FRACTURE AND LUXATION OF THE VERTEBRAL COLUMN Dislocations and fractures of the vertebral column are exceedingly rare in childhood and differ but little from the same conditions in adults. Occasionally they are observed after instrumental deliveries. I once saw the entire cervical portion separated from the rest of the column at the autopsy on a newborn infant.
The local symptoms of a bilateral luxation of the cervical column are: anterior inclination of the head; unusual prominence of one of the spinous processes posteriorly; prominence of the body of one of the vertebrte palpable through the pharynx; fixation of the head; extreme tension of the muscles. In unilateral luxations the head is inclined to the opposite side, the cervical column is convex toward the dislocated side, and the muscles on the side of the luxation are tense. Luxations are seen chiefly in the cervical column, fractures at any point of the backbone and particularly in the lower portion.
The cord itself may escape injury. If the latter is present it is due to the direct pressure of the injured vertebra; to hminorrhage into the central canal, into the meninges or into the substance of the spinal marrow. Symptoms of hmmatomyelia and other symptoms pointing
to the nervous system are not necessarily present. When present, they are usually the same as the symptoms of compression of the spinal cord from caries, or of spinal hmmorrhage, or, if long continued, of spinal tumor. Injuries and luxations of the first two cervical vertebrm are usually rapidly fatal; injuries of the third and fourth are of very bad omen because of the danger to the phrenic nerve. The remaining spinal symptoms can be deduced from the table on page 245. Erection of the penis is one of the commonest symptoms of injuries of the cervical column. The differential diagnosis between luxations and fractures often necessi tates an .X-ray examination.
The prognosis is always extremely grave. If death does not occur in a short time, or, in the case of luxations, if the latter is not success fully reduced, a chronic condition similar to that of myelitis with all its dangers may be expected to de \ elop. For the treatment the reader is referred to the sections on surgical diseases.