The treatment of paraplegia due to fracture-dislocations of the dorso-lumbar spine

Abstract

This paper concerns the treatment of paraplegia due to bony injuries of the spine at the dorso-lumbar level. The observations made are based on the experiences gained in the early treatment of 156 patients of whom 61 had had bony injuries at the D.V.11/12 level and 95 at the D.V.12/L.V.1 level.

The anatomical relationships of the spinal cord and its nerve roots to the bony levels are detailed. The mechanism of the different types of fracture and fracture-dislocation is outlined and shown to have a bearing on the type of spinal cord and root injury at the dorso-lumbar junction.

The importance of the nursing routine is emphasised and the method used at the Spinal Injuries Unit in Sheffield is described.

The patterns of neurological recovery are listed. The cases showing most recovery were those with the preservation of some sensory or motor activity from the time of the accident. The speed and quality of recovery was inversely proportional to the time taken for any one new feature to appear.

There was no great difference between the results in the operative and non-operative groups of cases. True comparison of the two groups was not possible because of the biased selection of cases for each group. The non-operative group tended to include the cases with the lesser degrees of bony injury while the operative group included the major degrees of bony displacement and instability.

The ease of handling of this latter group of cases was greatly improved by the operative procedures.

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