PARAPLEGIA

ROLAND
From the Department

IN

CERVICAL
GLASGOW,
Surgery,

SPINE
SCOTLAND
University

INJURIES

BARNES,
of Orthopaedic

of

Glasgow

The
Edwin ments scious pessimism and and
of

first
Smith

recorded papyrus,

reference written

to paraplegia some : legs, justification the more

injpy,

in cervical thousand years

spine ago.

injuries The not by

is to be unknown

found author

in

the cornSuch

four

briefly
(1)f his

upon
two was and
of

the
arms

condition and
two

One
and

having
for in

a crushed
An of patients survivors of caliper spite the

vertebra
ailment notable traction with are left

of his neck,
to be contributions Coleman, with parapjjie

he is uncon

is speechless.

treated. by

not more

without recently
cord

Walton from the

Taylor, Crutchfield,
paralysis.

introduction than and half many

McKenzie, degrees

considerably
spinal

varying

One tion There damaged; that the radiographic dislocation

post-mortem

of the the cases others, spinal has

most

puzzling

features

of injuries displacement evidence may the it view

in is

of the and injury no

cervical the severity

spine the It arches, spontaneous

is the cord in

lack

of

correlalesion. believed

between are

degree with cord with is

of vertebral gross of place.

of

of the

spinal

cord

no radiographic dislocation, damaged bone This

specimens

of bone have assumed dislocated is not, which the

in which

is irretrievably the absence of of the or lipiodol least one

paraplegia. neural that in sac not are there locked

is commonly and with reduction experimental filled of with at

by injury

evidence taken
observations. study

however, the dural do until

accord has produce the

Radiographic

been is locking Furthermore,

shows
of the

quite
spinal

clearly canal

that which (Fig. 1).

the

dislocated would Once be compress the

neural articular without vertebral for OF may an

arches cord processes

a degree dislocation me that

of narrowing is usually examination spinal is clear cord injury. cord idio-

articular stable, and

process reduction occur

cannot in
of

secured of any

manipulation. dis1ocaqp,j and

the
fracture

absence
of

unless

there

graphic

evidence

the

articular

processes

which

will

permit

spontaneous

reduc-

tion

of the

dislocation

we

should

look

alternative

explanation INJURY by flexion injury injuries in

of the

TYPES Damage injuries. patients of the cervical of cases is shown cord of

CERVICAL be type I. TABLE I caused of

and a series

hyperextension of twenty-two

The
with

number paraplegia

each
in Table

cervical

Flexion

injuries. . . . . . . . .

Dislocation

8 cases

Crush
Acute

fracture
retropulsion

of vertebral
of

body.
intervertebral

disc
. .

4 3 15

Total
Hvperextension
Dislocation Injury to arthritic

injuries. . . . . . . . . .

spine

1 6 7

Total

Three fracture two 234 types of

types

of

flexion body;

injury 3) injury:

may acute

be

recognised: of dislocation;
THE

1) an

anterior intervertebral 2) injury

dislocation; disc. to
BONE

2) There arthritic
JOINT

crush are spine.

a vertebral of hyperextension

retropulsion

1) posterior

an
AND

JOURNAL

OF

SURGERY

PARAPLEGIA

IN

CERVICAL

SPINE

INJ

1RIES

235

FIG.

been show cord

displacements of the cervical spine in which the dural sac has filled with lipiodol. A shows the specimen in neutral position and C, D, E degrees of flexion dislocation. B is a soft tissue radiograph of the spinal for comparison of size. In C there is subluxation of the articular processes. In 1) one articular process is locked. In E both articular processes are locked. The spinal cord is not compressed by the displaced neural arches until at least one articular process is locked.

Experimental

It the obscure proportion All of

VOL.

must that types of no

NO.

be

emphasised some were It the

that treated is likely The one injuries

these

twenty-two Injury that of in extension, arthritic spines therefore incidence

cases Centre an the

were

not

an tends series

unselected to would is interesting under in patients receive show

group, the (Fig. fifty a higher

for more 6). years under

reason

in a Spinal age

which groups

of injury. dislocations. and

unselected various occurred were

flexion age;

injuries,

dislocation in

in patients encountered

hyperextension 2, siv 1948

30 B,

236 fifty-seven three patients years with of age. disc The injury, mortality all

R.

BARNES

rate

in

all

types

was

high

except

in

the

group

of

of whom

survived.

FLEXION Cervical injury may dislocations-In be due cord of cord, to by

INJURIES dislocation

OF of the

THE cervical

CERVICAL spine : a) pressure

SPINE it is generally on by easily, pressure the dorsal agreed surface that cord of the

a combination

of two

factors b) often can be

cord
surface is the damage

by

the
of the

dislocated

neural
retropulsed choice. and with The

arches
disc better

; and material. prospect

co-incident
traction reduced the

compression
means without of the

of the
of a skull risk disc of

ventral
caliper further than by

Skeletal of relieving

treatment to the

dislocation

other methods. be unprofitable

Acute flexion but
Case
was

The nine to discuss

of on the

dislocations in this series them in further detail.

disc-There trunk. In narrowing
over
of

presented

no unusual

features

and

it would

retropulsion of the all I.

examined

were none

three was of one

cases there intervertebral

of to his have

of

this disc.

type,

all

due of

to bone

forcible injury

head

radiographic

evidence

the

radiographs
34
an

showed
ears-Fe1l
hour

IV. 1., aged

within

the

handlebars and and paralysis found Radiographic

cycle

on

to

the

back lipping disc and

of and

his of (Fig. was

was

head. sensory the 2). an anterior

He loss There arrest

the upper

accident limbs. vertebrae injury

incomplete showed intervertebral increased of the

paralysis

in was of of

the no urine.

lower of the bone The

limbs, third injury. opposie

trunk, and On the legs. and not recovery without the

and fourth day

examination of the 3). a large compressed fourth, after and operation, legs block, had and By
the

margin

cervical after showed test

narrowing spinal

there revealed

retention

Oueckenstedt damaged

complete disc performed, The cord the sensation

was

myelography

lipiodol of the pulsation

was

intervertebral vertebrae.
to

(Fig. and was third,

third

day
of the the

there
disc and had disc

complete
observed laminae, removed. the patient

paralysis between and There was

both third did

Laminectomy fourth return support. the

protrusion between fifth and two

was the been later

cord power

until and

laminae months

steady to walk

of motor

able

(ornnient-Radiographic accident, spinal In treatment acute vertebral reasonably Similar Although examination of the cord. have disc will traction the of skull by now the disc disc, canal the and as other (Table and cases revealed this the no two II), the have doubt result and

evidence predisposed of flexion cases, there

indicated to injury.

that massive recovery no the

the

disc protrusion

was

degenerated of disc occurred substance without injury the make and readings, severe was narrowed the

before into operative caused diagnosis

the the

considerable is therefore of radiographic reported test in protrusion by

of proof evidence

paralysis that of the

cord injury, Brown causing

by inter-

protrusion. certain.

Nevertheless absence been a large

mechanism

injury,

of bone (1944) gave which and normal was

Brooke patient the disc

Little

(1939).

Queckenstedt

Brookes of

post-mortem compression

Treatment-We cord caliper the not fluid disc happen pressure, traction is negative. in acute traction substance

to

consider Providing the normal way

the disc back out not is no (1943) normal

treatment that height, into the under recovery should and be the knuckle the

most disc and it pressing is

likely not

to

relieve that

pressure before some Even (Jefferson at if this

on least

the of does

protrusions. restore may should cord traction, Fleiss and find its

degenerated space. on the and within even have when reported cord

injury,

is possible

intervertebral

straighten

1940). trial of the

If paraplegia skull
test

is incomplete, is justified.

and
If

the
there

Queckenstedt

test
severe of Brooke

gives

normal

readings

of cerebro-spinal
preliminary a few the days cases of

is probably laminectomy Ingham disc with

compression paraplegia considered

application compression

Queckenstedt of cord

(1944)
readings.
THE JOURNAL

a herniated

manometric

OF

BONE

AND

JOINT

SURGERY

PARAPLEGIA

IN

CERVICAL

SPINE

INJURIES

237

FIG. Case

2
Flexion injury disc between after block at of the cervical the third and injection the level

FIG.

3
paraplegia.
is theca narrowed

1.
is

W. T.,
that
no the bone

shows Lthere

aged 34 years. intervertebral injury.

spine
fourth

with
cervical the

incomplete
vertebrae lumbar disc.

Fig.
but

Myelography complete

of lipiodol into of the herniated

(Fig.

3)

shows

FIG. Case limbs

4
years. Fracture Fig. there of cervical spine with residual sixth the

FIG. paralysis cervical fractured

4.
two

A. G., aged
yeans

30

of vertebra.

upper Fig.

and

lowet

after injury. the mvelogram;

shows crush fracture of is a filling defect opposite

5 shows

vertebra.

VOL.

30 B,

NO.

2, MAY

1948

238

R.

BARNES

TABLE
POSTERIOR PROTRUSION OF

II
INTERVERTEBRAL Disc

Case

Age

Nature

of

Radiographic

Type

of

Quecken-

Operative

injury F eli over h andlebars of c vie on to b ack of head

appearances Narrowing of disc between C.3 and 4 with arthritic lipping of adjacent vertebrae. No bone injury.
Mvelograph revealed

Result

paraplegia Incomplete

stedt Complete block

test

treatment Laminectomy Considerable recovery

1 \V. T.

34

complete the 2
W.

block above level

narrowing between

at

39 S.

Fell
cycle

from and

Marked of disc

Incomplete

No

block

Nil

Almost
conlete

C .5
bone

turned
somersault

and
upping

6 with
of

arthritic
adjacent

recovery

vertebrae. injury 3 B. R. 40 F eli headlong downstairs

No

Slight narrowing of disc between C.3 and 4. No other injury

Incomplete. BrownS#{233}quard syndrome

No

block

Nil

Considerable recovery

TABLE
CO!PRESSION

III
FRACTURES

Case

Age

Nature injury

of

Radiographic appearances Compression fracture of C.6. Myelograph later showed persistent anterior filling defect at level of fracture Comminuted body fracture of C.5

Type of paraplegla Incomplete

Treatment

Result

4 A. G.

30

Lorry collided with another v e h i c 1 e. Thrown on to back of head

Plaster three half

jacket, and a months

Incomplete recovery

40 T.

J.

Fell feet

on
of

twenty to deck
ship

Complete

Nil

Death on the day of injury. Post mortem -herniationof disc in addition to fracture;

severe

crush
cord

of

\V.

6 McA.

18

P e r for m i n g hand spring; arms gave way and fell heavily onneck

Compression fracture of C.5.

Complete

Nil

Death second day. Post mortem no evidence of dislocation; severe crushing of cord at level of fracture tracIncomplete recovery

18 R.

J.

Root of fell on to
of head

tree back

Compression of C.4

fracture and 5

Incomplete

Caliper

Queckenstedt-no

tion

ten weeks

block

\Vhen demonstrated

there by traction.

is

strong

presumptive decompression

evidence of

of the

disc cord

protrusion, is indicated

and

spinal

block In these

is

manometry,

urgently.

circumstances
than caliper

laminectomy

is likelr

to

be

more

effective

in relieving

pressure

on the

cord

THE

JOURNAL

OF

BONE

AND

JOINT

SURGERY

PARAPLEGIA

IN

CERVICAL

SPINE

INJURIES

239
crush of the crushed was fractures articular made but of the paraplegia, injury.
treated two anterior years in a later filling plaster with defect

Crush cervical These fatal spinal there

Case
jacket residual

fracture column cases cases canal. was 4.

for

of

cervical in 6). patients In processes. two

vertebra-Four radiographic Table both, In who III the Case during

fracture He and by lower the was limbs. residual admitted

patients evidence
.

sustained examination was severely a large protrusion incomplete years after

vertebra, Injury

of processes. in the was into and

the two no the vet

without summarised 5 and

of cord was had

dislocation

are (Cases

Post-mortem spinal 5 there a period

of the to Mvelogra)hv spinal deformity,

there disc

dislocation

of articular The poor .-1. G.,

three paralysis

survived

initially of two
sixth the

recovery
aged
and of a both 30 half

of function
rears-Crush months. upper

cervical Spinal showed and

Centre

a constant was

which
I)rotrusin

could

hardly
(Figs.

be

explained 5).

)resumably

clue

to

(usc

4 and
of

The that body,

of

evidence injur\ by in

this simple with by

case crush disc paraplegia

strongly fractures material. should

supports is due reduction, The

the not but

view to
to

of

Cramer

and of the

McGowan fractured ventral

(1944) vertebral surface

cord the cord spinal

pressure
compression

of the

or to dislocation retropulsed cord by complicated

spontaneous

treatment disc. IN to this type (Fig. 6).

of compression be on similar lines

fracture to that

of a cervical of compression

vertebra of the

therefore

a retropulsed

intervertebral INJURIES any six reference Nevertheless cases years

of

HYPEREXTENSION I have paper by injuries been Crooks unable and Birkett to find (1944). were over
fifty

ARTHRITIC of injuries and All they six arthritic are were

SPINES spines by no had means arthritic responsible except for all in the

injuries these

uncommon. spinal changes

In the
cord

present

series
in patients

there

of age

patients

Age incidence of Hyperextension Injuries in Arthritic Spines compared with remaining types Cervical Injury.

as of
6

Hyperextension arthritic

injuries spines

in
-

ii
Ii

Other

types of injury

cervical

FIG.

6 of moderate vertebral complete

63 years-Fell motor osteoarthritic fourth, of the to patient no day 1948 spinal after move was block. injury. fifth, third the left able to From

20

30

4-3

50

60

70

80

in

the

cervical evidence only

12. T. B., showed ligament lower injury after test on the

spine one
aged was

or

severe The

degree, injury cases

feet

and proved

there fatal to
his

was illustrate

strikingly in five of the the

forcibly

little six features:

hyperextending

radiopatients

graphic although
Case the

of recent had

injury. paraplegia.
a distance

Two
of ten

serve
on to

forehead,

neck.

There

complete marked the margin able the

paralysis changes

and in and sixth cervical leg, and the move

sensory the vertebrae vertebrae; tactile both eighth

loss cervical

below spine (Fig. there

the with 7). was had

fifth

cervical

cord of the was injury. lower

segment. anterior avulsed Five limbs. The and

Radiographs common from the hours Four he died after days

ossification An osteophyte no other bone returned to both

between anterior he injury showed eleventh 2, was

sensation legs day and his

urine condition

was

passed deteriorated

voluntarily. steadily

Queckenstedt

VOL

30 B,

NO.

MAY

240

R.

BARNES

FIG.

11G.

8 paraplegia.
is ossified and inter-

Case 12. T. B., aged 63 years. Hyperextension injury of osteoarthritic spine Fig. 7 shows an osteophyte avulsed from lower margin of C.3. The anterior between C.4, 5, and 6. Fig. 8 shows the autopsy specimen; the anterior vertebral disc between (.3 an(l 4 are ruptured.

with incomplete common ligament common ligament

Post-mortcni fourth ligament injury aj-)art but

from

examination vertebrae. was was intact no The (Fig. dislocation at

rcvealc-(I rupture 8). of the

rupture extended Abnormal the level articular

of injury.

of

the

anterior the

common intervertebral of The the spinal

liganu-nt (usc spin cor(l was had to

between the possible a normal psteri()r

the

third common the level

and

cervical wInch there slight

through hyperextension processes.

at

of

appearance

constriction

(o,n,nent-The injury. for might

(ace paralysis; forms hut hours
of

post-mortem Ossification
of

findings anterior to the ossified upper region.

prove common The

beyond ligament
and

doubt in the was the

that lower

this common severe,

was cervical and

a hvperextension spine ligament a younger accounted ruptured

patient

of the violence the

localisation have
9. 7.

vertebrae,

anterior
not

imniediately

above recovered.
.V.,

cord

injury

aged

58

years-Fell sensation

from

a were

glass impaired

roof

on below

to

his the

head. fourth

There cervical

was cord

complete segment;

motor other

pain and temperature sensation were normal.

of recent Injury. injury. examination

Radiographs
There was

showed no change
of the

moderate in the
anterior disc

arthritic neurological
common was avuisecl

changes hndings
ligament from hyperextension with on the both articular

in until
between

the he

cervical died
the of

spine eighteen

no

evidence
after

Post-mortem

showed

rupture The ligament

sixth

and

seventh
vertebra

cervical
but the

vertebrae
posterior injury;

(Fig. 9).
common the capsule upper of

intervertebral was intact. hinged processes

the

body
of

the spine

upper was
acting

Abnormal on the was lower, intact

the
processes The

possible as the had

medullary

at the level of fulcrum.

haemorrhage

vertebra the articular

The

joint
was

sides.

spinal no

cord intra-

normal

appearances

aI)art from
observed

slight
on section

constriction
of the

opposite
cord (Fig.

the
10).

sixth

cervical

vertebra;

(o,nmcnt-The beyond indicated vertebral of the cord. doubt that injury, It

post-mortem that the and the level injury

of

findings was spinal however, due cord

were injury unlikely that the

very was that cord

similar three the was to

to four

those

in

Case higher clue to

12,

and than

proved that contusion moment

SURGERY

to hyperextension

violence. paraplegia subjected

THE JOURNAL

Neurological segments was to traction

OF BONE AND

examination of direct at the

JOINT

it is therefore

is possible,

PARAPLEGIA

IN

CERVICAL

SPINE

INJURIES

241

,,.

x.

I
FIG. Case 9. common T. N., aged 58 years. ligament between Fig. 10 shows slight

9
Hyperextension
(.

FIG.

10

injury

and
constriction

7 is ruptured
of the

with incomplete paraplegia (Fig. 9). The anterior and the disc is avulsed from the upper vertebra. spinal cord at the level of vertebral injury.

of

extreme well No

hyperextension, be and several the segments examination radiographic injuries. in Table IV. A post-mortem

and

in higher

these than made of was

circumstances the vertebral other little and in the leave the TABLE clinical I\
IN

the injury. three room

upper fatal for

level cases doubt

of but that

the the they

cord nature too of

lesion of were six

might accident,

appearances, summary

hyperextension cases is given

radiographic

features

the

HYPEREXTENSION

INJURIES

ARTHRITIC

SPINES

Case

Age

Nature i nj urv

of

Radiographic appearances

Type paraplegia Incomplete

(if

Result

57

Fell

downstairs
to face

on

J. S.

Moderate Osteophyte lower margin

osteoarthritis. avulsed

of C.6.

from No

Recovery from

apart residual

displacement 9 T. 10 M. C. N. 77 Knocked motor 58 Fell through roof down car glass Moderate No fracture Advanced \ertebrae (.4. of Fracture osteoarthritis. or dislocation spondylitis. ankylosed lower on below margin Incomplete

weakness hands
l)eath day Incomplete Death day fourth second

in

by

C.3.

Backward
of C.3

displace4
by 5 cm. No Complete Death after one week injury

ment

11 J.
Mc.

67

Knocked car

down

by

Gross osteoarthritis. fracture or dislocation Gross osteoarthritis.

12
T. B.

63

Fell

from

ladder

Incomplete

l)eathtenthday

distance
on to

of

ten
head

feet

Fracture
lower

of
anterior

osteophyte
margin

on
f

(.3. 13 G. B. 61
Fell seven head feet from Gross

No

dislocation
No Incomplete I)eath second

osteoarthritis.

scafiolding

on to fore-

fractuce.
tervertebral C .4 and

Widening

of in-

(lay

space between 5 anteriorly

VOL.

30 B,

NO.

2,

MAY

1948

242
Mechanism factors. \\ith of injury-Elderly advancing \ears patients there

R.

BARNES

are is usually sion relatively degree jury by of joints neck manner, the

predisposed to compensated of fixed of (Brown extension and is ligaments. be that

to kvphosis the is Kuhns

hperextension of the by neck-Fig. and liable 1942). by In the in the the head to any cause The arthritic event thoracic cervical

injury spine lordosis 12). increase strain risk when of normal strikes the a of This

by

two

is a tendency deformity

which (extenis in or mobility the ina

position,

injury in the

hyperextension spine and cannot so

violence impaired flexed when strain The common

is greater

changes fall, defensive ground

p\sTerful angulation the cervical region. on

or

in extension brunt of this ligament : it be the itself is spinal the further of of of the the the the disc no may of backwards
disc

is applied violence max avulsed rupture;

to falls from

the

anterior

small
lower 1 1). the

flake
anterior The vertebra tear disc,

of

bone
margin extends or the

the (Fig. from

11G. \Iechanisii cervical ligament fragment. 11

upper may

vertebra through be the torn for in the

intervertebral

above. into injuries. resistance separation

There the Once to

tendency as has ruptured

the case there and can

disc of is occur joint

to flexion little

herniate

canal

f hvperextension inj urv of spine. lhe anterior common is torn or avulsed with a hone There is no (lislocation of articular

hvperextension, vertebral lax striking neck bodies posterior force muscles

considerable without capsules. is restored

rupture Immediately by spasm

common is removed and graphic deceptive. Nature jury-I

a c tion these

ligament normal this reason 9.) appearances

(Case

or

the the ma

zvgapophyseal of radiobe the

alignment

vertebrae

for

of have

the

spinal been unable

cord
to

infind

mpletelv
of

satisfactory spinal
cord

explanalesion in

the flexion gross

hvpercxtension

inj uries. injuries dislocation

retropulsion disc.

Unlike neither
vertebrae,

there
of

is the )rd for in Two

nor
is not

of the
C(

intervertebral
damage

The severe, incomplete

usually was six patients.

of

the five

paraplegia of injury the explanations have

possible cord

the

sjiinal by reof a

been be

considere(l:
caused

1)

that

it

may

spinal sult of

concussion as minor displacement

the

vertebral may the be due moment

body; to
of

or

2)

that
injury hvper-

it
at
Tracing of radiograph to of

Fio.

12 deformity
kyphosis.

traction extreme

extension
thoracic

of
The

cervical
angle

5P11
between

compensatory

severe

extension.

pedlicles an(l body is more acute than in a normal spine an(l the spinalcanal is therefore narrowed.

THE

JOtRNAI.

OF

BONE

AND

JOINT

SURGERY

PARAPLEGIA

IN

CERVICAL

SPINE

INJURIES

243 for (Fig. thoracic I 2) canal that minor separation be traction injury was cor(l
,

When angle the from reduce

of

there the canal posterior margin also

is extension vertebral is narrowed. margins of safety. may be and that the in observed

deformity bodies of In that some sufficient the these to when patients injury and

of the the in

neck

compensating is decreased arthritis, into the cord. considerable that to there level this spinal it is possible

kvphosis consequently may and still

the

between spinal the the We have The higher

pedicles hypertrophic bodies the disc to the gave

and

Moreover, vertebral

osteophytes

J)roject further

circumstances concuss the spinal

displacements of verteinjury several

of

the

vertebrae bodies

is ruptured neurological support

i)ral the

is possible fact than

it is tempting vertebral

postulate

max of view.

cord.

segments

jIG.

13

11G.

14

markers have the third common ligament have been divided the distalce between

Steel

i)etween

been placed in the spinal cord through the intervertebral (usc and fourth, and fifth and sixth vertebrae (Fig. 13). Flie anterior and intervertebral disc between the fourth and fifth vertel)rae and the neck hyperextended (Fig. 14). There is no increase in the markers an(I therefore no evjdence that traction force has been applie(l to the spinal cOr(i.

Experiments needles which

of

were inserted

performed through and cord the

and

on cadavers the were intervertebral pushed a steel the markers two below was markers the forcibly radiographs Finally nee(lles

to

test discs the was

the spinal

accuracy

of

this above

hypothesis. and checking the below the lumen films ligament placed ere and between the and and any injury crude, of neural and the the of the be

Hollow the position of each taken interthe

of

were was into the needles

immediately
cord.

one

to be divided, by the disc spinal between between

above

on into marker were was level of measured.

After through

the

radiography and the

introduced Further anterior \Vith in order until taken spinal in cord failed be the living due to experiments subject, which stop The

needle and
spinous

removed. divided. section,

X-ray

distance
processes

common wedges
to simulate

vertebral an arthritic

rigidity distance position cord certainly unwise disruption. separation

spine, the the vertebrae. markers

the

neck again by theory be

hvperextended were the These may that of the traction

there this was to

was position removed

a considerable

gap

between between of the of the did not

Further measured.

markers markers,

rechecked and It must the

MAY

radiography. that the paraplegia however, conditions of mild

tests

demonstrate traction were

SO

the accurately

is

unsupported. reproduce finally

NO.

admitted,

that

it would

to dismiss
vOL.

possibility 1948

lesions

short

30 B,

2,

244 Treatment-There of an arthritic canal, of the of cord application Since more nursing improvement comfortable the than care becoming use of on a few and neck. function, often a small more cervical any spinal flexion tion their is no vertebral It is not and aware paraplegic ambitious remaining hours hastens pillow elderly the of the to indication The for

R.

BARNES

the

use that

of caliper disc there external so intolerant may

traction is not

in

hperextension backwards easily jackets been to the merit or content arrange results of making by assist collars to the are

injury into moderate restorathat do usual any more no the

spine.

intervertebral

displaced

displacement necessary patients fatal true keep methods, or days nature the It to

be is corrected for of plaster I have flexed, claimed it has life. and that the

use are

splintage

it cannot

termination. of these neck cannot but at of the slightly be least patients injuries

patient.

SUMMARY Twenty-two been Flexion fracture presented there is no compression laminectomy Hyperextension to arthritic in The plegia scribed.
The author Neurosurgical observations.

cases The a vertebral

of vertebral are body; of the

paraplegia
injury three 3) view types acute that of bone

complicating
may of disc be flexion protrusion injury, and and due

injury
to injury: of an is the in some the flexion

of
1)

the
or

cervical
hyperextension 2) disc. of at for the least caliper cord

column
compression Evidence lesion there traction

have
violence. is when is a and

reviewed. injury-There of in

dislocation; cause cases

retropulsion

intervertebral

support radiographic fracture. are spines.

evidence Treatment here Hyperextension over

fifty

when

is discussed are two of types injury age. cord

for the and

indications injury: spine of its

of

presented. of hyperextension of an The injury,

clinical Mr J.

injurv-T patients possible

1) dislocation; is the usual are

was

2) injury cause injury of parais de-

arthritic mechanism and

details

years

hyperextension discussed.
under

causes
thank Mr at Killearn

of spinal
Nichols Hospital,

treatment,
Case 1 which

wishes to Service

his

care

in

the

Tulloch

Brown

for

assistance

with

the

experimental

REFERENCES BROOKE, BROWN, BROWN, CRAMER, CROOKS, FLEI5s,

JEFFERSON,

W.

S.

(1944):
and and

Journal
LITTLE,

of

the

American Journal Medical Surgery, British Journal of the Royal

Medical of Journal Bone

Association, and of Joint

125,
Surgery.

117. 24,
79,

L. T.,
M. F., M., and and

KUHNS,

J. G. (1942):
N. (1939):
F. A. N. H.

329.
516.

Australia, and Surgery,

1, 798.
Obstetrics,

McGoWAN, BIRKETT, and INGHAM,

J.

(1944):

Gynecology, Journal of the Society of American of

F., A.

(1944):
(1943):

31,
Medical

252.
Association, Section of

N., G.

123,
Orthopaedics,

759. 33, 657.

(1940):

Proceedings

Medicine,

THE

JOURNAL

OF

BONE

AND

JOINT

SURGERY