasized, the proviso
is the speedy recovery of the initial transverse cord syndrome within 24-48 hours a
view which is also held by the present writer. True concussion is very rare following
vertebral injuries, and Marburg has seen only four cases in his large material of the First
World War who fulfilled this condition. I have seen only one case during the Second
World War, a man, who, while sitting in his room, was thrown to the ground by the blast
of an exploding bomb nearby. On admission to the Spinal Unit he showed an incomplete
transverse syndrome at mid-thoracic level. X-ray was normal but the lumbar puncture
showed a high C.S.F. pressure of 250 mm. However, the fluid was not xantochromic nor
was there increase of protein or cells. He recovered completely within 24 hours from his
symptoms, including pyramidal signs. Foerster's (1929) two patients, who recovered
only after 10 and n days respectively, cannot be considered as concussion in the strict
71
