SPINAL CORD SURGERY. The sur gery of the spinal cord has been much advanced during the last decade and at the present time clear indications exist for operative interference.
In injuries of the spinal cord due to fracture of the vertebra or bullet or high explosive wounds, operative interference should be done only if the spinal cord has not been completely crushed. If the X-ray gives evidence of pres sure on the cord from fractured bone or for eign bodies, a laminectomy should be per formed. If there is doubt as to whether the lesion is a complete one, i.e., involving the com plete thickness of the cord, the patient should be watched for symptoms to give evidence that part of the cord is still functionizing. Spinal cord surgery has had its greatest triumphs in the removal of tumors pressing upon the cord, and if the condition is recognized early the patients can be entirely relieved of their symp toms. Inflammatory diseases of the spinal cord sometimes demand operative interference, es pecially in those cases in which the disease is slowly progressing and at a definite level of the cord. Operations upon the spinal cord are
sometimes required for the condition of the nerve roots. The technic of spinal operations has been much simplified. In the large major ity of instances, in otherwise healthy individ uals, the dangers of operation are very small. In the operation, known as larninectomy, the spinal canal is opened by the removal of its posterior wall, that is, by the removal of the spinous processes and laminae forming together a posterior arch of each vertebra. The func tions of the vertebral column are fully re gained after spinal operations. The mortality of the spinal operation itself, in otherwise healthy individuals, should be no more than 5 per cent, which is a small mortality for a major operation of this kind.