INJURIES OF SPINAL COLUMN.
Gunshot wounds, fractures and dislocations of the spinal segments or fracture-dislocations must he treated on general surgical principles. Where no paralysis exists the union of the fragments may be effected by absolute rest in the horizontal position on a firm mattress (with suitable extension appliances in compression fractures), and finally by the applica tion of a plaster or poroplastic jacket till firm bony union has taken place.
Dislocations may be reduced under a general anesthetic by skilfully applied extension and manipulation; as dislocation without fracture only occurs in the cervical region, it can be reduced when extension fails by cutting down on the vertebrae and excising the articular process of the vertebra below the displaced one. The presence of a moderate degree of paralysis in spinal fractures is an indication for laminectomy, in order to relieve the pressure of the fragments on the cord. As regards the ad
visability of operation and the time to operate, Horsley advises that the surgeon should wait if the lesion is acute and in the cervical region, hut that there is no necessity for delay in lumbar cases. In injuries to the cauda equina an exploratory operation should certainly be undertaken as soon as symptoms of shock have been combated. Where the cord has been severely crushed, operative procedures are useless; the only resource in these grave cases is to place the patient on a water-bed, which, with the aid of skilful nursing, will prevent the formation of bedsores. Aseptic catheterisation, or the methods mentioned in the last paragraph on spinal concussion, will always he required to avoid the cystitis which is su liable to supervene.